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Seika P, Biebl M, Raakow J, Berndt N, Feldbrügge L, Maurer MM, Dobrindt E, Thuss-Patience P, Pratschke J, Denecke C. The Association between Neoadjuvant Radio-Chemotherapy and Prolonged Healing of Anastomotic Leakage after Esophageal Resection Treated with EndoVAC Therapy. J Clin Med 2022; 11:jcm11164773. [PMID: 36013012 PMCID: PMC9410280 DOI: 10.3390/jcm11164773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 12/24/2022] Open
Abstract
(1) Background: Endoscopic vacuum therapy (EVT) has become the mainstay in the treatment of early anastomotic leakage (AL) after esophageal resection. The effect of nRCT on the efficacy of EVT is currently unknown. (2) Methods: Data of 427 consecutive patients undergoing minimally invasive esophagectomy between 2013 and 2022 were analyzed. A total of 26 patients received EVT for AL after esophagectomy between 2010 and 2021. We compared a cohort of 13 patients after treatment with EVT for anastomotic leakage after neoadjuvant radiochemotherapy (nRCT) with a control group of 13 patients after neoadjuvant chemotherapy (nCT) using inverse propensity score weighting to adjust for baseline characteristics between the groups. EVT therapy was assessed regarding patient survival, treatment failure as defined by a change in treatment to stent/operation, duration of treatment, and secondary complications. Statistical analysis was performed using linear regression analysis. (3) Results: Time to EVT after initial tumor resection did not vary between the groups. The duration of EVT was longer in patients after nRCT (14.69 days vs. 20.85 days, p = 0.002) with significantly more interventions (4.38 vs. 6.85, p = 0.001). The success rate of EVT did not differ between the two groups (nCT n = 8 (61.54%) vs. nCT n = 5 (38.46%), p = 0.628). The rate of operative revision did not vary between the groups. Importantly, no mortality was reported within 30 days and 90 days in both groups. (4) Conclusions: EVT is a valuable tool for the management of AL after esophageal resection in patients after nRCT. While the success rates were comparable, EVT was associated with a significantly longer treatment duration. Anastomotic leakages after nRCT often require prolonged and multimodal treatment strategies while innovative strategies such as prophylactic endoVAC placement or use of a VAC-Stent may be considered.
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Affiliation(s)
- Philippa Seika
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
- Department of Surgery, Division of Surgical Sciences, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - Matthias Biebl
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Jonas Raakow
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Nadja Berndt
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Linda Feldbrügge
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Max Magnus Maurer
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Eva Dobrindt
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Peter Thuss-Patience
- Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Johann Pratschke
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Christian Denecke
- Chirurgische Klinik, Campus Charité Mitte|Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, 13353 Berlin, Germany
- Correspondence:
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Glowacki J, Epperly MW, Bellare A, Wipf P, Greenberger JS. Combined injury: irradiation with skin or bone wounds in rodent models. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2021; 41:S561-S577. [PMID: 34233299 DOI: 10.1088/1361-6498/ac125b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/07/2021] [Indexed: 06/13/2023]
Abstract
A radiation combined injury is defined as an injury that occurs in the setting of irradiation, such as those expected after a nuclear accident, radiation dispersal device release (a 'dirty bomb'), or a nuclear weapon detonation. There is much research on irradiation-associated burns and their healing, but there is less known about other injuries sustained in the context of irradiation. Animal models are limited in their correlations to clinical situations but can support research on specific questions about injuries and their healing. Mouse models of irradiation with skin or bone wounds are validated as highly reproducible and quantitative. They show dose-dependent impairment of wound healing, with later recovery. Irradiation-induced delay of bone wound healing was mitigated to different extents by single doses of gramicidin S-nitroxide JP4-039, a plasmid expressing manganese superoxide dismutase, amifostine/WR2721, or the bifunctional sulfoxide MMS-350. These models should be useful for research on mechanisms of radiation dermal and osseous damage and for further development of new radioprotectors. They also provide information of potential relevance to the effects of clinical radiation therapies.
