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Min S, Xing M, Jiang H, Zhang L, Chen C, Ma Y, Ma Y. Exploring causal correlations between inflammatory cytokines and varicose veins: A Mendelian randomization analysis. Int Wound J 2024; 21:e14714. [PMID: 38353374 PMCID: PMC10865274 DOI: 10.1111/iwj.14714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/16/2024] Open
Abstract
This study aimed to investigate the causal relationship between inflammatory cytokines and the risk of varicose veins. The data were sourced from genome-wide association studies (GWAS) of European individuals. Multiple Mendelian randomization (MR) methods were used to evaluate the association between inflammatory cytokines and varicose veins. The study found significant associations between elevated levels of certain inflammatory biomarkers (e.g., CASP-8, Vascular endothelial growth factor A levels (VEGF_A)) and an increased risk of varicose veins, while others (e.g., 4EBP1, MMP-10) showed a protective effect. The MR-Egger Intercept and heterogeneity tests indicated no significant pleiotropy or heterogeneity. This comprehensive MR analysis identifies several cytokines as potential contributors to the pathogenesis of varicose veins, offering insights into novel therapeutic targets. Our findings underscore the importance of inflammation in varicose veins and suggest that targeting specific cytokines could be a promising strategy for the treatment and prevention of varicose veins.
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Affiliation(s)
- Shen Min
- Department of Acupuncture and Massage CollegeShandong University of Traditional Chinese MedicineJinanChina
| | - Mengzhen Xing
- Department of Acupuncture and Massage CollegeShandong University of Traditional Chinese MedicineJinanChina
| | - Hehe Jiang
- Department of Acupuncture and Massage CollegeShandong University of Traditional Chinese MedicineJinanChina
| | - Linlin Zhang
- Department of Acupuncture and Massage CollegeShandong University of Traditional Chinese MedicineJinanChina
| | - Chen Chen
- Department of Acupuncture and Massage CollegeShandong University of Traditional Chinese MedicineJinanChina
| | - Yuning Ma
- Department of Acupuncture and Massage CollegeShandong University of Traditional Chinese MedicineJinanChina
| | - Yuxia Ma
- Department of Acupuncture and Massage CollegeShandong University of Traditional Chinese MedicineJinanChina
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2
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Chen T, Liu P, Zhang C, Jin S, Kong Y, Feng Y, Sun Z. Pathophysiology and Genetic Associations of Varicose Veins: A Narrative Review. Angiology 2024:33197241227598. [PMID: 38226614 DOI: 10.1177/00033197241227598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Varicose veins (VVs) have a high prevalence worldwide and have become a major medical burden. Their pathophysiology involves a complex interplay of inflammation and tissue remodeling, and current treatment is limited by its impact on the pathophysiological mechanisms. In addition, despite clear environmental factors, family history is an important risk factor, suggesting a genetic component to the risk of developing VVs. Our understanding of the pathogenesis of these diseases has benefited greatly from the expansion of population genetic studies, from pioneering family studies to large genome-wide association studies; we now find multiple risk loci for each venous disease. This review considers the pathophysiology of VVs, highlighting the current state of genetic knowledge. We also propose future directions for research.
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Affiliation(s)
- Tao Chen
- Department of Clinical Medicine, Jining Medical University, Jining, China
| | - Peng Liu
- Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Chenguang Zhang
- Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Song Jin
- Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, China
| | - Yuhu Kong
- Department of Clinical Medicine, Jining Medical University, Jining, China
| | - Yanan Feng
- Department of Clinical Medicine, Jining Medical University, Jining, China
| | - Ziqiang Sun
- Department of Vascular Surgery, Affiliated Hospital of Jining Medical University, Jining, China
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3
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Yin C, Tang F, Lao J, Yang Y, Li M, Cao J, Song R, Wu P, Wang Y. Risk factors for venous ulceration in patients with varicose veins of lower extremities. Wound Repair Regen 2024; 32:47-54. [PMID: 38087425 DOI: 10.1111/wrr.13139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/20/2023] [Accepted: 11/27/2023] [Indexed: 12/30/2023]
Abstract
The aim of this case-control study was to explore the potential risk factors for venous ulceration in patients with varicose veins of lower extremities and to establish a simplified diagnostic score model. Seventy subjects with varicose veins of lower extremities and venous ulceration were compared with 1164 controls with varicose veins of lower extremities and no history of venous ulceration. Stepwise multivariate logistic regression analysis was used to identify the risk factors for venous ulceration. The steps in developing the diagnostic score model were based on the Framingham Heart study. The area under the receiver operating characteristic curve (AUC) was calculated to assess the diagnostic ability of the diagnostic score model. Multivariate analysis showed that men, overweight, obesity, longer duration varicose veins, deep venous valve insufficiency, low lymphocyte counts, and high fibrinogen content were independently associated with an increased risk of venous ulceration. The AUC for the diagnostic score model was 0.75, which indicated good discriminatory ability. Special attention should be paid to the high-risk group of patients with lower extremity varicose veins. The diagnostic score model might be a useful screening tool for clinicians, policy makers, and patients.
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Affiliation(s)
- Chaonan Yin
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan, China
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Fang Tang
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan, China
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Jiahui Lao
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yang Yang
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Mingzhuo Li
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jia Cao
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ru Song
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan, China
| | - Peng Wu
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan, China
| | - Yibing Wang
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, Jinan, China
- Center for Big Data Research in Health and Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Shandong Provincial Qianfoshan Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
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Souza MDGCD, Leal IB, Cyrino FZGDA, Bouskela E. Effects of different routes of administration and doses of Sulodexide on leukocyte-endothelium interaction and tissue perfusion on an animal model of low flow and high pressure in veins. Phlebology 2022; 37:721-731. [DOI: 10.1177/02683555221114539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objectives To assess the effects of different doses and routes of Sulodexide on leukocyte-endothelium interaction and tissue perfusion in a model of venous hypertension and low blood flow. Methods Six weeks after venous hypertension induction, through external iliac vein ligature male hamsters ( Mesocricetus auratus) received Sulodexide at 1, 2, or 4 mg/kg/day or saline (placebo) by subcutaneous or intramuscular routes during 2 or 4 weeks. After treatments, leukocyte rolling and adhesion, functional capillary density (FCD), and venular diameter were evaluated on the affected hindlimb. Results Subcutaneous and intramuscular treatments with Sulodexide after 2 and 4 weeks, significantly reduced leukocyte rolling and adhesion and increased FCD. Sulodexide did not affect venular diameter and intramuscular treatment was more effective in reducing leukocyte adhesion than the subcutaneous one. Conclusion This preliminary study demonstrated that Sulodexide significantly decreased leukocyte-endothelium interaction and improved tissue perfusion in hamsters subjected to venous hypertension and low blood flow.
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Affiliation(s)
- Maria das Graças Coelho de Souza
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular (BioVasc), Centro Biomédico, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Iasmim Bento Leal
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular (BioVasc), Centro Biomédico, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Fatima Zely Garcia de Almeida Cyrino
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular (BioVasc), Centro Biomédico, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Eliete Bouskela
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular (BioVasc), Centro Biomédico, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
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Ong BS, Dotel R, Ngian VJJ. Recurrent Cellulitis: Who is at Risk and How Effective is Antibiotic Prophylaxis? Int J Gen Med 2022; 15:6561-6572. [PMID: 35983462 PMCID: PMC9379124 DOI: 10.2147/ijgm.s326459] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Recurrent cellulitis following successful treatment is common and prevention should be a major component in the management of cellulitis. Conditions that increase the risk of recurrence include chronic edema, venous disease, dermatomycosis and obesity. These risk factors should be actively managed as further episodes of cellulitis increases the risk of recurrence. The role of non-antibiotic measures is important and should be first-line in prevention. Antibiotic prophylaxis is effective, but its role is limited to non-purulent cellulitis where risk factors are appropriately managed.
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Affiliation(s)
- Bin S Ong
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
| | - Ravindra Dotel
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
| | - Vincent Jiu Jong Ngian
- Department of Ambulatory Care, Division of Medicine, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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6
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Wang Y, Du J, Liu Y, Yang S, Wang Q. microRNA-301a-3p is a potential biomarker in venous ulcers vein and gets involved in endothelial cell dysfunction. Bioengineered 2022; 13:14138-14158. [PMID: 35734851 PMCID: PMC9342147 DOI: 10.1080/21655979.2022.2083821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 05/23/2022] [Accepted: 05/24/2022] [Indexed: 11/04/2022] Open
Abstract
Venous ulcer is a common contributor to chronic venous insufficiency (CVI) of lower limbs, which seriously affects the life quality of patients. In this study, we researched the expression characteristics of microRNA-301a-3p (miR-301a-3p) in patients with CVI and investigated the impact of miR-301a-3p on the dysfunction of human umbilical vein endothelial cells (HUVECs). The plasma level of miR-301a-3p in normal controls, patients with varicose great saphenous vein, and patients with the venous ulcer of lower limbs were measured. We adopted Interleukin-1β (IL-1β), H2O2, and oxygen and glucose deprivation (OGD) to induce endothelial cell injury in vitro. In this way, we evaluated the influence of miR-301a-3p on HUVEC viability, apoptosis, inflammatory response, and oxidative stress. Our data showed that miR-301a-3p was substantially overexpressed in patients with lower limb venous ulcers. The viability of HUVECs decreased, and miR-301a-3p was up-regulated after IL-1β, H2O2, and OGD treatment. miR-301a-3p inhibition greatly ameliorated the dysfunction and cell damage of HUVECs, promoted IGF1/PI3K/Akt/PPARγ, and down-regulated NF-κB/MMPs. The phosphatidylinositol 3-kinase (PI3K) inhibitor (LY294002) or the peroxisome proliferator-activated receptor-γ (PPARγ) inhibitor (GW9661) reversed the anti-inflammatory, antioxidant, and anti-apoptotic effects mediated by miR-301a-3p down-regulation. The nuclear factor-κB (NF-κB) inhibitor lessened cell injury mediated by miR-301a-3p overexpression. In terms of the mechanism, miR-301a-3p targeted the 3'UTR of Insulin-like growth factor-1 (IGF1) and repressed the profile of IGF1. Thus, miR-301a-3p mediates venous endothelial cell damage by targeting IGF1 and regulating the IGF1/PI3K/Akt/PPARγ/NF-κB/MMPs pathway.
