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Khorsandi K, Fekrazad R. Skin wound healing in diabetic rat model using low-dose photodynamic therapy. Biotechnol Appl Biochem 2024. [PMID: 38409884 DOI: 10.1002/bab.2568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 01/20/2024] [Indexed: 02/28/2024]
Abstract
Chronic wound is one of the major challenges in medicine and imposes a heavy financial burden on the healthcare of different countries. Diabetic foot ulcers as one of the important examples for chronic wounds can lead to lower limb amputation, disability, and death in diabetics. In this regard, novel technology with low side effects got attention in recent years. Low-dose photodynamic therapy (LDPDT) is one of the noninvasive techniques that can be considered for wound healing in diabetic wounds. In this experiment, we aim to study the effect of LDPDT on diabetic rats' wound healing and compare it to healthy rats. In this in vitro experimental study, 32 male rats were used. Rats in both normal and diabetic (streptozotocin injection) groups after being wounded (two wounds [0.8 × 0.8 cm]) on the back of each rat were randomly divided into four groups, including the control group (without treatment), radiation-only (660 nm-1 J/cm2 ) group, 5-ALA-only (1 µg/mL) group, and LDPDT-recipient group. The procedure has been done for 2 days, and at the end of Days 3, 7, 14, and 21, the wound sample was sent to the histopathology laboratory, and the wound size and tissue indices in these groups were evaluated by histology and microscopy techniques. The impact of low concentrations of 5-ALA and low irradiation energy density in both normal and diabetic rats were positive, which accelerated the wound-healing process as seen in the histology study. In diabetic rats treated with only radiation and LDPDT, the process of epithelial regeneration, collagen production, reduction of mast cells, and production of follicles was more as compared to the normal group. The results suggest that LDPDT can have a positive impact on the diabetic rat model wound healing.
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Affiliation(s)
- Khatereh Khorsandi
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran
- Department of Photodynamic, Medical Laser Research Center, YARA Institute, ACECR, Tehran, Iran
| | - Reza Fekrazad
- Radiation Sciences Research Center, Laser Research Center in Medical Sciences, AJA University of Medical Sciences, Tehran, Iran
- International Network for Photo Medicine and Photo Dynamic Therapy (INPMPDT), Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Adibi H, Arjmand B, Aghayan HR, Bahrami-Vahdat E, Alavi-Moghadam S, Rezaei-Tavirani M, Arjmand R, Namazi N, Larijani B. Standardized GMP-Compliant Scalable 3D-Bioprocessing of Epidermal Stem Cells for Diabetic Foot Ulcers. Methods Mol Biol 2024. [PMID: 38376750 DOI: 10.1007/7651_2024_514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Diabetic foot ulcers (DFUs) pose a significant threat to the health and well-being of individuals with diabetes, often leading to lower limb amputations. Fortunately, epidermal stem cell therapy offers hope for improving the treatment of DFUs. By leveraging 3D culture techniques, the scalability of stem cell manufacturing can be greatly enhanced. In particular, using bioactive materials and scaffolds can promote the healing potential of cells, enhance their proliferation, and facilitate their survival. Furthermore, 3D tissue-mimicking cultures can accurately replicate the complex interactions between cells and extracellular matrix, thereby ensuring that the stem cells are primed for therapeutic application. To ensure the safety and quality of these stem cells, it is essential to adhere to good manufacturing practice (GMP) principles during cultivation. This chapter provides a comprehensive overview of the step-by-step process for GMP-based 3D epidermal stem cell cultivation, thus laying the groundwork for developing reliable regenerative medicine therapies.
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Affiliation(s)
- Hossein Adibi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Babak Arjmand
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Student Research Committee, Aja University of Medical Sciences, Tehran, Iran.