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Affiliation(s)
- Julie Glowacki
- Department of Orthopedic Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Michael W Epperly
- Department of Radiation Oncology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States of America
| | - Anuj Bellare
- Department of Orthopedic Surgery, Brigham & Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Peter Wipf
- Department of Chemistry, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Joel S Greenberger
- Department of Radiation Oncology, University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States of America
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Wei S, Xu P, Yao Z, Cui X, Lei X, Li L, Dong Y, Zhu W, Guo R, Cheng B. A composite hydrogel with co-delivery of antimicrobial peptides and platelet-rich plasma to enhance healing of infected wounds in diabetes. Acta Biomater 2021; 124:205-218. [PMID: 33524559 DOI: 10.1016/j.actbio.2021.01.046] [Citation(s) in RCA: 114] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 01/05/2023]
Abstract
Diabetic wound healing remains a major challenge due to its vulnerability to bacterial infection, as well as the less vascularization and prolonged inflammatory phase. In this study, we developed a hydrogel system for the treatment of chronic infected wounds, which can regulate inflammatory (through the use of antimicrobial peptides) and enhance collagen deposition and angiogenesis (through the addition of platelet-rich plasma (PRP)). Based on the formation of Schiff base linkage, the ODEX/HA-AMP/PRP hydrogel was prepared by mixing oxidized dextran (ODEX), antimicrobial peptide-modified hyaluronic acid (HA-AMP) and PRP under physiological conditions, which exhibited obvious inhibition zones against three pathogenic bacterial strains (E. coli, S. aureus and P. aeruginosa) and slow release ability of antimicrobials and growth factors. Moreover, CCK-8, live/dead fluorescent staining and scratch test confirmed that ODEX/HA-AMP/PRP hydrogel could facilitate the proliferation and migration of L929 fibroblast cells. More importantly, in vivo experiments further demonstrated that the prepared hydrogels could significantly improve wound healing in a diabetic mouse infection by regulating inflammation, accelerating collagen deposition and angiogenesis. In addition, prepared hydrogel showed a significant antibacterial activity against S. aureus and P. aeruginosa, inhibited pro-inflammatory factors (TNF-α, IL-1β and IL-6), enhanced anti-inflammatory factors (TGF-β1) and vascular endothelial growth factor (VEGF) production. The findings of this study suggested that the composite hydrogel with AMP and PRP controlled release ability could be used as a promising candidate for chronic wound healing and infection-related wound healing.
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Affiliation(s)
- Shikun Wei
- The Graduate School of Southern Medical University, Guangzhou 510515, China; The Second People's Hospital of Panyu Guangzhou, Guangzhou 510120, China
| | - Pengcheng Xu
- The Graduate School of Southern Medical University, Guangzhou 510515, China
| | - Zexin Yao
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, China; The Guangdong Pharmaceutical University, Guangzhou, China
| | - Xiao Cui
- The Guangdong Provincial Hospital of Chinese Medicine, Guangzhou 510010, China
| | - Xiaoxuan Lei
- Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam UMC and Academic Center for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Amsterdam Movement Science, Amsterdam, The Netherlands
| | - Linlin Li
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, China
| | - Yunqing Dong
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, China
| | - Weidong Zhu
- Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, China
| | - Rui Guo
- Key Laboratory of Biomaterials of Guangdong Higher Education Institutes, Guangdong Provincial Engineering and Technological Research Center for Drug Carrier Development, Department of Biomedical Engineering, Jinan University, Guangzhou 510632, China.
| | - Biao Cheng
- The Graduate School of Southern Medical University, Guangzhou 510515, China; Department of Burn and Plastic Surgery, General Hospital of Southern Theater Command, PLA, Guangzhou 510010, China.
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Mieczkowski M, Mrozikiewicz-Rakowska B, Siwko T, Bujalska-Zadrozny M, de Corde-Skurska A, Wolinska R, Gasinska E, Grzela T, Foltynski P, Kowara M, Mieczkowska Z, Czupryniak L. Insulin, but Not Metformin, Supports Wound Healing Process in Rats with Streptozotocin-Induced Diabetes. Diabetes Metab Syndr Obes 2021; 14:1505-1517. [PMID: 33854349 PMCID: PMC8039538 DOI: 10.2147/dmso.s296287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/23/2021] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Optimal glycemic control is crucial for proper wound healing in patients with diabetes. However, it is not clear whether other antidiabetic drugs support wound healing in mechanisms different from the normalization of blood glucose control. We assessed the effect of insulin and metformin administration on the wound healing process in rats with streptozotocin-induced diabetes. METHODS The study was conducted on 200 male Wistar rats with streptozotocin-induced diabetes. In the last phase of the study, 45 rats, with the most stable glucose levels in the range of 350-500 mg/dL, were divided into three groups: group I received human non-protamine insulin subcutaneously (5 IU/kg body mass) once a day, group II received metformin intragastrically (500 mg/kg b.m.), and group III (control) was given saline subcutaneously. After 14 days of antidiabetic treatment, a 2 cm × 2 cm thin layer of skin was cut from each rat's dorsum and a 4 cm disk with a hole in its center was sewn in to stabilize the skin and standardize the healing process. The wound healing process was followed up for 9 days, with assessment every 3 days. Biopsy samples were subjected to hematoxylin and eosin staining and immunohistochemical assays. RESULTS Analysis of variance revealed significant influence of treatment type (insulin, control, or metformin) on the relative change in wound surface area. The wound healing process in rats treated with insulin was more effective than in the metformin and control groups. Wound tissue samples taken from the insulin-treated animals presented significantly lower levels of inflammatory infiltration. Immunohistochemical assessment showed the greatest density of centers of proliferation Ki-67 in insulin-treated animals. CONCLUSION These results suggest that an insulin-based treatment is more beneficial than metformin, in terms of accelerating the wound healing process in an animal model of streptozocin-induced diabetes.
