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Segreto F, Carotti S, Marangi GF, Francesconi M, Calia E, Cagli B, Cimmino A, Rossi C, Morini S, Persichetti P. Cathelicidin LL-37 Expression in Human Breast Implant Capsules. Plast Reconstr Surg 2024; 153:1066-1073. [PMID: 37220260 DOI: 10.1097/prs.0000000000010733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Capsular contracture is the most common complication following breast implant placement. Cathelicidin LL-37 is a cationic peptide involved in innate immunity. Initially investigated for its antimicrobial role, it was found to have pleiotropic activities, such as immunomodulation, angiogenesis stimulation, and tissue healing. The aim of the study was to investigate the expression and localization of LL-37 in human breast implant capsules and its relationship with capsular formation, remodeling, and clinical outcomes. METHODS The study enrolled 28 women (29 implants) who underwent expander substitution with definitive implant. Contracture severity was evaluated. Specimens were stained with hematoxylin and eosin, Masson trichrome, immunohistochemistry, and immunofluorescence for LL-37, CD68, α-smooth muscle actin, collagen type I and type III, CD31, and Toll-like receptor-4. RESULTS LL-37 was expressed in macrophages and myofibroblasts of capsular tissue in 10 (34%) and nine (31%) of the specimens, respectively. In eight cases (27.5%), it was expressed by both macrophages and myofibroblasts of the same specimen. In infected capsules, expression by both cell types was found in all (100%) specimens. LL-37 expression by myofibroblasts positively correlated with its expression by macrophages ( P < 0.001). Moreover, LL-37 expression by macrophages of periexpander capsules negatively correlated with the severity of capsular contracture on definitive implants ( P = 0.04). CONCLUSIONS This study demonstrates the expression of LL-37 in macrophages and myofibroblasts of capsular tissue and its negative correlation with the severity of capsular contracture following permanent implant placement. Expression or up-regulation of LL-37 may be involved in myofibroblast and macrophage modulation, thus playing a role in the pathogenic fibrotic process underlying capsular contracture. CLINICAL RELEVANCE STATEMENT This is the first study to demonstrate LL37 expression in capsular tissue and to hypothesize its role in contracture and as a prognostic marker for contracture severity. If confirmed, medical strategies or implant coating could be implemented to reduce the risk of contracture for high-risk patients.
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Affiliation(s)
- Francesco Segreto
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Simone Carotti
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | | | - Maria Francesconi
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | - Eleonora Calia
- Department of Obstetrics and Gynecology, Campus Bio-Medico of Rome University
| | - Barbara Cagli
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Andrea Cimmino
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Caterina Rossi
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
| | - Sergio Morini
- Center for Integrated Biomedical Research, Laboratory of Microscopic and Ultrastructural Anatomy
| | - Paolo Persichetti
- From the Department of Plastic, Reconstructive, and Aesthetic Surgery
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Zhang J, Zhang X, Zhao J, Wu J. The Effects of Vitamin D on Movement and Cognitive Function in Senile Mice After Sevoflurane Anaesthesia. Exp Aging Res 2023:1-15. [PMID: 37990880 DOI: 10.1080/0361073x.2023.2282350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 11/08/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Vitamin D (VD) is a neuroactive steroid involved in many brain functions, such as neurotrophic, neuroimmune control and neurotransmission, which affects the growth and function of the brain. The purpose of this study is to explore the effect of VD on motor and cognitive function of aged mice after sevoflurane anesthesia. METHOD We established sevoflurane anesthesia model and VD(-) and VD(+) mice model. The VD concentration of mice in each group was determined by enzyme-linked immunosorbent assay (ELISA). An open-field test was used to evaluate the mice's capacity for movement and exploration. A Y-maze test was used to gauge the mice's short-term memory. The primary purpose of the water-maze experiment was to examine mice's long-term spatial memory. RESULTS The ELISA results showed that the model was successfully constructed. In the open-field test, VD increased the exercise distance of mice (P < .05). In the Y-maze experiment, VD improved short-term memory impairment in mice (P < .05). In the water-maze test, VD increased the activity time and platform crossing number of mice in the target quadrant. (P < .05). CONCLUSION Sevoflurane anesthesia caused cognitive dysfunction in aged mice, including reduced learning ability, memory loss, lower motor and exploratory abilities and depression, and VD deficiency aggravated these impairments. By supplementing with VD, learning ability and long-term memory were enhanced, motor and exploratory abilities were improved, and depression levels were reduced. Anxiety was also improved.