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Affiliation(s)
- Ying Wang
- Department of Vascular Surgery, The Second Affiliated Hospital of Qiqihar Medical College, Qiqihar, Heilongjiang, China
| | - Jingchen Du
- Department of Vascular Surgery, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
| | - Yu Liu
- Department of Vascular Surgery, The First Hospital of Qiqihar, Qiqihar, Heilongjiang, China
| | - Shuhui Yang
- Department of Vascular Surgery, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
| | - Qingshan Wang
- Department of Vascular Surgery, Heilongjiang Provincial Hospital, Harbin, Heilongjiang, China
- Department of Vascular Surgery, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
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7
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Kamaev A, Bulatov V, Vakhratyan P, Volkov A, Volkov A, Gavrilov E, Golovina V, Efremova O, Ivanov O, Ilyukhin E, Katorkin S, Konchugova T, Kravtsov P, Maksimov S, Mzhavanadze N, Pikhanova Z, Pryadko S, Smirnov A, Sushkov S, Chabbarov R, Shimanko A, Yakushkin S, Apkhanova T, Derkachev S, Zolotukhin I, Kalinin R, Kirienko A, Kulchitskaya D, Pelevin A, Petrikov A, Rachin A, Seliverstov E, Stoyko Y, Suchkov I. Varicose Veins. FLEBOLOGIIA 2022; 16:41. [DOI: 10.17116/flebo20221601141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2024]
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8
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Zemkewicz JL, Akwii RG, Mikelis CM, Doçi CL. Investigating Epidermal Interactions Through an In Vivo Cutaneous Wound-Healing Assay. Methods Mol Biol 2021; 2193:1-11. [PMID: 32808253 DOI: 10.1007/978-1-0716-0845-6_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Cutaneous wound healing is an intricate and multifaceted process. Despite these complexities, the distinct phases of wound healing provide a unique opportunity to evaluate the roles of different targets in these coordinated responses. This protocol details an in vivo wound healing assay to study the intersection of cellular, molecular, and systemic effector pathways. The role of certain proteins in the wound healing process can be efficiently explored in vivo through the generation of tissue-specific deficient mice. This approach, although optimized for use with animal models displaying epithelial deficiencies, can be used for other tissue-specific deficiencies, and utilizes simple and cost-effective methods, allowing investigators to precisely devise their experimental design. The coordination of immunological, epithelial, vascular, and microenvironmental factors in wound healing makes this technique a valuable tool for investigators across fields.
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Affiliation(s)
- John L Zemkewicz
- College of Osteopathic Medicine, Marian University Indianapolis, Indianapolis, IN, USA
| | - Racheal G Akwii
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Constantinos M Mikelis
- Department of Pharmaceutical Sciences, School of Pharmacy, Texas Tech University Health Sciences Center, Amarillo, TX, USA
| | - Colleen L Doçi
- College of Health Professions, Marian University Indianapolis, Indianapolis, IN, USA.
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Raffetto JD, Ligi D, Maniscalco R, Khalil RA, Mannello F. Why Venous Leg Ulcers Have Difficulty Healing: Overview on Pathophysiology, Clinical Consequences, and Treatment. J Clin Med 2020; 10:jcm10010029. [PMID: 33374372 PMCID: PMC7795034 DOI: 10.3390/jcm10010029] [Citation(s) in RCA: 104] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 12/13/2022] Open
Abstract
Venous leg ulcers (VLUs) are one of the most common ulcers of the lower extremity. VLU affects many individuals worldwide, could pose a significant socioeconomic burden to the healthcare system, and has major psychological and physical impacts on the affected individual. VLU often occurs in association with post-thrombotic syndrome, advanced chronic venous disease, varicose veins, and venous hypertension. Several demographic, genetic, and environmental factors could trigger chronic venous disease with venous dilation, incompetent valves, venous reflux, and venous hypertension. Endothelial cell injury and changes in the glycocalyx, venous shear-stress, and adhesion molecules could be initiating events in VLU. Increased endothelial cell permeability and leukocyte infiltration, and increases in inflammatory cytokines, matrix metalloproteinases (MMPs), reactive oxygen and nitrogen species, iron deposition, and tissue metabolites also contribute to the pathogenesis of VLU. Treatment of VLU includes compression therapy and endovenous ablation to occlude the axial reflux. Other interventional approaches such as subfascial endoscopic perforator surgery and iliac venous stent have shown mixed results. With good wound care and compression therapy, VLU usually heals within 6 months. VLU healing involves orchestrated processes including hemostasis, inflammation, proliferation, and remodeling and the contribution of different cells including leukocytes, platelets, fibroblasts, vascular smooth muscle cells, endothelial cells, and keratinocytes as well as the release of various biomolecules including transforming growth factor-β, cytokines, chemokines, MMPs, tissue inhibitors of MMPs (TIMPs), elastase, urokinase plasminogen activator, fibrin, collagen, and albumin. Alterations in any of these physiological wound closure processes could delay VLU healing. Also, these histological and soluble biomarkers can be used for VLU diagnosis and assessment of its progression, responsiveness to healing, and prognosis. If not treated adequately, VLU could progress to non-healed or granulating VLU, causing physical immobility, reduced quality of life, cellulitis, severe infections, osteomyelitis, and neoplastic transformation. Recalcitrant VLU shows prolonged healing time with advanced age, obesity, nutritional deficiencies, colder temperature, preexisting venous disease, deep venous thrombosis, and larger wound area. VLU also has a high, 50-70% recurrence rate, likely due to noncompliance with compression therapy, failure of surgical procedures, incorrect ulcer diagnosis, progression of venous disease, and poorly understood pathophysiology. Understanding the molecular pathways underlying VLU has led to new lines of therapy with significant promise including biologics such as bilayer living skin construct, fibroblast derivatives, and extracellular matrices and non-biologic products such as poly-N-acetyl glucosamine, human placental membranes amnion/chorion allografts, ACT1 peptide inhibitor of connexin 43, sulodexide, growth factors, silver dressings, MMP inhibitors, and modulators of reactive oxygen and nitrogen species, the immune response and tissue metabolites. Preventive measures including compression therapy and venotonics could also reduce the risk of progression to chronic venous insufficiency and VLU in susceptible individuals.
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Affiliation(s)
- Joseph D. Raffetto
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
- Correspondence: (J.D.R.); (F.M.)
| | - Daniela Ligi
- Department of Biomolecular Sciences, Section of Biochemistry and Biotechnology, Unit of Clinical Biochemistry, University Carlo Bo of Urbino, 61029 Urbino, Italy; (D.L.); (R.M.)
| | - Rosanna Maniscalco
- Department of Biomolecular Sciences, Section of Biochemistry and Biotechnology, Unit of Clinical Biochemistry, University Carlo Bo of Urbino, 61029 Urbino, Italy; (D.L.); (R.M.)
| | - Raouf A. Khalil
- Vascular Surgery Research Laboratories, Division of Vascular and Endovascular Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
| | - Ferdinando Mannello
- Department of Biomolecular Sciences, Section of Biochemistry and Biotechnology, Unit of Clinical Biochemistry, University Carlo Bo of Urbino, 61029 Urbino, Italy; (D.L.); (R.M.)
- Correspondence: (J.D.R.); (F.M.)
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10
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Ulloa JH, Glickman M. Human trial using the novel bioprosthetic VenoValve in patients with chronic venous insufficiency. J Vasc Surg Venous Lymphat Disord 2020; 9:938-944. [PMID: 33221526 DOI: 10.1016/j.jvsv.2020.10.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 10/16/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Chronic venous insufficiency (CVI) is a disease characterized by failure of the venous valves that allow blood from the lower limbs to return to the heart. The more severe types of CVI (C4b-C6 disease) significantly influence patients' quality of life (QOL). The treatment options for CVI of the deep system are limited. The present study is the first-in-human study using a prosthetic venous valve, VenoValve, to initially evaluate patient outcomes. We evaluated the feasibility, initial safety, and performance outcomes of the VenoValve. METHODS Ten patients with C5-C6 CVI of the deep venous system secondary to postthrombotic syndrome had had a VenoValve surgically implanted into the femoral vein in Bogota, Colombia, under approval of the local ethics committee and Colombian National Food and Drug Surveillance Institute, national health care regulatory body, or the Colombian National Food and Drug Surveillance Agency. Follow-up examinations were conducted postoperatively at 2 and 14 days and then every 30 days for 6 months. The results of the assessments for adverse events, reflux time, disease severity (venous clinical severity scores), pain scores (visual analog scale), and QOL (VEINES-QOL/Sym [venous insufficiency epidemiological and economic study-QOL/symptoms] questionnaire) were documented. RESULTS Ten patients underwent successful implantation of the VenoValve into the femoral vein as outpatients (100% technical success rate). Of the 10 patients, 9 had undergone VenoValve placement under regional anesthesia and 1 under local anesthesia. Six patients had required bovine patch angioplasty of the vein. Four adverse events occurred, including one case of hematoma at the incision site that was aspirated, 2 cases of superficial wound infection in C6 patients treated with antibiotics, and 1 case of a bleeding complication due to warfarin anticoagulation. One patient's VenoValve had thrombosed at 5 months due to nontherapeutic anticoagulation. Improvements in all 5 patients who had reached the 6-month follow-up mark with the VenoValve were demonstrated during the study period by decreases in the venous clinical severity scores (61% decrease from baseline), visual analog scale for pain scores (57% decrease), and reflux time (40% decrease) and a statistically significant improvement in the VEINES-QOL/Sym questionnaire. The patient with the occluded VenoValve had experienced improvements in all areas except for the reflux time. The latter patient had shown improvement because her ulcer had nearly healed before the occurrence of the thrombosis. CONCLUSIONS The early results of the first-in-human trial using the VenoValve appear promising, with improvements in clinical outcomes and QOL. The VenoValve is the first prosthetic valve that has shown success at 6 months of follow-up. These findings offer insight for creating better outcomes for these highly disabled patients.
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Affiliation(s)
- Jorge H Ulloa
- Department of Surgery, Fundacion Santa Fe de Bogota, Universidad de Los Andes, Bogota, Colombia.
