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Asl ZR, Rezaee K, Ansari M, Zare F, Roknabadi MHA. A review of biopolymer-based hydrogels and IoT integration for enhanced diabetes diagnosis, management, and treatment. Int J Biol Macromol 2024; 280:135988. [PMID: 39322132 DOI: 10.1016/j.ijbiomac.2024.135988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 08/10/2024] [Accepted: 09/22/2024] [Indexed: 09/27/2024]
Abstract
The prevalence of diabetes has been increasing globally, necessitating innovative approaches beyond conventional blood sugar monitoring and insulin control. Diabetes is associated with complex health complications, including cardiovascular diseases. Continuous Glucose Monitoring (CGM) devices, though automated, have limitations such as irreversibility and interference with bodily fluids. Hydrogel technologies provide non-invasive alternatives to traditional methods, addressing the limitations of current approaches. This review explores hydrogels as macromolecular biopolymeric materials capable of absorbing and retaining a substantial amount of water within their structure. Due to their high-water absorption properties, these macromolecules are utilized as coating materials for wound care and diabetes management. The study emphasizes the need for early diagnosis and monitoring, especially during the COVID-19 pandemic, where heightened attention to diabetic patients is crucial. Additionally, the article examines the role of the Internet of Things (IoT) and machine learning-based systems in enhancing diabetes management effectiveness. By leveraging these technologies, there is potential to revolutionize diabetes care, providing more personalized and proactive solutions. This review explores cutting-edge hydrogel-based systems as a promising avenue for diabetes diagnosis, management, and treatment, highlighting key biopolymers and technological integrations.
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Affiliation(s)
- Zahra Rahmani Asl
- Department of Biomedical Engineering, Meybod University, Meybod, Iran
| | - Khosro Rezaee
- Department of Biomedical Engineering, Meybod University, Meybod, Iran.
| | - Mojtaba Ansari
- Department of Biomedical Engineering, Meybod University, Meybod, Iran
| | - Fatemeh Zare
- Department of Electrical and Computer Engineering, Texas A&M University, College Station, TX, USA
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Sen CK, Roy S, Khanna S. Diabetic Peripheral Neuropathy Associated with Foot Ulcer: One of a Kind. Antioxid Redox Signal 2023. [PMID: 35850520 DOI: 10.1089/ars.2022.0093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Significance: Diabetic peripheral neuropathy (DPN) associated with a diabetic foot ulcer (DFU) is likely to be complicated with critical factors such as biofilm infection and compromised skin barrier function of the diabetic skin. Repaired skin with a history of biofilm infection is known to be compromised in barrier function. Loss of barrier function is also observed in the oxidative stress affected diabetic and aged skin. Recent Advances: Loss of barrier function makes the skin prone to biofilm infection and cellulitis, which contributes to chronic inflammation and vasculopathy. Hyperglycemia favors biofilm formation as glucose lowering led to reduction in biofilm development. While vasculopathy limits oxygen supply, the O2 cost of inflammation is high increasing hypoxia severity. Critical Issues: The host nervous system can be inhabited by bacteria. Because electrical impulses are a part of microbial physiology, polymicrobial colonization of the host's neural circuit is likely to influence transmission of action potential. The identification of perineural apatite in diabetic patients with peripheral neuropathy suggests bacterial involvement. DPN starts in both feet at the same time. Future Directions: Pair-matched studies of DPN in the foot affected with DFU (i.e., DFU-DPN) compared with DPN in the without ulcer, and intact skin barrier function, are likely to provide critical insight that would help inform effective care strategies. This review characterizes DFU-DPN from a translational science point of view presenting a new paradigm that recognizes the current literature in the context of factors that are unique to DFU-DPN.