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Affiliation(s)
- Mateusz Mieczkowski
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Beata Mrozikiewicz-Rakowska
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
- Correspondence: Beata Mrozikiewicz-Rakowska Department of Diabetology and Internal Medicine, Medical University of Warsaw, Poland ul. Banacha 1A, Warsaw, 02-097, PolandTel +48 600 311 399Fax +48225992832 Email
| | - Tomasz Siwko
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | | | | | - Renata Wolinska
- Department of Pharmacodynamics, Medical University of Warsaw, Warsaw, Poland
| | - Emilia Gasinska
- Department of Pharmacodynamics, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Grzela
- Department of Histology and Embryology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Foltynski
- Nalecz Institute of Biocybernetics and Biomedical Engineering Polish Academy of Sciences, Warsaw, Poland
| | - Michal Kowara
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Zofia Mieczkowska
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Czupryniak
- Department of Diabetology and Internal Medicine, Medical University of Warsaw, Warsaw, Poland
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Yang J, Zhou M, Li W, Lin F, Shan G. Preparation and Evaluation of Sustained Release Platelet-Rich Plasma-Loaded Gelatin Microspheres Using an Emulsion Method. ACS OMEGA 2020; 5:27113-27118. [PMID: 33134671 PMCID: PMC7593996 DOI: 10.1021/acsomega.0c02543] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/30/2020] [Indexed: 05/12/2023]
Abstract
The management and treatment of chronic wounds or acute wounds remain a major challenge in modern medicine. The application of autologous platelet-rich plasma (PRP) has become a promising adjuvant therapy to promote wound healing. PRP is derived from centrifuged whole blood to extract concentrated platelets, and a large amount of cytokines and growth factors are released upon activation. These bioactive molecules can enhance angiogenesis and tissue regeneration. Herein, PRP-loaded gelatin microspheres were prepared by the emulsion cross-linking method. Scanning electron microscopy results showed that the prepared microspheres are completely spherical, with an average particle size of 15.95 ± 3.79 μm and having a uniform particle size. Among them, the surface of a single microsphere is smooth and has a microporous structure, which may be the main channel for drug diffusion. Results of drug release measurements show that the prepared microspheres can slowly release the vascular endothelial growth factor for more than 7 days. In vitro cell experiments show that the prepared microspheres can promote proliferation and migration of L929 mouse fibroblast cells. In summary, the prepared PRP-loaded gelatin microspheres with high and long-term activity can provide experimental and theoretical knowledge for the development of the clinical long-acting injectable formulations.
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Affiliation(s)
- Jing Yang
- Department
of Clinical Laboratory, Guanghua School of Stomatology, Hospital of
Stomatology, Sun Yat-sen University, Guangdong
Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong 510055, China
| | - Mou Zhou
- Department
of Blood Transfusion, General Hospital of
Southern Theatre Command of PLA, Guangzhou 510010, China
| | - Wendan Li
- Department
of Blood Transfusion, General Hospital of
Southern Theatre Command of PLA, Guangzhou 510010, China
| | - Fang Lin
- Department
of Blood Transfusion, General Hospital of
Southern Theatre Command of PLA, Guangzhou 510010, China
| | - Guiqiu Shan
- Department
of Blood Transfusion, General Hospital of
Southern Theatre Command of PLA, Guangzhou 510010, China
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Rabiee Motmaen S, Tavakol S, Joghataei MT, Barati M. Acidic pH derived from cancer cells as a double-edged knife modulates wound healing through DNA repair genes and autophagy. Int Wound J 2019; 17:137-148. [PMID: 31714008 DOI: 10.1111/iwj.13248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/18/2019] [Accepted: 09/22/2019] [Indexed: 12/16/2022] Open
Abstract
Wound healing is a sequester program that involves diverse cell signalling cascades. Notwithstanding, complete signal transduction pathways underpinning acidic milieu derived from cancer cells is not clear, yet. MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay, fluorescein diacetate/propidium iodide staining, and cell cycle flow cytometry revealed that acidic media decreased cell viability and cell number along with enhanced dead cells and S-phase arrest in normal fibroblasts. Notably, the trends of intracellular reactive oxygen species production and lactate dehydrogenase release significantly increased with time. It seems the downregulation of Klf4 is in part due to acidosis-induced DNA damage. It promoted cells towards S-phase arrest and diminished cell proliferation. Klf4 downregulation had a direct correlation with the P53 level while acidic microenvironment promotes cells towards cell death mechanisms including apoptosis and autophagy. Noteworthily, the unchanged levels of Rb and Mlh1 indicated in those genes had no dominant role in the repairing of DNA damage in fibroblasts treated with the acidic microenvironment. Therefore, cells owing to not entering to mitosis and accumulation of DNA damage were undergone cell death to preserve cell homeostasis. Since acidic media decreased the level of tumour suppressor and DNA repair genes and altered the normal survival pathways in fibroblasts, caution should be exercised to not lead to cancer rather than wound healing.
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Affiliation(s)
| | - Shima Tavakol
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad T Joghataei
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Barati
- Department of Medical Biotechnology, Iran University of Medical Sciences, Tehran, Iran
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