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11
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Shi C, Wang C, Liu H, Li Q, Li R, Zhang Y, Liu Y, Shao Y, Wang J. Selection of Appropriate Wound Dressing for Various Wounds. Front Bioeng Biotechnol 2020; 8:182. [PMID: 32266224 PMCID: PMC7096556 DOI: 10.3389/fbioe.2020.00182] [Citation(s) in RCA: 195] [Impact Index Per Article: 48.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/24/2020] [Indexed: 12/30/2022] Open
Abstract
There are many factors involved in wound healing, and the healing process is not static. The therapeutic effect of modern wound dressings in the clinical management of wounds is documented. However, there are few reports regarding the reasonable selection of dressings for certain types of wounds in the clinic. In this article, we retrospect the history of wound dressing development and the classification of modern wound dressings. In addition, the pros and cons of mainstream modern wound dressings for the healing of different wounds, such as diabetic foot ulcers, pressure ulcers, burns and scalds, and chronic leg ulcers, as well as the physiological mechanisms involved in wound healing are summarized. This article provides a clinical guideline for selecting suitable wound dressings according to the types of wounds.
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Affiliation(s)
- Chenyu Shi
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Chenyu Wang
- Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - He Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Qiuju Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ronghang Li
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yan Zhang
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Yuzhe Liu
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
| | - Ying Shao
- Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China.,Department of Plastic and Reconstructive Surgery, The First Hospital of Jilin University, Changchun, China
| | - Jincheng Wang
- School of Nursing, Jilin University, Changchun, China.,Orthopaedic Medical Center, The Second Hospital of Jilin University, Changchun, China
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12
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Effect of Polyhexamethylene Biguanide Solution on Bacterial Load and Biofilm in Venous Leg Ulcers: A Randomized Controlled Trial. J Wound Ostomy Continence Nurs 2019; 45:425-431. [PMID: 29939885 DOI: 10.1097/won.0000000000000455] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to investigate the effect of polyhexamethylene biguanide (PHMB) solution as a wound cleanser on bacterial load and bacterial biofilm in venous leg ulcers. DESIGN Randomized controlled trial. SUBJECTS AND SETTING The target population was adults attending the dermatology outpatient clinic of the Clinical Hospital of the Federal University of Minas Gerais, Brazil. The sample comprised 44 patients with venous leg ulcers recruited over a 6-month period. METHODS Participants were divided into 2 groups: the intervention group had their wounds cleansed with PHMB, and the control group had their wound cleansed with a 0.9% saline solution. Tissue fragments of the wounds were collected for bacteriological analysis; transmission electron microscopy was used to identify the presence of biofilm. RESULTS The bacterial load was reduced in both groups compared to baseline values; no significant difference was found when groups were compared. Correlation analysis between wound duration (months), wound area (cm²), necrosis (%), variables, and bacterial count (colony forming units [CFUs]/g) after cleansing showed a significant relationship between area of the wound and CFUs/g (P = .0070, r = 0.51). Transmission electron microscopy revealed the presence of bacterial biofilm in the wounds after cleansing with both solutions. CONCLUSIONS The results of this study indicate that both PHMB and saline solution are effective in reducing the bacterial load in venous leg ulcers. However, bacterial biofilm was present after cleansing with both solutions. These findings provide important evidence regarding effectiveness of 2 common wound cleansers on bacterial presence in wounds.
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Aslan R, Erbin A, Celik S, Ucpinar B, Sahinalp S, Yıldızhan M, Eryilmaz R, Taken K. Evaluation of hemorrhoidal disease and lower extremity venous insufficiency in primary adult varicocele: A prospective controlled study. Phlebology 2019; 34:621-626. [PMID: 30836835 DOI: 10.1177/0268355519834426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background The study investigated the association between varicocele, lower extremity venous insufficiency and hemorrhoidal disease. Methods The study included 62 patients with varicocele and 60 voluntary subjects with no varicocele. Patients who were diagnosed as having varicocele on physical examination and Doppler ultrasonography were included in the study group. Examination of lower extremity venous insufficiency was performed by physical examination and Doppler ultrasonography. Examination of hemorrhoidal disease was performed by a general surgery specialist. Results The patients with varicocele had a statistically significant ( p < 0.05) higher rates of venous insufficiency of the lower extremities and had a borderline significant difference of higher hemorrhoidal disease rates ( p = 0.05). Therewithal incidences of hemorrhoidal disease and lower extremity venous insufficiency were significantly higher in body mass index > 25 and age > 30 years of varicocele patients. Conclusion There is a statistically significant relation between varicocele, lower extremity venous insufficiency, and hemorrhoidal disease. In particular, varicocele patients who are aged over 30 years and overweight are at higher risk.
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Affiliation(s)
- Rahmi Aslan
- Department of Urology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Akif Erbin
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sebahattin Celik
- Department of General Surgery, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Burak Ucpinar
- Department of Urology, Haseki Training and Research Hospital, Istanbul, Turkey
| | - Sahin Sahinalp
- Department of Cardiovascular Surgery, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Murat Yıldızhan
- Department of Radiology, Viransehir Medical Center, Sanliurfa, Turkey
| | - Recep Eryilmaz
- Department of Urology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
| | - Kerem Taken
- Department of Urology, Medical Faculty, Yuzuncu Yil University, Van, Turkey
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Affiliation(s)
- Jan Stana
- Specialist in Vascular Surgery; Schön Klinik Vogtareuth, Klinik für operative und interventionelle Gefäßchirurgie, Krankenhausstraße 20, DE-83569 Vogtareuth, Germany
| | - Uroš Maver
- Head of Institute of Biomedical Sciences, Assistant Professor in Pharmacology and Toxicology; University of Maribor, Faculty of Medicine, Institute of Biomedical Sciences, Taborska ulica 8, SI-2000 Maribor, Slovenia. University of Maribor, Faculty of Medicine, Department of Pharmacology, Taborska ulica 8, SI-2000 Maribor, Slovenia
| | - Uroš Potočnik
- Head of Center for Human Molecular Genetics and Pharmacogenomics, Professor of Biochemistry and Genetics; University of Maribor, Faculty of Medicine, Center for human molecular genetics and pharmacogenomics, Taborska ulica 8, SI-2000 Maribor, Slovenia. University of Maribor, Faculty for Chemistry and Chemical engineering, Laboratory for Biochemistry, Molecular Biology and Genomics, Smetanova 17, SI-2000 Maribor, Slovenia
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Abstract
Sulodexide is a glycosaminoglycan extracted from porcine intestinal mucosa. The purpose of this review is to discuss sulodexide's complex pharmacological profile and its clinical applications for venous disease. Sulodexide has wide-ranging biological effects on the vascular system, including antithrombotic, profibrinolytic, anti-inflammatory, endothelial protective and vasoregulatory effects. Sulodexide has emerged as a potential therapeutic option for the management of chronic venous insufficiency, including venous ulceration, and the prevention of recurrent venous thromboembolism, with a low rate of major bleeding complications. Sulodexide's pleiotropic vascular effects may facilitate the management of common venous disorders.
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Affiliation(s)
- B J Carroll
- Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - G Piazza
- Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - S Z Goldhaber
- Division of Cardiovascular Medicine, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
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Shadrina A, Tsepilov Y, Sokolova E, Smetanina M, Voronina E, Pakhomov E, Sevost'ianova K, Shevela A, Ilyukhin E, Seliverstov E, Zolotukhin I, Filipenko M. Genome-wide association study in ethnic Russians suggests an association of the MHC class III genomic region with the risk of primary varicose veins. Gene 2018; 659:93-99. [DOI: 10.1016/j.gene.2018.03.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 02/16/2018] [Accepted: 03/14/2018] [Indexed: 10/17/2022]
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Piperigkou Z, Götte M, Theocharis AD, Karamanos NK. Insights into the key roles of epigenetics in matrix macromolecules-associated wound healing. Adv Drug Deliv Rev 2018; 129:16-36. [PMID: 29079535 DOI: 10.1016/j.addr.2017.10.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/14/2017] [Accepted: 10/20/2017] [Indexed: 02/08/2023]
Abstract
Extracellular matrix (ECM) is a dynamic network of macromolecules, playing a regulatory role in cell functions, tissue regeneration and remodeling. Wound healing is a tissue repair process necessary for the maintenance of the functionality of tissues and organs. This highly orchestrated process is divided into four temporally overlapping phases, including hemostasis, inflammation, proliferation and tissue remodeling. The dynamic interplay between ECM and resident cells exerts its critical role in many aspects of wound healing, including cell proliferation, migration, differentiation, survival, matrix degradation and biosynthesis. Several epigenetic regulatory factors, such as the endogenous non-coding microRNAs (miRNAs), are the drivers of the wound healing response. microRNAs have pivotal roles in regulating ECM composition during wound healing and dermal regeneration. Their expression is associated with the distinct phases of wound healing and they serve as target biomarkers and targets for systematic regulation of wound repair. In this article we critically present the importance of epigenetics with particular emphasis on miRNAs regulating ECM components (i.e. glycoproteins, proteoglycans and matrix proteases) that are key players in wound healing. The clinical relevance of miRNA targeting as well as the delivery strategies designed for clinical applications are also presented and discussed.
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das Graças C de Souza M, Cyrino FZ, de Carvalho JJ, Blanc-Guillemaud V, Bouskela E. Protective Effects of Micronized Purified Flavonoid Fraction (MPFF) on a Novel Experimental Model of Chronic Venous Hypertension. Eur J Vasc Endovasc Surg 2018; 55:694-702. [PMID: 29588131 DOI: 10.1016/j.ejvs.2018.02.009] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 02/08/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess protective effects of micronized purified flavonoid fraction (MPFF) on microcirculation in an original chronic model of hind limb venous hypertension with low blood flow in small animals. METHODS Vein ligatures were performed on male hamsters, as follows: A-right femoral vein; A + B-right femoral vein and its right branch; A + C-right femoral vein and its left branch; A + B + C-right femoral and its right and left branches; D-external right iliac vein. In sham operated groups, similar vascular dissections were performed without ligatures. Superficial (epigastric) and central (jugular) venous pressure evaluations were made during a 10 week period. Hamsters subjected to A + B + C and D ligatures were selected for leukocyte rolling and sticking, functional capillary density (FCD), and venular and arteriolar diameter observations. D ligature was selected to evaluate pharmacological treatment efficacy. MPFF (100 mg/kg), concomitant active flavonoids of MPFF (diosmetin, hesperidin, linarin, and isorhoifolin) (10 mg/kg), diosmin (100 mg/kg) or drug vehicle were administered orally during 2 weeks before vein ligature and 6 weeks thereafter. RESULTS A, A + B and A + C models maintained venous return through collaterals. From the 2nd to the 10th weeks after vein ligatures, A + B + C and D models elicited a progressive increase of superficial venous pressure (3.83 ± 0.65 vs. 8.56 ± 0.72 mmHg, p < .001 and 4.13 ± 0.65 vs. 9.35 ± 0.65 mmHg, p < .001, respectively) with significant changes to the microcirculation. As D model significantly increased superficial venous pressure without affecting central venous pressure, it was used to evaluate the long-term effects of treatment. Compared with vehicle, MPFF, concomitant active flavonoids of MPFF, and diosmin, significantly decreased leukocyte-endothelium interaction and prevented FCD reduction. Only MPFF significantly prevented venular enlargement as observed in the vehicle treated group. CONCLUSION MPFF was more effective than diosmin in improving all microvascular variables. The superiority of MPFF over diosmin alone can be explained by the synergistic beneficial effects of the association between diosmin and active flavonoids of MPFF.
