Melanoma Misdiagnosed as Multiple Diabetic Foot Ulcer: A Case Report

Malignant skin ulcerations may mimic diabetic foot ulcers leading to misdiagnosis. In this case report, we discuss an uncommon but severe problem of malignant tumors initially misdiagnosed as diabetic foot ulcers, underlying the need to improve medical awareness, diagnostics, and approaches for therapy once the correct diagnosis is made. We describe the case of an 82-year-old male with diabetes mellitus and melanoma metastases initially misdiagnosed as diabetic foot ulcers. In diabetic patients, several skin disorders may coexist on the same foot, including actual diabetic foot ulcers and skin cancers. Among multiple skin disorders that coexist on the foot of a diabetic patient, the skin metastases may be misdiagnosed as diabetic foot ulcers. Significant efforts should be made to create new non-invasive, rapid diagnostic techniques to eliminate misdiagnoses of skin disorders in diabetic patients.

First Experience of Personalized in Situ Tissue Engineering for Thoracic Surgery of the Sarcoma Patient: MSCs-Containing Minimally Manipulated Cells and an Individualized Micropore Titanium Sternum in a One-Year Follow-Up Case Report

Individually customized grafts have become standard for reconstructing extensive chest wall defects resulting from surgical interventions for sternal malignant neoplasms. However, the outcomes of these graft implantations can be further improved by administering patient-derived cells, which have minimal oncological risks. In 2021, a 52-year-old woman with chondrosarcoma (pT2N0M0G2, stage IIB) was admitted to the Department of Thoracic Surgery. The patient presented with a large tumor in the body of the sternum, measuring 81 × 94 × 91 mm, according to the computed tomography (CT) scan. To address this, an individualized endoprosthesis was modeled and created using the original 'pincer-dock' construction based on CT-scan screens. The mononuclear cell fraction (MNCs) was obtained from the patient's peripheral blood one week before surgery using a Haemonetics cell separation device and cryopreserved until the day of the procedure. The resulting 30 mL MNC suspension contained 12 mln cells per 1 mL. We performed flow cytometry analysis using a FACS Aria III flow cytometer to confirm the presence of mesenchymal stromal cells in the MNCs. We also performed immunostaining for S-100, a common tumor marker for benign and malignant diseases, and D2-40, a marker for the lymphatic endothelium that reacts with Kaposi's sarcoma and a subset of angiosarcomas. None of the cells were positive for either marker. Approximately 3 ml of the MNC suspension was injected into each rib edge and 30 ml into the operating field immediately after resection. The titanium endoprosthesis was placed in the sternal defect, and the body of the endoprosthesis was securely covered with a laparoscopically mobilized omental flap. After a one-year follow-up, the patient showed no signs of recurrence or post-surgical complications. These outstanding functional and cosmetic results highlight the potential for the broader clinical utilization of minimally manipulated cells in personalized medicine in oncology. These results could pave the way for wider clinical application of peripheral blood-derived minimally manipulated cells in personalized medicine as an adjuvant for titanium endoprosthesis reconstruction of osteochondral defects in patients with sarcoma.

BILIARY MICROBIOTA AND BILE DUCT DISEASES

Traditionally, the biliary tract has been considered to be normally sterile, and the presence of microorganisms in bile is a marker of a pathological process. This assumption was confirmed by failure in allocation of bacterial strains from the normal bile duct. The paper provides rationale for a phenomenon of the normal biliary microbiota as a separate functional layer which protects a biliary tract from colonization by exogenous microorganisms. We revealed the potential of metagenomic data for prevention of infectious diseases, post-operative complications of reconstructive interventions including bile duct stenting and implantation the tissue-engineered structures exposed to the risks of colonization with pathogenic / exogenous microorganisms. The methods based on preserving homeostasis of normal biliary microbiota ecosystem can be used for prevention of hepatobiliary diseases and treatment of biliary tract inflammatory diseases.

Cartilage Laser Engraving for Fast-Track Tissue Engineering of Auricular Grafts

In this study, the optimal engraving parameters were determined through the analysis of scanning electron microscopy (SEM) data, as follows: a laser power density of 5.5 × 105 W/cm2, an irradiation rate of 0.1 mm/s, a well radius of 60 μm, a distance between well centers of 200 μm, and a number of passes for each well of 20. After 1 week of in vitro cultivation, chondrocytes were located on the surface of the scaffolds, in the sockets and lacunae of decellularized cartilage. When implanted into animals, both cellular and acellular scaffolds were able to support cartilage in-growth and complete regeneration of the defect without clear boundaries with normal tissue. Nevertheless, the scaffolds populated with cells exhibited superior biocompatibility and were not subject to rejection, in contrast to cell-free constructs.

