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1.
Teriparatide Promotes Bone Healing in Medication-Related Osteonecrosis of the Jaw: A Placebo-Controlled, Randomized Trial.
Sim, IW, Borromeo, GL, Tsao, C, Hardiman, R, Hofman, MS, Papatziamos Hjelle, C, Siddique, M, Cook, GJR, Seymour, JF, Ebeling, PR
Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2020;(26):2971-2980
Abstract
PURPOSE Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent but morbid and potentially serious condition associated with antiresorptive and antiangiogenic therapies. Although MRONJ can be prevented by optimizing oral health, management of established cases is supportive and remains challenging. Teriparatide, an osteoanabolic agent that improves bone healing in preclinical studies and in chronic periodontitis, represents a potential treatment option. PATIENTS AND METHODS In a double-blind, randomized, controlled trial, 34 participants with established MRONJ, with a total of 47 distinct MRONJ lesions, were allocated to either 8 weeks of subcutaneous teriparatide (20 µg/day) or placebo injections, in addition to calcium and vitamin D supplementation and standard clinical care. Participants were observed for 12 months, with primary outcomes that included the clinical and radiologic resolution of MRONJ lesions. Secondary outcomes included osteoblastic responses as measured biochemically and radiologically and changes in quality of life. RESULTS Teriparatide was associated with a greater rate of resolution of MRONJ lesions (odds ratio [OR], 0.15 v 0.40; P = .013), and 45.4% of lesions resolved by 52 weeks compared with 33.3% in the placebo group. Teriparatide was also associated with reduced bony defects at week 52 (OR, 8.1; P = .017). The incidence of adverse events was balanced between groups, including nausea, anorexia, and musculoskeletal pain, most of mild severity. CONCLUSION Teriparatide improves the rate of resolution of MRONJ lesions and represents an efficacious and safe treatment for it.
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2.
The use of moist exposed burn ointment (MEBO) for the treatment of burn wounds: a systematic review.
Mabvuure, NT, Brewer, CF, Gervin, K, Duffy, S
Journal of plastic surgery and hand surgery. 2020;(6):337-343
Abstract
Moist exposed burn ointment (MEBO) is an oil-based herbal paste, purported to be efficacious in managing burn wounds and more commonly used in Asia and the Middle East. A PRISMA-compliant systematic review was performed to analyse the evidence for the use of MEBO on burn wounds. Wound healing rate was the primary outcome of interest. PubMed-listed randomised controlled trials (RCTs) comparing the efficacy of MEBO with placebo, standard care or other therapies in the treatment of partial thickness burns in adults and children were eligible for inclusion (November 2019). Six RCTs were eligible. The majority of trials comparing wound healing between MEBO and SSD favoured MEBO (two of three). There may be improved healing in MEBO-treated wounds vs. those treated with povidone-iodine + bepanthenol cream. There was no difference between MEBO and Acquacel Ag, but Helix Aspersa had faster healing rates than MEBO. However, all evidence was from moderately to poorly reported trials with a high risk of bias, thereby limiting the strength of this evidence. In conclusion, the evidence for MEBO in English-language literature was poor and inconsistent with respect to wound healing rate and analgesis compared to 1% SSD, Acquacel Ag, Helix aspersa cream and povidone-iodine + bepanthenol cream. Blinded RCTs comparing MEBO to both placebo and other common topical treatments may further improve the confidence in concluding their analysis. There is some evidence that MEBO is as safe as its comparators as shown by the low complication rate.
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3.
Effectiveness of Topical Insulin Dressings in Management of Diabetic Foot Ulcers.