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Affiliation(s)
- Jialei Zhang
- Department of Anesthesiology, Changzhi People's Hospital Affiliated with Shanxi Medical University, Changzhi, China
- Department of Anesthesiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Xiaoling Zhang
- Department of Oncology, Changzhi People's Hospital Affiliated with Shanxi Medical University, Changzhi, China
| | - Jun Zhao
- Department of Oncology, Changzhi People's Hospital Affiliated with Shanxi Medical University, Changzhi, China
| | - Jie Wu
- Department of pain treatment, Changzhi People's Hospital Affiliated with Shanxi Medical University, Changzhi, China
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Hao Z, Liu G, Ren L, Liu J, Liu C, Yang T, Wu X, Zhang X, Yang L, Xia J, Li W. A Self-Healing Multifunctional Hydrogel System Accelerates Diabetic Wound Healing through Orchestrating Immunoinflammatory Microenvironment. ACS APPLIED MATERIALS & INTERFACES 2023; 15:19847-19862. [PMID: 37042619 DOI: 10.1021/acsami.2c23323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Developing an effective treatment strategy of drug delivery to improve diabetic wound healing remains a major challenge in clinical practice nowadays, due to multidrug-resistant bacterial infections, angiopathy, and oxidative damage in the wound microenvironment. Herein, an effective and convenient strategy was designed through a self-healing multiple-dynamic-bond cross-linked hydrogel with interpenetrating networks, which was formed by multiple-dynamic-bond cross-linking of reversible catechol-Fe3+ coordinate bonds, hydrogen bonding, and Schiff base bonds. The excellent autonomous healing of the hydrogel was initiated and accelerated by Schiff bonds with reversible breakage between 3,4-dihydroxybenzaldehyde containing catechol and aldehyde groups and chitosan chains, and further consolidated by the co-optation of other noncovalent interactions contributed of hydrogen bonding and Fe3+ coordinate bonds. Intriguingly, cathelicidin LL-37 was introduced and uniformly dispersed in the dynamic interpenetrating networks of the hydrogel as a bioactive molecular to orchestrate the diabetic wound healing microenvironment. This multifunctional wound dressing can significantly promote diabetic wound healing by antibacterial activity, immunomodulation, anti-inflammation, neovascularization, and antioxidant activity. Therefore, this study provided an effective and safe strategy for guiding the diabetic wound treatment in clinical applications.
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Affiliation(s)
- Zhichao Hao
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
| | - Gen Liu
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
| | - Lin Ren
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
| | - Jiangchen Liu
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
| | - Chuanzi Liu
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
| | - Tao Yang
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
| | - Xiangnan Wu
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
| | - Xinchun Zhang
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
| | - Ling Yang
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
| | - Juan Xia
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
| | - Weichang Li
- Hospital of Stomatology, Guanghua School of Stomatology, Guangdong Provincial Key Laboratory of Stomatology, Sun Yat-sen University, Guangzhou 510050, China
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Mabrouk DM. Antimicrobial peptides: features, applications and the potential use against covid-19. Mol Biol Rep 2022; 49:10039-10050. [PMID: 35606604 PMCID: PMC9126628 DOI: 10.1007/s11033-022-07572-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Antimicrobial peptides (AMPs) are a diverse class of molecules that represent a vital part of innate immunity. AMPs are evolutionarily conserved molecules that exhibit structural and functional diversity. They provide a possible solution to the antibiotic-resistance crisis. MAIN TEXT These small cationic peptides can target bacteria, fungi, and viruses, as well as cancer cells. Their unique action mechanisms, rare antibiotic-resistant variants, broad-spectrum activity, low toxicity, and high specificity encourage pharmaceutical industries to conduct clinical trials to develop them as therapeutic drugs. The rapid development of computer-assisted strategies accelerated the identification of AMPs. The Antimicrobial Peptide Database (APD) so far contains 3324 AMPs from different sources. In addition to their applications in different fields, some AMPs demonstrated the potential to combat COVID-19, and hinder viral infectivity in diverse ways. CONCLUSIONS This review provides a brief history of AMPs and their features, including classification, evolution, sources and mechanisms of action, biosynthesis pathway, and identification techniques. Furthermore, their different applications, challenges to clinical applications, and their potential use against COVID-19 are presented.
