Nutrition and wound healing: the necessity of assessment

The effect of κ-carrageenan and ursolic acid on the physicochemical properties of the electrospun nanofibrous mat for biomedical application

Wound dressing materials such as nanofiber (NF) mats have gained a lot of attention in recent years owing to their wonderful effect on accelerating the healing process and protection of wounds. In this regard, three different types of NF mats were fabricated using pure polyvinylpyrrolidone (PVP), PVP/κ-carrageenan (KG), and ursolic acid (UA) in the optimal PVP/KG ratio by electrospinning method to apply them as wound dressings. The morphology, chemical structure, degradation, porosity, mechanical properties and antioxidant activity of the produced NFs were investigated. Moreover, cell studies (e.g., cell proliferation, adhesion, and migration) and their antibacterial properties were evaluated. Adding KG and UA reduced the mean diameter size of the PVP-based NFs to ∼98 nm in the optimal sample, with defect-free morphology. The PVP/KG/UA 0.25 % exhibited the highest porosity, hydrophilicity, and degradation rate and a wound closure rate of 60 %, 2.5 times higher than that of the control group. Furthermore, this sample's proliferation and antibacterial ability were significantly higher than the other groups. These findings confirmed that the produced UA-loaded NFs have excellent properties as wound dressing.

Unwinding the potentials of vitamin C in COVID-19 and other diseases: An updated review

Background: The discovery of vitamin C (ascorbic acid) is related to the ancient history of persistent research on the origins of the haemorrhagic disease scurvy. Vitamin C is an important nutrient that aids in a variety of biological and physiological processes. Scientists have been researching the function of vitamin C in the prevention and ailment of sepsis and pneumonia for decades. This has created a potential platform for applying these results to individuals suffering from severe coronavirus infection (COVID-19). Vitamin C's ability to activate and enhance the immune system makes it a promising treatment in the present COVID-19 pandemic. Vitamin C also aids in the activation of vitamin B, the production of certain neurotransmitters, and the transformation of cholesterol into bile acids. Hence, vitamin C is used for the treatment of many diseases. Aim: This review highlights the Vitamin C investigations that are performed by various researchers on patients with COVID 19 infection, the clinical studies and their observations. The authors have additionally updated information on the significance of vitamin C insufficiency, as well as its relevance and involvement in diseases such as cancer, wound healing, iron deficiency anaemia, atherosclerosis and neurodegenerative disorders. Here, we discuss them with the references. Methods: The method used in order to perform literature search was done using SciFinder, PubMed and ScienceDirect. Results: There is a potential role of vitamin C in various diseases including neurodegenerative disorders, COVID-19 and other diseases and the results are highlighted in the review with the help of clinical and preclinical data. Conclusion: More research on vitamin C and the undergoing clinical trials might prove a potential role of vitamin C in protecting the population from current COVID-19 pandemic.

Plant-Based, Hydrogel-like Microfibers as an Antioxidant Platform for Skin Burn Healing

Natural polymers from organic wastes have gained increasing attention in the biomedical field as resourceful second raw materials for the design of biomedical devices which can perform a specific bioactive function and eventually degrade without liberating toxic residues in the surroundings. In this context, patches and bandages, that need to support the skin wound healing process for a short amount of time to be then discarded, certainly constitute good candidates in our quest for a more environmentally friendly management. Here, we propose a plant-based microfibrous scaffold, loaded with vitamin C (VitC), a bioactive molecule which acts as a protecting agent against UV damages and as a wound healing promoter. Fibers were fabricated via electrospinning from various zein/pectin formulations, and subsequently cross-linked in the presence of Ca2+ to confer them a hydrogel-like behavior, which we exploited to tune both the drug release profile and the scaffold degradation. A comprehensive characterization of the physico-chemical properties of the zein/pectin/VitC scaffolds, either pristine or cross-linked, has been carried out, together with the bioactivity assessment with two representative skin cell populations (human dermal fibroblast cells and skin keratinocytes, HaCaT cells). Interestingly, col-1a gene expression of dermal fibroblasts increased after 3 days of growth in the presence of the microfiber extraction media, indicating that the released VitC was able to stimulate collagen mRNA production overtime. Antioxidant activity was analyzed on HaCaT cells via DCFH-DA assay, highlighting a fluorescence intensity decrease proportional to the amount of loaded VitC (down to 50 and 30%), confirming the protective effect of the matrices against oxidative stress. Finally, the most performing samples were selected for the in vivo test on a skin UVB-burn mouse model, where our constructs demonstrated to significantly reduce the inflammatory cytokines expression in the injured area (50% lower than the control), thus constituting a promising, environmentally sustainable alternative to skin patches.