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Affiliation(s)
- Chandan K Sen
- Indiana Center for Regenerative Medicine & Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Sashwati Roy
- Indiana Center for Regenerative Medicine & Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Savita Khanna
- Indiana Center for Regenerative Medicine & Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Larsen HF, Ahlström MG, Gjerdrum LMR, Mogensen M, Ghathian K, Calum H, Sørensen AL, Forman JL, Vandeven M, Holerca MN, Du-Thumm L, Jorgensen LN, Ågren MS. Noninvasive measurement of reepithelialization and microvascularity of suction-blister wounds with benchmarking to histology. Wound Repair Regen 2018; 25:984-993. [DOI: 10.1111/wrr.12605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 11/13/2017] [Indexed: 12/23/2022]
Affiliation(s)
- Heidi F. Larsen
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Malin G. Ahlström
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | | | - Mette Mogensen
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Khaled Ghathian
- Department of Clinical Microbiology, Hvidovre Hospital; University of Copenhagen; Copenhagen Denmark
| | - Henrik Calum
- Department of Clinical Microbiology, Hvidovre Hospital; University of Copenhagen; Copenhagen Denmark
| | - Anne L. Sørensen
- Section of Biostatistics, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | - Julie L. Forman
- Section of Biostatistics, Department of Public Health; University of Copenhagen; Copenhagen Denmark
| | | | | | | | - Lars N. Jorgensen
- Digestive Disease Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
| | - Magnus S. Ågren
- Department of Dermatology and Copenhagen Wound Healing Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
- Digestive Disease Center, Bispebjerg Hospital; University of Copenhagen; Copenhagen Denmark
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Saboo A, Rathnayake A, Vangaveti VN, Malabu UH. Wound healing effects of dipeptidyl peptidase-4 inhibitors: An emerging concept in management of diabetic foot ulcer-A review. Diabetes Metab Syndr 2016; 10:113-119. [PMID: 25990796 DOI: 10.1016/j.dsx.2015.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Dipeptidyl peptidase-4 (DPP-4) inhibitors have a well-known effect on glycaemic control in patients with diabetes but little is known on their wound healing role in this group of population. This paper reviews the effects of DPP-4 inhibitors on wound healing of diabetic foot ulcers. METHODS Published data on effects and mechanism of DDP-4 inhibitors on wound healing were derived from Medline, PubMed and Google Scholar search of English language literature from 1994 to 2014 using the key words such as "DPP-4 inhibitors", "endothelial healing" "diabetes" and "chronic ulcers". RESULTS DPP-4 inhibitors show a potential benefit in processes of wound healing in diabetic chronic foot ulcers. The enzyme inhibitors promote recruitment of endothelial progenitor cells and allow the final scaffolding of wounds. Furthermore DPP-4 inhibitors augment angiogenesis and have widespread effects on optimising the immune response to persistent hypoxia in chronic diabetes wounds. CONCLUSION DPP-4 inhibitors show promise in the local wound healing of diabetic foot ulcers in addition to its already established glycaemic control. In the light of high rate of amputations due to non-healing ulcers with profound psychological and economical liability, more investigations on the usefulness of DPP-4 inhibitors in the high risk diabetes population are needed.
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Affiliation(s)
- Apoorva Saboo
- Translational Research in Endocrinology and Diabetes [TREAD], College of Medicine and Dentistry, James Cook University, The Townsville Hospital, 100 Angus Smith Drive, Douglas 4814, QLD, Australia
| | - Ayeshmanthe Rathnayake
- Translational Research in Endocrinology and Diabetes [TREAD], College of Medicine and Dentistry, James Cook University, The Townsville Hospital, 100 Angus Smith Drive, Douglas 4814, QLD, Australia
| | - Venkat N Vangaveti
- Translational Research in Endocrinology and Diabetes [TREAD], College of Medicine and Dentistry, James Cook University, The Townsville Hospital, 100 Angus Smith Drive, Douglas 4814, QLD, Australia
| | - Usman H Malabu
- Translational Research in Endocrinology and Diabetes [TREAD], College of Medicine and Dentistry, James Cook University, The Townsville Hospital, 100 Angus Smith Drive, Douglas 4814, QLD, Australia.
