CONGRESS OF WOUND AND TISSUE REPAIR | Year:2019 | دوره:6 |Papers Count:19

Psoriasis is a skin disease with a T-cell-mediated nature. Interaction between skin immune cells and keratinocyte in the epidermis causes it. Psoriasis is characterized by thick, scaly, itchy and sometimes painful wounds that occur on the surface of the skin. At present, topical treatments, systemic medications, and phototherapy are the main methods to treat psoriasis. In general, oral administration of Methotrexate is one of the current therapeutic strategies for the treatment of psoriasis that has many side effects. Topical therapy due to low systemic toxicity and potential targeting ability recommended for patients with mild to moderate psoriasis. Barrier of skin, poor water solubility and low chemical stability of drugs are important barriers to the development of new effective psoriasis drugs. Nanotechnology has been effective in facilitating the passage of drugs to the topical treatment of skin diseases. Lipid and polymer based nanoparticles (NPs) have highly affinity to skin barriers and are suitable for loading lipophilic drugs for psoriasis (Methotrexate-loaded lipid carrier provided drug accumulation (0. 88 μ g/cm2/h), higher than free drug (0. 59 μ g/cm2/h)) curcumin loaded (poly lactic-co-glycolic acid) (PLGA) nanoparticles (NPs) could facilitate Cur's dispersion, sustained-release, accumulation, and penetration across the skin and into the blood circulation. Fluidized nanovesicles exhibited remarkable drug deposition amounting to a total of 81. 51% in the different skin layers. Conclusion: Nanoparticles can be useful for the treatment of psoriasis and other skin problems due to increased permeability, reduced drug destruction and minimized side effects of them which further research will be revealed their importance.

Nanofibrous architecture mimics natural extracellular matrix (ECM) and dictate cell proliferation and differentiation to promote tissue regeneration. Additionally, synergistic methods that compartmentalize biological payloads can be achieved by partitioning within polymers. This study examines fabrication techniques and mechanisms involved for osteoblast cell adhesion and proliferation for tissue regeneration. Previously, we have demonstrated that nanofibrous scaffold system promotes mesenchymal stem cells differentiation and bone regeneration. In the current study, we generated 3D nanofibrous scaffolds using electrospinning technique with Polycaprolactone (PCL). Small molecule (GSK3 inhibitor), morphogens (growth factors) or natural antioxidants (AX) were incorporated in matrices. Characterization and payload release studies were performed. Cellular and molecular studies in mesenchymal stem cells or pre-osteoblast cells were examined. SEM reveals the architecture of the scaffolds effectively mimic spatial features of ECM, and the cells adhered to the fiber matrix. FTIR confirmed solvent was completely evaporated during process. Biochemical assays demonstrated that biomolecules have incorporated and released in a controlled manner. The biomimetic nanofibrous matrix significantly induces cells adhesion, proliferation and differentiation. Our study provided evidence that a delivery of morphogens or small molecules in combination with scaffold system induce the process of cell differentiation and tissue regeneration both in-vitro and in-vivo respectively. The generation of these sophisticated, spatiotemporal scaffold systems serve as a platform for modular clinical translational systems capable of directing stem cell responses for tissue regeneration.

Mesenchymal stem cells derived from human adipose tissue are novel therapeutic technology and more topical than ever. Here we evaluated the effects of cells of adipose on wound healing in an in vivo diabetic rat model. Materials and methods We injected intradermal and sprayed MSCs in skin wounds in diabetic rat and evaluated wound healing parameters. In 7, 14 and 21 days, we compared the percent of wound closure, pathologic staining, biometric and mechanical analysis and the angiogenic potential between two groups. Results Two groups significantly induced a faster healing and a higher number of blood vessels in the wound when compared to controls (Normal saline injection). Biometric and mechanical data and image J software analysis showed we have good treatment. Conclusion Results indicate that two groups exert similar beneficial effects on wound closure and neovascularization in our rat model. Using spray device as carrier for MSCs propagates rapid cell migration towards the wound area that allows a fast and clinically practicable method for stem cells application.