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Affiliation(s)
- Maria das Graças C de Souza
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Centro Biomédico, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil.
| | - Fatima Zga Cyrino
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Centro Biomédico, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | - Jorge J de Carvalho
- Laboratório de Ultraestrutura e Biologia Tecidual, Departamento de Histologia e Embriologia, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
| | | | - Eliete Bouskela
- Laboratório de Pesquisas Clínicas e Experimentais em Biologia Vascular, Centro Biomédico, Universidade do Estado do Rio de Janeiro (UERJ), Rio de Janeiro, RJ, Brazil
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Moreno-Eutimio MA, Espinosa-Monroy L, Orozco-Amaro T, Torres-Ramos Y, Montoya-Estrada A, Jose Hicks J, Rodríguez-Ayala E, Moral PD, Moreno J, Cueto-García J. Enhanced healing and anti-inflammatory effects of a carbohydrate polymer with zinc oxide in patients with chronic venous leg ulcers: preliminary results. Arch Med Sci 2018; 14:336-344. [PMID: 29593807 PMCID: PMC5868658 DOI: 10.5114/aoms.2016.59851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 08/01/2015] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Insufficient wound healing related to chronic inflammation of chronic venous leg ulcers (CVUs) represents an important public health problem. The aim of this study was to evaluate the effects of a carbohydrate polymer with zinc oxide therapy on CVUs. MATERIAL AND METHODS Forty patients with CVUs were recruited for this study and were divided into a study group and control group. Patients In the study group were instructed to use venous compression treatment andtopical carbohydrate polymer with zinc oxide twice daily, while patients In the control group were treated with only venous compression treatment. All patients were followed up for 8 weeks. Peripheral blood samples and biosy tissue specimens were obtained at the initiation of treatment and after 8 weeks to assess serum levels of inflammatory cytokines as well as the percentage of leukocytes, T-helper cells, cytotoxic-T cells, macrophages and endothelial cells in the biopsy tissue using flow cytometry. RESULTS A significantly greater reduction in the mean percentage ulcer area from baseline to eight weeks was observed in the study group (up to 40% for large ulcers). Furthermore, the patients in the study group had reduced systemic levels of the pro-inflammatory cytokines IL-8 (p = 0.0028) and IL-6 (p = 0.0302), fewer total CD45+ cells (p = 0.0038) and more CD31+ cells (p = 0.045) present in ulcer biopsies compared to the control group. CONCLUSIONS The carbohydrate polymer with zinc oxide treatment with venous compression enhances healing of CVUs and improves quality of life due, in part, to its anti-inflammatory properties.
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Affiliation(s)
| | - Lorena Espinosa-Monroy
- Wound and Ostomy Clinic, Division of Research, Hospital Juarez de México, Ministry of Health, Mexico City, Mexico
| | - Tania Orozco-Amaro
- Immunobiology Laboratory, Hospital Juarez de México, Ministry of Health, Mexico City, Mexico
| | - Yessica Torres-Ramos
- Biochemistry Department, National Institute of Perinatology, Ministry of Health, Mexico City, Mexico
| | - Araceli Montoya-Estrada
- Biochemistry Department, National Institute of Perinatology, Ministry of Health, Mexico City, Mexico
| | - Juan Jose Hicks
- Health Research Policies, Coordinating Commission of National Health Institutes and Highly Specialized Hospitals, Mexico City, Mexico
| | | | - Pamela Del Moral
- Health Sciences Faculty, Anahuac University, State of Mexico, Mexico
| | - Jose Moreno
- Immunobiology Laboratory, Hospital Juarez de México, Ministry of Health, Mexico City, Mexico
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Abstract
Summary
Objective: To study the CD34 expression in the leg veins with primary varicose veins.
Material and Methods: The study included 18 patients with lower limbs varicose veins and deep vein valves insufficiency of C3 and C4 clinical classes (CEAP). To correct blood flow phlebectomy was accompanied by posterior tibial veins resection. Using immunohistochemistry, we compared the expression of CD34 in resected posterior tibial veins specimens and vena saphena magna distal fragment.
Results: Posterior tibial veins wall in patients with lower limb varicosity and deep veins valves insufficiency vary the CD34 degree expression comparing with the control group. Total area of expression was significantly greater than in control sample. CD34 expression area was also significantly greater in vena saphena magna than in control group. CD34 expression comparison in the specimens from patients with varicose veins showed its significantly higher degree in the vena saphena magna than in tibial veins.
Conclusion: With primary varicose veins superficial and deep leg veins develop unidirectional increase of CD34 expression, that can be assumed as a pathogenetic factors of further disease progression and involvement of deep vein valves.
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Köksoy C, Akkoca M, Tokgöz S, Çetinkaya A, Sevim Y, Demirel-Yılmaz E. Venous stent placement ameliorates cutaneous microvascular function in iliocaval venous obstruction. J Vasc Surg Venous Lymphat Disord 2017; 6:57-65. [PMID: 29248109 DOI: 10.1016/j.jvsv.2017.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 07/16/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND The role of cutaneous microvascular dysfunction is well known in the development of chronic venous disease. However, the effects of venous obstruction on microcirculation have not been well investigated. The aim of this study was to assess cutaneous microvascular function in patients with iliocaval venous obstruction (ICVO) before and after venous stent placement. METHODS Endothelium-dependent and endothelium-independent vasodilator responses to iontophoretic administration of incremental doses of acetylcholine (ACh) and sodium nitroprusside (SNP) were evaluated using a laser Doppler scanner in the perimalleolar region in the supine and sitting positions in patients with ICVO (n = 11) and in healthy control subjects (n = 15). Cutaneous microvascular function, the Venous Clinical Severity Score (VCSS), and the Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) clinical class were re-evaluated 3 months after stent placement in patients with ICVO. RESULTS The vasodilatory responses to ACh and SNP in the cutaneous microcirculation were lower in patients with ICVO than in healthy subjects in the sitting position (P < .05). Recanalization and stent placement were successful in all patients in the evaluation of VCSS and clinical class, and a significant decrease was determined in the signs and symptoms of the venous disease (P < .01). Stent placement resulted in a significant increase in vasodilation response to both ACh and SNP in the supine position and no improvement in the sitting position in patients with ICVO. CONCLUSIONS ICVO impairs endothelium-dependent and endothelium-independent vasodilation in the perimalleolar region. Iliocaval venous stent placement may recover microvascular dysfunction at different levels.
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Affiliation(s)
- Cüneyt Köksoy
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey.
| | - Muzaffer Akkoca
- Department of General Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Serhat Tokgöz
- Department of General Surgery, University of Health Sciences, Dışkapı Yıldırım Beyazıt Research and Training Hospital, Ankara, Turkey
| | - Arda Çetinkaya
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Yusuf Sevim
- Division of Vascular Surgery, Department of Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Emine Demirel-Yılmaz
- Department of Medical Pharmacology, Faculty of Medicine, Ankara University, Ankara, Turkey
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Chronic Venous Insufficiency: Transforming Growth Factor-β Isoforms and Soluble Endoglin Concentration in Different States of Wound Healing. Int J Mol Sci 2017; 18:ijms18102206. [PMID: 29065449 PMCID: PMC5666886 DOI: 10.3390/ijms18102206] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 10/18/2017] [Accepted: 10/19/2017] [Indexed: 01/01/2023] Open
Abstract
Venous leg ulcer (VLU) is a huge healthcare problem with poorly understood pathophysiology. Transforming growth factor-β (TGF-β) and endoglin (Eng), are inflammatory and wound healing mediators. Eng, co-receptor for TGF-β type-II receptors, may be cleaved forming soluble Eng (sEng), antagonizing TGF-β signaling, a crucial process in vascular pathologies. We evaluated the accumulation in wound fluid (WF) of TGF-β isoforms and sEng in healing stages, showing the effects of sulodexide treatments, a glycosaminoglycan with clinical efficacy in VLU healing. Patients with inflammatory (Infl) and granulating (Gran) VLU were recruited. WFs and THP-1 monocytes exposed to Infl and Gran WF (treated/untreated with sulodexide) were analyzed for TGF-β isoforms and sEng by multiplex immunoassay. In both Infl and Gran WF, TGF-β1 and β2 were similar; TGF-β3 was significantly increased in Infl compared to Gran WFs (p = 0.033). sEng was significantly elevated in Gran compared to Infl WFs (p = 0.002). In THP-1 monocytes there was a significant increase in sEng after co-treatment of WF and sulodexide. The increase in TGF-β3 found in Infl WF highlights its negative effect on wound healing, while the increased levels of sEng in Gran WF affects the leukocyte adhesion/transmigration through the endothelium, reducing the inflammatory response and favoring the wound healing. Glycosaminoglycan sulodexide potentiates the effects of sEng release from monocyte, representing an important therapeutic option for wound healing.
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Lin YN, Hsieh TY, Huang SH, Liu CM, Chang KP, Lin SD. Management of venous ulcers according to their anatomical relationship with varicose veins. Phlebology 2017; 33:44-52. [DOI: 10.1177/0268355516676124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Adequately excising varicose and incompetent perforating veins is necessary for reducing their recurrence rate of venous ulcer. Method In total, 66 venous ulcers (C6) in 1083 legs with primary varicose veins were managed through endoscopic-assisted surgery. In an endoscopic operative view, the nonvaricose, varicose, and incompetent perforating veins were clearly visualized and precisely dissected. The varicose and incompetent perforating veins were divided and completely excised. Result The varicose veins were traced to the base or periphery of the 55 ulcers. Moreover, 89.4% of the ulcers healed within 14 weeks. Kaplan–Meier analysis revealed a five-year recurrence rate of 0.0%, and the satisfaction mean score was 4.6. Conclusion Endoscopic-assisted surgery can be used to radically excise varicose veins complicated with venous ulcers; the surgery yields low recurrence and high satisfaction rates.