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5
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Quondamatteo F. Skin and diabetes mellitus: what do we know? Cell Tissue Res 2013; 355:1-21. [PMID: 24318789 DOI: 10.1007/s00441-013-1751-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 10/29/2013] [Indexed: 12/20/2022]
Abstract
Diabetes mellitus (DM) is becoming increasingly prevalent worldwide. Although major complications of this condition involve kidney, retina and peripheral nerves, the skin of diabetic patients is also frequently injured. Hence, interest is mounting in the definition of the structural and molecular profile of non-complicated diabetic skin, i.e., before injuries occur. Most of the available knowledge in this area has been obtained relatively recently and, in part, derives from various diabetic animal models. These include both insulin-dependent and insulin-resistant models. Structural work in human diabetic skin has also been carried out by means of tissue samples or of non-invasive methods. Indications have indeed been found for molecular/structural changes in diabetic skin. However, the overall picture that emerges is heterogeneous, incomplete and often contradictory and many questions remain unanswered. This review aims to detail, as much as possible, the various pieces of current knowledge in a systematic and synoptic manner. This should aid the identification of areas in which key questions are still open and more research is needed. A comprehensive understanding of this field could help in determining molecular targets for the prevention and treatment of skin injuries in DM and markers for the monitoring of cutaneous and systemic aspects of the disease. Additionally, with the increasing development of non-invasive optics-based deep-tissue-imaging diagnostic technologies, precise knowledge of cutaneous texture and molecular structure becomes an important pre-requisite for the use of such methods in diabetic patients.
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Affiliation(s)
- Fabio Quondamatteo
- Skin and ECM Research Group-Anatomy, NUI Galway, Anatomy Building, University Road, Galway, Ireland,
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Abstract
The skin is a vital organ for life and, among its many functions, the role as a protective barrier is one of the most important. It is the main boundary between the body and the external environment. As defensive barrier, the epidermis protects internal organs from physical and chemical trauma, microorganism invasion, and ultraviolet radiation. It also acts in the regulation of transepidermal movement of water and electrolytes, and in preventing dehydration, all of which are essential for sustaining life. The main role is allotted to the stratum corneum and to the lipid matrix located in the intercellular space. The occurrence of dysfunction in the epidermal barrier is an important factor in the physiopathogenesis of skin diseases, particularly atopic dermatitis and psoriasis. There are few, but important, systemic changes that influence or are influenced by dysfunctions in the epidermal barrier. We review the effects of some systemic diseases on the maintenance of the skin's homeostasis.
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Colombo TE, Soares MMCN, D'Ávilla SCGP, Nogueira MCL, de Almeida MTG. Identification of fungal diseases at necropsy. Pathol Res Pract 2012; 208:549-52. [PMID: 22840384 DOI: 10.1016/j.prp.2012.06.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 01/27/2012] [Accepted: 06/29/2012] [Indexed: 10/28/2022]
Abstract
The purpose of the Death Verification Service is to elucidate the causes of deaths that occur without medical assistance and of ill-defined deaths. In recent decades, the epidemiological reality of fungal infections has changed due to the rise in opportunistic infections chiefly in immunocompromised patients. A study of fungal diseases in autopsies performed in the Death Verification Service of the Medicine School in São José do Rio Preto between January 2000 and December 2009 was made. Sixty-seven cases of fungal disease, most involving men (70%), were found in 4824 autopsies. Cryptococcosis was the most prevalent (45%), followed by paracoccidioidomycosis, candidiasis, histoplasmosis, aspergillosis and mucormycosis. Associations between AIDS (n=14) and fungal diseases were identified for cryptococcosis (36%), candidiasis (28.5%) and histoplasmosis (28.5%). Pneumonia, AIDS and fungal diseases were evident in 26% of the cases, with the most prevalent etiologies being Cryptococcus neoformans (55.5%) and Histoplasma capsulatum (22%). Pneumonia alone occurred in 43% of cases, with cryptococcosis (53%) and paracoccidioidomycosis (33%) being the main infectious agents. Diabetes mellitus was associated with candidiasis in two cases and aspergillosis in one. One case of renal transplantation linked to paracoccidioidomycosis and one case of bone marrow aplasia with mucormycosis were reported. Despite the reduction in the number of autopsies over recent decades, these findings suggest that this procedure is useful to provide additional data on the etiology, underlying disease and specific risk factors, essential for quality control and to improve treatment protocols.