| | - Hamid Reza Aghayan
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sepideh Alavi-Moghadam
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Rasta Arjmand
- Cell Therapy and Regenerative Medicine Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazli Namazi
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Tai TY, Lin KJ, Chang HY, Wu YC, Huang CU, Lin XY, Tsai FC, Tsai CS, Chen YH, Wang FY, Chang SC. Early identification of delayed wound healing in complex diabetic foot ulcers treated with a dermal regeneration template: a novel clinical target and its risk factors. Int J Surg 2024; 110:943-955. [PMID: 38085826 PMCID: PMC10871583 DOI: 10.1097/js9.0000000000000898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/02/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND The dermal regeneration template (DRT), a tissue-engineered skin substitute composing a permanent dermal matrix and an upper temporary silicone layer that serves as the epidermis, has demonstrated efficacy in treating uncomplicated diabetic foot ulcers (DFUs). Our institution has obtained good outcomes with DRT in patients with more complicated DFUs. Because of its chronicity, the authors are working to identify a clinical target that anticipates delayed healing early in the treatment in addition to determining the risk factors linked to this endpoint to increase prevention. MATERIALS AND METHODS This retrospective single-center study analyzed patients with DFUs who underwent wound reconstruction using DRT between 2016 and 2021. The patients were categorized into poor or good graft-take groups based on their DRT status on the 21st day after the application. Their relationship with complete healing (CH) rate at day 180 was analyzed. Variables were collected for risk factors for poor graft take at day 21. Independent risk factors were identified after multivariable analysis. The causes of poor graft take were also reported. RESULTS This study examined 80 patients (38 and 42 patients in the poor and good graft-take groups, respectively). On day 180, the CH rate was 86.3% overall, but the poor graft-take group had a significantly lower CH rate (76.3 vs. 95.2%, P =0.021) than the good graft-take group. Our analysis identified four independent risk factors: transcutaneous oxygen pressure less than 30 mmHg (odds ratio, 154.14), off-loading device usage (0.03), diabetic neuropathy (6.51), and toe wound (0.20). The most frequent cause of poor graft take was infection (44.7%), followed by vascular compromise (21.1%) and hematoma (15.8%). CONCLUSION Our study introduces the novel concept of poor graft take at day 21 associated with delayed wound healing. Four independent risk factors were identified, which allows physicians to arrange interventions to mitigate their effects or select patients more precisely. DRT represents a viable alternative to address DFUs, even in complicated wounds. A subsequent split-thickness skin graft is not always necessary to achieve CH.
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Affiliation(s)
- Ting-Yu Tai
- Division of Cardiovascular Surgery, Heart Center, Cheng Hsin General Hospital
| | - Kuan-Jie Lin
- Division of Cardiovascular Surgery, Department of Surgery, Shuang-Ho Hospital
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University
| | - Hao-Yun Chang
- Department of Medical Education, Division of General Medicine, Far Eastern Memorial Hospital
| | - Yi-Chun Wu
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University
- Division of Plastic Surgery, Integrated Burn and Wound Care Center, Department of Surgery, Shuang-Ho Hospital
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Uen Huang
- Division of Plastic Surgery, Integrated Burn and Wound Care Center, Department of Surgery, Shuang-Ho Hospital
| | - Xin-Yi Lin
- Division of Plastic Surgery, Integrated Burn and Wound Care Center, Department of Surgery, Shuang-Ho Hospital
| | - Feng-Chou Tsai
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University
- Division of Plastic Surgery, Integrated Burn and Wound Care Center, Department of Surgery, Shuang-Ho Hospital
| | - Ching-Sung Tsai
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University
- Division of Plastic Surgery, Integrated Burn and Wound Care Center, Department of Surgery, Shuang-Ho Hospital
| | - Yu-Han Chen
- Division of Plastic Surgery, Integrated Burn and Wound Care Center, Department of Surgery, Shuang-Ho Hospital
| | | | - Shun-Cheng Chang
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University
- Division of Plastic Surgery, Integrated Burn and Wound Care Center, Department of Surgery, Shuang-Ho Hospital
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Platini H, Adammayanti KA, Maulana S, Putri PMK, Layuk WG, Lele JAJMN, Haroen H, Pratiwi SH, Musthofa F, Mago A. The Potential of Autologous Platelet-Rich Plasma Gel for Diabetic Foot Ulcer Care Among Older Adults: A Systematic Review and Meta-Analysis. Ther Clin Risk Manag 2024; 20:21-37. [PMID: 38288358 PMCID: PMC10823873 DOI: 10.2147/tcrm.s433033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
Introduction Poorly controlled diabetes mellitus can lead to the development of diabetic foot ulcers (DFU), which is a frequent complication in patients. However, several diabetes management guidelines for older adults do not mention the occurrence of DFUs. Nowadays, Autologous Platelet-Rich Gel (APG) is being used for treating diabetic ulcers. APG is an innovative platelet-derived product with many advantages, such as being low-cost, easy to produce, and readily available materials. Additionally, it does not lead to any rejection reaction. Objective This study aims to assess the safety and efficacy of APG as a novel treatment of DFU compared with standard treatment in older adult patients. Methods Randomized Controlled Trials (RCTs) were searched using PubMed, Cochrane, Google Scholar, Wiley, and PlosOne. The keywords have been arranged using the Boolean operator, including autologous platelet-rich gel, DFU, and elderly. The data was screened by inclusion and exclusion criteria. The final inclusion study was analyzed and synthesized by tabulation, clusterization, contextual and thematic approach, and assessed for risk of bias using ROB 2.0. Meta-analysis was conducted by using Review Manager 5.4 and the Mantel Haenszel method. Results Eight RCTs with 598 patients were eligible for the present analysis. Compared with standard care/conventional treatment, APG could significantly improve the healing wound in patients with diabetic foot ulcers (Relative risk (RR) 1.32, 95% confidence interval (CI) 1.22-1.57, p < 0.0001), shortened the healing time (Mean difference [MD] -16.97 days (95% CI: -32.64 to -1.29; p < 0.00001), shortened the length of hospital stay (MD= -20.11, 95% CI: -38.02, -2.20; p = 0.03), and amputation rate (MD= 0.36, 95% CI: 0.16, 0.84; p = 0.02). Conclusion APG treatment can better treat DFU in terms of duration of healing, wound healing, length of hospital stay, and amputation prevention than the standard treatment.