Augmentation-Mastopexy: Analysis of 95 Consecutive Patients and Critical Appraisal of the Procedure

Single-stage mastopexy-augmentation has been demonstrated to be a safe procedure. However, revisions may still be necessary. We evaluate 95 consecutive patients undergoing mastopexy-augmentation and introduce a new surgical technique for the procedure: the modified dual plane technique. In this retrospective study, 95 patients (mean age 34 ± 11 years) underwent mastopexy-augmentation between 2009 and 2019. The procedures were classified as subglandular, dual plane, or modified dual plane technique. The outcome measures included major and minor complications. A total of 19 patients underwent a subglandular procedure, 32 patients a dual plane procedure, and 44 patients a modified dual plane procedure. We observed a high overall complication rate in the subglandular group (n = 12, 63%), dual plane group (n = 15, 47%), and modified dual plane group (n = 10, 23%). Complications leading to implant loss/change occurred in seven patients in the subglandular group (37%), six patients in the dual plane group (19%), and no patient in the modified dual plane group. While we observed a high complication rate in patients undergoing mastopexy-augmentations, the modified dual plane technique was associated with a lower complication rate.

Nutritional Management of Infants With a Giant Ruptured Omphalocele: Clinical Observations From a Single Institution Case Series

The nutritional requirements of neonates with congenital abdominal wall defects (AWDs) remain poorly described. In particular, there is a lack of literature on the calorie, protein, and micronutrient needs of those with AWD. Nutritional therapy is a cornerstone of care in patients with burns due to the metabolic consequences of injury to the epithelial layer. Similarly, children with AWD may require specialized nutritional plans to support their growth and wound healing. This case series supports the theory that patients with ruptured omphaloceles may require higher calorie, protein, and micronutrient provisions in comparison to patients with intact omphaloceles, due to increased metabolic demand to support wound healing and skin epithelialization.

SVCT2-GLUT1-mediated ascorbic acid transport pathway in rat dental pulp and its effects during wound healing

Ascorbic acid (AA; vitamin C) plays a crucial role in the biosynthesis and secretion of collagen to produce the organic matrix of hard tissues. Nevertheless, the detailed mechanism by which AA induces reparative dentinogenesis is still unknown. This study aimed to investigate the pathway and function of AA during wound healing in a rat pulpotomy model. Sodium-dependent vitamin C transporter (SVCT) 2 and glucose transporter (GLUT) 1 were detected in odontoblasts, endothelial cells, and nerve fibers in normal pulp tissues. SVCT2 and GLUT1 were also expressed in odontoblast-like cells in pulpotomized tissues of Wistar rats, and immunopositive cells of SVCT2 were significantly increased at 5 days after pulpotomy (p < 0.05). By contrast, osteogenic disorder Shionogi (ODS) rats, which cannot generate AA, also expressed SVCT2 and GLUT1 in normal and wound healing conditions. However, in ODS rats, when compared with the AA-addition group, the formation of dentin bridges in the AA-loss group was not evident, a layer of osteopontin was significantly increased beneath the wound surface (p < 0.05), and alpha smooth muscle actin at the odontoblast-like cells observed along this layer was significantly increased (p < 0.05), but not Nestin. Moreover, the amounts of type 1 collagen generated in the reparative dentin and beneath the wound healing site were significantly diminished (p < 0.05). Macrophages expressing CD68 and CD206 increased beneath the wound site. Hence, AA may be involved in odontoblast-like cell differentiation and anti-inflammatory response during dental pulp wound healing. Our results provide new insights into the function of AA through SVCT2 and GLUT1 in reparative dentinogenesis and may help in developing new therapeutic targets for dental pulpal disease.