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Affiliation(s)
- Tatiana Elias Colombo
- Laboratório de Microbiologia da Faculdade de Medicina de São José do Rio Preto, SP, Brazil
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Bush JA, McGrouther DA, Young VL, Herndon DN, Longaker MT, Mustoe TA, Ferguson MWJ. Recommendations on clinical proof of efficacy for potential scar prevention and reduction therapies. Wound Repair Regen 2011; 19 Suppl 1:s32-7. [DOI: 10.1111/j.1524-475x.2010.00607.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rodrigues AN, Szymaniak NP, Andrade Sobrinho JD. Influência das dermatoses na qualidade de vida do portador de diabetes mellitus. CIENCIA & SAUDE COLETIVA 2010; 15 Suppl 1:1325-32. [DOI: 10.1590/s1413-81232010000700041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2007] [Accepted: 12/14/2007] [Indexed: 11/22/2022] Open
Abstract
O diabetes mellitus (DM) predispõe às dermatoses associadas à própria afecção, infecções cutâneas, reações medicamentosas ou ao pé diabético. Este estudo, analítico, transversal e quantitativo, parte da hipótese de que as dermatoses influenciam a qualidade de vida dos portadores de DM e foi desenvolvido no Programa de Saúde da Família (PSF) Odilom Lacerda, em Planura (MG). A amostra tem 47 (100%) pacientes portadores de DM e cadastrados no programa HIPERDIA. A coleta de dados foi feita durante a consulta pelo dermatologista, que aplicou a anamnese direcionada para dermatopatias e qualidade de vida e um formulário para a avaliação subjetiva da influência das dermatoses na qualidade de vida. A análise dos dados foi numérica e percentual, quanto às manifestações provocadas pela dermatose no comprometimento da qualidade de vida, segundo o próprio paciente. Para a mensuração dos resultados, foram estabelecidos os critérios de frequência: alta (80 a 100%), média (50 a 79%), baixa (1 a 49%) e nula às situações inexistentes. Todos os pacientes (47-100%) apresentaram dermatoses e demonstraram que influenciam a sua qualidade de vida, com média frequência no que se refere ao ressecamento e sensação dolorosa na pele (24-51%) e baixa frequência, especialmente a dificuldade na higienização pessoal (19-40,3%) e a interferência no relacionamento interpessoal com parentes ou amigos (18-38,2%).
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A minimally invasive human in vivo cutaneous wound model for the evaluation of innate skin reactivity and healing status. Arch Dermatol Res 2010; 302:383-93. [PMID: 20229284 DOI: 10.1007/s00403-010-1043-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2009] [Revised: 02/09/2010] [Accepted: 02/22/2010] [Indexed: 12/19/2022]
Abstract
Individual variability in skin reactivity and healing capacity after trauma are important clinical issues. The aims were to develop an in vivo, human wound model based on a standardised minimal skin injury and to demonstrate therapeutic effect of simple wound therapies in terms of morphological wound outcome with changes in skin blood perfusion as a quantified indicator of wound healing. In a series of experiments, wounds were induced on the normal forearm skin of volunteers using a blood collection lancet. This was well tolerated. Wounds were assessed by naked eye examination or laser Doppler perfusion imaging (LDPI) at baseline and at up to 6 further time points up to 96 h in control wounds and wounds treated by commonly used occlusive dressing options. Assessment by clinical observation with 10x magnification showed over 96 h a progression of erythema, surface crust, a new keratinisation layer and finally healed areas. LDPI quantifying wound erythema showed a peak at 24 h and near normal levels at 96 h. Inter-individual variability was evident but intra-individual variability was much less pronounced. Wounds treated with occlusion showed a statistically significant more rapid return to baseline blood perfusion as measured by LDPI compared to controls supported by favourable healing parameters in the clinical assessment. The paper exemplifies use of non-invasive, bioengineering technique for quantification of individual innate variability in skin reactivity, wound healing capacity and therapeutic effect in a well-tolerated in vivo, human, minimal skin trauma model.