Bhettani, MK, Rehman, M, Altaf, HN, Altaf, OS
World journal of surgery. 2020;(6):2028-2033
Abstract
BACKGROUND Infected diabetic foot ulcers are always a problem for the surgeon, as well as, an economic burden upon the patient and state, in terms of increased hospital stay and cost of medications and dressings. Various methods have been devised for the treatment of infected wounds in history with varying results in different patients groups. The purpose of this study is to compare the effectiveness of topical insulin on the healing of diabetic foot ulcers with the conventional Pyodine® povidone iodine dressing. Our objective was to compare effectiveness of topical insulin with conventional Pyodine® povidone iodine dressings in frequency of healing of diabetic foot ulcers. MATERIALS AND METHODS It was a quasi-experimental study done at Pakistan Institute of Medical Sciences Islamabad over a period of 20 months from January 2015 to September 2016. One hundred ten patients were included in the study. Sampling technique used was non-probability consecutive. Patients were assigned into two groups, group A receiving treatment with solution of 30 International Units Insulin Regular in 30 ml of normal saline and group B receiving conventional dressing with normal saline. The wound were compared for both groups at the days 7, 14 and 21 for wound healing. Complete healing time of diabetic foot ulcers was determined from patients' followup visits in outpatient department. Data was by analyzed by SPSS 20. RESULTS A total of 110 patients were enrolled in the study. Patients were divided equally into both control and experimental groups. The mean age of the patients was 53.23 ± 6.21 years. The mean pre-treatment wound diameter was 4.81 ± 0.85 cm in the placebo group, while it was 4.84 ± 0.81 cm in the topical insulin group (CI 0.29-0.35, P = 0.875). The mean post-treatment wound diameter was 3.90 ± 0.76 cm in the placebo group, while it was 2.46 ± 0.57 cm in the topical insulin group (CI 0.44-0.58, P = 0.022). The mean wound difference was 0.91 ± 0.25 cm in the placebo group, while it was 2.4 ± 0.34 cm in the topical insulin group (CI 0.40-0.20, P = 0.041). The mean percent reduction in wound diameter was 19.2 ± 4.6% in the placebo group, while it was 49.7 ± 5.2% cm in the topical insulin group (CI 10.6-6.1, P = 0.001). CONCLUSION There was significant contraction seen in the size of the ulcer in both the study groups depicting the healing process.
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4.
Multinutrient Supplementation Increases Collagen Synthesis during Early Wound Repair in a Randomized Controlled Trial in Patients with Inguinal Hernia.
Kjaer, M, Frederiksen, AKS, Nissen, NI, Willumsen, N, van Hall, G, Jorgensen, LN, Andersen, JR, Ågren, MS
The Journal of nutrition. 2020;(4):792-799
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Abstract
BACKGROUND Inguinal hernia disease is associated with an imbalanced collagen metabolism. Surgical stress has a negative impact on nutrients important for collagen synthesis. OBJECTIVE We hypothesized that supplementation with a combination of nutrients would enhance collagen biosynthesis in inguinal hernia disease patients when undergoing hernia repair. METHODS In this exploratory randomized controlled trial, 21 men (age: 55.2 ± 2.8 y; BMI: 25.0 ± 0.7 kg/m2) scheduled for Lichtenstein inguinal hernia repair were assigned to multinutrient supplementation (n = 10; multinutrient group) or no multinutrient supplementation (n = 11; control group). The multinutrient group received 14 g l-arginine, 14 g l-glutamine, 1250 mg vitamin C, and 55 mg zinc daily starting 14 d before surgery and ending 14 d after surgery. The multinutrient and control groups received high-quality protein to ensure a daily intake of 1.5 g protein/kg. Collagen biosynthesis was measured by the biomarkers type I procollagen propeptide (CICP), type III procollagen propeptide (PRO-C3), and type V procollagen propeptide (PRO-C5) in the sera on days -14, 0, and 1, and in the wound fluids on postoperative days 1 and 2. Compliance was recorded after the 28-d intervention period. RESULTS Serum PRO-C5 concentrations decreased (P < 0.05) postoperatively in the control but not the multinutrient group. Neither CICP nor PRO-C3 serum concentrations differed significantly between the 2 groups. In wound fluid, the CICP concentrations increased (P < 0.05) from days 1 to 2 in the multinutrient group and were 49% higher (P = 0.10) than those in the control group on day 2. Wound fluid concentrations PRO-C3 and PRO-C5 showed no significant time or group differences. The 28-d compliance was similar (P = 0.27) in the 2 groups. CONCLUSION Oral supplementation with arginine, glutamine, vitamin C, and zinc augment collagen synthesis during the first 2 d after inguinal hernia repair. This trial was registered at clinicaltrials.gov as NCT03221686.
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The Effect of Comorbidities on Wound Healing.
Beyene, RT, Derryberry, SL, Barbul, A
The Surgical clinics of North America. 2020;(4):695-705
Abstract
Wound healing is affected by several factors. Preexisting diagnoses may significantly alter, delay, or inhibit normal wound healing. This is most commonly seen with chronic disorders, such as diabetes and renal failure, but also occurs secondary to aging and substance abuse. Less commonly, genetic or inflammatory disorders are the cause of delayed wound healing. In some cases, it is not the illness, but the treatment that can inhibit wound healing. This is seen in patients getting chemotherapy, radiation, steroids, methotrexate, and a host of other medications. Understanding these processes may help treat or avoid wound healing problems.
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Effects of sea salt rinses on subjects undergone to oral surgery: a single blinded randomized controlled trial.