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Affiliation(s)
- Yun-Nan Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tung-Ying Hsieh
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Hung Huang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chia-Ming Liu
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Yuan’s General Hospital, Kaohsiung, Taiwan
| | - Kao-Ping Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sin-Daw Lin
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Fan L, Zou S, Ge H, Xiao Y, Wen H, Feng H, Liu M, Nie M. Preparation and characterization of hydroxypropyl chitosan modified with collagen peptide. Int J Biol Macromol 2016; 93:636-643. [DOI: 10.1016/j.ijbiomac.2016.07.093] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 07/21/2016] [Accepted: 07/27/2016] [Indexed: 12/22/2022]
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Kelechi TJ, Mueller M, Madisetti M, Prentice MA, Dooley MJ. Does cryotherapy improve skin circulation compared with compression and elevation in preventing venous leg ulcers? Int Wound J 2016; 14:641-648. [PMID: 27511115 DOI: 10.1111/iwj.12657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 07/06/2016] [Accepted: 07/10/2016] [Indexed: 12/22/2022] Open
Abstract
This trial compared skin blood flow, temperature and incidence of venous leg ulcers in patients with chronic venous disease using compression wraps and elevation pillows. Patients with CEAP C4 skin damage and C5 history of ulcers were randomly assigned to a cryotherapy intervention (n = 138) or placebo cuff control (n = 138) applied to the lower legs over 9 months. The time the ulcers healed prior to enrollment in the study for the cryotherapy group ranged from 1 to 2218 days (n = 8, median = 32 days); for the control group, the range was 24 to 489 days (n = 6, median = 390 days). There were no statistically significant blood flow changes measured in perfusion units with a laser Doppler flowmetre within or between the groups; mean difference between the groups was 0·62, P = 0·619. No differences were noted in skin temperature measured with an infrared thermometer within and between the groups; mean difference between the groups was -0·17°C, P = 0·540. Cryotherapy did not improve skin blood flow or temperature and did not show efficacy in preventing ulcers. However, at least 30% of intervention and 50% of control participants were anticipated to develop an ulcer during the study; only ∼7% occurred. These findings suggest that strict adherence to standard of care decreases the incidence of leg ulcers and remains a best practice for leg ulcer prevention.
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Affiliation(s)
- Teresa J Kelechi
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Martina Mueller
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Mohan Madisetti
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Margie A Prentice
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
| | - Mary J Dooley
- Medical University of South Carolina, College of Nursing, Charleston, SC, USA
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Ligi D, Mosti G, Croce L, Raffetto JD, Mannello F. Chronic venous disease - Part II: Proteolytic biomarkers in wound healing. Biochim Biophys Acta Mol Basis Dis 2016; 1862:1900-8. [PMID: 27460704 DOI: 10.1016/j.bbadis.2016.07.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/04/2016] [Accepted: 07/22/2016] [Indexed: 12/14/2022]
Abstract
Venous leg ulcers (VLU) are characterized by sustained proteolytic microenvironment impairing the healing process. Wound fluid (WF) reflect the biomolecular activities occurring within the wound area; however, it is unclear if WF from different healing phases have different proteolytic profiles and how VLU microenvironment affects the wound healing mechanisms. We investigated the proteolytic network of WF from distinct VLU phases, and in WF- and LPS-stimulated THP-1 monocytes treated with glycosaminoglycan sulodexide, a well known therapeutic approach for VLU healing. WF were collected from patients with VLU during inflammatory (Infl) and granulating (Gran) phases. WF and THP-1 supernatants were analyzed for nine matrix metalloproteinases (MMP) and four tissue inhibitors of metalloproteinases (TIMP) by multiplex immunoassays. Our results demonstrated that: 1) WF from Infl VLU contained significantly increased concentrations of MMP-2, MMP-9, MMP-12, TIMP-1, and TIMP-2 compared to Gran WF; 2) WF from Gran VLU showed significantly increased levels of MMP-1, MMP-7, MMP-13, and TIMP-4 compared to Infl WF; 3) LPS- and WF-stimulation of THP-1 cells significantly increased the expression of several MMP compared to untreated cells; 4) Sulodexide treatment of both LPS- and WF-stimulated THP-1 significantly down-regulated the release of several MMPs. Our study provides evidence-based medicine during treatment of patients with VLU. WF from Infl and Gran VLU have different MMP and TIMP signatures, consistent with their clinical state. The modulation of proteolytic pathways in wound microenvironment by glycosaminoglycan sulodexide, provide insights for translating research into clinical practice during VLU therapy.
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Affiliation(s)
- Daniela Ligi
- Department of Biomolecular Sciences, Section of Clinical Biochemistry and Molecular Genetics, University "Carlo Bo", Urbino, Italy
| | - Giovanni Mosti
- Department of Angiology, Barbantini's Clinic, via del Calcio 2, 55100 Lucca, Italy
| | - Lidia Croce
- Department of Biomolecular Sciences, Section of Clinical Biochemistry and Molecular Genetics, University "Carlo Bo", Urbino, Italy
| | - Joseph D Raffetto
- Vascular Surgery Division, VA Boston Healthcare System, West Roxbury, MA, USA; Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Ferdinando Mannello
- Department of Biomolecular Sciences, Section of Clinical Biochemistry and Molecular Genetics, University "Carlo Bo", Urbino, Italy.
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Abstract
BACKGROUND Venous leg ulcers (VLUs) or varicose ulcers are the final stage of chronic venous insufficiency (CVI), and are the most common type of leg ulcer. The development of VLUs on ankles and lower legs can occur spontaneously or after minor trauma. The ulcers are often painful and exudative, healing is often protracted and recurrence is common. This cycle of healing and recurrence has a considerable impact on the health and quality of life of individuals, and healthcare and socioeconomic costs. VLUs are a common and costly problem worldwide; prevalence is estimated to be between 1.65% to 1.74% in the western world and is more common in adults aged 65 years and older. The main treatment for a VLU is a firm compression bandage. Compression assists by reducing venous hypertension, enhancing venous return and reducing peripheral oedema. However, studies show that it only has moderate effects on healing, with up to 50% of VLUs unhealed after two years of compression. Non-adherence may be the principal cause of these poor results, but presence of inflammation in people with CVI may be another factor, so a treatment that suppresses inflammation (healing ulcers more quickly) and reduces the frequency of ulcer recurrence (thereby prolonging time between recurrent episodes) would be an invaluable intervention to complement compression treatments. Oral aspirin may have a significant impact on VLU clinical practice worldwide. Evidence for the effectiveness of aspirin on ulcer healing and recurrence in high quality RCTs is currently lacking. OBJECTIVES To assess the benefits and harms of oral aspirin on the healing and recurrence of venous leg ulcers. SEARCH METHODS In May 2015 we searched: The Cochrane Wounds Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE and EBSCO CINAHL. Additional searches were made in trial registers and reference lists of relevant publications for published or ongoing trials. There were no language or publication date restrictions. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared oral aspirin with placebo or no drug intervention (in the presence or absence of compression therapy) for treating people with venous leg ulcers. Our main outcomes were time to complete ulcer healing, rate of change in the area of the ulcer, proportion of ulcers healed in the trial period, major bleeding, pain, mortality, adverse events and ulcer recurrence (time for recurrence and proportion of recurrence). DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, extracted data, assessed the risk of bias of each included trial and assessed overall quality of evidence for the main outcomes in the 'Summary of findings' table. MAIN RESULTS The electronic search located 62 studies. We included two RCTs of oral aspirin (300 mg/daily) given in addition to compression compared with compression and placebo, or compression alone. To date, the impact of aspirin on VLUs has been examined by only two randomised clinical trials, both with a small number of participants. The first RCT was conducted in the United Kingdom (n=20) and reported that daily administration of aspirin (300mg) in addition to compression bandages increased both the rate of healing, and the number of participants healed when compared to placebo in addition to compression bandaging over a four month period. Thirty-eight per cent of the participants given aspirin reported complete healing compared with 0% in the placebo group . Improvement (assessed by reduction in wound size) occurred in 52% of the participants taking aspirin compared with 26% in those taking placebo). The study identified potential benefits of taking aspirin as an adjunct to compression but the sample size was small, and neither the mechanism by which aspirin improved healing nor its effects on recurrence were investigated.In 2012 an RCT in Spain (n=51) compared daily administration of aspirin (300mg) in addition to compression bandages with compression alone over a five month period. There was little difference in complete healing rates between groups (21/28 aspirin and 17/23 compression bandages alone) but the average time to healing was shorter (12 weeks in the treated group vs 22 weeks in the compression only group) and the average time for recurrence was longer in the aspirin group (39 days: [SD 6.0] compared with 16.3 days [SD 7.5] in the compression only group). Although this trial provides some limited data about the potential use of aspirin therapy, the sample size (only 20 patients) was too small for us to draw meaningful conclusions. In addition, patients were only followed up for 4 months and no information on placebo was reported. AUTHORS' CONCLUSIONS Low quality evidence from two trials indicate that there is currently insufficient evidence for us to draw definitive conclusions about the benefits and harms of oral aspirin on the healing and recurrence of venous leg ulcers. We downgraded the evidence to low quality due to potential selection bias and imprecision due to the small sample size. The small number of participants may have a hidden real benefit, or an increase in harm. Due to the lack of reliable evidence, we are unable to draw conclusions about the benefits and harms of oral daily aspirin as an adjunct to compression in VLU healing or recurrence. Further high quality studies are needed in this area.