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Koskela M, Gäddnäs F, Ala-Kokko TI, Laurila JJ, Saarnio J, Oikarinen A, Koivukangas V. Epidermal wound healing in severe sepsis and septic shock in humans. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2009; 13:R100. [PMID: 19552820 PMCID: PMC2717472 DOI: 10.1186/cc7932] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2008] [Revised: 02/17/2009] [Accepted: 06/24/2009] [Indexed: 12/30/2022]
Abstract
Introduction The effect of sepsis on epidermal wound healing has not been previously studied. It was hypothesised that epidermal wound healing is disturbed in severe sepsis. Methods Blister wounds were induced in 35 patients with severe sepsis and in 15 healthy controls. The healing of the wounds was followed up by measuring transepidermal water loss and blood flow in the wound, reflecting the restoration of the epidermal barrier function and inflammation, respectively. The first set of suction blisters (early wound) was made within 48 hours of the first sepsis-induced organ failure and the second set (late wound) four days after the first wound. In addition, measurements were made on the intact skin. Results The average age of the whole study population was 62 years (standard deviation [SD] 12). The mean Acute Physiology and Chronic Health Evaluation II (APACHE II) score on admission was 25 (SD 8). The two most common causes of infections were peritonitis and pneumonia. Sixty-six percent of the patients developed multiple organ failure. The decrease in water evaporation from the wound during the first four days was lower in septic patients than in the control subjects (56 g/m2 per hour versus 124 g/m2 per hour, P = 0.004). On the fourth day, septic patients had significantly higher blood flow in the wound compared with the control subjects (septic patients 110 units versus control subjects 47 units, P = 0.001). No difference in transepidermal water loss from the intact skin was found between septic patients and controls. Septic patients had higher blood flow in the intact skin on the fourth and on the eighth day of study compared with the controls. Conclusions The restoration of the epidermal barrier function is delayed and wound blood flow is increased in patients with severe sepsis.
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Affiliation(s)
- Marjo Koskela
- Department of Anesthesiology, Division of Intensive Care Medicine, Oulu University Hospital, 90029 OUH, Finland.
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12
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Abstract
Wound healing is a complicated and integrated process. Although there is some tolerance in terms of redundancy and interrelated control mechanisms, pushing beyond such limits may contribute to delayed wound healing, and in extreme cases lead to chronic wounds/ulcers and thus potentially to lower extremity amputation. Diabetes is associated with such disruption in wound healing. Research in humans and in animal models has identified a large number of changes associated with diabetes at the molecular level in delayed wound healing and to a lesser extent in chronic diabetic ulcers. Better overall understanding of these changes and how they are interrelated would allow for specifically targeted treatment, thus ensuring improved quality of life for patients and providing savings to the high costs that are associated with all aspects of chronic diabetic ulcers. This review examines the work done at the molecular level on chronic diabetic ulcers, as well as considering changes seen in diabetes in general, both in humans and animal models, that may in turn contribute to ulcer formation.
