Wound Repair and Regeneration最新文献

Rotator cuff (RC) pathology encompasses a wide range of conditions, which include bursitis, tendinitis, tendinosis, partial thickness tears and full-thickness tears. To treat painful musculoskeletal problems, low-level laser therapy (LLLT) has been employed as a non-pharmacological alternative. Photobiomodulation (PBM), which uses light-emitting diodes (LEDs) and other photo-emitting devices, is a minimally invasive approach used to treat a wide range of conditions. The purpose of this pre-post study design is to evaluate the effectiveness of PBM and exercise-based rehabilitation on pain and functional recovery in patients with RC pathology. Twenty of the thirty-seven patients who were tested for shoulder disorders and found to have RC pathology were included in the study. The patients' pain levels were measured using the Numerical Pain Rating Scale (NPRS) both at baseline and 6 weeks later. The mean ± standard deviation of NPRS was calculated, data was checked for normal distribution, and the Wilcoxon rank test was conducted to compare the values. Our study showed a statistically significant reduction in pain scores from baseline (7.33 ± 0.79) to 6 weeks (2.50 ± 0.69), p < 0.001 of PBM and exercise-based rehabilitation. The knowledge about the evidence regarding the effectiveness of PBM, along with exercise-based rehabilitation, is critical.

Delayed wound healing and non-healing wounds are common in diabetic patients due to the hostile microenvironments and complex pathophysiology of diabetic wounds. Addressing these challenges remains a significant concern for clinicians and researchers. Recently, microneedle technology has emerged as an effective, minimally invasive delivery system for treating diabetic wounds, offering ease of use and efficient drug delivery. Naturally derived biomaterial-based microneedles have demonstrated excellent biocompatibility, degradability, and low toxicity, enhancing the healing process by providing mechanical support and delivering antimicrobial agents, growth factors, and antioxidants. Some microneedles are designed to adapt to the specific microenvironments of diabetic wounds, leading to improved healing outcomes. This review summarises the design and development of naturally derived biomaterial-based microneedles for diabetic wound healing and discusses the mechanisms of action in response to varying diabetic wound conditions. The review also addresses critical considerations for developing microenvironment-response microneedles, highlighting implications for translational medicine. Collectively, interdisciplinary collaboration and technological innovation have advanced the creation of these microenvironment-response microneedles using natural biomaterials, which hold significant potential for improving diabetic wound healing.

The late 1980s saw the emergence of experimental therapies based on human cell and tissue products (HCTPs) within academic and hospital settings, several of them wound healing related. In 2008, the European Commission introduced the Regulation on advanced therapy medicinal products (ATMPs), defining many of these HCTPs as ATMPs, and more specifically as somatic cell therapy medicinal products (sCTMPs) or tissue-engineered products (TEPs). In 2013, we predicted that the ATMP regulation would adversely impact Member States' health care systems and would threaten the sustainability of many HCTPs provided by public health institutions. To assess the current ATMP state of play and investigate whether these predictions ultimately came true, we consulted relevant scientific and trade literature and official competent authority reports and surveyed the former Belgian HCTP producers. We found that the ATMP Regulation produced 19 authorised ATMPs, with 16 of them (84.2%) belonging to the gene therapy medicinal product (GTMP) class and only 3 HCTPs (15.8%), 2 TEPs and 1 sCTMP. List prices varied according to the ATMP class, with public health insurances struggling to reimburse ATMPs, especially the exuberantly priced GTMPs. This led to marketing authorization withdrawals, and crowd funding approaches and lotteries to determine who would receive lifesaving treatments. A hospital exemption (HE) scheme was enacted to protect ATMPs not intended for commercial exploitation. Whilst limited financial resources generally hampered HE utilisation by public actors, stringent regulatory policies made it virtually impossible in Belgium, resulting in meaningful HCTPs no longer being available to surgeons and their patients.

Full-thickness skin wound management remains a significant clinical challenge, necessitating innovative approaches that combine cellular therapy with biomaterial scaffolds. One of the promising approaches in regenerative medicine is the recellularisation of wound dressings. A polydimethylsiloxane (PDMS) substrate imprinted with ovine foetal keratinocytes was used as a template to induce the keratinocyte differentiation of adipose-derived mesenchymal stem cells (ADSCs) in this study. The therapeutic efficacy on full-thickness cutaneous wound regeneration was evaluated by employing keratinocyte-differentiated ADSCs (KC-ADSCs) in combination with collagen scaffolds in an ovine model. The successful differentiation of ADSCs into keratinocyte-like cells through the imprinted PDMS substrate was confirmed via immunocytochemical analysis of specific keratinocyte markers. The study implemented a randomised controlled design comparing four treatment groups: KC-ADSCs seeded on a collagen scaffold, undifferentiated ADSCs on a collagen scaffold, acellular collagen scaffold, and untreated controls. Wound healing was evaluated with and without polypropylene wound isolation chambers to prevent keratinocyte migration and wound contraction. Healing outcomes were assessed through standardised macroscopic documentation and comprehensive histopathological analysis over 3 weeks. The KC-ADSC/collagen scaffold combination demonstrated significantly superior wound healing characteristics (p < 0.05), including enhanced re-epithelialisation, advanced granulation tissue maturation, reduced inflammatory infiltrate, and improved neovascularisation compared to control groups. This therapeutic superiority was particularly evident in chambered wounds, where the KC-ADSC/collagen construct promoted substantial epithelial regeneration despite restricted wound contraction and cell migration. Ultimately, this method can be introduced as a growth factor-independent approach for cell differentiation and a clinically applicable therapeutic strategy for skin tissue engineering and regenerative medicine.