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Affiliation(s)
- Paulo Eduardo de Oliveira Carvalho
- Marilia Medical SchoolEvidence Based Health Actions Department and Thoracic Surgery DepartmentAvenida Monte Carmelo, 800Bairro FragataMariliaSao PauloBrazil17519‐030
| | - Natiara G Magolbo
- Marilia Medical SchoolEvidence Based Health Actions Department and Thoracic Surgery DepartmentAvenida Monte Carmelo, 800Bairro FragataMariliaSao PauloBrazil17519‐030
| | - Rebeca F De Aquino
- Federal University of São PauloDepartment of MedicineDr Diogo de Faria Street, 377Apto 12 ? Vila ClementinoSão PauloSão PauloBrazil04037‐000
| | - Carolina D Weller
- Monash UniversityDepartment of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health SciencesMelbourneVICAustralia3004
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Apollonio A, Antignani PL, Di Salvo M, Failla G, Guarnera G, Mosti G, Ricci E. A large Italian observational multicentre study on vascular ulcers of the lower limbs (Studio Ulcere Vascolari). Int Wound J 2016; 13:27-34. [PMID: 24618175 PMCID: PMC7949669 DOI: 10.1111/iwj.12216] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/15/2013] [Accepted: 12/19/2013] [Indexed: 11/28/2022] Open
Abstract
An observational study of 2 years was promoted by the Italian Association for Cutaneous Ulcers (AIUC) in order to monitor the epidemiology of leg ulcers, the trend of healing and the more frequent therapeutic approaches in lower limb ulcers. Fifty-nine sites in 14 different Italian regions involved in the study, with 1333 enrolled patients (1163 patients fully evaluated and followed up for 9 months). A prevalence of females (62%) was observed with a mean age of 70 years and a high rate of hypertension (62%), diabetes (38%) and obesity (29%). Venous ulcer was most frequent (55%), followed by mixed (25%) and diabetic (8·3%) ulcers. Basically, all patients received a local therapy (LT) (compression and advanced local therapies), while 63% of patients have an associated systemic pharmaceutical treatment. Ulcer healing rates progressively increased throughout the study and despite the type of observational study does not allow conclusions on the treatment, it was observed that the patients receiving additional systemic drugs were associated with a more rapid acceleration of healing rates of ulcers compared to LT alone (3 months: 39·7% versus 29·2%; 6 months: 62·0% versus 47·0%; 9 months: 74·7% versus 63·8%). In particular, the Studio Ulcere Vascolari (SUV) study showed that a combination treatment with sulodexide and compression therapy allows for a greater increase in the healing rates in venous ulcers.
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Ruggiero M, Grande R, Naso A, Butrico L, Rubino P, Placida GD, Cannistrà M, Serra R. Symptoms in patients with skin changes due to chronic venous insufficiency often lead to emergency care service: an Italian observational study. Int Wound J 2015; 13:967-71. [PMID: 26345466 DOI: 10.1111/iwj.12498] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/08/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022] Open
Abstract
Chronic venous insufficiency (CVI) is the most advanced form of chronic venous disease (CVD), and is often associated with skin changes such as hyperpigmentation, eczema, lipodermatosclerosis and venous skin ulceration that cause discomfort, pain, sleep disturbances, absenteeism in the workplace, disability and deteriorated quality of life (QoL). The purpose of this study is to evaluate the prevalence of CVI and skin changes in patients who turn to Continuous Assistance Services due to the presence of disturbing symptoms of their condition. Data were evaluated by consulting the medical records, during a 16-month period, available with three Continuous Assistance Services of the Italian territory. The overall population of the referring centres consisted of 1186 patients [739 females (62·31%) and 447 males (37·69%)]. Seventy-nine patients (6·66%) consulted the emergency unit for venous symptoms related to CVD. Patients with more severe disease (CVI, categories C4-C6) represented the majority accounting for 60·75%, while patients with moderate disease (C3) accounted for 35·44% and patients with mild disease (C1-C2 stages) accounted for 3·79%. The main finding of this study is that despite CVI not being a disease that commonly requires medical emergency/urgency intervention, patients with CVI, especially in advanced stage with skin changes, may turn to Continuous Assistance Service for treating bothersome symptoms related to their condition.
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Affiliation(s)
- Michele Ruggiero
- Department of Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Raffaele Grande
- Department of Primary Care, Provincial Health Authority of Catanzaro, Catanzaro, Italy.
| | - Agostino Naso
- Department of Primary Care, Provincial Health Authority of Vibo Valentia, Vibo Valentia, Italy
| | - Lucia Butrico
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Paolo Rubino
- Department of Surgery, 'Pugliese-Ciaccio' Hospital, Catanzaro, Italy
| | | | - Marco Cannistrà
- Department of Surgery, Annunziata Hospital of Cosenza, Cosenza, Italy
| | - Raffaele Serra
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
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30
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Wells A, Nuschke A, Yates CC. Skin tissue repair: Matrix microenvironmental influences. Matrix Biol 2015; 49:25-36. [PMID: 26278492 DOI: 10.1016/j.matbio.2015.08.001] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/11/2015] [Accepted: 08/12/2015] [Indexed: 12/31/2022]
Abstract
The process of repair of wounded skin involves intricate orchestration not only between the epidermal and dermal compartments but also between the resident and immigrant cells and the local microenvironment. Only now are we beginning to appreciate the complex roles played by the matrix in directing the outcome of the repair processes, and how this impacts the signals from the various cells. Recent findings speak of dynamic and reciprocal interactions that occurs among the matrix, growth factors, and cells that underlies this integrated process. Further confounding this integration are the physiologic and pathologic situations that directly alter the matrix to impart at least part of the dysrepair that occurs. These topics will be discussed with a call for innovative model systems of direct relevance to the human situation.
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Affiliation(s)
- Alan Wells
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213 USA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA 15213 USA; McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15213 USA.
| | - Austin Nuschke
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA 15213 USA; McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15213 USA
| | - Cecelia C Yates
- Department of Health Development and Promotion, University of Pittsburgh, Pittsburgh, PA 15213 USA; McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA 15213 USA
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31
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Varatharajan L, Thapar A, Lane T, Munster AB, Davies AH. Pharmacological adjuncts for chronic venous ulcer healing: a systematic review. Phlebology 2015; 31:356-65. [PMID: 26036247 DOI: 10.1177/0268355515587194] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of this study was to systematically review the current evidence and determine whether there is a clinical benefit for using pharmacological agents as adjunctive treatment for chronic venous ulcers. METHOD A systematic review of the MEDLINE and EMBASE (from 1 January 1947 through 15 August 2013) and Cochrane databases (from inception through 15 August 2013) was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Inclusion criteria were all randomised controlled trials investigating pharmacological adjuncts for the treatment of venous ulcers with a minimum sample size of 20 patients for each treatment arm. RESULTS Ten relevant articles were identified; one pilot randomised controlled trial and four Cochrane reviews were included. Pentoxifylline, aspirin, sulodexide, mesoglycan, flavonoids, thromboxane A2 antagonist (ifetroban), zinc, prostaglandin and prostacyclin analogues were the drugs reviewed. Pentoxifylline was found to be more effective than placebo in terms of complete ulcer healing or in causing a significant improvement (greater than 60% reduction in ulcer size) (RR 1.70, 95% CI 1.30 to 2.24). Aspirin and flavonoids show potential to be effective adjuncts but methodological shortcomings and issues with bias limit the validity of results from trials involving each of these drugs, respectively. There was no significant difference between placebo and Ifetroban and likewise pooled results from trials investigating sulodexide and zinc showed no benefit in comparison to placebo. CONCLUSION Many systemic pharmacological agents have been investigated as adjuncts to venous ulcer healing; however, pentoxifylline (400 mg, three times a day) is currently the only drug that has promising evidence to support its use. Other compounds are in early stage research.
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Affiliation(s)
| | - Ankur Thapar
- Academic Section of Vascular Surgery, Imperial College London, UK
| | - Tristan Lane
- Academic Section of Vascular Surgery, Imperial College London, UK
| | - Alex B Munster
- Academic Section of Vascular Surgery, Imperial College London, UK
| | - Alun Huw Davies
- Academic Section of Vascular Surgery, Imperial College London, UK
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32
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Kelechi TJ, Mueller M, King DE, Madisetti M, Prentice M. Impact of daily cooling treatment on skin inflammation in patients with chronic venous disease. J Tissue Viability 2015; 24:71-9. [PMID: 25703058 DOI: 10.1016/j.jtv.2015.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 01/20/2015] [Accepted: 01/29/2015] [Indexed: 10/24/2022]
Abstract
People with chronic venous disease are at high risk for developing venous leg ulcers. Inflammation is posited as a pathological factor for this chronic condition as evidenced by persistently elevated skin temperature. As part of a larger trial to test the effects of a cooling regimen on leg ulcer prevention, the objective of this preliminary study was to evaluate the first 30 days of intense daily cooling. Compared to a placebo control cuff, a gel cuff applied to the most severely affected lower leg skin for 30 min daily showed no statistically significant differences between temperatures taken in the home at baseline compared to those measured at the 1 month follow up visit. There were also no differences in temperatures noted between the two groups, although the temperatures in the treatment group were lower 30 min after treatment, an indication of adherence. There was no discernable decrease or increase in temperature at a given time point during the 30 day treatment period compared to the control group. It may be better to have patients monitor skin temperature on a daily basis and then apply the cuff as necessary, rather than requiring daily cooling based on baseline measurement. This "prn" approach may provide a sufficient cooling milieu to prevent escalation of inflammation and thwart ulcer occurrence or recurrence. Clinical trials registration #NCT01509599.
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Affiliation(s)
- Teresa J Kelechi
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Charleston, SC 29425, USA.
| | - Martina Mueller
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Charleston, SC 29425, USA
| | - Dana E King
- West Virginia University, Department of Family Medicine, Robert C. Byrd Health Sciences Center, P.O. Box 9152, Morgantown, WV 26506, USA
| | - Mohan Madisetti
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Charleston, SC 29425, USA
| | - Margie Prentice
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas Street MSC 160, Charleston, SC 29425, USA
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Ramsay S, Cowan L, Davidson JM, Nanney L, Schultz G. Wound samples: moving towards a standardised method of collection and analysis. Int Wound J 2015; 13:880-91. [PMID: 25581688 DOI: 10.1111/iwj.12399] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/20/2014] [Accepted: 10/24/2014] [Indexed: 01/02/2023] Open
Abstract
Chronic wounds, including diabetic foot ulcers, pressure ulcers and venous leg ulcers, impact the lives of millions of people worldwide. These types of wounds represent a significant physical, social and financial burden to both patients and health care systems. Wound care has made great progress in recent years as a result of the critical research performed in academic, clinical and industrial settings. However, there has been relatively little translation of basic research discoveries into novel and effective treatments. One underlying reason for this paucity may be inconsistency in the methods of wound analysis and sample collection, resulting in the inability of researchers to accurately characterise the healing process and compare results from different studies. This review examines the various types of analytical methods being used in wound research today with emphasis on sampling techniques, processing and storage, and the findings call forth the wound care research community to standardise its approach to wound analysis in order to yield more robust and comparable data sets.