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Affiliation(s)
- Dalia Mamdouh Mabrouk
- Cell Biology Department, National Research Centre, 33 El Bohouth, St., P.O.12622, Dokki, Giza, Egypt.
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Effects of Oral Nutritional Supplementation on Patients with Venous Ulcers: A Clinical Trial. J Clin Med 2022; 11:jcm11195683. [PMID: 36233551 PMCID: PMC9570985 DOI: 10.3390/jcm11195683] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/14/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022] Open
Abstract
Background: The dosage and safety of nutritional supplements for patients with venous ulcers are still not well established. Aim: To evaluate the effects of a high calorie, high protein, arginine-, zinc-, and vitamins A, C, and E-enriched nutritional supplement on the biochemical profile, dietary intake, anthropometry, muscle strength, and characteristics of lesions of patients with venous ulcers. Methods: A controlled before−after clinical trial with a four-week follow-up involved 27 patients with venous ulcers under outpatient treatment in Brazil. It was administered in two to three doses per day (200 mL each) of a high-calorie and high-protein supplement enriched with arginine, zinc, and vitamins A, C, and E. Patients were assessed for anthropometric parameters, dietary intake, biochemical tests, and healing conditions according to the Pressure Ulcer Scale for Healing (PUSH). Results: It was observed that an increase in energy and protein supply led to an adequate intake of immunonutrients (zinc and vitamins A, C, and E), increased body weight, increased body mass index, and stronger handgrip strength. The injury area and the score on the PUSH notably decreased after the intervention (p < 0.001). Conclusions: The administered supplement, at the tested dosage, improved the nutritional status and characteristics of lesions in patients with venous ulcers.
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Cytokines and Venous Leg Ulcer Healing-A Systematic Review. Int J Mol Sci 2022; 23:ijms23126526. [PMID: 35742965 PMCID: PMC9224200 DOI: 10.3390/ijms23126526] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 06/08/2022] [Accepted: 06/08/2022] [Indexed: 01/01/2023] Open
Abstract
Venous leg ulcers (VLUs) are the most common type of leg ulcers with a significant socioeconomic burden due to slow healing. Cytokines may be involved in the pathogenesis of VLUs. In this systematic review, our objective was to investigate the association between cytokine levels, including growth factors, with the healing of VLUs. PubMed, Embase, Web of Science and Cochrane Library were searched from their inception to August 2021. We retrieved 28 articles investigating 38 different cytokines in 790 patients. Cytokines were most commonly investigated in wound fluid and less frequently in biopsies and serum. The studies were judged as having a moderate to high risk of bias, and the results were often inconsistent and sometimes conflicting. A meta-analysis was not performed due to clinical and methodological heterogeneities. We found weak evidence for elevated IL-1α, IL-6, IL-8, TNF-α and VEGF levels in non-healing VLUs, an elevation that declined with healing. TGF-β1 levels tended to increase with VLU healing. Other cytokines warranting further investigations include EGF, FGF-2, GM-CSF, IL-1β, IL-1Ra and PDGF-AA/PDGF-BB. We conclude that non-healing VLUs may be associated with an elevation of a palette of pro-inflammatory cytokines, possibly reflecting activated innate immunity in these wounds. There is a paucity of reliable longitudinal studies monitoring the dynamic changes in cytokine levels during wound healing.