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Affiliation(s)
- Hesti Platini
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Keyzha Amartya Adammayanti
- Clinical Clerkship Program, Faculty of Medicine, Universitas Kristen Indonesia (UKI), UKI Hospital East Jakarta, Special Capital Region, Indonesia
| | - Sidik Maulana
- Master of Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Putu Moradha Kharisma Putri
- Clinical Clerkship Program, Faculty of Medicine, Universitas Kristen Indonesia (UKI), UKI Hospital East Jakarta, Special Capital Region, Indonesia
| | - Welly Grivin Layuk
- Clinical Clerkship Program, Faculty of Medicine, Universitas Kristen Indonesia (UKI), UKI Hospital East Jakarta, Special Capital Region, Indonesia
| | | | - Hartiah Haroen
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Sri Hartati Pratiwi
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Faizal Musthofa
- Nursing Internship Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- West Sapphire Medical-Surgical Ward, Santosa Bandung Central, Bandung, West Java, Indonesia
| | - Arpit Mago
- Department of Clinical Medicine, Jawaharlal Nehru Medical College, Belagavi, India
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Zhang HM, Yang ML, Xi JZ, Yang GY, Wu QN. Mesenchymal stem cells-based drug delivery systems for diabetic foot ulcer: A review. World J Diabetes 2023; 14:1585-1602. [DOI: 10.4239/wjd.v14.i11.1585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 07/16/2023] [Accepted: 09/11/2023] [Indexed: 11/14/2023] Open
Abstract
The complication of diabetes, which is known as diabetic foot ulcer (DFU), is a significant concern due to its association with high rates of disability and mortality. It not only severely affects patients’ quality of life, but also imposes a substantial burden on the healthcare system. In spite of efforts made in clinical practice, treating DFU remains a challenging task. While mesenchymal stem cell (MSC) therapy has been extensively studied in treating DFU, the current efficacy of DFU healing using this method is still inadequate. However, in recent years, several MSCs-based drug delivery systems have emerged, which have shown to increase the efficacy of MSC therapy, especially in treating DFU. This review summarized the application of diverse MSCs-based drug delivery systems in treating DFU and suggested potential prospects for the future research.
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Affiliation(s)
- Hong-Min Zhang
- Department of Endocrinology, People’s Hospital of Chongqing Liangjiang New Area, Chongqing 400030, China
| | - Meng-Liu Yang
- Department of Endocrinology, The Second Affiliated Hospital of The Chongqing Medical University, Chongqing 400030, China
| | - Jia-Zhuang Xi
- Department of Endocrinology, Dazu Hospital of Chongqing Medical University, The People’s Hospital of Dazu, Chongqing 406230, China
| | - Gang-Yi Yang
- Department of Endocrinology, The Second Affiliated Hospital of The Chongqing Medical University, Chongqing 400030, China
| | - Qi-Nan Wu
- Department of Endocrinology, Dazu Hospital of Chongqing Medical University, The People’s Hospital of Dazu, Chongqing 406230, China
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Clayton EO, Njoku-Austin C, Scott DM, Cain JD, Hogan MV. Racial and Ethnic Disparities in the Management of Diabetic Feet. Curr Rev Musculoskelet Med 2023; 16:550-556. [PMID: 37733148 PMCID: PMC10587034 DOI: 10.1007/s12178-023-09867-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 09/22/2023]
Abstract
PURPOSE OF REVIEW Diabetes mellitus is a chronic medical condition affecting many individuals worldwide and leads to billions of dollars spent within the healthcare system for its treatment and complications. Complications from diabetes include diabetic foot conditions that can have a devasting impact on quality of life. Diabetic foot ulcers and amputations occur in minority individuals at an increased rate compared to Caucasian individuals. This review provides an update examining the racial and ethnic disparities in the management of diabetic foot conditions and the differences in rates of amputation. RECENT FINDINGS Current research continues to show a disparity as it relates to diabetic foot management. There are novel treatment options for diabetic foot ulcers that are currently being explored. However, there continues to be a lack in racial diversity in new treatment studies conducted in the USA. Individuals from racial and ethnic minority groups have diabetes at higher rates compared to Caucasian individuals, and are also more likely to develop diabetic foot ulcers and receive amputations. Over the last few years, more efforts have been made to improve health disparities. However, there needs to be an improvement in increasing racial diversity when investigating new therapies for diabetic foot ulcers.