Burn, diabetic, and pressure wounds are debilitating and serious clinical conditions that cause major health complications for patients, caregivers and health care providers. The cost of treating these conditions worldwide is at least $25 billion per year. Despite all advancements made in this field, current therapies have neither improved the healing outcomes of these wounds, nor decreased their prevalence. This is mainly because conventional skin grafts, scaffolds, and even sheets of skin substitute are ineffective due to the their inability to fill up all void spaces seen within these wounds. Thus, these patients have an increased rate of morbidity and prolonged hospital stays due to wound infection and treatment difficulties. For this reason, a new strategy for treating these difficult-to-heal wounds is needed to ease patients’ suffering and reduce the socio-economic burden associated with these wounds. To address the aforementioned difficulties, we have recently developed a shelf-ready collagen based powdered, reconstituteable liquid skin substitute called MeshFill. It is made of natural skin proteins and remains liquid at low temperature and solidifies within 20 minutes of application to the wound site and thereby filling up all voids and cavities within wounds from bottom up. We have already shown that, when MeshFill is applied to delayed wounds in a diabetic mice and autologous meshed skin grafts on pigs, it fills up all cavities and generates a nutritional environment for skin cells from the edge of their wounds to migrate within and on the surface of the resultant scaffold and accelerate the healing process with a significantly better clinical outcome. In a human pilot study, we have also shown that some deep pressure ulcers and surgical wounds can be treated with Liquid MeshFill with a very promising results. Being: 1) Powder to be shipped to any place, 2) Liquid to fill up all cavities, 3) Nutritional for skin cells to migrate in and proliferate, 4) Cost effective and its easy use makes MeshFill very effective in improving non-healing wounds in general and pressure and diabetic wounds in particular. In this presentation, the challenges and solutions for treating non-healing wounds in general and pressure ulcers in particular will be outlined. Funding: This study has been supported by a grant from the Canadian Institute of Health Research and iCORD Seed grant.

Today, mesenchymal stem cells (MSCs) have been identified as a powerful tool for wound healing. The differentiation potential of MSCs together with easy accessibility, low immunogenicity and integral and important role in wound healing physiology make these cells an attractive candidate for therapeutic purposes. Mesenchymal stem cells are effective at all stages of wound healing. These cells migrate to the site of skin damage and mainly inhibit the immune and inflammatory responses through paracrine signalling. At the stage of proliferation, MSCs not only differentiate into the desired cells but also stimulate the proliferation and differentiation of resident progenitor cells, including fibroblasts, endothelial cells and epidermal cells, and thus induce angiogenesis, epithelialization and granule tissue formation and accelerate wound healing. In the regeneration and maturation phase which occurs following wound closure, the use of MSCs increases wound tensile strength, reduces scar formation, weakens wound contraction, and increases collagen expression. These cells alter their function based on the biomolecular and biochemical factors that characterize the microenvironment of the lesion site, such as hypoxia, and create a wound-healing rather than fibrotic microenvironment. Modern bioengineering techniques have led to significant progresses in stromal cell delivery methods for wound healing. MSCs are transplanted either by intravenous delivery or local injection into the dermis. They can be delivered in phosphate buffered saline or in combination with matrigel, fibrin polymer or hydrogels. In addition, the conditioned medium of MSCs is also effective alone and circumvents the challenges associated with MSCs transplantation.

There are many different methods in the treatment of Leishmaniasis. However the disease has spontaneous remission; so only the RCTs may help to evaluate the efficacy of these methods of treatments. There are only few systemic reviews about these modalities which confirm the higher quality of each treatment; so many others may not be reliable. On the other hand the cure rate of placebo was about 40% which emphasis on the need to have control group. The different treatment modalities of the cutaneous Leishmaniasis include “ Chemical, Physical, Herbal and Immunological“ ; also all have their own limitations.