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Zhao H, Sheng Z, Tan Y, Chen R, Zhou J, Li J, Zhao Q, Wang Y, Zhao X, Chen Y, Zhou P, Liu C, Song L, Yan H. High Human Antimicrobial Peptide LL-37 Level Predicts Lower Major Adverse Cardiovascular Events after an Acute ST-Segment Elevation Myocardial Infarction. J Atheroscler Thromb 2021; 29:1499-1510. [PMID: 34853213 PMCID: PMC9529390 DOI: 10.5551/jat.63221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Aims: We previously associated acute ST-elevation myocardial infarction (STEMI) with decreased plasma LL-37 levels. Therefore, this study investigated whether plasma LL-37 levels could predict ischemic cardiovascular events in patients after STEMI.
Methods: We prospectively collected peripheral plasma samples and clinical and laboratory data from consecutive patients who presented with STEMI and underwent primary percutaneous coronary intervention at Fuwai Hospital between April and November 2017. Enzyme-linked immunosorbent assay measured plasma LL-37 levels, and we followed the patients for 3 years. Major adverse cardiovascular events (MACEs) were a composite of all-cause mortality, reinfarction, unscheduled revascularization, or ischemic stroke.
Results: The study included 302 patients divided into high (≥ median) and low LL-37 level (<median) groups.
The cumulative incidence of MACE (29.1% vs. 12.6%, p=0.0003), all-cause death (12.6% vs. 3.3%, p=0.003),
reinfarction (7.1% vs. 2.0%, p=0.04), and unscheduled revascularization (13.0% vs. 5.4%, p=0.04) were higher in the low than those in the high LL-37 level group.
Multivariable Cox regression analysis showed that higher LL-37 level independently predicted lower risks of MACE (hazard ratio [HR] 0.390; 95% confidence interval [CI] 0.227–0.669; p<0.001),
all-cause death (HR 0.324; 95%CI 0.119–0.879; p=0.027), and unscheduled revascularization (HR 0.391; 95%CI 0.171–0.907; p=0.027).
Conclusions: High basal plasma level of human LL-37 may predict lower 3-year risks of ischemic cardiovascular events in patients after STEMI.
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Affiliation(s)
- Hanjun Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Zhaoxue Sheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.,Department of Cardiology, China-Japan Friendship Hospital
| | - Yu Tan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Runzhen Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jinying Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Jiannan Li
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | | | - Ying Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Xiaoxiao Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Yi Chen
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Peng Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Chen Liu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Li Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College
| | - Hongbing Yan
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College.,Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences
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Alford MA, Baquir B, Santana FL, Haney EF, Hancock REW. Cathelicidin Host Defense Peptides and Inflammatory Signaling: Striking a Balance. Front Microbiol 2020; 11:1902. [PMID: 32982998 PMCID: PMC7481365 DOI: 10.3389/fmicb.2020.01902] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022] Open
Abstract
Host-defense peptides (HDPs) are vital components of innate immunity in all vertebrates. While their antibacterial activity toward bacterial cells was the original focus for research, their ability to modulate immune and inflammatory processes has emerged as one of their major functions in the host and as a promising approach from which to develop novel therapeutics targeting inflammation and innate immunity. In this review, with particular emphasis on the cathelicidin family of peptides, the roles of natural HDPs are examined in managing immune activation, cellular recruitment, cytokine responses, and inflammation in response to infection, as well as their contribution(s) to various inflammatory disorders and autoimmune diseases. Furthermore, we discuss current efforts to develop synthetic HDPs as therapeutics aimed at restoring balance to immune responses that are dysregulated and contribute to disease pathologies.
