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Ruiz-Muñoz M, Martinez-Barrios FJ, Fernandez-Torres R, Lopezosa-Reca E, Marchena-Rodriguez A. Autologous platelet-rich plasma (APRP) in diabetes foot disease: a meta-analysis. J Diabetes Complications 2024; 38:108690. [PMID: 38278034 DOI: 10.1016/j.jdiacomp.2024.108690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/28/2024]
Abstract
INTRODUCTION This study will explore the effectiveness of autologous platelet-rich plasma in the treatment of diabetic foot disease compared to conventional treatments, based on the ulcer healing rate. METHODS The electronic databases of PubMed, EMBASE, and WOS internet were searched. Evaluated outcome rate of complete ulcer healing. Statistical analysis was performed with RevMan 5.0 software and SPSS 25.0. RESULTS Eleven RCTs with 828 patients were included in this study. The meta-analysis showed a higher complete ulcer healing rate (OR = 3.69, 95 % CI 2.62 to 5.20, P < 0.01, I2 = 0 %) in growth factors based in autologous platelech-rich plasma (aPRP) group compared with control. Mixed evidence was seen for publication bias, but analyses by using the trim-and-fill method did not appreciably alter results. CONCLUSION Autologous platelet-rich plasma can improve the complete healing rate of the ulcer compared to current conventional treatments in diabetic foot ulcer patients.
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Affiliation(s)
- Maria Ruiz-Muñoz
- Department Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain.
| | | | - Raul Fernandez-Torres
- Department Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain.
| | - Eva Lopezosa-Reca
- Department Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain.
| | - Ana Marchena-Rodriguez
- Department Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain.
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2
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Huang H, Xin R, Li X, Zhang X, Chen Z, Zhu Q, Tai Z, Bao L. Physical therapy in diabetic foot ulcer: Research progress and clinical application. Int Wound J 2023; 20:3417-3434. [PMID: 37095726 PMCID: PMC10502280 DOI: 10.1111/iwj.14196] [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: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Diabetes foot ulcer (DFU) is one of the most intractable complications of diabetes and is related to a number of risk factors. DFU therapy is difficult and involves long-term interdisciplinary collaboration, causing patients physical and emotional pain and increasing medical costs. With a rising number of diabetes patients, it is vital to figure out the causes and treatment techniques of DFU in a precise and complete manner, which will assist alleviate patients' suffering and decrease excessive medical expenditure. Here, we summarised the characteristics and progress of the physical therapy methods for the DFU, emphasised the important role of appropriate exercise and nutritional supplementation in the treatment of DFU, and discussed the application prospects of non-traditional physical therapy such as electrical stimulation (ES), and photobiomodulation therapy (PBMT) in the treatment of DFU based on clinical experimental records in ClinicalTrials.gov.
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Affiliation(s)
- Hao Huang
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Rujuan Xin
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiaolong Li
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xinyue Zhang
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhongjian Chen
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Quangang Zhu
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Leilei Bao
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
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SARIAN MN, ZULKEFLI N, CHE ZAIN MS, MANIAM S, FAKURAZI S. A review with updated perspectives on in vitro and in vivo wound healing models. Turk J Biol 2023; 47:236-246. [PMID: 38152620 PMCID: PMC10751087 DOI: 10.55730/1300-0152.2659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 08/31/2023] [Accepted: 08/10/2023] [Indexed: 12/29/2023] Open
Abstract
A skin wound or perforation triggers a series of homeostatic reactions to safeguard internal organs from invasion by pathogens or other substances that could damage body tissues. An injury may occasionally heal quickly, leading to the closure of the skin's structure. Healing from chronic wounds takes a long time. Although many treatment options are available to manage wound healing, an unmet therapy need remains because of the complexity of the processes and the other factors involved. It is crucial to conduct consistent research on novel therapeutic approaches to find an effective healing agent. Therefore, this work aims to cover various in vitro and in vivo methodologies that could be utilised to examine wound recovery. Before deciding on the optimal course of action, several techniques' benefits, drawbacks, and factors need to be reviewed.
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Affiliation(s)
- Murni Nazira SARIAN
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia (National University of Malaysia), 43600, Bandar Baru Bangi, Selangor,
Malaysia
| | - Nabilah ZULKEFLI
- Institute of Systems Biology (INBIOSIS), Universiti Kebangsaan Malaysia (National University of Malaysia), 43600, Bandar Baru Bangi, Selangor,
Malaysia
| | - Mohamad Shazeli CHE ZAIN
- Bioresource Technology Division, School of Industrial Technology, Universiti Sains Malaysia (Science University of Malaysia), 11800, Pulau Pinang,
Malaysia
| | - Sandra MANIAM
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (University of Putra Malaysia), Serdang 43400, Selangor,
Malaysia
| | - Sharida FAKURAZI
- Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (University of Putra Malaysia), Serdang 43400, Selangor,
Malaysia
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Gerotto Viola S, Facco Dalmolin L, Villarruel Muñoz JB, Araújo Martins Y, Dos Santos Ré AC, Aires CP, Fonseca Vianna Lopez R. Investigation of the antimicrobial effect of anodic iontophoresis on Gram-positive and Gram-negative bacteria for skin infections treatment. Bioelectrochemistry 2023; 151:108374. [PMID: 36750011 DOI: 10.1016/j.bioelechem.2023.108374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 12/28/2022] [Accepted: 01/20/2023] [Indexed: 01/31/2023]
Abstract
Iontophoresis, a non-invasive application of a constant low-intensity electric current, is a promising strategy to accelerate wound healing. Although its mechanisms are not yet fully elucidated, part of its action seems related to inhibiting bacteria growth. This work aimed to investigate the antimicrobial effect of iontophoresis using Staphylococcus epidermidis and Escherichia coli strains, Gram-positive and Gram-negative bacteria, respectively. Anodic iontophoresis was applied to each bacterial suspension using Ag/AgCl electrodes, and bacteria viability was evaluated after 24 h incubation by counting colony-forming units. A Quality-by-Design approach was performed to assess the influence of the iontophoresis' intensity and application time on bacterial viability. Cell morphology was evaluated by scanning electron microscopy. Iontophoresis showed antimicrobial effects on the Gram-positive bacteria only at 5 mA and 60 min application. However, a linear relationship was observed between intensity and application time for the Gram-negative one, causing drastic morphological changes and up to 98 % death. The cell wall of Gram-negative bacteria seems more susceptible to disorganization triggered by iontophoresis-induced ion transport than Gram-positive ones. Therefore, anodic iontophoresis can be a powerful ally in controlling Gram-negative bacteria proliferation in wounds.
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Affiliation(s)
- Sofia Gerotto Viola
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14040-900, Brazil
| | - Luciana Facco Dalmolin
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14040-900, Brazil
| | | | - Yugo Araújo Martins
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14040-900, Brazil
| | - Ana Carolina Dos Santos Ré
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14040-900, Brazil
| | - Carolina Patrícia Aires
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14040-900, Brazil
| | - Renata Fonseca Vianna Lopez
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP 14040-900, Brazil.
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Girgis B, Carvalho D, Duarte JA. The effect of high-voltage monophasic pulsed current on diabetic ulcers and their potential pathophysiologic factors: A systematic review and meta-analysis. Wound Repair Regen 2023; 31:171-186. [PMID: 36507861 DOI: 10.1111/wrr.13063] [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: 06/13/2022] [Revised: 10/04/2022] [Accepted: 11/08/2022] [Indexed: 12/15/2022]
Abstract
The present review was conducted to determine the efficacy of high-voltage monophasic pulsed current (HVMPC) in treating diabetic ulcers, assess its effect on skin lesions with each of the pathophysiologic factors potentially contributing to diabetic ulcers, evaluate its safety, and identify treatment parameters. Electronic search of PubMed, Scopus, PEDro and Google Scholar databases was conducted. The revised tool for assessing risk of bias in randomised trials (RoB 2), the risk of bias in non-randomised studies-of interventions (ROBINS-I) and the Joanna Briggs Institute (JBI) critical appraisal tool were used to assess risk of bias and methodological quality. Overall quality of evidence was determined using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) principles. Thirty-two studies matched the eligibility criteria, and included 1061 patients with 1103 skin lesions of selected aetiologies; 12 randomised controlled trials were included in quantitative synthesis. HVMPC plus standard wound care (SWC) likely increased the probability of complete wound healing of pressure ulcers (PrUs) compared with sham/no stimulation plus SWC; relative risk (RR) 2.08; 95% CI: [1.42, 3.04], p = 0.0002; I2 = 0%, p = 0.61; eight studies, 358 ulcers. Although conclusive evidence regarding the effect of HVMPC on diabetic ulcers was not found, collateral evidence might suggest a potential benefit. Direct evidence, with moderate certainty, may support its efficacy in treating PrUs, albeit few adverse reactions were reported. Other observations, moreover, might indicate that this efficacy may not be limited to PrUs. Nonetheless, several aspects remain to be clarified for safe and effective application of electrical stimulation for wound healing.