Impact of Minimally Manipulated Cell Therapy on Immune Responses in Radiation-Induced Skin Wound Healing

The current treatment of radiation-induced skin wounds utilizes mainly conventional therapies, including topical steroids, creams, ointments, and hydrogel dressings, which do not take into account the immunologic changes that occur in the skin after radiation exposure. Therefore, it is relevant to consider alternative therapies and their impact on changes in the immune landscape of the skin. The aim of this study was to investigate the effect of allogeneic minimally manipulated keratinocytes and fibroblasts on rat skin repair and the development of immune responses. We found that the use of cell therapy compared to treatment with syntazone ointment and no treatment resulted in faster healing and a reduction in the size of radiation-induced skin wounds, area of inflammation, and edema. Additionally, in the group receiving the cell therapy application, there was an observed increase in the number of mast cells (MCs), activation of MC interaction with M2 macrophages, a reduction in the direct contact of MCs with the vascular bed, an increase in the content of collagen fibers due to the intensification of collagen fibrillogenesis, and a restoration of their histotopographic organization. Thus, the positive effect of cell therapy based on allogeneic minimally manipulated keratinocytes and fibroblasts on skin regeneration indicated that it can be used in clinical practice to improve the effectiveness of rehabilitation after radiation therapy.

Effectiveness of Stem Cell Therapy for Diabetic Foot Ulcers: Cell Therapy Alone is Not Enough for Effective Management of Chronic Wounds

We read with great interest the meta-analysis by Mudgal et al. (2024) regarding the effectiveness and safety assessment of stem cell therapy for diabetic foot ulcers. Indeed, The management of chronic wounds requires innovative approaches to avoid unsuccessful outcomes, and stromal cell therapies have emerged as a potential solution for soft tissue repair. A critical aspect of this therapeutic strategy is the role of mast cells in stimulating delayed inflammation through their interactions with various cells as well as the extracellular matrix. Mast cells are critical in orchestrating the inflammatory response and their activation can influence macrophage behavior and secondary healing efficacy. The use of mesenchymal stromal cells in regenerative medicine for diabetic foot ulcers treatment is often limited by their time-limited anti-inflammatory responses. However, these time-limited effects could not achieve the prolonged effects and impact of cell therapy efficacy and the potential enhancement of cell function by biologically active factors such as growth factors or gene therapeutics for prolonged release. The integration of cell and prolonged release gene therapeutics is a promising approach that goes beyond regenerative medicine by preventing secondary inflammatory complications. While mesenchymal stromal cells have shown promising results in experimental and clinical studies, there are limitations to their efficacy in regenerative medicine for diabetic foot ulcers. These limitations include the heterogeneity of cell populations used in the studies, the difficulty in determining the contribution of cells when used in combination with materials, the lack of data on optimal cell numbers for tissue repair, the effect of culture conditions on cell therapy efficacy, and the potential enhancement of cell efficacy by the use of additional biologics such as growth factors or gene therapeutics. The combination of cell and gene therapy is seen as a promising approach that goes beyond regenerative medicine into the field of molecular surgery of chronic wounds.

Stem Cells and Their Derivatives: Unlocking the Promising Potential of Minimally Manipulated Cells for In Situ Tissue Engineering

We've read with great interest the article by Smolinska et al. entitled "Stem Cells and Their Derivatives: An Implication for the Regeneration of Nonunion Fractures" regarding the recent scientific studies dealing with the treatment of nonunion fractures in clinical and preclinical settings using Mesenchymal Stem Cell (MSC)-based therapeutic techniques. Bone tissue regeneration is a dynamic process that involves the restoration of damaged or lost bone structure and function. Traditional approaches such as autografts and allografts, platelet rich plasma (PRP) treatment and cell therapies, have limitations, including donor site morbidity and immunologic concerns, as well as cell culture and processing requirements. In contrast, the use of minimally manipulated cells that do not require culturing has emerged as a promising alternative that offers several advantages in bone tissue regeneration.