Macronutrient and micronutrient intake of individuals with diabetic foot ulceration: A short report

BACKGROUND

Adequate nutrition is essential in individuals with diabetic foot ulceration (DFU); therefore, an assessment of dietary intake is critical. A lack of nutrients including protein, zinc and vitamins C and D have all been associated with poor wound healing. However, the comprehensive dietary intake of Australian adults with DFU is poorly understood. The aim of this cross-sectional study was to describe the dietary intake of adults with DFU in an Australian setting.

METHODS

Participants (n = 115) with diabetes (type 1 and 2), a mean body mass index of 36 and current foot ulceration were recruited from across New South Wales, Australia. Dietary intake was assessed using the Australian Eating Survey, a self-reported validated food frequency questionnaire.

RESULTS

The mean (SD) reported energy intake was 9.57 (±SD 4.43) MJ day^-1 . A mean protein intake of 104 (±SD 49) g day^-1 is below recommended intake for wound healing; however, the mean protein intake contribution to energy (19%E) was within recommendations for normal populations. The mean carbohydrate intake (43%E) was within recommended ranges for healthy populations; however, the mean total fat intake (36%E) was above recommendations. Micronutrient intake was adequate, apart from folate, which was below the recommended intake, and sodium, vitamin C, vitamin A and selenium, which were above the recommended intake.

CONCLUSIONS

A lack of adequate folate may have a negative impact on healing, with folate proposed to play a role in tissue repair. Wound management of individuals with DFU should include a regular assessment of dietary intake to recognise deficiencies in macro- and micronutrients, and subsequently address these inadequacies to optimise healing.

Associations between Nutrients and Foot Ulceration in Diabetes: A Systematic Review

We reviewed the literature to evaluate potential associations between vitamins, nutrients, nutritional status or nutritional interventions and presence or healing of foot ulceration in diabetes. Embase, Medline, PubMed, and the Cochrane Library were searched for studies published prior to September 2020. We assessed eligible studies for the association between nutritional status or interventions and foot ulcers. Fifteen studies met the inclusion criteria and were included in this review. Overall, there is a correlation between poor nutritional status and the presence of foot ulceration or a delay in healing. However, there is not enough data to reach conclusions about whether the relationships are causal or only association. Further research is required to test whether any forms of nutritional supplementation improve foot ulcer healing.

A split-mouth randomized clinical trial to evaluate the effect of local and systemic administration of vitamin C on extraction wound healing

A split-mouth single-blind randomized-controlled clinical trial study was designed to investigate the effect of local and systemic vitamin C administration on extraction wound healing. Thirty patients who underwent bilateral premolar extraction were randomly divided into three group pairs; group 1: control and systemic administration (Con/CSA), group 2: control and a combination of local and systemic administration (Con/CLSA), and group 3: systemic and a combination of local and systemic administration (CSA/CLSA). The vitamin C (600 mg) was taken by swallowing (systemic administration) or slow oral dissolution (combined local and systemic administration). The socket size and radiographic density were evaluated immediately after extraction, and 7 days and 21 days later. The results demonstrated that the percentage radiographic density of new bone formation in the socket did not differ significantly within each group. However, in the CSA and CLSA group there was an improvement of soft tissue healing based in terms of socket depth reduction at 21 days after extraction compared with the control (P < 0.05).