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Affiliation(s)
- Beshoy Girgis
- CIAFEL, Faculty of Sport, University of Porto, Porto, Portugal
| | - Davide Carvalho
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar S. João, Faculty of Medicine, University of Porto, Porto, Portugal.,Instituto de Investigação e Inovação em Saúde (i3S), University of Porto, Porto, Portugal
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Zulbaran-Rojas A, Park C, El-Refaei N, Lepow B, Najafi B. Home-Based Electrical Stimulation to Accelerate Wound Healing-A Double-Blinded Randomized Control Trial. J Diabetes Sci Technol 2023; 17:15-24. [PMID: 34328024 PMCID: PMC9846397 DOI: 10.1177/19322968211035128] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Electrical stimulation (E-Stim) may offer a unique adjunctive treatment to heal complicated diabetic foot ulcers (DFU). Our primary goal is to examine the effectiveness of daily home-based E-Stim therapy to speed-up wound healing. METHODS Patients with chronic DFUs and mild to severe peripheral arterial disease (PAD) were recruited and randomized to either control (CG) or intervention (IG) groups. The IG received 1-hour home-based E-Stim therapy on daily basis for 4 weeks (4W). E-Stim was delivered through electrical pads placed above the ankle joint using a bio-electric stimulation technology (BEST®) platform (Tennant Biomodulator® PRO). The CG was provided with an identical but non-functional device for the same period. The primary outcome included wound area reduction at 4W from baseline (BL). RESULTS Thirty-eight patients were recruited and 5 were removed due to non-compliance or infection, leaving 33 participants (IG, n = 16; CG, n =17). At 4W, the IG showed a significant wound area reduction of 22% (BL: 7.4 ± 8.5 cm2 vs 4W: 5.8 ± 8.0 cm2, P = 0.002). Average of wound area was unchanged in the CG (P = 0.982). The self-report adherence to daily home-therapy was 93.9%. CONCLUSIONS Daily home-based E-Stim provides early results on the feasibility, acceptability, and effectiveness of E-Stim as an adjunctive therapy to speed up wound healings in patients with chronic DFU and mild to severe PAD.
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Affiliation(s)
- Alejandro Zulbaran-Rojas
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Catherine Park
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Nesreen El-Refaei
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Brian Lepow
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
| | - Bijan Najafi
- Michael E. DeBakey Department of
Surgery, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP),
Division of Vascular Surgery and Endovascular Therapy, Baylor College of Medicine,
Houston, TX, USA
- Bijan Najafi, PhD, MSc, Michael E. DeBakey
Department of Surgery, Interdisciplinary Consortium on Advanced Motion
Performance (iCAMP), Division of Vascular Surgery and Endovascular Therapy,
Baylor College of Medicine, 7200 Cambridge St., Houston, TX 77030, USA.
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7
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Mendes C, Thirupathi A, Zaccaron RP, Corrêa MEAB, Bittencourt JVS, Casagrande LDR, de Lima ACS, de Oliveira LL, de Andrade TAM, Gu Y, Feuser PE, Machado-de-Ávila RA, Silveira PCL. Microcurrent and Gold Nanoparticles Combined with Hyaluronic Acid Accelerates Wound Healing. Antioxidants (Basel) 2022; 11:2257. [PMID: 36421443 PMCID: PMC9686715 DOI: 10.3390/antiox11112257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/03/2022] [Accepted: 11/07/2022] [Indexed: 01/30/2024] Open
Abstract
This study aimed to investigate the effects of iontophoresis and hyaluronic acid (HA) combined with a gold nanoparticle (GNP) solution in an excisional wound model. Fifty Wistar rats (n = 10/group) were randomly assigned to the following groups: excisional wound (EW); EW + MC; EW + MC + HA; EW + MC + GNPs; and EW + MC + HA + GNPs. The animals were induced to a circular excision, and treatment started 24 h after injury with microcurrents (300 µA) containing gel with HA (0.9%) and/or GNPs (30 mg/L) in the electrodes (1 mL) for 7 days. The animals were euthanized 12 h after the last treatment application. The results demonstrate a reduction in the levels of pro-inflammatory cytokines (IFNϒ, IL-1β, TNFα, and IL-6) in the group in which the therapies were combined, and they show increased levels of anti-inflammatory cytokines (IL-4 and IL-10) and growth factors (FGF and TGF-β) in the EW + MC + HA and EW + MC + HA + GNPs groups. As for the levels of dichlorofluorescein (DCF) and nitrite, as well as oxidative damage (carbonyl and sulfhydryl), they decreased in the combined therapy group when compared to the control group. Regarding antioxidant defense, there was an increase in glutathione (GSH) and a decrease in superoxide dismutase (SOD) in the combined therapy group. A histological analysis showed reduced inflammatory infiltrate in the MC-treated groups and in the combination therapy group. There was an increase in the wound contraction rate in all treated groups when compared to the control group, proving that the proposed therapies are effective in the epithelial healing process. The results of this study demonstrate that the therapies in combination favor the tissue repair process more significantly than the therapies in isolation.
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Affiliation(s)
- Carolini Mendes
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Science of Health, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
| | - Anand Thirupathi
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Rubya Pereira Zaccaron
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Science of Health, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
| | - Maria Eduarda Anastácio Borges Corrêa
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Science of Health, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
| | - João V. S. Bittencourt
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Science of Health, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
| | - Laura de Roch Casagrande
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Science of Health, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
| | - Anadhelly C. S. de Lima
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Science of Health, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
| | - Lara L. de Oliveira
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Science of Health, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
| | - Thiago A. M. de Andrade
- Graduate Program of Biomedical Science, Herminio Ometto Foundation, Araras 13607-339, Brazil
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
| | - Paulo Emílio Feuser
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Science of Health, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
| | - Ricardo A. Machado-de-Ávila
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Science of Health, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
| | - Paulo Cesar Lock Silveira
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China
- Laboratory of Experimental Phisiopatology, Program of Postgraduate in Science of Health, Universidade do Extremo Sul Catarinense, Criciúma 88806-000, Brazil
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Engler B, Tselmin S, Ziehl D, Weigmann I, Birkenfeld A, Bornstein SR, Barthel A, Drechsel T, Zippenfennig C, Milani T, Perakakis N. The Potential of Electrical Stimulation and Smart Textiles for Patients with Diabetes Mellitus. Horm Metab Res 2022; 54:583-586. [PMID: 35793708 PMCID: PMC9451947 DOI: 10.1055/a-1892-6489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Diabetes mellitus is one of the most frequent diseases in the general population. Electrical stimulation is a treatment modality based on the transmission of electrical pulses into the body that has been widely used for improving wound healing and for managing acute and chronic pain. Here, we discuss recent advancements in electroceuticals and haptic/smart devices for quality of life and present in which patients and how electrical stimulation may prove to be useful for the treatment of diabetes-related complications.