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Affiliation(s)
- Sarah Ramsay
- Research & Development, Smith & Nephew, Inc., Fort Worth, TX, USA.
| | - Linda Cowan
- Center of Innovation for Disability and Rehabilitation Research (CINDRR), North Florida/South Georgia Veterans Health System, Gainesville, FL, USA
| | - Jeffrey M Davidson
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA.,VA Tennessee Valley Healthcare System, Research Service, Nashville, TN, USA
| | - Lillian Nanney
- Department of Plastic Surgery, Cell & Developmental Biology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Gregory Schultz
- Department of Obstetrics and Gynecology, University of Florida Medical School, Gainesville, FL, USA
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Modulation of circulating cytokine-chemokine profile in patients affected by chronic venous insufficiency undergoing surgical hemodynamic correction. J Immunol Res 2014; 2014:473765. [PMID: 24741602 PMCID: PMC3984831 DOI: 10.1155/2014/473765] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/17/2014] [Accepted: 02/17/2014] [Indexed: 12/14/2022] Open
Abstract
The expression of proinflammatory cytokines/chemokines has been reported in in vitro/ex vivo settings of chronic venous insufficiency (CVI), but the identification of circulating mediators that might be associated with altered hemodynamic forces or might represent innovative biomarkers is still missing. In this study, the circulating levels of 31 cytokines/chemokines involved in inflammatory/angiogenic processes were analysed in (i) CVI patients at baseline before surgical hemody namic correction, (ii) healthy subjects, and (iii) CVI patients after surgery. In a subgroup of CVI patients, in whom the baseline levels of cytokines/chemokines were analyzed in paired blood samples obtained from varicose vein and forearm vein, EGF, PDGF, and RANTES were increased at the varicose vein site as compared to the general circulation. Moreover, while at baseline, CVI patients showed increased levels of 14 cytokines/chemokines as compared to healthy subjects, 6 months after surgery, 11 cytokines/chemokines levels were significantly reduced in the treated CVI patients as compared to the CVI patients before surgery. Of note, a patient who exhibited recurrence of the disease 6 months after surgery, showed higher levels of EGF, PDGF, and RANTES compared to nonrecurrent patients, highlighting the potential role of the EGF/PDGF/RANTES triad as sensitive biomarkers in the context of CVI.
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35
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GM-CSF exhibits anti-inflammatory activity on endothelial cells derived from chronic venous disease patients. Mediators Inflamm 2013; 2013:561689. [PMID: 24327798 PMCID: PMC3845402 DOI: 10.1155/2013/561689] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/19/2013] [Accepted: 09/27/2013] [Indexed: 11/17/2022] Open
Abstract
Twenty patients affected by chronic venous disease (CVD) in tertiary venous network and/or saphenous vein were analyzed before surgical ablation by echo-color-doppler for the hemodynamic parameters reflux time (RT) and resistance index (RI), a negative and a positive prognostic factor, respectively. RT and RI were next correlated with relevant in vitro parameters of venous endothelial cells (VEC) obtained from surgical specimens, such as cell migration in response to serum gradient, proliferation index, intercellular adhesion molecule (ICAM)-1 and vascular cell adhesion molecule (VCAM)-1 expression, as well as cytokines release. Of interest, ICAM-1 expression in patient-derived VEC cultures correlated positively with RT and negatively with RI. Moreover, RT showed a positive correlation with the baseline osteoprotegerin (OPG) expression by VEC and an inverse correlation with VEC proliferation index. On the other hand, RI correlated positively with TNF-related apoptosis inducing ligand (TRAIL) expression. Among the cytokines released by VEC, GM-CSF showed a positive correlation with VEC proliferation and TRAIL expression and a negative correlation with OPG, ICAM-1 and VCAM-1 expression. Since in vitro recombinant GM-CSF induced VEC proliferation and counteracted the induction of ICAM-1, VCAM-1 and OPG upon exposure to TNF-α, our data suggest an anti-inflammatory activity of GM-CSF on venous endothelial cells.
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36
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Geyer SH, Nöhammer MM, Tinhofer IE, Weninger WJ. The dermal arteries of the human thumb pad. J Anat 2013; 223:603-9. [PMID: 24205910 DOI: 10.1111/joa.12113] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2013] [Indexed: 01/23/2023] Open
Abstract
The arteries of the skin have been postulated to form a profound plexus at the dermal/hypodermal junction and a superficial plexus in the papillary dermis. Our article aims to rebut this concept and to provide an alternative description of the arrangement of the dermal arteries. Employing a novel technique, we produced digital volume data (volume size: 2739 × 2054 × 3000 μm(3) ; voxel size: 1.07 × 1.07 × 2 μm(3) ) from biopsies of the skin of the thumb pads of 15 body donors. Utilizing these data, we analysed the arrangement of the dermal arteries with the aid of virtual re-sectioning tools, and, in three specimens, with high-quality three-dimensional (3D) surface models. In all specimens we observed a tree-like ramification of discrete dermal arteries. The terminal branches of the arterial trees gave rise to the ascending segments of the capillary loops of the dermal papillae. None of the specimens showed a superficial arterial plexus. This suggests that the skin of the human thumb pad can be split in discrete 'arterial units'. Each unit represents the zone of the papillary dermis and epidermal/dermal junction, to which blood is supplied exclusively by the branches of a single dermal artery. The concept of dermal arterial units is in contrast to all existing descriptions of the architecture of the dermal arteries. However, whether it can be transferred to the skin of other body parts, remains to be tested. Likewise, the consequences of arterial units for understanding the mechanisms of wound healing and the appearance and genesis of skin diseases remain to be examined.
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Affiliation(s)
- S H Geyer
- Medical University of Vienna, Centre for Anatomy and Cell Biology, Vienna, Austria
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37
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Yasim A, Resim S, Sahinkanat T, Eroglu E, Ari M, Efe E. Clinical and subclinical varicocele incidence in patients with primary varicose veins requiring surgery. Ann Vasc Surg 2013; 27:758-61. [PMID: 23790768 DOI: 10.1016/j.avsg.2012.07.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 07/16/2012] [Accepted: 07/24/2012] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to analyze the incidence of clinical and subclinical varicocele in patients with primary varicose veins requiring surgery. METHODS A total of 100 patients with primary varicose veins requiring surgery were evaluated. Clinical varicocele was found in each patient through physical examination. Each patient was also evaluated with ultrasound because of evidence of subclinical varicocele. RESULTS Among the patients with varicose veins, 28 had no clinical sign of varicocele, whereas the remaining 72 had varicocele with different clinical levels (72%). Doppler ultrasound revealed that 32 patients had no reflux flow, whereas the other 68 had different grades of reflux flow (68%). CONCLUSIONS Clinical or subclinical varicocele may be highly present in patients with severe venous disease. However, these types of varicoceles do not cause infertility in most patients. Nevertheless, infertility may occur in subsequent years, especially in young patients who have venous disease and undergo surgery, and they should be aware of this condition.
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Affiliation(s)
- Alptekin Yasim
- Faculty of Medicine, Department of Cardiovascular Surgery, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey.
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Abstract
Chronic venous ulcers (CVUs) occur in approximately 1% of the general population. Risk factors for chronic venous disease (CVD) include heredity, age, female sex and obesity. Although not restricted to the elderly, the prevalence of CVD, especially leg ulcers, increases with age.1 CVD has a considerable impact on health-care resources. It has been estimated that venous ulcers cause the loss of approximately two million working days and incur treatment costs of approximately $3 billion per year in the USA.2 Overall, CVD has been estimated to account for 1–3% of the total health-care budgets in countries with developed health-care systems.1 The pathophysiology of dermal abnormalities in CVU is reflective of a complex interplay that involves sustained venous hypertension, inflammation, changes in microcirculation, cytokine and matrix metalloproteinase (MMP) activation, resulting in altered cellular function and delayed wound healing.3,4
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Affiliation(s)
- J D Raffetto
- Harvard Medical School, VA Boston Healthcare System, West Roxbury
- Brigham and Women's Hospital, Boston, MA, USA
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Weinstock LB, Walters AS, Paueksakon P. Restless legs syndrome--theoretical roles of inflammatory and immune mechanisms. Sleep Med Rev 2012; 16:341-54. [PMID: 22258033 DOI: 10.1016/j.smrv.2011.09.003] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 09/22/2011] [Accepted: 09/26/2011] [Indexed: 12/13/2022]
Abstract
Theories for restless legs syndrome (RLS) pathogenesis include iron deficiency, dopamine dysregulation and peripheral neuropathy. Increased prevalence of small intestinal bacterial overgrowth (SIBO) in controlled studies in RLS and case reports of post-infectious RLS suggest potential roles for inflammation and immunological alterations. A literature search for all conditions associated with RLS was performed. These included secondary RLS disorders and factors that may exacerbate RLS. All of these conditions were reviewed with respect to potential pathogenesis including reports of iron deficiency, neuropathy, SIBO, inflammation and immune changes. A condition was defined as highly-associated if there was a prevalence study that utilized an appropriate control group. Small case reports were recorded but not included as definite RLS-associated conditions. Fifty four diseases, syndromes and conditions have been reported to cause and/or exacerbate RLS. Of these, 38 have been reported to have a higher prevalence than age-matched controls, 9 have adequate sized reports and have general acceptance as RLS-associated conditions and 7 have been reported in case report form. Overall, 42 of the 47 RLS-associated conditions (89%) have also been associated with inflammatory and/or immune changes. In addition, 43% have been associated with peripheral iron deficiency, 40% with peripheral neuropathy and 32% with SIBO. Most of the remaining conditions have yet to be studied for these factors. The fact that 95% of the 38 highly-associated RLS conditions are also associated with inflammatory/immune changes suggests the possibility that RLS may be mediated or affected through these mechanisms. Inflammation can be responsible for iron deficiency and hypothetically could cause central nervous system iron deficiency-induced RLS. Alternatively, an immune reaction to gastrointestinal bacteria or other antigens may hypothetically cause RLS by a direct immunological attack on the central or peripheral nervous system.