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Affiliation(s)
- R Blakytny
- Fachklinik Hornheide, Tumor Forschung, Münster, Germany
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13
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Koivukangas V, Oikarinen A, Risteli J, Haukipuro K. Effect of jaundice and its resolution on wound re-epithelization, skin collagen synthesis, and serum collagen propeptide levels in patients with neoplastic pancreaticobiliary obstruction. J Surg Res 2005; 124:237-43. [PMID: 15820253 DOI: 10.1016/j.jss.2004.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2004] [Indexed: 11/26/2022]
Abstract
BACKGROUND Wound and anastomotic healing is considered to be delayed in patients with obstructive jaundice. The study was designed to find out whether the healing of experimental suction blister wounds, skin collagen synthesis, and serum procollagen levels are affected by obstructive jaundice, and if biliary drainage may cause any alterations in these processes. PATIENTS AND METHODS Suction blisters were induced on 24 patients with obstructive jaundice caused by neoplastic pancreaticobiliary obstruction and 17 control patients with the corresponding condition without jaundice, to compare healing parameters and collagen synthesis between the groups. A second set of suction blisters were induced on 13 formerly jaundiced patients after the resolution of jaundice and on 14 control patients, to find out whether drainage or time modifies healing or collagen synthesis. By using this model, it is possible to evaluate the re-epithelization and inflammation on wound healing and to assess the baseline skin collagen synthesis. The healing of suction blisters was followed up by measuring water evaporation and blood flow in the wound. Blister fluids and serum samples were collected to study collagen propeptides. RESULTS Healing of the blister wound was unaffected by obstructive jaundice. Drainage had no effect on healing. The baseline synthesis of type I and type III collagen in the skin was decreased in jaundiced patients. Biliary drainage improved the synthesis. Serum type III procollagen propeptide levels were elevated in jaundiced patients, but began to normalize after drainage. CONCLUSION Healing of an experimental blister wound is not disturbed by obstructive jaundice. The decreased baseline skin collagen synthesis is partly restored by the resolution of jaundice. The results indicate that cell protein synthesis is disturbed earlier than cell dynamics in obstructive jaundice. The elevated serum PIIINP levels, which are most likely to be related to early fibrosis in liver, decreased after drainage.
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Affiliation(s)
- V Koivukangas
- Department of Surgery, Oulu University Hospital, University of Oulu, Oulu, Finland.
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Minelli L, Nonino AB, Salmazo JC, Neme L, Marcondes M. Diabetes mellitus e afecções cutâneas. An Bras Dermatol 2003. [DOI: 10.1590/s0365-05962003000600010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O diabetes mellitus é doença metabólica que predispõe a diversas afecções, notadamente às doenças cutâneas. São de natureza variada, porém de etiologia infecciosa em sua maioria. Uma revisão detalhada sobre tais doenças, evidenciando suas características clínicas bem como uma adequada abordagem terapêutica é o tema do presente artigo.
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15
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Bernene J, Zgonis T, Jolly GP. Diabetes mellitus and pharmacological therapy. Clin Podiatr Med Surg 2003; 20:635-53. [PMID: 14636030 DOI: 10.1016/s0891-8422(03)00066-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Diabetes mellitus can be a devastating lifelong disease if not treated appropriately. The physician and the patient should be aware of both extremes involved with DM: hyperglycemia and hypoglycemia. Patient education and preventive care are perhaps more important in this disease than many others. A multidisciplinary approach involving the patient, physician, and diabetic educator is best to assure a better quality of life. Enormous advances in the treatment of diabetes have occurred over the past decade and even greater ones can be expected in the future. New drugs, insulin delivery devices, and noninvasive glucose monitoring machines have the potential to normalize blood sugar levels and return diabetics to a near normal lifespan without complications.
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Affiliation(s)
- James Bernene
- Department of Medicine, New Britain General Hospital, New Britain, CT 06052, USA
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16
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Malminen M, Koivukangas V, Peltonen J, Karvonen SL, Oikarinen A, Peltonen S. Immunohistological distribution of the tight junction components ZO-1 and occludin in regenerating human epidermis. Br J Dermatol 2003; 149:255-60. [PMID: 12932229 DOI: 10.1046/j.1365-2133.2003.05438.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Molecular characterization of tight junction proteins during the past few years has provided novel methods for studying these specialized junctions. Tight junctions have recently been characterized in the granular cell layer of human epidermis, and the role of these junctions in the epidermal barrier is now being re-evaluated. OBJECTIVES To investigate the expression of tight junction components during the re-epithelialization of suction blisters and the regeneration of the corneal layer after tape stripping. METHODS Suction blisters were induced in eight healthy volunteers, and skin biopsies were taken 4 or 6 days afterwards. The restoration of epidermal barrier function was evaluated by measuring water evaporation (WE) from the wound area. Tape stripping was performed on three volunteers to remove the corneal layer. The tissues were immunolabelled using indirect immunofluorescence or the avidin-biotin method. RESULTS Prior to the biopsies, WE from the blister wounds was markedly elevated in comparison with normal skin. In the epidermis surrounding the blister, occludin and ZO-1 were expressed in the granular cell layer only. In the hyperproliferative zone adjacent to the border of the blister, the expression of ZO-1 was redistributed into several spinous cell layers, while occludin expression was restricted to the upper epidermis. In the leading edge of migrating keratinocytes, both proteins were expressed exclusively in the most superficial layer of keratinocytes. Double labelling for ZO-1 and involucrin showed expression of both proteins in the same layers of hyperproliferative keratinocytes, while the expression patterns were clearly different in the migrating keratinocytes. CONCLUSIONS Tight junctions of regenerating epidermis may provide a functional barrier prior to regeneration of the corneal layer.