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Affiliation(s)
- Babette Engler
- Department of Medicine III, University Hospital Carl Gustav Carus,
Dresden, Germany
| | - Sergey Tselmin
- Lipidology and Center for Extracorporeal Therapy, Department of
Medicine III, Technical University Dresden, Medical Faculty Carl Gustav Carus,
Dresden, Germany
| | - Doreen Ziehl
- Department of Medicine III, University Hospital Carl Gustav Carus,
Dresden, Germany
| | - Ingo Weigmann
- Department of Medicine III, University Hospital Carl Gustav Carus,
Dresden, Germany
| | - Andreas Birkenfeld
- Department of Medicine III, University Hospital Carl Gustav Carus,
Dresden, Germany
- Medical Clinic IV, University Hospital Tübingen,
Tübingen, Germany
| | - Stefan R. Bornstein
- Department of Medicine, Carl Gustav Carus, University of Dresden,
Dresden, Germany
- Division of Diabetes & Nutritional Sciences, Faculty of Life
Sciences & Medicine, King’s College London, London, United
Kingdom of Great Britain and Northern Ireland
- Klinik für Endokrinologie, Diabetologie und Klinische
Ernährung, University Hospital Zürich, Zurich,
Switzerland
- Correspondence Prof. Stefan R.
Bornstein University of
DresdenDepartment of Medicine, Carl Gustav
CarusFetscherstrasse 7401307
DresdenGermany0049351458595500493514586398
| | - Andreas Barthel
- Department of Medicine III, University Hospital Carl Gustav Carus,
Dresden, Germany
- Medicover, Bochum, Medicover, Bochum, Bochum, Germany
| | - Tina Drechsel
- Department of Human Locomotion, Faculty of Behavioral and Social
Sciences, Institute of Human Movement Science and Health, Chemnitz University of
Technology, Chemnitz, Germany
| | - Claudio Zippenfennig
- Department of Human Locomotion, Faculty of Behavioral and Social
Sciences, Institute of Human Movement Science and Health, Chemnitz University of
Technology, Chemnitz, Germany
| | - Thomas Milani
- Department of Human Locomotion, Faculty of Behavioral and Social
Sciences, Institute of Human Movement Science and Health, Chemnitz University of
Technology, Chemnitz, Germany
| | - Nikolaos Perakakis
- Department of Medicine III, University Hospital Carl Gustav Carus,
Dresden, Germany
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Dymarek R, Kuberka I, Rosińczuk J, Walewicz K, Taradaj J, Sopel M. The Immediate Clinical Effects Following a Single Radial Shock Wave Therapy in Pressure Ulcers: A Preliminary Randomized Controlled Trial of The SHOWN Project. Adv Wound Care (New Rochelle) 2022; 12:440-452. [PMID: 35996355 DOI: 10.1089/wound.2021.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Recent preliminary reports indicate that extracorporeal shock wave therapy (ESWT) might be useful for chronic wounds, especially venous leg ulcers (VLUs) and diabetic foot ulcers (DFUs). However, there is limited evidence for the utility and safety of ESWT in pressure ulcers (PUs). Therefore, this randomized controlled trial (RCT) aimed to assess immediate planimetric and clinical effects following a single radial ESWT session in PUs. APPROACH A group of 40 patients with PUs was randomly assigned into two groups: active ESWT (n=20), which underwent a single treatment with radial ESWT (300+100 impulses per 1 cm2, 2.5 bars, 0.15 mJ/mm2, and 5 Hz) and placebo ESWT (n=20) which was exposed to sham-radial ESWT. All patients continued standard wound care procedures. The planimetric assessment and clinical outcomes using Wound Bed Score (WBS) and Bates-Jansen Wound Assessment Tool (BWAT) were assessed before (M0) and after ESWT sessions (M1). RESULTS There was a significant planimetric enhancement observed after active ESWT reported as a reduction in all metric parameters: wound area from 11.51 cm2 to 8.09 cm2 (p<0.001), wound length from 4.97 cm to 4.41 cm (p<0.001), and wound width from 3.15 cm to 2.49 cm (p<0.0001). Also, there was a significant beneficial clinical improvement observed with a WBS as an increased score from 3.85 to 9.65 points (p<0.001) and with the BWAT as a decreased score from 45.45 to 30.70 points (p<0.001). In turn, a regression in the placebo ESWT group was observed in all studied outcomes. INNOVATION This study is the first RCT to provide the positive and immediate clinical effects of radial ESWT in promoting the healing of PUs. CONCLUSION This preliminary RCT showed that even a single session of ESWT is a promising and clinically effective modality in managing PUs. However, there is still limited data regarding the usefulness of ESWT in PUs, and further studies are in demand.
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Affiliation(s)
- Robert Dymarek
- Wroclaw Medical University, Department of Physiotherapy, Wroclaw, Poland;
| | - Izabela Kuberka
- Wroclaw Medical University, Division of Anaesthetic and Surgical Nursing, Wroclaw, Poland;
| | - Joanna Rosińczuk
- Wroclaw Medical University, Division of Internal Medicine Nursing, Wroclaw, Poland;
| | | | - Jakub Taradaj
- Jerzy Kukuczka Academy of Physical Education In Katowice, Institute of Physiotherapy and Health Sciences, Katowice, Poland;
| | - Mirosław Sopel
- Wroclaw Medical University, Department of Basic Sciences, Wroclaw, Poland;
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10
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Analgesic and Functional Efficiency of High-Voltage Electrical Stimulation in Patients with Lateral Epicondylitis-A Report with a 180-Day Follow-Up. J Clin Med 2022; 11:jcm11092571. [PMID: 35566697 PMCID: PMC9105087 DOI: 10.3390/jcm11092571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/28/2022] [Accepted: 04/30/2022] [Indexed: 11/17/2022] Open
Abstract
The available publications describing the beneficial effects of electrostimulation does not unequivocally confirm the clinical utility of high-voltage electrical stimulation (HVES) in the treatment of the lateral epicondylitis (LE). The aim of this study was the estimation of the effect of HVES on pain intensity and functional efficiency, both in the short and long term in patients with LE. The trial was registered by the Australian and New Zealand Clinical Trials Registry (ACTRN12621001389897). There were 58 patients allocated into two groups: the HVES group (n = 29, mean age 49.9 ± 11.0 years), treated with HVES (pulse duration: 200μs, frequency: 100 Hz, current amplitude in the range of 18-25 mA, voltage amplitude: 100 V), and the NORM group (n = 29, mean age 48.0 ± 12.6 years), who were healthy and untreated patients. The treatments were performed 5 days a week (from Monday to Friday) for two weeks. Treatment progress was measured by the visual analogue scale (VAS) for rest pain, night pain, and pain during activity; the Laitinen Pain Scale (LPS); and hand grip strength (HGS) before and after the treatment, as well as after 3, 6, 12, and 24 weeks. The reduction of pain (according to the VAS and LPS) and increase in the functional condition (according to the HGS) were observed in all HVES patients in the short- and long-term observation. Therefore, the HVES in treatment of LE was found to be effective and safe.
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Chen L, Ruan Y, Ma Y, Ge L, Han L. Effectiveness and safety of electrical stimulation for treating pressure ulcers: A systematic review and meta-analysis. Int J Nurs Pract 2022; 29:e13041. [PMID: 35244315 DOI: 10.1111/ijn.13041] [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: 01/04/2021] [Revised: 04/26/2021] [Accepted: 01/16/2022] [Indexed: 12/01/2022]
Abstract
AIM This study aims to synthesize qualitative evidence on the effectiveness and safety of electrical stimulation for treating pressure ulcers. BACKGROUND Electrical stimulation is often used clinically to treat pressure ulcers, but its effectiveness and safety and some potential problems are not clear. DESIGN This is a qualitative systematic review. DATA SOURCES The data sources are four English databases (PubMed, EMBASE, The Cochrane Library and Web of Science) and four Chinese databases (CNKI, SinoMed, VIP and WANFANG). METHODS Two reviewers independently examined the records according to the eligibility criteria and extracted the data of each included study. We used the Review Manager 5.3 software to perform data analysis. RESULTS Seventeen randomized controlled trials including 740 patients were included in this study. Meta-analysis of eight randomized controlled trials demonstrated that electrical stimulation significantly reduced the ulcer surface in contrast with standard wound care alone or pulsed sham electrical stimulation. Nine studies showed that electrical stimulation increased the risk of pressure ulcers being completely healed than the controlled group. Three studies reported that adverse reactions were rare. CONCLUSIONS This study demonstrated that electrical stimulation was a relatively effective and safe adjunctive therapy for pressure ulcers treatment.