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Affiliation(s)
- Leonard B Weinstock
- Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Rodrigues LM, Pinto PC, Fluhr JW. In vivo assessment of peripheral vascular function by tcpO₂ and skin blood flow modelling. Exp Dermatol 2011; 21:38-42. [PMID: 22151389 DOI: 10.1111/j.1600-0625.2011.01398.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
There are multiple techniques and methods to assess peripheral vascular function in vivo but not without limitations. More discriminative, sensitive and also practical evaluation strategies are needed to fully characterize the peripheral vascular function. In the present work, a new quantitative descriptor, the 'elimination half-life time' was developed from flow-related variables as a non-invasive microcirculatory rate parameter to describe vascular dynamics. Fifty-four healthy volunteers and six type 2 diabetic patients, both genders, were submitted to a dynamical procedure consisting in the inhalation of a 100% saturated atmosphere of oxygen for 10 min. The tcpO(2) and microcirculatory blood flow [Laser Doppler Flowmetry (LDF)] were measured in a randomly selected leg with a Periflux 5000 system before, during and after the procedure. A monocompartmental model was adjusted to tcpO(2) and LDF data. The tcpO(2) constant elimination rate, expressed as the Oxygen elimination half-life, was used as an indicator of the vulnerability of peripheral tissue and compared in healthy versus non-healthy individuals. Under normal conditions, the saturated ventilation increases the tissue's O(2) availability, as an expression of the natural capacity to adjust the tissue hemodynamics to new metabolical/perfusion conditions. Diabetic patients are expected to suffer vascular impairment and ischemia. Under O(2) overloading conditions, those hypoxic territories tend to uptake all the delivered oxygen, expressed as a significant increase in the O(2) elimination half-life. This approach allows to propose 'elimination half-life time' as the first quantitative descriptive parameter combining miogenic, hemodynamic and metabolic aspects of the microcirculatory physiology and to help to identify the individual's vascular vulnerability.
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Lee K, Kim H, Kim JM, Chung YH, Lee TY, Lim HS, Lim JH, Kim T, Bae JS, Woo CH, Kim KJ, Jeong D. Nacre-driven water-soluble factors promote wound healing of the deep burn porcine skin by recovering angiogenesis and fibroblast function. Mol Biol Rep 2011; 39:3211-8. [PMID: 21688145 DOI: 10.1007/s11033-011-1088-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 06/11/2011] [Indexed: 11/26/2022]
Abstract
To assess the recovery effect of water-soluble components of nacre on wound healing of burns, water-soluble nacre (WSN) was obtained from powdered nacre. Alterations to WSN-mediated wound healing characteristics were examined in porcine skin with deep second-degree burns; porcine skin was used as a proxy for human. When WSN was applied to a burned area, the burn-induced granulation sites were rapidly filled with collagen, and the damaged dermis and epidermis were restored to the appearance of normal skin. WSN enhanced wound healing recovery properties for burn-induced apoptotic and necrotic cellular damage and spurred angiogenesis. Additionally, WSN-treated murine fibroblast NIH3T3 cells showed increased proliferation and collagen synthesis. Collectively, the findings indicate that WSN improves the process of wound healing in burns by expeditiously restoring angiogenesis and fibroblast activity. WSN may be useful as a therapeutic agent, with superior biocompatibility to powdered nacre, and evoking less discomfort when applied to a wounded area.
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Affiliation(s)
- Kyunghee Lee
- Department of Microbiology, Yeungnam University College of Medicine, Daegu 705-717, Korea
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Abstract
Calciphylaxis represents a dermatological emergency with a mortality of up to 80%. The disease is characterized by a triad of arteriolar medial calcification, thrombotic cutaneous ischemia and necrotic ulcerations. Recently several mechanisms of vascular calcification have been identified. This may led to preventive measures in the future. Early diagnosis is important to avoid complications such as sepsis. The dermatologist plays an important role in early diagnosis based on the recognition of clinical presentation and histopathology. Patients with end-stage renal disease are most commonly affected by calciphylaxis. The most frequent non-uremic predisposing conditions are primary hyperparathyroidism, malignancies, alcohol-induced liver disease, and autoimmune connective tissue diseases. Medical treatment aims to normalize mineral metabolism to reduce the serum concentration of sodium phosphate and thus to prevent precipitation and calcification. Newer compounds are bisphosphonates, non-sodium/non-aluminium phosphate binders, cinacalcet, paricalcitrol, and sodium thiosulfate. Among the surgical procedures parathyroidectomy did not result in a significant survival benefit. An aggressive surgical debridement of necrotic ulcerations, on the other hand, improved survival. Early diagnosis and a multidisciplinary treatment approach including re-vascularization by the vascular surgeon, repeated surgical debridement and split skin transplantation support wound healing and insure limb conservation.
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Affiliation(s)
- U Wollina
- Klinik für Dermatologie und Allergologie, Krankenhaus Dresden-Friedrichstadt, Städtisches Klinikum, Akademisches Lehrkrankenhaus der Technischen Universität Dresden, Friedrichstr. 41, 01067, Dresden.
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Helary C, Zarka M, Giraud-Guille MM. Fibroblasts within concentrated collagen hydrogels favour chronic skin wound healing. J Tissue Eng Regen Med 2011; 6:225-37. [DOI: 10.1002/term.420] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 02/17/2011] [Indexed: 01/07/2023]
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Abstract
Although our understanding of chronic venous insufficiency (CVI) has improved, many important questions remain unanswered. Ensuring that patients are appropriately referred for specialist assessment and then receive evidence-based, cost-effective treatment continues to be challenging. The lifetime of risk of chronic venous ulceration (CVU) is around 1% with approximately 10% ulcers being open at any one time. The incidence skin changes disease is about 10 times greater (10%). However, many of the studies upon which these estimates are based are old and/or methodologically flawed. There is reason to believe that the incidence, prevalence and characteristics of CVI/CVU may have changed considerably over the last 10-20 years and that future change is likely. Further cross-sectional and longitudinal epidemiological studies are required to establish the size and nature of the health-care need going forward in developed and increasingly developing countries. CVI culminating CVU is primarily the result of sustained ambulatory venous hypertension, which in turn arises from superficial and/or deep venous reflux with or without deep vein obstruction. However, there are many other elements to this complex condition, for example, microvascular dysfunction; calf muscle pump efficiency; dermal inflammation; disordered fibroblast function and matrix production; failure of epithelialization; congenital and acquired thrombophilia; malnutrition, obesity and diet; and bacterial colonization. None of the currently available treatment modalities is entirely satisfactory and novel therapies based upon a clearer understanding of the disease at the psychological, genetic, mechanical, microvascular and microscopic level are required.
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Affiliation(s)
- Andrew W Bradbury
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
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Singh AV, Subhashree L, Milani P, Gemmati D, Zamboni P. Review: Interplay of Iron Metallobiology, Metalloproteinases, and FXIII, and Role of Their Gene Variants in Venous Leg Ulcer. INT J LOW EXTR WOUND 2010; 9:166-79. [DOI: 10.1177/1534734610384653] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The iron metallobiology has long been suspected as a causal agent in venous leg ulcer (VLU) pathophysiology. However, it was demonstrated only recently that visible iron deposits cause lesions in only some individuals due to functional iron and related gene variants. In this article, the mechanism by which dysregulated iron cycle leads to local iron overload that could generate free radicals or activate a proteolytic hyperactivity on the part of matrix metalloproteinases (MMPs) or else downregulate tissue inhibitors of MMPs is reviewed. Also reviewed is the interplay of other vital factors such as coagulation factor XIII (FXIII), which influences tissue remodeling and angiogenesis, leading to impaired healing of the lesion, whether there exists altered interaction with MMPs or in presence of particular unfavorable single nucleotide polymorphisms.
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Affiliation(s)
- Ajay V Singh
- European School of Molecular Medicine, Milan, Italy, University of Milan, Milan, Italy,
| | | | - Paolo Milani
- Smt Kashibai Navale College of Pharmacy, Pune, India
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Hydrogen Sulfide Protects Against Ischemia-Reperfusion Injury in an In Vitro Model of Cutaneous Tissue Transplantation. J Surg Res 2010; 159:451-5. [DOI: 10.1016/j.jss.2009.05.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2009] [Revised: 04/22/2009] [Accepted: 05/01/2009] [Indexed: 12/19/2022]
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Abstract
Multiple sclerosis (MS) is primarily an autoimmune disorder of unknown origin. This review focuses iron overload and oxidative stress as surrounding cause that leads to immunomodulation in chronic MS. Iron overload has been demonstrated in MS lesions, as a feature common with other neurodegenerative disorders. However, the recent description of chronic cerebrospinal venous insufficiency (CCSVI) associated to MS, with significant anomalies in cerebral venous outflow hemodynamics, permit to propose a parallel with chronic venous disorders (CVDs) in the mechanism of iron deposition. Abnormal cerebral venous reflux is peculiar to MS, and was not found in a miscellaneous of patients affected by other neurodegenerative disorders characterized by iron stores, such as Parkinson's, Alzheimer's, amyotrophic lateral sclerosis. Several recently published studies support the hypothesis that MS progresses along the venous vasculature. The peculiarity of CCSVI-related cerebral venous blood flow disturbances, together with the histology of the perivenous spaces and recent findings from advanced magnetic resonance imaging techniques, support the hypothesis that iron deposits in MS are a consequence of altered cerebral venous return and chronic insufficient venous drainage.
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An experimental in vivo model to characterize "heavy legs" symptom in topical formulations. Dermatol Res Pract 2009; 2009:547039. [PMID: 20585480 PMCID: PMC2877621 DOI: 10.1155/2009/547039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Accepted: 12/30/2009] [Indexed: 11/17/2022] Open
Abstract
The “Heavy legs” symptom is regarded as an early expression of chronic venous failure, estimated to affect 40% of the population in developing countries. A new methodology is proposed to approach the “tired or heavy legs” symptom. Seven females with this complaint applied a standard topical formulation during 28 days in one leg randomly chosen. Local blood flow records were obtained instantaneously and during postural change with a laser doppler flowmeter (LDF). High-frequency sonography and local morphometry were also obtained at Days 0, 14, and 28. When compared with D0, LDF values present a significant decrease of both basal and dynamical values after Day 14 and Day 28 suggesting that this effect may result from the formulation application, also involving the related massage. Centimetric measurements and sonographic analysis also supported those inferences. The proposed methodology can evaluate the dynamical changes of “heavy legs” symptom and eventually be very useful to assess the related claim support.
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