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Affiliation(s)
- M Malminen
- Department of Medical Biochemistry, University of Turku, Kiinamyllynkatu 4-8, 20520 Turku, Finland
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Abstract
There is now widespread appreciation of the importance of maintaining glucose levels as close to the normal range as possible among outpatients with diabetes. However, the importance of tight glucose control in inpatients is less well established. During the past several years, it has become apparent that hyperglycemia in hospitalized patients, especially those in the postoperative setting, is associated with poorer outcomes. In addition, two randomized trials have shown improved outcomes with intensive glucose management in acutely ill patients. Based on these studies and our own experience, we propose guidelines and a framework for improving the glycemic control of hospitalized patients.
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Affiliation(s)
- Lee N Metchick
- Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut 06520, USA
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Oyibo SO, Jude EB, Tarawneh I, Nguyen HC, Armstrong DG, Harkless LB, Boulton AJ. The effects of ulcer size and site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. Diabet Med 2001; 18:133-8. [PMID: 11251677 DOI: 10.1046/j.1464-5491.2001.00422.x] [Citation(s) in RCA: 214] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIMS The outcome of foot ulcers is affected by wound depth, infection, ischaemia and glycaemic control. The aim of this study was to determine the effects of ulcer size, site, patient's age, sex and type and duration of diabetes on the outcome of diabetic foot ulcers. METHODS Diabetic patients with new foot ulcers presenting during a 12-month period had demographics and ulcer characteristics recorded at presentation. Ulcers were followed-up until an outcome was noted. RESULTS One hundred and ninety-four patients (77% males) with a mean (+/- SD) age and duration of diabetes of 56.6 +/- 12.6 and 15.4 +/- 9.9 years, respectively, were included in the study. The majority of ulcers were neuropathic (67.0%) and present on the forefoot (77.8%) with a median (interquartile range) area of 1.5 (0.6-4.0) cm2. Amputations were performed for 15% of ulcers; 65% healed; 16% remained unhealed and 4% of patients died. The median (95% confidence interval) time to healing was 10 (8.8-11.6) weeks. Ulcer area at presentation was greater in the amputation group compared to healed ulcers (3.9 vs. 1.2 cm2, P < 0.0001). Ulcer area correlated with healing time (rs = 0.27, P < 0.0001) and predicted healing (P = 0.04). Patient's age, sex, duration/type of diabetes, and ulcer site had no effect on outcome. CONCLUSIONS Ulcer area, a measure of ulcer size, predicts the outcome of foot ulcers. Its inclusion into a diabetic wound classification system will make that system a better predictor of outcome.
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Affiliation(s)
- S O Oyibo
- Department of Medicine and Diabetes, Manchester Royal Infirmary, Manchester, UK.
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Abstract
Ankle fracture in patients with DM mandates a stepwise protocol to minimize the potential complications of delayed fracture healing, wound complications, and development of Charcot arthropathy. For nondisplaced ankle fracture, a nonoperative approach with increased duration of immobilization seems successful based on experience of the limited series. A displaced ankle fracture in a patient with DM requires a surgical intervention. The authors advocate tight glucose control in both groups to improve the fracture milieu and to ameliorate the potential complications. Appropriate stable fixation with adequate length of immobilization is crucial for successful fracture resolution.
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Affiliation(s)
- C Bibbo
- Department of Orthopaedics, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark 07103, USA
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