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Affiliation(s)
- Lian Chen
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yue Ruan
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Yuxia Ma
- School of Nursing, Lanzhou University, Lanzhou, China
| | - Long Ge
- Evidence-Based Social Science Research Center, School of Public Health, Lanzhou University, Lanzhou, China.,Department of Social Science and Health Management, School of Public Health, Lanzhou University, Lanzhou, China
| | - Lin Han
- School of Nursing, Lanzhou University, Lanzhou, China.,Department of Nursing, Gansu Provincial Hospital, Lanzhou, China
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12
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Edwick DO, Hince DA, Rawlins JM, Wood FM, Edgar DW. Does electrical stimulation improve healing in acute minor burn injury, as measured by bioimpedance spectroscopy? A single center, randomized, controlled trial. BURNS OPEN 2022. [DOI: 10.1016/j.burnso.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Figueira TN, Backes MTS, Knihs NDS, Maliska ICA, Amante LN, Bellaguarda MLDR. Products and technologies for treating patients with evidence-based pressure ulcers. Rev Bras Enferm 2021; 74:e20180686. [PMID: 34468545 DOI: 10.1590/0034-7167-2018-0686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 02/26/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to identify products/technologies for treating patients with pressure ulcers with an evidence level 1. METHOD this is an integrative literature review. A survey of studies was carried out using the United States National Library of Medicine Portal, Scientific Electronic Library Online, Virtual Health Library, National Library of Medicine(®), The Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean in Health Sciences, Nursing Database. RESULTS sixteen articles were selected with level of evidence 1. The findings were categorized into five categories: Topical therapy to promote healing; Alternative therapy to promote healing; Topical therapy to promote debridement; Topical therapy to minimize lesion contamination; Topical therapy to reduce lesion size. FINAL CONSIDERATIONS the 17 products/technologies identified favor/fast healing, debridement, minimize contamination and reduce lesion size to accelerate healing.
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Affiliation(s)
| | | | | | - Isabel Cristina Alves Maliska
- Universidade Federal de Santa Catarina, Hospital Universitário Professor Polydoro Ernane de São Thiago. Florianópolis, Santa Catarina, Brazil
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Wang XF, Li ML, Fang QQ, Zhao WY, Lou D, Hu YY, Chen J, Wang XZ, Tan WQ. Flexible electrical stimulation device with Chitosan-Vaseline® dressing accelerates wound healing in diabetes. Bioact Mater 2021; 6:230-243. [PMID: 32913931 PMCID: PMC7451868 DOI: 10.1016/j.bioactmat.2020.08.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/06/2020] [Accepted: 08/06/2020] [Indexed: 12/16/2022] Open
Abstract
The healing process of diabetic wounds is typically disordered and prolonged and requires both angiogenesis and epithelialization. Disruptions of the endogenous electric fields (EFs) may lead to disordered cell migration. Electrical stimulation (ES) that mimics endogenous EFs is a promising method in treating diabetic wounds; however, a microenvironment that facilitates cell migration and a convenient means that can be used to apply ES are also required. Chitosan-Vaseline® gauze (CVG) has been identified to facilitate wound healing; it also promotes moisture retention and immune regulation and has antibacterial activity. For this study, we created a wound dressing using CVG together with a flexible ES device and further evaluated its potential as a treatment for diabetic wounds. We found that high voltage monophasic pulsed current (HVMPC) promoted healing of diabetic wounds in vivo. In studies carried out in vitro, we found that HVMPC promoted the proliferation and migration of human umbilical vein endothelial cells (HUVECs) by activating PI3K/Akt and ERK1/2 signaling. Overall, we determined that the flexible ES-chitosan dressing may promoted healing of diabetic wounds by accelerating angiogenesis, enhancing epithelialization, and inhibiting scar formation. These findings provide support for the ongoing development of this multidisciplinary product for the care and treatment of diabetic wounds.
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Affiliation(s)
- Xiao-Feng Wang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
| | - Meng-Lu Li
- Key Laboratory of Micro-Nano Electronic Devices and Smart Systems of Zhejiang Province, College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, 310027, Zhejiang Province, PR China
| | - Qing-Qing Fang
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
| | - Wan-Yi Zhao
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
| | - Dong Lou
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
| | - Yan-Yan Hu
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
| | - Jun Chen
- Innovation Center for Signaling Network, College of Life Sciences, Zhejiang University, Hangzhou, 310058, Zhejiang Province, PR China
| | - Xiao-Zhi Wang
- Key Laboratory of Micro-Nano Electronic Devices and Smart Systems of Zhejiang Province, College of Information Science & Electronic Engineering, Zhejiang University, Hangzhou, 310027, Zhejiang Province, PR China
| | - Wei-Qiang Tan
- Department of Plastic Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, Zhejiang Province, PR China
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15
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Sen CK, Mathew-Steiner SS, Das A, Sundaresan VB, Roy S. Electroceutical Management of Bacterial Biofilms and Surgical Infection. Antioxid Redox Signal 2020; 33:713-724. [PMID: 32466673 PMCID: PMC7475090 DOI: 10.1089/ars.2020.8086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 01/04/2023]
Abstract
Significance: In the host-microbe microenvironment, bioelectrical factors influence microbes and hosts as well as host-microbe interactions. This article discusses relevant mechanistic underpinnings of this novel paradigm. It also addresses how such knowledge may be leveraged to develop novel electroceutical solutions to manage biofilm infection. Recent Advances: Systematic review and meta-analysis of several hundred wound studies reported a 78.2% prevalence of biofilms in chronic wounds. Biofilm infection is a major cause of delayed wound healing. In the host-microbe microenvironment, bioelectrical factors influence interactions between microbes and hosts. Critical Issues: Rapid biological responses are driven by electrical signals generated by ion currents moving across cell membranes. Bacterial life, growth, and function rely on a bioelectrical milieu, which when perturbed impairs their ability to form a biofilm, a major threat to health care. Electrokinetic stability of several viral particles depend on electrostatic forces. Weak electrical field strength, otherwise safe for humans, can be anti-microbial in this context. In the host, the electric field enhanced keratinocyte migration, bolstered immune defenses, improved mitochondrial function, and demonstrated multiple other effects consistent with supporting wound healing. A deeper mechanistic understanding of bioelectrical principles will inform the design of next-generation electroceuticals. Future Directions: This is an opportune moment in time as there is a surge of interest in electroceuticals in medicine. Projected to reach $35.5 billion by 2025, electroceuticals are becoming a cynosure in the global market. The World Health Organization reports that more than 50% of surgical site infections can be antibiotic resistant. Electroceuticals offer a serious alternative.