Intraoperative Cerebrospinal Fluid Leak in Extradural Spinal Tumor Surgery

Objective

Patients with extradural spine tumors are at an increased risk for intraoperative cerebrospinal fluid (CSF) leaks and postoperative wound dehiscence due to radiotherapy and other comorbidities related to systemic cancer treatment. In this case series, we discuss our experience with the management of intraoperative durotomies and wound closure strategies for this complex surgical patient population.

Methods

We reviewed our recent single-center experience with spine surgery for primarily extradural tumors, with attention to intraoperative durotomy occurrence and postoperative wound-related complications.

Results

A total of 105 patients underwent tumor resection and spinal reconstruction with instrumented fusion for a multitude of pathologies. Twelve of the 105 patients (11.4%) reviewed had intraoperative durotomies. Of these, 3 underwent reoperation for a delayed complication, including 1 epidural hematoma, 1 retained drain, and 1 wound infection. Of the 93 uncomplicated index operations, there were a total of 9 reoperations: 2 for epidural hematoma, 3 for wound infection, 2 for wound dehiscence, and 2 for recurrent primary disease. One patient was readmitted for a delayed spinal fluid leak. The average length of stay for patients with and without intraoperative durotomy was 7.3 and 5.9 days, respectively, with a nonsignificant trend for an increased length of stay in the durotomy cases (p=0.098).

Conclusion

Surgery for extradural tumor resections can be complicated by CSF leaks due to the proximity of the tumor to the dura. When encountered, a variety of strategies may be employed to minimize subsequent morbidity.

Micronutrients and Natural Compounds Status and Their Effects on Wound Healing in the Diabetic Foot Ulcer

The diabetic foot ulcer (DFU) is an invariably common complication of diabetes mellitus, it is also a significant cause of amputation as well as extended hospitalization. As most patients with DFU suffer from malnutrition, which has been related to improper metabolic micronutrients status, alterations can affect impaired wound healing process. Micronutrients and herbal remedies applications present a wide range of health advantages to patients with DFU. The purpose of this review is to provide current evidence on the potential effect of dietary supplementations such as vitamins A, C, D, E, magnesium, zinc, copper, iron, boron, and such naturally occurring compounds as Aloe vera, Naringin, and Radix Astragali (RA) and Radix Rehmanniae (RR) in the administration of lower extremity wounds, especially in DFU, and to present some insights for applications in the treatment of DFU patients in the future.

CORRELATION BETWEEN NUTRITIONAL STATUS AND CLINICAL RESULTS IN PATIENTS UNDERGOING SPINAL SURGERY

ABSTRACT Objective: To investigate the relationship between preoperative vitamin D and albumin levels and postoperative quality of life in patients undergoing spinal surgery. Methods: Patients undergoing thoracic and lumbar spine surgery were evaluated in this prospective study. Their vitamin D and albumin levels were assessed before surgery and quality of life was measured by two questionnaires, Oswestry Disability Index (ODI) and Scoliosis Research Society - 22 (SRS-22), one year after the procedure. Data on infection occurrence and healing time were collected. Preoperative nutritional values and patients’ quality of life were analyzed using the chi-square test and ANOVA for albumin and vitamin D, respectively. The relationship among nutritional status, healing time, and the occurrence of infection was evaluated by the Pearson correlation coefficient. Results: Forty-six patients were included and their mean nutritional values were 19.1 (6.6) ng/mL for vitamin D and 3.9 (0.6) g/dL for albumin [mean (standard deviation)]. No association was found between vitamin D and quality of life of patients measured by ODI (p=0.534) and SRS-22 (p=0.739) questionnaires. There was also no association between albumin levels and quality of life measured by ODI (p=0.259) and SRS-22 (p=0.076) questionnaires. No correlation was found between the healing time or occurrence of infection and nutritional values. Conclusions: There was no association between vitamin D and albumin levels and the surgical result, according to the patient’s perception, besides the occurrence of complications with the surgical wound.