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Affiliation(s)
- Morgan A. Alford
- Centre for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, BC, Canada
| | - Beverlie Baquir
- Centre for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, BC, Canada
| | - Felix L. Santana
- Centre for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, BC, Canada
- Departamento de Medicina Molecular y Bioprocesos, Instituto de Biotecnología, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Evan F. Haney
- Centre for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, BC, Canada
| | - Robert E. W. Hancock
- Centre for Microbial Diseases and Immunity Research, University of British Columbia, Vancouver, BC, Canada
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Overview of Host Defense Peptides and Their Applications for Plastic and Reconstructive Surgeons. Plast Reconstr Surg 2020; 146:91-103. [PMID: 32590651 DOI: 10.1097/prs.0000000000006910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Host defense peptides are a family of endogenous short peptides that are found in all living beings and play a critical role in innate immunity against infection. METHODS A nonsystematic review of host defense peptides was conducted with specific interest in properties and applications relevant to plastic and reconstructive surgery. RESULTS In addition to their direct antimicrobial actions against pathogens, including multidrug-resistant bacteria, they also demonstrate important functions in immunomodulation, tumor cell lysis, and tissue regeneration. These properties have made them a topic of clinical interest for plastic surgeons because of their potential applications as novel antibiotics, wound healing medications, and cancer therapies. The rising clinical interest has led to a robust body of literature describing host defense peptides in great depth and breadth. Numerous mechanisms have been observed to explain their diverse functions, which rely on specific structural characteristics. However, these peptides remain mostly experimental, with limited translation to clinical practice because of numerous failures to achieve acceptable results in human trials. CONCLUSIONS Despite the broad ranging potential of these peptides for use in the field of plastic and reconstructive surgery, they are rarely discussed in the literature or at scientific meetings. In this review, the authors provide a summary of the background, structure, function, bacterial resistance, and clinical applications of host defense peptides with the goal of stimulating host defense peptide-based innovation within the field of plastic and reconstructive surgery.
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Barber GA, Weller CD, Gibson SJ. Effects and associations of nutrition in patients with venous leg ulcers: A systematic review. J Adv Nurs 2017; 74:774-787. [PMID: 28985441 DOI: 10.1111/jan.13474] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/04/2023]
Abstract
AIMS To identify the associations and effects of nutritional characteristics and interventions on ulcer outcomes in adult patients with venous leg ulcers. BACKGROUND Venous leg ulcers are the most prevalent type of lower limb ulcer; however, little evidence exists regarding the relationship between nutritional status and ulcer healing. DESIGN A systematic search of English language articles was conducted using the Cochrane Collaboration Handbook for Systematic Reviews of Interventions. DATA SOURCES A search of databases Ovid MEDLINE, EMBASE, Cochrane, CINAHL and Scopus was performed for studies published between January 2004 - May 2017. REVIEW METHODS Quality of the included studies was assessed using the Cochrane Collaboration's Risk of Bias Assessment tool and the relevant Joanna Briggs Institute quality appraisal checklists. RESULTS Twenty studies met the inclusion criteria. All participants had Clinical Aetiology Anatomy Pathophysiology classification C5 (healed) or C6 (active) ulcers. Studies were conducted in a range of clinical settings with relatively small sample sizes. The majority of patients were overweight or obese. Increased body mass index was associated with delayed wound healing. Vitamin D, folic acid and flavonoids were associated with some beneficial effects on ulcer healing. Dietary intakes of omega-3 fatty acids, vitamin C and zinc were low for some patients. CONCLUSION Current evidence suggests that venous leg ulcer patients are more likely to be overweight or obese. However, evidence for weight management improving wound healing is lacking. Micronutrients, including vitamin D and folic acid, may improve wound healing in at-risk patients.
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Affiliation(s)
- Georgina A Barber
- Faculty Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Melbourne, Vic., Australia.,School of Clinical Sciences, Department Nutrition, Dietetics and Food, Monash University, Melbourne, Vic., Australia
| | - Carolina D Weller
- Faculty Medicine, Nursing and Health Sciences, School of Nursing and Midwifery, Monash University, Melbourne, Vic., Australia
| | - Simone J Gibson
- Faculty Medicine, Nursing and Health Sciences, School of Clinical Sciences, Department Nutrition, Dietetics and Food, Monash University, Notting Hill, Vic., Australia
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