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Affiliation(s)
- Chandan K. Sen
- Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Shomita S. Mathew-Steiner
- Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Amitava Das
- Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Vishnu Baba Sundaresan
- Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, Ohio, USA
| | - Sashwati Roy
- Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Arora M, Harvey LA, Glinsky JV, Nier L, Lavrencic L, Kifley A, Cameron ID. Electrical stimulation for treating pressure ulcers. Cochrane Database Syst Rev 2020; 1:CD012196. [PMID: 31962369 PMCID: PMC6984413 DOI: 10.1002/14651858.cd012196.pub2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Pressure ulcers (also known as pressure sores, decubitus ulcers or bedsores) are localised injuries to the skin or underlying tissue, or both. Pressure ulcers are a disabling consequence of immobility. Electrical stimulation (ES) is widely used for the treatment of pressure ulcers. However, it is not clear whether ES is effective. OBJECTIVES To determine the effects (benefits and harms) of electrical stimulation (ES) for treating pressure ulcers. SEARCH METHODS In July 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. We did not impose any restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA We included published and unpublished randomised controlled trials (RCTs) comparing ES (plus standard care) with sham/no ES (plus standard care) for treating pressure ulcers. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials for inclusion, extracted data, and assessed risk of bias. We assessed the certainty of evidence using GRADE. MAIN RESULTS We included 20 studies with 913 participants. The mean age of participants ranged from 26 to 83 years; 50% were male. ES was administered for a median (interquartile range (IQR)) duration of five (4 to 8) hours per week. The chronicity of the pressure ulcers was variable, ranging from a mean of four days to more than 12 months. Most of the pressure ulcers were on the sacral and coccygeal region (30%), and most were stage III (45%). Half the studies were at risk of performance and detection bias, and 25% were at risk of attrition and selective reporting bias. Overall, the GRADE assessment of the certainty of evidence for outcomes was moderate to very low. Nineteen studies were conducted in four different settings, including rehabilitation and geriatric hospitals, medical centres, a residential care centre, and a community-based centre. ES probably increases the proportion of pressure ulcers healed compared with no ES (risk ratio (RR) 1.99, 95% confidence interval (CI) 1.39 to 2.85; I2 = 0%; 11 studies, 501 participants (512 pressure ulcers)). We downgraded the evidence to moderate certainty due to risk of bias. It is uncertain whether ES decreases pressure ulcer severity on a composite measure compared with no ES (mean difference (MD) -2.43, 95% CI -6.14 to 1.28; 1 study, 15 participants (15 pressure ulcers) and whether ES decreases the surface area of pressure ulcers when compared with no ES (12 studies; 494 participants (505 pressure ulcers)). Data for the surface area of pressure ulcers were not pooled because there was considerable statistical heterogeneity between studies (I2 = 96%) but the point estimates for the MD of each study ranged from -0.90 cm2 to 10.37 cm2. We downgraded the evidence to very low certainty due to risk of bias, inconsistency and imprecision. It is uncertain whether ES decreases the time to complete healing of pressure ulcers compared with no ES (hazard ratio (HR) 1.06, 95% CI 0.47 to 2.41; I2 = 0%; 2 studies, 55 participants (55 pressure ulcers)). We downgraded the evidence to very low certainty due to risk of bias, indirectness and imprecision. ES may be associated with an excess of, or difference in, adverse events (13 studies; 586 participants (602 pressure ulcers)). Data for adverse events were not pooled but the types of reported adverse events included skin redness, itchy skin, dizziness and delusions, deterioration of the pressure ulcer, limb amputation, and occasionally death. We downgraded the evidence to low certainty due to risk of selection and attrition bias and imprecision. ES probably increases the rate of pressure ulcer healing compared with no ES (MD 4.59% per week, 95% CI 3.49 to 5.69; I2 = 25%; 12 studies, 561 participants (613 pressure ulcers)). We downgraded the evidence to moderate certainty due to risk of bias. We did not find any studies that looked at quality of life, depression, or consumers' perception of treatment effectiveness. AUTHORS' CONCLUSIONS ES probably increases the proportion of pressure ulcers healed and the rate of pressure ulcer healing (moderate certainty evidence), but its effect on time to complete healing is uncertain compared with no ES (very low certainty evidence). It is also uncertain whether ES decreases the surface area of pressure ulcers. The evidence to date is insufficient to support the widespread use of ES for pressure ulcers outside of research. Future research needs to focus on large-scale trials to determine the effect of ES on all key outcomes.
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Affiliation(s)
- Mohit Arora
- Northern Sydney Local Health DistrictKolling Institute of Medical ResearchReserve RoadSt LeonardsNSWAustralia2065
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Lisa A Harvey
- Northern Sydney Local Health DistrictKolling Institute of Medical ResearchReserve RoadSt LeonardsNSWAustralia2065
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Joanne V Glinsky
- Northern Sydney Local Health DistrictKolling Institute of Medical ResearchReserve RoadSt LeonardsNSWAustralia2065
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Lianne Nier
- Royal North Shore HospitalSpinal Cord Injury UnitWard 7E, Royal North Shore Hospital, Reserve Road, St LeonardsSydneyNSWAustralia2065
| | - Lucija Lavrencic
- Royal North Shore HospitalSpinal Cord Injury UnitWard 7E, Royal North Shore Hospital, Reserve Road, St LeonardsSydneyNSWAustralia2065
| | - Annette Kifley
- Northern Sydney Local Health DistrictKolling Institute of Medical ResearchReserve RoadSt LeonardsNSWAustralia2065
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
| | - Ian D Cameron
- Northern Sydney Local Health DistrictKolling Institute of Medical ResearchReserve RoadSt LeonardsNSWAustralia2065
- The University of SydneyJohn Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical SchoolReserve RoadSt LeonardsNSWAustralia2065
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Sabater González M, Mayer J. Technological Advances in Wound Treatment of Exotic Pets. Vet Clin North Am Exot Anim Pract 2019; 22:451-470. [PMID: 31395325 DOI: 10.1016/j.cvex.2019.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although most research about the use of technological advances for wound healing was performed in laboratory animals but oriented to human medicine, recent technological advances allowed its application not only to small animals but also to exotic pets. This article reviews the literature available about some of these techniques (negative wound pressure therapy, photobiomodulation [laser therapy], electrical stimulation therapy, therapeutic ultrasonography, hyperbaric oxygen therapy), and other advances in wound management (skin expanders, xenografts, and bioengineered autologous skin substitutes) in exotic pet species.
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Affiliation(s)
| | - Jörg Mayer
- Department of Small Animal Medicine and Surgery, University of Georgia, Athens, GA, USA
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ZHANG Z, LI B, WANG Z, WU L, SONG L, YAO Y. Efficacy of Bimodal High-Voltage Monopulsed Current in the Treatment of Pressure Ulcer: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2019; 48:1952-1959. [PMID: 31970093 PMCID: PMC6961193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/21/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND We aimed to systematically evaluate the efficacy of high-voltage pulsed current (HVPC) in the treatment of pressure ulcer. METHODS We searched the databases of PubMed, Cochrane Library, Elsevier and EMBASE to identify randomized controlled studies on the application of HVPC in pressure ulcer treatment, up to January 2019. Two authors independently screened the literature according to the inclusion and exclusion criteria, extracted the data and evaluated the quality. RevMan 5.3 software was used for statistical analysis. Four randomized controlled trials involving a total of 176 patients were included in the study. RESULTS Meta-analysis showed that the percentage of wound area reduction in the HVPC treatment group was higher than that in the control group (95%CI 24.59, 47.76, P<0.001). Descriptive analysis showed that there was no significant difference in wound healing between the HVPC treatment group and the control group. One study reported that there was contact dermatitis, and the rest of the studies reported no adverse events. CONCLUSION Compared with the conventional therapy, the combination with HVPC therapy can reduce the area of pressure ulcers more effectively. However, due to the small number of the studies included in this evaluation, the conclusions need to be verified by more high-quality studies.
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Affiliation(s)
- Zhiwei ZHANG
- Department of Nursing, The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang Province, China
| | - Bojun LI
- The Second Clinical Medical College, Nanchang University, Nanchang, Jiangxi Province, China
| | - Zhichao WANG
- Department of Academic Theory Research, Qiqihar Medical University, Qiqihar, Heilongjiang Province, China
| | - Lina WU
- School of Medical Technology, Qiqihar Medical University, Qiqihar, Heilongjiang Province, China
| | - Lili SONG
- Department of Anesthesiology, The Third Affiliated Hospital of Qiqihar Medical University, Qiqihar, Heilongjiang Province, China
| | - Yexiang YAO
- Department of Social Medicine and Health Management, School of Public Health, Qiqihar Medical University, Qiqihar, Heilongjiang Province, China
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Souza AK, Souza TR, Siqueira das Neves LM, de Paula Marcondes Ferreira Leite G, Garcia SB, Roberto de Jesus Guirro R, Barbosa RI, Caldeira de Oliveira Guirro E. Effect of High Voltage Pulsed Current on the integration of total skin grafts in rats submitted to nicotine action. J Tissue Viability 2019; 28:161-166. [DOI: 10.1016/j.jtv.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 05/14/2019] [Accepted: 05/19/2019] [Indexed: 10/26/2022]
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High Voltage Monophasic Pulsed Current (HVMPC) for stage II-IV pressure ulcer healing. A systematic review and meta-analysis. J Tissue Viability 2018; 27:274-284. [DOI: 10.1016/j.jtv.2018.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/07/2018] [Accepted: 08/10/2018] [Indexed: 01/02/2023]
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Nontoxic Three-Part Combination Local Wound Therapy to Eradicate Carbapenem-Resistant Klebsiella pneumoniae. Adv Skin Wound Care 2018; 31:521-523. [PMID: 30335644 DOI: 10.1097/01.asw.0000546119.25057.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This case report describes eradication of carbapenem-resistant Klebsiella pneumoniae from an ischial pressure injury in a patient who underwent a 3-week course of nontoxic three-part combination local wound therapy. With this therapy, providers prevented systemic spread of this multidrug-resistant pathogen and avoided the nephrotoxicity associated with conventional triple antibiotic therapy.