Cantore, S, Ballini, A, Saini, R, Altini, V, De Vito, D, Pettini, F, Dipalma, G, Inchingolo, F
La Clinica terapeutica. 2020;(1):e46-e52
Abstract
PURPOSE It has been customary to explain the dentally beneficial effects of xylitol and certain other natural compound as lysozyme and seas salt in terms of microbiological effects only. Several studies have tested the use of natural ingredients, alcohol and fluoride free, in mouthwashes. The purpose of this study was to evaluate a combined mouthwash formulation containing natural antibiofilm agents in oral care wound healing after routinely oral surgery (extraction) procedures. METHODS Patients were assigned following a blinded randomized controlled trial and divided into two groups, an experimental group (I = 15) and a control (placebo) group (II = 15). Any infectious complications, wound healing, plaque accumulation in the stitches, and presence of trismus and inflammation were evaluated at ten and thirty days after extraction procedure. Pain and swelling were evaluated using the well-known visual analogue scale (VAS) scale throughout study period following extraction. The mean difference in Pre and Post values were compared among the groups. The change in pre-post score was analyzed using the paired t test. RESULTS An appreciable wound healing was seen in the experimental group when compared to the control sites, with no reported adverse effects. Four weeks postoperative patient's satisfaction level, to subjective and objective outcome measurements in documenting the result of a mouthwash treatment showed an interesting difference between groups. CONCLUSIONS Since combined mouthwash formulations, containing natural/bioactive substances, could provide a cheap, safe and acceptable alternative in oral care, further studies will also be required to study these effects and their mechanism of action in detail.
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A bioengineered living cell construct activates metallothionein/zinc/MMP8 and inhibits TGFβ to stimulate remodeling of fibrotic venous leg ulcers.
Stone, RC, Stojadinovic, O, Sawaya, AP, Glinos, GD, Lindley, LE, Pastar, I, Badiavas, E, Tomic-Canic, M
Wound repair and regeneration : official publication of the Wound Healing Society [and] the European Tissue Repair Society. 2020;(2):164-176
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Abstract
Venous leg ulcers (VLU) represent a major clinical unmet need, impairing quality of life for millions worldwide. The bioengineered bilayered living cell construct (BLCC) is the only FDA-approved therapy demonstrating efficacy in healing chronic VLU, yet its in vivo mechanisms of action are not well understood. Previously, we reported a BLCC-mediated acute wounding response at the ulcer edge; in this study we elucidated the BLCC-specific effects on the epidermis-free ulcer bed. We conducted a randomized controlled clinical trial (ClinicalTrials.gov NCT01327937) enrolling 30 subjects with nonhealing VLUs, and performed genotyping, genomic profiling, and functional analysis on wound bed biopsies obtained at baseline and 1 week after treatment with BLCC plus compression or compression therapy (control). The VLU bed transcriptome featured processes of chronic inflammation and was strikingly enriched for fibrotic/fibrogenic pathways and gene networks. BLCC application decreased expression of profibrotic TGFß1 gene targets and increased levels of TGFß inhibitor decorin. Surprisingly, BLCC upregulated metallothioneins and fibroblast-derived MMP8 collagenase, and promoted endogenous release of MMP-activating zinc to stimulate antifibrotic remodeling, a novel mechanism of cutaneous wound healing. By activating a remodeling program in the quiescent VLU bed, BLCC application shifts nonhealing to healing phenotype. As VLU bed fibrosis correlates with poor clinical healing, findings from this study identify the chronic VLU as a fibrotic skin disease and are first to support the development and application of antifibrotic therapies as a successful treatment approach.
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8.
Pressure Injury Prevention Considerations for Older Adults.
Cowan, L, Broderick, V, Alderden, JG
Critical care nursing clinics of North America. 2020;(4):601-609
Abstract
There are well-documented physiologic changes that occur in the human body during the aging process, such as decreased body fat, decreased muscle mass, cellular senescence, changes in skin pH, decreased metabolism, decreased immune function, vascular changes, altered tissue perfusion, nutritional status changes, and poor hydration. These changes affect skin integrity and wound healing, and raise the risk of pressure-related skin injury. This article discusses aging as a risk factor for pressure injury (PrI). Topics include evidence for advancing age as a significant PrI risk factor, identifying pathophysiologic changes/mechanisms of aging, and specific PrI preventive interventions to consider in older adults.
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Traditional uses, phytochemistry and pharmacology of Chios mastic gum (Pistacia lentiscus var. Chia, Anacardiaceae): A review.