All patients with diabetes mellitus are at risk for developing diabetic foot ulcers (DFUs) in which occur in up to 25% of patients with diabetes. Among them, up to 24 % of ulcers will experience limb amputation. One major problem to chronic wound care such as DFUs in developing countries is lack of electronic medical record systems to collect, manage, and report clinical data. The objective of this study was to create a practical standardized electronic medical records and database of clinically relevant variables in the care of diabetic patients with foot ulcers. In this study, we implemented a simple wound care electronic medical record at a chronic wound care center (Yara) in Tehran. This electronic medical record consist on comprehensive data of the patients including demographics, medical history, baseline laboratory values, neural and vascular testing data, radiology data, wound characteristics, wound debridement data including pathology, culture results, and amputation data. The database contains variables that can be easily exported for analysis. The preliminary report of this electronic medical record showed that it could be a useful tool to increase patient safety and quality of care, allowing clinicians to more easily identify a chronic wound and intervene.

Many chronic non-healing wounds require targeted approaches rather than the standard conventional therapies. Maggot debridement therapy (MDT) or the use of maggots to treat wounds is one such therapy that has been in use for centuries. Larvae of the green bottle fly Lucilia sericata are used in MDT. An important step in assisting chronic non-healing wounds progress through healing is wound bed preparation. This is usually achieved by effective debridement technique to remove devitalized tissue, including slough and eschar. The methods of debriding a wound can be classified as surgical, autolytic, mechanical, enzymatic, or biological. MDT mainly helps in wound healing by debridement of necrotic tissue by both mechanical and biochemical means. Mechanical debridement is achieved by the “ mouth hooks” of the maggots and their rough bodies that scratch the necrotic tissue. They may also secrete a mixture of proteolytic enzymes that lyse nonviable tissue, making it easier for the maggots to digest. MDT can be used for any type of chronic wounds that have moist slough or necrotic tissue on its floor where urgent surgical debridement (eg, necrotizing fasciitis) is not indicated, possible or refused by the patient. MDT should be used cautiously under close supervision near exposed blood vessels, organs, or wounds body cavities. Bleeding complications have been encountered with previous use of MDT, and close observation of the therapy is required when used in patients with bleeding tendencies, for example, Warfarin induced coagulopathy. The use of maggot debridement therapy has provided an effective method for removing non-viable tissue and in some cases, preparing the wound bed for surgical reconstruction intervention in order to achieve wound healing and full closure.

Stem cells are important for living organisms for many reasons. In some tissues, such as bone marrow, muscle, and brain, discrete populations of adult stem cells generate replacements for cells that are lost through normal wear and tear, injury, or disease. So, the great progress in the field of stem cell research has arranged the foundation for cell based therapies of disease which cannot be cured by conventional medicines. In this regard, the studies in this field, give us hope for the therapeutics with stem cells. According to the mentioned content, in our stem cell research center, we have developed several advanced technologies associated with the stem cell biology and isolation of stem cells for using in the cell therapy and/or organs transplantation and the influence of different factors on functionality of stem cells especially on skin, cartilage and bone. Furthermore, regarding our activities on regeneration of skin, we have developed bio-printed and acellular scaffolds with mineral pitch and boron based-hydrogel that we used these scaffolds for treatment of full thickness burn in skin. In should be noted that the obtained good results from our studies will provide promising prospect in skin tissue regeneration.

Survival after sever burn and other trauma has improved dramatically in the developed world. New strategies are required to manage increasing numbers of patients with functionally and cosmetically debilitating scars. The recent increase in the use of ablative fractional laser devices has fastened enthusiasm for laser-assisted delivery (LAD) of medications and other agents. LAD is a novel delivery method that enable the treating physician to uniformly distribute large molecules and even cells through narrow channels to the desired depth in cutaneous tissue. The parameters in LAD need to be adjusted to the patient, the skin condition and its location and the drug. With regards to scars, these channels may be used in the immediate postoperative period to deliver drugs and other substances to synergistically enhance the local therapeutic and remodeling response.

Fat is abundant easily accessible tissue and for the first time in 1912 was described for treatment of facial lipoatrophy by Eugene Holler. Adipose tissue, which contains cellular and extracellular matrix component with stem cells in its cellular component, is considered as a promising source in the field of wound healing and regenerative medicine. For search strategy we use databases from pubmed, medline, google scholar with mesh terms such as Wound healing, fat tissue, Adipose derived stem cell. The purpose of this review article is to investigate the wound healing properties of fat and adipose derived stem cells.