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Nair HK. Microcurrent as an adjunct therapy to accelerate chronic wound healing and reduce patient pain. J Wound Care 2018; 27:296-306. [DOI: 10.12968/jowc.2018.27.5.296] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Harikrishna K.R. Nair
- Head of Wound Care Unit; Department of Internal Medicine, SCACC Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
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Khouri C, Kotzki S, Roustit M, Blaise S, Gueyffier F, Cracowski JL. Hierarchical evaluation of electrical stimulation protocols for chronic wound healing: An effect size meta-analysis. Wound Repair Regen 2017; 25:883-891. [DOI: 10.1111/wrr.12594] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 09/07/2017] [Indexed: 01/28/2023]
Affiliation(s)
- Charles Khouri
- Pharmacovigilance Unit, Grenoble Alps University Hospital; Grenoble France
- Clinical Pharmacology Department, INSERM CIC1406; Grenoble Alps University Hospital; Grenoble France
| | - Sylvain Kotzki
- UMR 1042-HP2, INSERM, University of Grenoble Alpes; Grenoble France
| | - Matthieu Roustit
- Clinical Pharmacology Department, INSERM CIC1406; Grenoble Alps University Hospital; Grenoble France
- UMR 1042-HP2, INSERM, University of Grenoble Alpes; Grenoble France
| | - Sophie Blaise
- UMR 1042-HP2, INSERM, University of Grenoble Alpes; Grenoble France
- Department of Vascular Medicine; Grenoble Alps University Hospital; Grenoble France
| | - Francois Gueyffier
- Department of Clinical Pharmacology; Lyon University Hospital; Lyon France
- UMR 5558, Biometry and Evolutionary Biology Laboratory; Claude-Bernard Lyon 1 University, CNRS; Lyon France
| | - Jean-Luc Cracowski
- Clinical Pharmacology Department, INSERM CIC1406; Grenoble Alps University Hospital; Grenoble France
- UMR 1042-HP2, INSERM, University of Grenoble Alpes; Grenoble France
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Polak A, Kloth LC, Blaszczak E, Taradaj J, Nawrat-Szoltysik A, Ickowicz T, Hordynska E, Franek A, Kucio C. The Efficacy of Pressure Ulcer Treatment With Cathodal and Cathodal-Anodal High-Voltage Monophasic Pulsed Current: A Prospective, Randomized, Controlled Clinical Trial. Phys Ther 2017; 97:777-789. [PMID: 28789467 DOI: 10.1093/ptj/pzx052] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 05/03/2017] [Indexed: 11/14/2022]
Abstract
BACKGROUND Studies show that anode and cathode electrical stimulation (ES) promotes the healing of wounds, but specific protocols for both electrodes are not available. OBJECTIVE To compare the effectiveness of cathodal versus cathodal+anodal ES in the treatment of Category II-IV pressure ulcers (PrUs). DESIGN Prospective, randomized, controlled, clinical study. SETTING Three nursing and care centers. PATIENTS Sixty-three participants with PrUs were randomly formed into a cathodal ES group (CG: N = 23; mean age of 79.35; SD 8.48), a cathodal+anodal ES group (CAG: N = 20; mean age of 79.65; SD 11.44) and a placebo ES group (PG: N = 20; mean age of 76.75; SD 12.24). INTERVENTION All patients were treated with standard wound care and high-voltage monophasic pulsed current (HVMPC; twin-peak impulses; 154 μs; 100 pps; 0.25 A; 250 μC/s) for 50 minutes per day, 5 times a week, for 6 weeks. The CG, CAG, and PG received, respectively, cathodal, cathodal+anodal, and sham ES through electrodes placed on a moist gauze pad. The treatment electrode was placed on the wound, and the return electrode was positioned on healthy skin at least 20 cm from the PrU. MEASUREMENTS Measurements were made at baseline, and after each of the 6 weeks of treatment. Primary outcome was percentage wound surface area reduction at week 6. RESULTS Wound surface area decreased in the CG by 82.34% (95% confidence interval [CI] 70.06-94.63) and in the CAG by 70.77% (95% CI 53.51-88.04). These reductions were significantly greater than in the PG (40.53%; 95% CI 23.60-57.46). The CG and CAG were not statistically significantly different regarding treatment results. LIMITATIONS The time of treatment proved insufficient for PrUs to close. CONCLUSIONS Cathodal and cathodal+anodal HVMPC similarly reduced the area of Category II-IV PrUs.
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Affiliation(s)
- Anna Polak
- Department of Physical Therapy, Academy of Physical Education, Mikolowska 72A, Katowice 40-065 Poland and Medical Department, Katowice School of Exonomics, Katowice, Poland
| | - Luther C Kloth
- Department of Physical Therapy, Marquette University, Milwaukee, Wisconsin
| | - Edward Blaszczak
- Department of Medical Biophysics, Medical University of Silesia, Katowice, Poland
| | - Jakub Taradaj
- Department of Physical Therapy, Academy of Physical Education and Institute of Physical Therapy, Public School of Medicine, Opole, Poland
| | - Agnieszka Nawrat-Szoltysik
- Department of Physical Therapy, Academy of Physical Education and Skilled Nursing Home, Sw Elzbieta, Ruda Slaska, Poland
| | - Tomasz Ickowicz
- Department of Physical Therapy, Academy of Physical Education and Department of Neurological Rehabilitation, Rehabilitation Center Repty, Tarnowskie Gory, Poland
| | - Ewa Hordynska
- Department of Neurological Rehabilitation, Rehabilitation Center Repty
| | - Andrzej Franek
- Department of Medical Biophysics, Medical University of Silesia
| | - Cezary Kucio
- Department of Physical Therapy, Academy of Physical Education and Department of Internal Medicine, Specialist Hospital, Jaworzno, Poland
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Frederich BJ, Timofeyev V, Thai PN, Haddad MJ, Poe AJ, Lau VC, Moshref M, Knowlton AA, Sirish P, Chiamvimonvat N. Electrotaxis of cardiac progenitor cells, cardiac fibroblasts, and induced pluripotent stem cell-derived cardiac progenitor cells requires serum and is directed via PI3'K pathways. Heart Rhythm 2017; 14:1685-1692. [PMID: 28668623 DOI: 10.1016/j.hrthm.2017.06.038] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The limited regenerative capacity of cardiac tissue has long been an obstacle to treating damaged myocardium. Cell-based therapy offers an enormous potential to the current treatment paradigms. However, the efficacy of regenerative therapies remains limited by inefficient delivery and engraftment. Electrotaxis (electrically guided cell movement) has been clinically used to improve recovery in a number of tissues but has not been investigated for treating myocardial damage. OBJECTIVE The purpose of this study was to test the electrotactic behaviors of several types of cardiac cells. METHODS Cardiac progenitor cells (CPCs), cardiac fibroblasts (CFs), and human induced pluripotent stem cell-derived cardiac progenitor cells (hiPSC-CPCs) were used. RESULTS CPCs and CFs electrotax toward the anode of a direct current electric field, whereas hiPSC-CPCs electrotax toward the cathode. The voltage-dependent electrotaxis of CPCs and CFs requires the presence of serum in the media. Addition of soluble vascular cell adhesion molecule to serum-free media restores directed migration. We provide evidence that CPC and CF electrotaxis is mediated through phosphatidylinositide 3-kinase signaling. In addition, very late antigen-4, an integrin and growth factor receptor, is required for electrotaxis and localizes to the anodal edge of CPCs in response to direct current electric field. The hiPSC-derived CPCs do not express very late antigen-4, migrate toward the cathode in a voltage-dependent manner, and, similar to CPCs and CFs, require media serum and phosphatidylinositide 3-kinase activity for electrotaxis. CONCLUSION The electrotactic behaviors of these therapeutic cardiac cells may be used to improve cell-based therapy for recovering function in damaged myocardium.