Diabetic foot ulcer is a meaningful risk factor for limb amputation. The aim of this study was to evaluate the relationship between parameters provided by Continuous Glucose Monitoring and the healing time of DFUs in the real world. This pilot prospective study included patients with Type 2 diabetes with DFUs grade I-II (stage A-C) of the University of Texas Diabetic Wound Classification System, treated in an outpatient Diabetic Foot Unit according to standards of care. Participants were fitted with a CGM device until the ulcer closure. We observed an inverse correlation between the elapsed time to achieve a complete ulcer closure and Time in Range (p = 0.005). In addition, a direct correlation was found between the time required for ulcer healing and both Time Above Range and Glucose Management Indicator (p < 0.05). Glycaemic control is directly related to ulcer wound healing in non-complicated diabetic foot ulcer.

Decubitus ulcers are common, hard-to-heal skin ulcers characterised by a high incidence, rapid progression, and a tendency to recur after healing. However, data on the burden and trends of this disease are limited. This study aimed to analyse the epidemiological characteristics and disease burden of decubitus ulcers from 1990 to 2021, and predict their future trends from 2022 to 2050. We retrieved decubitus ulcers data from 204 countries and regions worldwide from the Global Burden of Disease Study 2021 between 1990 and 2021. We analysed the prevalence, incidence, disability-adjusted life years (DALYs), age-standardised rates (ASRs), and estimated annual percentage changes at the global, regional, and national levels. Additionally, we examined global trends by age, sex, and socio-demographic index (SDI). Finally, we used the autoregressive integrated moving average and exponential smoothing models to predict future trends of the disease burden from 2022 to 2050. Globally, from 1990 to 2021, the incidence and prevalence of cases, deaths, and DALYs associated with decubitus ulcers revealed an increasing trend, while the corresponding ASRs exhibited a decreasing trend. Among all age groups, the elderly had the highest incidence, prevalence, and mortality rates. Regionally, high-income North America had the highest age-standardised incidence and prevalence rates; Southern Sub-Saharan Africa had the highest age-standardised death rate; and Eastern Sub-Saharan Africa had the highest age-standardised DALY rate. In terms of SDI, regions with a higher SDI had the highest age-standardised incidence and prevalence rates, while their mortality rates and DALYs were lower. By integrating the prediction results from the two models, we found that the incidence and prevalence of cases, deaths, and DALYs for both sexes will continue to increase from 2022 to 2050. However, the ASRs are expected to remain relatively stable in the future.

Facial symptoms of systemic sclerosis (SSc)-such as reduced skin elasticity, fibrosis and microstomy-significantly impact quality of life. In recent years, autologous fat grafting has emerged as a promising treatment for these issues, but determining the optimal timing and techniques for fat injection remains a challenge for surgeons. Our study aimed to perform a systematic review of the available literature to establish a standardised protocol for this procedure. We reviewed all relevant studies published up to 18 August 2023, focusing specifically on diffuse facial scleroderma. In addition to clinical reports, we included articles discussing the pathophysiological mechanisms behind the effects of adipose stem cells. A total of 18 articles were analysed, revealing a range of methods and timelines for the procedure. The volume of fat injected varied from 6 cc for perioral treatment to 72 cc for a full-face approach, with treatment intervals ranging from one session per year to one every 3 months. On average, around 50% of the fat was reabsorbed within 6 months. Adipose stem cells were identified as a key factor in both tissue regeneration and fat resorption rates. This review supports the effectiveness of autologous fat grafting for facial scleroderma, emphasising the role of adipose stem cells. For optimal results, two procedures spaced 3-6 months apart, followed by annual maintenance, are recommended. Consistent fat volumes in different facial areas are essential to achieve longer-lasting outcomes and minimise resorption.

Chronic wounds (CW) are a major public health problem. Acellular fish skin grafts (AFSG) are increasingly used in advanced wound care, but data on their effectiveness and costs in real-world settings are scarce. We therefore retrospectively analysed the wound surface area (WSA), pain scores, and AFSG-related costs in patients with CW over a 12-week follow-up period. In this single-centre observational study, we analysed two datasets of 34 (full dataset) and 22 (WSA-dataset) CW patients treated with AFSG in a university hospital. Of 34 AFSG-treated patients (mean age 75.9 ± 11.4 years, 44.0% females) with 50 CW of various aetiologies (median ulcer duration 32 weeks), 66.6% experienced pain improvement at 12 weeks. Of 22 patients, 19 (86.4%) showed a mean reduction in WSA of -60.7% ± 143.8% (p = 0.0025); 36.4% of CW were healed. AFSG-related costs were 1232.3 EUR/patient and 130.4 EUR/reduced cm² (n = 22), which was 6.5 times more cost-effective compared to previous study results using living cellular skin substitutes. During 12 weeks of follow-up in a real-world setting, AFSG resulted in reduced WSA in most patients, improved pain in two-thirds, and healed CW in one-third. AFSG may be more cost-effective than other products, but prospective head-to-head comparisons are needed.