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Affiliation(s)
- Elizabeth O Clayton
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite #911, Pittsburgh, PA, 15213, USA
| | - Confidence Njoku-Austin
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite #911, Pittsburgh, PA, 15213, USA
| | - Devon M Scott
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite #911, Pittsburgh, PA, 15213, USA
| | - Jarrett D Cain
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite #911, Pittsburgh, PA, 15213, USA
| | - MaCalus V Hogan
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Ave., Suite #911, Pittsburgh, PA, 15213, USA.
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Li X, Wen S, Dong M, Yuan Y, Gong M, Wang C, Yuan X, Jin J, Zhou M, Zhou L. The Metabolic Characteristics of Patients at the Risk for Diabetic Foot Ulcer: A Comparative Study of Diabetic Patients with and without Diabetic Foot. Diabetes Metab Syndr Obes 2023; 16:3197-3211. [PMID: 37867628 PMCID: PMC10590077 DOI: 10.2147/dmso.s430426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023] Open
Abstract
Backgrounds and Objective Diabetic foot is a relatively severe complication in patients with type 2 diabetes (T2D), with peripheral neuropathy and angiopathy frequently serving as risk factors. However, it is unknown how the other major systemic metabolic factors impacted the profile of these patients, besides glucose management. Thus, we investigated the distinct characteristics of patients with diabetic foot ulcers and their relationships with angiopathy. Materials and Methods We obtained the laboratory data of 334 diabetic patients at Shanghai Pudong Hospital from 2020 to 2023. The comparisons were performed between the groups with or without diabetic foot, including glucose metabolism, lipids profile, liver and kidney function, thyroid function, and serum iron. The association between metabolic factors and lower extremity computed tomography angiography (CTA) was analyzed. Results We found significant disparities between groups in relation to age, serum protein content, liver transferase, serum creatinine, estimated glomerular filtration rate (eGFR), serum uric acid (UA), small dense low-density lipoprotein (sdLDL), lipoprotein A (LP(a)), apolipoprotein A1 (APOA1), thyroid function, serum iron, and hemoglobin (Hb) (p<0.05). The Spearman correlational analyses showed that the severity of CTA, categorized by the unilateral or bilateral plaque or occlusion, was positively significantly correlated with UA (r=0.499), triglyceride (TG) (r=0.751), whereas inversely correlated with serum albumin (r=-0.510), alanine aminotransferase (r=-0.523), direct bilirubin (DBil) (r=-0.494), total bilirubin (TBil) (r=-0.550), Hb (r=-0.646). Conclusion This cross-section investigation showed that compared to T2D only, the patients with diabetic foot ulcer (DFU) might display similar glucose metabolic control context but adverse metabolic profiles, and this profile is associated with macrovascular angiopathy characteristics and their severity.