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Affiliation(s)
- Bert J Frederich
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Valeriy Timofeyev
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Phung N Thai
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Michael J Haddad
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Adam J Poe
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Victor C Lau
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Maryam Moshref
- Division of Cardiovascular Medicine, University of California, Davis, California
| | - Anne A Knowlton
- Division of Cardiovascular Medicine, University of California, Davis, California; US Department of Veterans Affairs, Northern California Health Care System, Mather, California
| | - Padmini Sirish
- Division of Cardiovascular Medicine, University of California, Davis, California.
| | - Nipavan Chiamvimonvat
- Division of Cardiovascular Medicine, University of California, Davis, California; US Department of Veterans Affairs, Northern California Health Care System, Mather, California.
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Spanò R, Muraglia A, Todeschi MR, Nardini M, Strada P, Cancedda R, Mastrogiacomo M. Platelet-rich plasma-based bioactive membrane as a new advanced wound care tool. J Tissue Eng Regen Med 2017; 12:e82-e96. [PMID: 27863057 DOI: 10.1002/term.2357] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/24/2016] [Accepted: 11/09/2016] [Indexed: 12/25/2022]
Abstract
Chronic skin ulcers, consequence of diabetes and other pathological conditions, heavily compromise the patient life quality and represent a high and constantly growing cost for National Health Services. Autologous platelet-rich plasma (PRP), has been proposed to treat these lesions. The absence of guidelines for the PRP production and the need of a fresh preparation for each treatment lead us to develop a protocol for the production of an allogenic PRP-based bioactive membrane (BAM), standardized for platelet concentration and growth factor release. This work compares BAMs obtained starting from two different platelet concentrations. There was no direct correlation between the amount of growth factors released by BAM in vitro and the initial platelet count. However, different release kinetics were noticed for different growth factors, suggesting that they were differently retained by the two BAMs. The angiogenic potential of both BAMs was determined by Luminex Angiogenesis Assay. The biological activity of the factors released by the two BAMs was confirmed by cell proliferation and migration. A diabetic mouse chronic ulcer model was used to define the best PRP therapeutic dose in vivo. Both BAMs induced wound healing by increasing the thickness of the regenerated epidermis and the vessel number. However, a too high platelet concentration resulted in a slowdown of the membrane resorption that interfered with the skin healing. Overall, the results indicate that the BAMs could represent a natural and effective wound healing tool for the treatment of skin ulcers. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Raffaele Spanò
- Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy.,IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | | | | | - Marta Nardini
- Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy.,IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Paolo Strada
- IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Ranieri Cancedda
- Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy.,IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
| | - Maddalena Mastrogiacomo
- Department of Experimental Medicine (DIMES), University of Genova, Genova, Italy.,IRCCS AOU San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genova, Italy
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Ashrafi M, Alonso-Rasgado T, Baguneid M, Bayat A. The efficacy of electrical stimulation in lower extremity cutaneous wound healing: A systematic review. Exp Dermatol 2017; 26:171-178. [DOI: 10.1111/exd.13179] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Mohammed Ashrafi
- Plastic and Reconstructive Surgery Research; Centre for Dermatological Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
| | | | - Mohamed Baguneid
- University Hospital South Manchester NHS Foundation Trust; Wythenshawe Hospital; Manchester UK
| | - Ardeshir Bayat
- Plastic and Reconstructive Surgery Research; Centre for Dermatological Research; Institute of Inflammation and Repair; University of Manchester; Manchester UK
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Evaluation of the Healing Progress of Pressure Ulcers Treated with Cathodal High-Voltage Monophasic Pulsed Current: Results of a Prospective, Double-blind, Randomized Clinical Trial. Adv Skin Wound Care 2016; 29:447-59. [DOI: 10.1097/01.asw.0000493164.75337.de] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Platelet-Rich Plasma for the Treatment of Clean Diabetic Foot Ulcers. Ann Vasc Surg 2016; 38:206-211. [PMID: 27522981 DOI: 10.1016/j.avsg.2016.04.023] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 04/11/2016] [Accepted: 04/15/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diabetic foot ulcer is considered as a major health problem that predisposes to limb amputation. Among the different methods to achieve ulcer healing, platelet-rich plasma (PRP) gel is gaining popularity. It is thought to stimulate wound closure by providing essential growth factors for healing. This study aims to evaluate the value of autologous PRP gel in the treatment of diabetic ulcers. METHODS The study included 56 patients of both sex from 18 to 80 years, with clean chronic diabetic foot ulcers divided into 2 equal groups. The first group was treated by antiseptic ointment dressing, and the second group was treated by autologous platelet gel. PRP together with thrombin were prepared by centrifugation at each dressing session. Thrombin and calcium chloride were used to activate the PRP. The formed platelet gel was applied to the wound twice weekly. RESULTS Statically significant increase in healing rate was found in the PRP-treated group, and complete healing was achieved in 86% of them in comparison to 68% of the control group. In the study group, rate of healing per week was greater during the first 8 weeks and starts to decline afterward. The use of platelet gel showed a lower rate of wound infection. CONCLUSIONS Autologous platelet gel is more effective than the local antiseptic dressing in terms of healing rate and prevention of infection in clean diabetic ulcers.
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Stefanou C. Electrical muscle stimulation in thomboprophylaxis: review and a derived hypothesis about thrombogenesis-the 4th factor. SPRINGERPLUS 2016; 5:884. [PMID: 27386332 PMCID: PMC4920783 DOI: 10.1186/s40064-016-2521-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 06/06/2016] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Electrical muscle stimulation (EMS) is an FDA-approved thromboprophylactic method. Thrombus pathogenesis is considered to depend on factors related to components of the vessel wall, the velocity of blood, and blood consistency-collectively known as, the Virchow's triad. OBJECTIVE The testimony supporting the thromboprophylactic effects of the EMS is reviewed. An emphasis is placed on the fact that, EMS has demonstrated, in certain circumstances, an efficacy rate that cannot be fully explained by the Virchow's triad; also that, in reviewing relevant evidence and the theorized pathophysiological mechanisms, several findings collectively point to a potentially missed point. Remarkably, venous thromboembolic disease (VTE) is extremely more common in the lower versus the upper extremities even when the blood velocities equalize; EMS had synergistic effects with intermittent compressive devices, despite their presumed identical mechanism of action; sleep is not thrombogenic; non-peroperative EMS is meaningful only if applied ≥5 times daily; neural insult increases VTEs more than the degree expected by the hypomobility-related blood stasis; etc. These phenomena infer the presence of a 4th thrombogenetic factor: neural supply to the veins provides direct antithrombic effects, by inducing periodic vessel diameter changes and/or by neuro-humoral, chemically acting factors. EMS may stimulate or substitute the 4th factor. This evidence-based hypothesis is analyzed. CONCLUSION A novel pathophysiologic mechanism of thrombogenesis is supported; and, based on this, the role of EMS in thromboprophylaxis is expanded. Exploration of this mechanism may provide new targets for intervention.