Background: Electrical stimulation is the standard technique for exploring electrical behavior of heart muscle, but this approach has considerable technical limitations. Here we report expression of the light-activated cation channel channelrhodopsin-2 for light-induced stimulation of heart muscle in vitro. Methods: For this purpose, primary cardiomyocytes (CM) were isolated and lentiviral delivery of ChR2 (H134R) in cardiomyocytes was done by infection. A stable channelrhodopsin-2 (ChR2) expressing cardiomyocyte was developed, characterized and used. Optical imaging of voltage or calcium was performed using voltage-sensitive dye Di-8-ANEEPPS, and intracellular calcium was imaged with Fura2-AM. Results: Our result demonstrated that following blue-light illumination CM-ChR2 exhibited 26% (P < 0. 05) enhancement of membrane potential as a result of depolarization compared with non-stimulated samples and 43% elevation of intracellular calcium compared with the non-stimulated group was observed. Conclusion: This method enabled precise localized stimulation and constant prolonged depolarization of cardiomyocytes resulting in alterations of membrane potential and Ca2+ homeostasis.

Understanding the legal aspects of medical activities is one of the essential requirements for any care provider. Lack of knowledge of these rules can lead to unfortunate events in one's career. On the other hand, the promotion of community knowledge on legal and individual rights issues, as well as the ease of access to legal information through the media, the Internet and virtual networks, has increased the level of community requests and doubtful attitudes towards medical and nursing procedures. This is especially more clear when there is no precise treatment plan for care. Treatment and care of chronic wounds is one of the therapeutic procedures which no specific protocol has been developed, so non-compliance with scientific and technical standards in this field can be very common, causing legal conflicts between patient and therapist. This study examined the set of measures that should be observed by wound and tissue repair providers. Because Clinicians need to protect themselves while ensuring evidence-based, high-quality care to their consumer-patients.

The incidence of varicose veins varies from 10% to 30%. Patients with varicose veins present from asymptomatic to significant symptoms, including discomfort, aching, pain, itching or eczema, ulcer and deep vein thrombosis (DVT). The diagnosis and treatment of venous disease has advanced more in the last recent years. Combination of Ultrasound, endovenous ablation techniques, foam sclerotherapy and tumescent anesthesia have greatly improved patient care and have moved treatment from the operating room to the office or radiology suite. In this article I review the most recent advances and techniques in treatment of varicose veins.

Background: Cold atmospheric plasma (CAP) is shown to decrease bacterial load in chronic wounds. It is also presented as a novel approach in healing the wounds in both in vitro and in vivo experiments. Objective: We aimed to implement the first randomized clinical trial in use of CAP in diabetic foot ulcers. Methods: Patients with diabetic wound (n=44) were randomized to receive standard care (SC, n=22) without or with CAP applied three times a week for three consecutive weeks (SC+CAP, n=22). CAP was generated from ionized helium gas in ambient air and driven by high voltage (10 kV) and high frequency (6 kHz) power supply. The primary outcomes were wound size, number of cases reached wound size of <50%, and bacterial load over three weeks of treatment. Results: Treatment with CAP was effective in reducing the fraction of wound size (p=0. 02). After 3 weeks, the number of wounds that reached the fraction of wound size of ≤ 50% was significantly more in SC+CAP group (77. 3%) compared with the SC group (36. 4%) (p = 0. 006). The mean of fraction of bacterial load counts in each session ‘ after CAP exposure’ was significantly less than ‘ before exposure’ measures. Conclusion: CAP could be an effective method for accelerating wound healing in diabetic foot ulcers. It also exerts immediate antiseptic effects, which seems not to last for a long time.