The potential benefits and harms of early feeding post-surgery: a literature review

The effect of nutrition on wound healing is widely recognized, with many studies highlighting the detrimental effect poor nutrition can have on wound healing. In addition, fasting pre-, peri- and postoperatively can contribute to further protein catabolism, leading to morbidity and mortality. By reviewing the current literature, this work evaluates the potential benefits and harms from early feeding (EF) during the early stages postsurgery. Current randomised control trials suggest that the early introduction of nutrients post-surgery may be beneficial for wound healing and recovery from surgery. Additionally, this approach does not seem to impose any increased complications post-operatively. Conversely, although there is ongoing research supporting EF and evidence showing that malnutrition can delay wound healing and recovery, healthcare professionals remain sceptical with a slow uptake in adopting EF protocols.

Influence of the nutritional status in the clinical and therapeutical evolution in adults and elderly with American Tegumentary Leishmaniasis

The objective of this study is to describe the nutritional status of adult and elderly patients with American Tegumentary Leishmaniasis (ATL). It was conducted a longitudinal study in 68 adult and elderly patients with ATL treating at the Surveillance Leishmaniasis Laboratory at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (Fiocruz), from 2009 to 2012. The nutritional assessment included the body mass index (BMI) and serum albumin levels. The clinical evolution (epithelialization and wound healing) was measured up to two years after ATL treatment. Most of the sample was composed of men (71%), adults (73%), with household income of 1-5 minimum wages (79%), and incomplete elementary school (48.5%). The predominant ATL form was cutaneous (72%), and 39% presented comorbidities, the most frequent was hypertension (30.8%). The most prevalent clinical and nutritional events were: recent decrease in food intake (23.9%); nasal obstruction (22.1%); oral ulcer (14.7%), anorexia and dysphagia (13.2% each) and odynophagia (10.3%). The total healing time was 115.00 (IR=80-230) days for skin lesions, and 120.00 (IR=104.50-223.50) days for mucous membrane lesions. Low body weight in 10%, and hypoalbuminemia in 12% of the patients have been observed. Low body weight was associated with age, mucosal leishmaniasis (ML), nasal obstruction, recent decrease in food intake and hypoalbuminemia. As for serum albumin depletion, association with the ML, dyspnea, dysphagia, odynophagia, recent decrease in food intake, absence of complete healing of the skin lesions, and increased healing time for mucous membrane lesions, was observed. The ML and their events that affect the alimentary intake have been related to the impairment of the nutritional status. Additionally, serum albumin depletion negatively affected the healing of the lesions, suggesting that a nutritional intervention can increase the effectiveness of the ATL treatment.

Wound healing essentials: let there be oxygen

The state of wound oxygenation is a key determinant of healing outcomes. From a diagnostic standpoint, measurements of wound oxygenation are commonly used to guide treatment planning such as amputation decision. In preventive applications, optimizing wound perfusion and providing supplemental O(2) in the perioperative period reduces the incidence of postoperative infections. Correction of wound pO(2) may, by itself, trigger some healing responses. Importantly, approaches to correct wound pO(2) favorably influence outcomes of other therapies such as responsiveness to growth factors and acceptance of grafts. Chronic ischemic wounds are essentially hypoxic. Primarily based on the tumor literature, hypoxia is generally viewed as being angiogenic. This is true with the condition that hypoxia be acute and mild to modest in magnitude. Extreme near-anoxic hypoxia, as commonly noted in problem wounds, is not compatible with tissue repair. Adequate wound tissue oxygenation is required but may not be sufficient to favorably influence healing outcomes. Success in wound care may be improved by a personalized health care approach. The key lies in our ability to specifically identify the key limitations of a given wound and in developing a multifaceted strategy to specifically address those limitations. In considering approaches to oxygenate the wound tissue it is important to recognize that both too little as well as too much may impede the healing process. Oxygen dosing based on the specific need of a wound therefore seems prudent. Therapeutic approaches targeting the oxygen sensing and redox signaling pathways are promising.