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Affiliation(s)
- Christos Stefanou
- ICU, Limassol General Hospital, Eptanisou 2, Agios Nicolaos, 3100 Limassol, Cyprus
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Otero-Viñas M, Falanga V. Mesenchymal Stem Cells in Chronic Wounds: The Spectrum from Basic to Advanced Therapy. Adv Wound Care (New Rochelle) 2016; 5:149-163. [PMID: 27076993 PMCID: PMC4817558 DOI: 10.1089/wound.2015.0627] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 03/03/2015] [Indexed: 02/06/2023] Open
Abstract
Significance: Almost 7 million Americans have chronic cutaneous wounds and billions of dollars are spent on their treatment. The number of patients with nonhealing wounds keeps increasing worldwide due to an ever-aging population, increasing number of obese and diabetic patients, and cardiovascular disease. Recent Advances: Advanced treatments for difficult wounds are needed. Therapy with mesenchymal stem cells (MSCs) is attractive due to their differentiating potential, their immunomodulating properties, and their paracrine effects. Critical Issues: New technologies (including growth factors and skin substitutes) are now widely used for stimulating wound healing. However, in spite of these advances, the percentage of complete wound closure in most clinical situations is around 50-60%. Moreover, there is a high rate of wound recurrence. Future Directions: Recently, it has been demonstrated that MSCs speed up wound healing by decreasing inflammation, by promoting angiogenesis, and by decreasing scarring. However, there are some potential limitations to successful MSC therapy. These limitations include the need to improve cell delivery methods, cell viability, heterogeneity in MSC preparations, and suboptimal wound bed preparation. Further large, controlled clinical trials are needed to establish the safety of MSCs before widespread clinical application.
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Affiliation(s)
- Marta Otero-Viñas
- Dermatology Department, Boston University School of Medicine, Boston, Massachusetts
- The Tissue Repair and Regeneration Laboratory, Department of Systems Biology, Universitat de Vic—Universitat Central de Catalunya, Vic, Spain
| | - Vincent Falanga
- Dermatology Department, Boston University School of Medicine, Boston, Massachusetts
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Hoare JI, Rajnicek AM, McCaig CD, Barker RN, Wilson HM. Electric fields are novel determinants of human macrophage functions. J Leukoc Biol 2015; 99:1141-51. [PMID: 26718542 DOI: 10.1189/jlb.3a0815-390r] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/18/2015] [Indexed: 01/08/2023] Open
Abstract
Macrophages are key cells in inflammation and repair, and their activity requires close regulation. The characterization of cues coordinating macrophage function has focused on biologic and soluble mediators, with little known about their responses to physical stimuli, such as the electrical fields that are generated naturally in injured tissue and which accelerate wound healing. To address this gap in understanding, we tested how properties of human monocyte-derived macrophages are regulated by applied electrical fields, similar in strengths to those established naturally. With the use of live-cell video microscopy, we show that macrophage migration is directed anodally by electrical fields as low as 5 mV/mm and is electrical field strength dependent, with effects peaking ∼300 mV/mm. Monocytes, as macrophage precursors, migrate in the opposite, cathodal direction. Strikingly, we show for the first time that electrical fields significantly enhance macrophage phagocytic uptake of a variety of targets, including carboxylate beads, apoptotic neutrophils, and the nominal opportunist pathogen Candida albicans, which engage different classes of surface receptors. These electrical field-induced functional changes are accompanied by clustering of phagocytic receptors, enhanced PI3K and ERK activation, mobilization of intracellular calcium, and actin polarization. Electrical fields also modulate cytokine production selectively and can augment some effects of conventional polarizing stimuli on cytokine secretion. Taken together, electrical signals have been identified as major contributors to the coordination and regulation of important human macrophage functions, including those essential for microbial clearance and healing. Our results open up a new area of research into effects of naturally occurring and clinically applied electrical fields in conditions where macrophage activity is critical.
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Affiliation(s)
- Joseph I Hoare
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Institute of Medical Sciences, Foresterhill, Aberdeen, United Kingdom
| | - Ann M Rajnicek
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Institute of Medical Sciences, Foresterhill, Aberdeen, United Kingdom
| | - Colin D McCaig
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Institute of Medical Sciences, Foresterhill, Aberdeen, United Kingdom
| | - Robert N Barker
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Institute of Medical Sciences, Foresterhill, Aberdeen, United Kingdom
| | - Heather M Wilson
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Institute of Medical Sciences, Foresterhill, Aberdeen, United Kingdom
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Abstract
Management of chronic wounds remains unsatisfactory in terms of treatment cost and time required for complete wound closure (CWC).This study aimed to calculate the healing rates, estimated cost, and time required for CWC in wounds; compare estimated wound care costs between healing and nonhealing wounds; and compare cost effectiveness between venous leg ulcer (VLU) and non-VLU.This was a retrospective cohort study performed at a physical therapy (PT) wound care clinic. Deidentified patient data in the electronic medical database from September 10, 2012 to January 23, 2015 were extracted.Among 159 included patients with wounds, 119 (74.84%) patients were healed with CWC. The included patients were treated for 109.70 ± 95.70 days, 29.71 ± 25.66 visits, and at the costs per treatment episode of $1629.65 ± 1378.82 per reimbursement rate and $2711.42 ± 2356.81 per breakeven rate. For patients with CWC (healing group), the treatment duration was 98.01 ± 76.12 days with the time for CWC as 72.45 ± 64.21 days; the cost per treatment episode was $1327.24 ± 1143.53 for reimbursement rate and $2492.58 ± 2106.88 for breakeven cost. For patients with nonhealing wounds, treatment duration was found to be longer with costs significantly higher (P < 0.01 for all). In the healing group, no differences were found between VLU and non-VLU in treatment duration (95.46 days vs. 100.88 days, P = 0.698), time for CWC (68.06 days vs. 77.38 days, P = 0.431), and cost ($2756.78 vs. 2397.84 for breakeven rate, P = 0.640) with the exception of wound dressing costs ($329.19 vs. 146.47, P = 0.001).Healing rates may be affected with patient exclusions. Costs at physicians' offices were not included.Incorporation of PT in wound care appeared to be cost effective. PT may thus be a good referral option for patients with wounds. However, the results should be interpreted cautiously and further studies are warranted.
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Affiliation(s)
- Kehua Zhou
- From the Daemen College Physical Therapy Wound Care Clinic, Daemen College, Amherst, New York, USA (KK, KZ); Department of Health Care Studies, Daemen College, Amherst, New York, USA (KZ); and Department of Physical Therapy, Daemen College, Amherst, New York, USA (MSB)
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Gibot L, Rols MP. Gene transfer by pulsed electric field is highly promising in cutaneous wound healing. Expert Opin Biol Ther 2015; 16:67-77. [DOI: 10.1517/14712598.2016.1098615] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Tran TDX, Le PTB, Van Pham P. Diabetic foot ulcer treatment by activated platelet rich plasma: a clinical study. BIOMEDICAL RESEARCH AND THERAPY 2014. [DOI: 10.7603/s40730-014-0008-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Yu C, Hu ZQ, Peng RY. Effects and mechanisms of a microcurrent dressing on skin wound healing: a review. Mil Med Res 2014; 1:24. [PMID: 26000170 PMCID: PMC4440595 DOI: 10.1186/2054-9369-1-24] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 10/10/2014] [Indexed: 12/28/2022] Open
Abstract
The variety of wound types has resulted in a wide range of wound dressings, with new products frequently being introduced to target different aspects of the wound healing process. The ideal wound dressing should achieve rapid healing at a reasonable cost, with minimal inconvenience to the patient. Microcurrent dressing, a novel wound dressing with inherent electric activity, can generate low-level microcurrents at the device-wound contact surface in the presence of moisture and can provide an advanced wound healing solution for managing wounds. This article offers a review of the effects and mechanisms of the microcurrent dressing on the healing of skin wounds.
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Affiliation(s)
- Chao Yu
- Beijing Institute of Radiation Medicine, Beijing, 100850 China
| | - Zong-Qian Hu
- Beijing Institute of Radiation Medicine, Beijing, 100850 China
| | - Rui-Yun Peng
- Beijing Institute of Radiation Medicine, Beijing, 100850 China
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