The soft tissue repair is a complex process which may change with external stimulations. Drugs and surgeries are two methods that contribute to the soft tissue repair and remodeling. In addition, some electromagnetic and electrical agents may increase the rate and quality of tissue repair. Modality dependency and dose dependency are two main components in clinical decision making for the non-invasive interventions. The most evidence based studies about healing consider modalities that stimulate the cells or change the energy of the nutrition cycle. Laser therapy, microcurrent, high voltage pulse current, short wave diathermy, ultrasound and radiofrequency therapy are the best modalities in repair process and these agents targets different tissues in the body and affects by different mechanisms. Although, some electrophysical modalities e. g magnet therapy, shock wave therapy, APS and DC currents need more evidences and further investigations about their effects in soft tissue repair.

Background: The incidence of dilabetic mellitus (DM) Worldwide, is estimated nearly 2 million and expected to double by year 2050. Diabetic foot ulceration is one of the most serious side effects of DM= which is secondary to peripheral neuropathy, vasculopathy and hyperglicemia caused by the disease, also would be the main reason for lower limb amputation. Persons with diabetes have 15 times higher lower extremity amputations (LEA) rate than normal person without diabetes. Despite multi medical and surgical ways in treatment of diabetic foot wound, role of rehabilitation and physical therapy remain insufficiently defined. Objective: This paper presents a review of the therapeutic effects of different types of physiotherapy interventions in treatment of diabetic foot wounds and design an effective program for the treatment of diabetic foot ulcers. Conclusion: Electrotherapy, such as ultrasound, laser and trans electrical stimulation can make a considerable contribution to overall management of patients with diabetic foot ulcer and increase the healing rate of wound. Also exercise therapy as other aspect of physiotherapy would be beneficial in improving muscle strength, balance problems and maintain their physical activity.

Today chronic wounds have imposed enormous economic and spiritual costs on human societies. Extensive efforts are underway to somehow alleviate the economic and social burden of chronic wounds. Understanding the mechanism of wound healing, the effective conditions and drugs in the process of wound healing will help to develop new therapeutic approaches. It has long been used to make compounds containing sex hormones in wound healing that have been recognized. Today with significant advances in the cellular and molecular domains, some of the mechanisms and processes underlying this idea have been recognized. Scientific evidence show that sex hormones Such as estrogens, progesterone’ s and androgens have positive effect on wound healing. Further studies are needed to achieve an effective and safe wound treatment based on sex hormones.

Introduction: Nowadays, wound management and treatment is one of the medical priorities. Wounds are a common problem in hospitals that causes mortality or morbidity, and a feeling of suffering and life impairment and the imposition of unwanted treatment costs. The repair of such wounds involves complex biological and dynamic processes such as Hemostasis, inflammation, proliferation and Maturation. The use of bio-materials to accelerate the process of wound healing is on the rise. Hence, this study examines the effect of biocomplex ointment on the healing of open cutaneous wounds. Materials & Methods: This study was clinical trial A total of 40 patients who needed skin graft were included in this study. This trial was done with an intra-individual model as such each patient also had his own control role. Patients with no certain underlying diseases or immunosuppressive diseases or scleroderma were included and a layer of skin with a thickness of 0. 04 mm from the anterior thigh was produced with a dermatome under local analgesia with dimensions less than 4 * 15 cm. Because the wounds were not equal on day zero, the size of the wounds of each group was adjusted. The surface of the wounds is divided into two parts and treated on days 0, 4, 7 and 14 under dressing with restorative ointment and Vaseline ointment was dressed by sterile gauze in treatment and control group, respectively. Results: There was a significant reduction in the size of the wound. Those wounds treated with restorative ointment showed healing rate about 25% till day 14 while in the control group was 13% (P=0. 045), in the process of reduction of the wound size, Treatment group was accelerated than the control group (P<0. 001). In the Likert scale, the physician's satisfaction in the treatment group versus control was more (P<0. 001). The rate of erythema reduction was higher in the treatment group versus control group (P=0. 005). There were no significant differences in pain, discomfort and itching factors. Conclusions: According to the results of these studies, the restorative ointment is more effective in reducing the size of the wound, accelerating the wound healing process, reducing of erythema and overall physician satisfaction compared to the Vaseline ointment used routinely in graft dressings.