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Affiliation(s)
- Xiucai Li
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Song Wen
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Meiyuan Dong
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
- Hebei Medical University, Shijiazhuang, 050013, People’s Republic of China
| | - Yue Yuan
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Min Gong
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Congcong Wang
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Xinlu Yuan
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Jianlan Jin
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
| | - Mingyue Zhou
- Clinical Research OB/GYN REI Division, University of California, San Francisco, CA, USA
| | - Ligang Zhou
- Department of Endocrinology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399, People’s Republic of China
- Hebei Medical University, Shijiazhuang, 050013, People’s Republic of China
- Shanghai Key Laboratory of Vascular Lesions Regulation and Remodeling, Shanghai Pudong Hospital, Shanghai, 201399, People’s Republic of China
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Chien WC, Tsai TF. The Pressurized Skin: A Review on the Pathological Effect of Mechanical Pressure on the Skin from the Cellular Perspective. Int J Mol Sci 2023; 24:15207. [PMID: 37894888 PMCID: PMC10607711 DOI: 10.3390/ijms242015207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
Since human skin is the primary interface responding to external mechanical stimuli, extrinsic forces can disrupt its balanced microenvironment and lead to cutaneous lesions. We performed this review to delve into the pathological effects of mechanical pressure on skin from the cellular perspective. Fibroblasts of different subsets act as heterogeneous responders to mechanical load and express diverse functionalities. Keratinocytes relay mechanical signals through mechanosensitive receptors and the ensuing neurochemical cascades to work collaboratively with other cells and molecules in response to pressure. Mast cells release cytokines and neuropeptides, promoting inflammation and facilitating interaction with sensory neurons, while melanocytes can be regulated by pressure through cellular and molecular crosstalk. Adipocytes and stem cells sense pressure to fine-tune their regulations of mechanical homeostasis and cell differentiation. Applying mechanical pressure to the skin can induce various changes in its microenvironment that potentially lead to pathological alterations, such as ischemia, chronic inflammation, proliferation, regeneration, degeneration, necrosis, and impaired differentiation. The heterogeneity of each cellular lineage and subset from different individuals with various underlying skin conditions must be taken into consideration when discussing the pathological effects of pressure on the skin. Thus, elucidating the mechanotransduction and mechanoresponsive pathways from the cellular viewpoint is crucial in diagnosing and managing relevant dermatological disorders.
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Affiliation(s)
- Wei-Chen Chien
- Department of Medical Education, National Taiwan University Hospital, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital, College of Medicine, National Taiwan University, No. 7, Chung-Shan South Road, Taipei 100, Taiwan
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Sanjeeviraj S, Subburaj A, Aluri S, Thakku Sekar BR, Jalan M, Joseph AG. A Cohort Study on the Outcome of Diabetic Foot Ulcers. Cureus 2023; 15:e48030. [PMID: 38034176 PMCID: PMC10687807 DOI: 10.7759/cureus.48030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) represent a significant and challenging complication of diabetes mellitus, often leading to serious morbidity and a substantial burden on healthcare systems. The study was conducted with the objectives of evaluating the outcomes of DFUs. MATERIALS AND METHODS A cohort study was conducted to evaluate the outcomes of DFUs from May 2019 to May 2020 at a tertiary care hospital located in Chennai. The study included patients aged 18 to 90 years who were diagnosed with DFUs. Individuals with diabetic foot lesions (skin lesions such as fissures, abscess, cellulites) other than ulcers or those without diabetes were excluded. The data was collected from a total of 100 diabetic patients using systematic random sampling technique. RESULTS The mean (SD) age of the study participants was 54.68 (6.72) years with males constituting 56% of the study population. Among 100 participants, 65% experienced healing while 35% did not. Logistic regression analysis showed that glycated haemoglobin (HbA1c) levels, age, and diabetes duration had significant effect on patient outcome. Logistic regression analysis showed that HbA1c levels, age, and diabetes duration had significant effect on patient outcome. Out of 12 patients with major amputation, seven (58.3%) survived, while out of 19 patients with minor amputations, 18 (94.7%) showed remarkably higher survival rate. Meanwhile, 100% survival rate was observed in patients with no amputation. CONCLUSION The study's comprehensive assessment of risk factors and their associations with healing outcomes provides essential knowledge for clinical practice. The study findings collectively support the optimization of interventions and strategies to prevent and manage DFUs, ultimately improving patient care and enhancing their quality of life. The study highlights the significance of glycemic control and limb preservation in DFU management.