Pachi, VK, Mikropoulou, EV, Gkiouvetidis, P, Siafakas, K, Argyropoulou, A, Angelis, A, Mitakou, S, Halabalaki, M
Journal of ethnopharmacology. 2020;:112485
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Chios mastic gum constitutes a unique Greek product, produced exclusively in the southern part of the island of Chios. References about its use from local populations for the treatment of gastrointestinal disorders or as a cosmetic agent can even be encountered in ancient texts of Galen, Theophrastus and Dioscorides. Nowadays, this versatile resin has been rediscovered, not only as a traditional remedy and aromatic agent, but as a potent phytotherapeutic product with various biological properties. AIM OF THE STUDY The aim of this study is to quote the summation of the ethnopharmacology, phytochemical profile and pharmacological properties of the resin of Pistacia lentiscus var. Chia and thus provide the scientific community with a summary of the research conducted so far. Furthermore, perspectives and uses are being discussed and studied so as to broaden the field of its applications. MATERIALS AND METHODS A comprehensive review of the literature on Pistacia lentiscus var. Chia was performed using as resources scientific databases such as Scopus, Sciencedirect, Pubmed and Web of science, studies and traditional books provided by the Chios Mastiha Growers Association as well as PhD and Master' s theses. RESULTS Chios mastic gum has been used as a traditional medicine over the last 2500 years. More than 120 chemical compounds have been identified in the resin and the major components are a natural polymer, acidic and neutral triterpenes and volatile secondary metabolites. Several plant extracts and compounds have been studied for their antibacterial, anti-inflammatory, antioxidant, anti-ulcer, anti-diabetic, cardioprotective and anti-cancer properties in vitro and in vivo. Clinical interventions and trials have also showed the therapeutic potential of Chios mastic gum. In 2015 Pistacia lentiscus L., resin (mastic) was recognized as a herbal medicinal product with traditional use by the European Medicines Agency (EMA) with two therapeutic indications (mild dyspeptic disorders & skin inflammation/healing of minor wounds). Over the last years, Chios mastic gum is widely involved in medicinal products, food supplements and cosmetics and has become object of study, also in the field of Pharmacotechnology. CONCLUSIONS Chios mastic's beneficial properties have been demonstrated in the treatment of gastrointestinal disorders, wound healing, skin inflammations, plasma lipid and blood sugar reduction and oral care. These properties are attributed to triterpenes and volatile compounds. However, because of the resin's chemical complexity and the lack of commercial standards for its main compounds, there is a notable gap in literature concerning the biological evaluation of CMG's isolated components. Therefore, future research should focus on the development of efficient extraction, isolation and analysis techniques in order to unravel CMG's full pharmacological potential.
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Resveratrol Inhibits Wound Healing and Lens Fibrosis: A Putative Candidate for Posterior Capsule Opacification Prevention.
Smith, AJO, Eldred, JA, Wormstone, IM
Investigative ophthalmology & visual science. 2019;(12):3863-3877
Abstract
PURPOSE Posterior capsule opacification (PCO) is a common complication of cataract surgery. In addition to improved surgical methods and IOL designs, it is likely additional agents will be needed to improve patient outcomes. Presently no pharmacological agent is in clinical use to prevent PCO. Here we investigate the putative ability of resveratrol (RESV), a naturally occurring polyphenol, as a therapeutic agent. METHODS The human lens epithelial cell line FHL124, a human lens capsular bag model, and central anterior epithelium were used as experimental systems. Standard culture was in 5% fetal calf serum Eagle's minimum essential medium; 10 ng/mL transforming growth factor-β2 (TGFβ2) was used to induce fibrotic changes. A scratch wound assay was used to measure cell migration and the patch assay was used to assess matrix contraction by FHL124 cells. Protein expression was assessed by immunocytochemistry and Western blot and gene expression by quantitative RT-PCR. In capsular bags, cell growth across the posterior lens capsule, capsular wrinkling, and epithelial-to-mesenchymal transition were determined by image analysis. RESULTS In FHL124 cells, addition of 30 μM RESV significantly impeded cell migration in a wound-healing assay. RESV significantly inhibited TGFβ2-induced expression of the myofibroblast marker alpha-smooth muscle actin (α-SMA) at both the message and protein levels, as well as significantly inhibiting matrix contraction induced by TGFβ2. In human capsular bags, 30 μM RESV significantly inhibited cell growth. TGFβ2-induced α-SMA expression and capsular wrinkling were also significantly inhibited by RESV treatment. RESV significantly suppressed expression of TGFβ2-induced genes associated with fibrotic disease, including matrix metalloproteinase-2 in FHL124 cells, capsular bags, and central anterior epithelium. CONCLUSIONS RESV can counter PCO-related physiological events in two human lens model systems. RESV therefore has the potential to be used as a candidate agent for the prevention of PCO, which in turn could benefit millions of cataract patients.