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Affiliation(s)
| | | | - Smriti Aluri
- Surgery, Kakatiya Medical College, Warangal, IND
| | | | - Manik Jalan
- Emergency Medicine, Tagore Hospital and Heart Care Centre, Jalandhar, IND
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Wu Y, Shen G, Hao C. Negative pressure wound therapy (NPWT) is superior to conventional moist dressings in wound bed preparation for diabetic foot ulcers: A randomized controlled trial. Saudi Med J 2023; 44:1020-1029. [PMID: 37777272 PMCID: PMC10541979 DOI: 10.15537/smj.2023.44.20230386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/24/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVES To compare the efficacy of negative pressure wound therapy (NPWT) and alginate dressings on wound bed preparation prior to split thickness skin graft (STSG) surgery for patients with chronic diabetic foot ulcers (DFUs). METHODS Between September 2022 and March 2023, we completed a randomized controlled trial in Nanjing First Hospital and PLA 454 Hospital. Patients were divided into 2 groups: i) the NPWT group (with vacuum-assisted closure, n=50); ii) the control group (with alginates dressings, n=50). Once DFU wound was filled with healthy granulation tissues, STSG surgery was performed. The time to STSG surgery was regarded as the primary outcome. The survival rates of skin graft, the wound blood perfusion, the wound neutrophil extracellular traps (NETs) formation, and polarization of M1 and M2 macrophages in DFU wounds were regarded ad secondary outcomes. RESULTS Patients in the NPWT group had less time to STSG surgery than the control group. The patients in the NPWT group had prominently increased survival rates of skin graft, increased wound blood perfusion, and decreased NET formation in comparison with the control group. The macrophages in DFU wounds switched from M1 to M2 phenotype in the NPWT group. CONCLUSION Negative pressure wound therapy is superior to conventional moist dressings in wound bed preparation prior to STSG surgery for patients with chronic DFUs.
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Affiliation(s)
- Yin Wu
- From the Department of Burn and Plastic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Gan Shen
- From the Department of Burn and Plastic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Chao Hao
- From the Department of Burn and Plastic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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Da Silva J, Leal EC, Carvalho E, Silva EA. Innovative Functional Biomaterials as Therapeutic Wound Dressings for Chronic Diabetic Foot Ulcers. Int J Mol Sci 2023; 24:9900. [PMID: 37373045 DOI: 10.3390/ijms24129900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 05/19/2023] [Accepted: 06/06/2023] [Indexed: 06/29/2023] Open
Abstract
The imbalance of local and systemic factors in individuals with diabetes mellitus (DM) delays, or even interrupts, the highly complex and dynamic process of wound healing, leading to diabetic foot ulceration (DFU) in 15 to 25% of cases. DFU is the leading cause of non-traumatic amputations worldwide, posing a huge threat to the well-being of individuals with DM and the healthcare system. Moreover, despite all the latest efforts, the efficient management of DFUs still remains a clinical challenge, with limited success rates in treating severe infections. Biomaterial-based wound dressings have emerged as a therapeutic strategy with rising potential to handle the tricky macro and micro wound environments of individuals with DM. Indeed, biomaterials have long been related to unique versatility, biocompatibility, biodegradability, hydrophilicity, and wound healing properties, features that make them ideal candidates for therapeutic applications. Furthermore, biomaterials may be used as a local depot of biomolecules with anti-inflammatory, pro-angiogenic, and antimicrobial properties, further promoting adequate wound healing. Accordingly, this review aims to unravel the multiple functional properties of biomaterials as promising wound dressings for chronic wound healing, and to examine how these are currently being evaluated in research and clinical settings as cutting-edge wound dressings for DFU management.
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Affiliation(s)
- Jessica Da Silva
- CNC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
- PDBEB-Ph.D. Programme in Experimental Biology and Biomedicine, University of Coimbra, 3004-504 Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra, Casa Costa Alemão, Rua Dom Francisco de Lemos, 3030-789 Coimbra, Portugal
- Department of Biomedical Engineering, Genome and Biomedical Sciences Facilities, UC Davis, 451 Health Sciences Dr., Davis, CA 95616, USA
| | - Ermelindo C Leal
- CNC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra, Casa Costa Alemão, Rua Dom Francisco de Lemos, 3030-789 Coimbra, Portugal
| | - Eugénia Carvalho
- CNC-Center for Neuroscience and Cell Biology, CIBB-Center for Innovative Biomedicine and Biotechnology, University of Coimbra, Rua Larga, 3004-504 Coimbra, Portugal
- Institute of Interdisciplinary Research, University of Coimbra, Casa Costa Alemão, Rua Dom Francisco de Lemos, 3030-789 Coimbra, Portugal
| | - Eduardo A Silva
- Department of Biomedical Engineering, Genome and Biomedical Sciences Facilities, UC Davis, 451 Health Sciences Dr., Davis, CA 95616, USA
- Department of Chemistry, Bioscience, and Environmental Engineering, University of Stavanger, Kristine Bonnevies vei 22, 4021 Stavanger, Norway
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Eder S. Diabetisches Fußsyndrom. Gefässchirurgie 2023. [DOI: 10.1007/s00772-023-00972-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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