Abstract : Our preliminary hypothesis is that there are factors, biological and psychosocial, that increase or reduce vulnerability to PrUs among spinal cord injured persons. A retrospective review of 120 randomly sampled charts from patients undergoing the SCI Comprehensive Preventive Health Evaluation between Jan 1 and Dec 31, 2009 was conducted using a data extraction tool based on a set of variables thought to be important in PrU development. This sample, which focuses on outpatient veterans with SCI, represents an older population than previously studied (mean age across all groups=62). 74% sustained their injury more than 10 years ago. 39% of the index sample reported never having a pressure ulcer, while 31% had greater than or equal to 3 pressure ulcers since the time of injury. In this study severity of spinal cord injury based on ASIA and FIM scores, BMI greater than 25, prior hospitalization within the previous year, anemia, and service connection were identified as factors that increase pressure ulcer vulnerability. The study identified body composition with or without spasticity and caregiver activity as two factors that warrant further investigation in a prospective fashion.
Understanding the complex interplay of pro-inflammatory and anti-inflammatory cytokines is crucial in the field of wound healing, as it holds the key to developing effective therapeutics. In the initial stages of wound healing, pro-inflammatory cytokines like IL-1β, IL-6, TNF-α, and various chemokines play vital roles in recruiting cells for debris clearance and the recruitment of growth factors. Careful regulation and timely resolution of this early inflammation are essential for optimal wound repair. As the healing process progresses, anti-inflammatory proteins such as IL-10 and IL-4 become instrumental in facilitating the transition to later stages where pro-inflammatory cytokines promote angiogenesis and wound remodeling. This Perspective underscores the complexity of inflammatory cytokines in wound healing research and emphasizes the need for comprehensive and unbiased methodologies in their evaluation. For robust and reliable results in wound-healing research, a more holistic approach is necessary─one that considers the roles, interactions, and timing of biological molecules, alongside careful sampling and evaluation strategies.
Abstract Chronic wounds, defined by their prolonged healing process, significantly impair patient quality of life and impose a hefty financial burden on healthcare systems worldwide. Sex/gender-specific mechanisms regulate inflammation and infection, angiogenesis, matrix synthesis, and cell recruitment contribute to cutaneous wound healing, but remain largely understudied. This review is aimed to spotlight the innovative realm of bioengineering and nanomedicine, which is at the helm of revolutionizing complex chronic wound care. It underscores the significance of integrating patient sex into the development and (pre)clinical testing of these avant-garde treatment modalities, in order to enhance healing prospects for both women and men. Moreover, we explore the representation of both sexes in clinical trials of bioengineered and nanomedicine products. Finally, we examine the primary reasons for the historical neglect in translating sex-specific wound healing research into clinical practice and propose strategic solutions. By tackling these issues, the article advocates for advanced treatment frameworks that could significantly improve healing outcomes for individuals of all sexes, thereby optimizing both efficacy and inclusivity in chronic wound management.
This review presents current research on the use of far-red to near-infrared (NIR) light treatment in various in vitro and in vivo models. Low-intensity light therapy, commonly referred to as "photobiomodulation," uses light in the far-red to near-infrared region of the spectrum (630–1000 nm) and modulates numerous cellular functions. Positive effects of NIR–light-emitting diode (LED) light treatment include acceleration of wound healing, improved recovery from ischemic injury of the heart, and attenuated degeneration of injured optic nerves by improving mitochondrial energy metabolism and production. Various in vitro and in vivo models of mitochondrial dysfunction were treated with a variety of wavelengths of NIR-LED light. These studies were performed to determine the effect of NIR-LED light treatment on physiologic and pathologic processes. NIRLED light treatment stimulates the photoacceptor cytochrome c oxidase, resulting in increased energy metabolism and production. NIR-LED light treatment accelerates wound healing in ischemic rat and murine diabetic wound healing models, attenuates the retinotoxic effects of methanol-derived formic acid in rat models, and attenuates the developmental toxicity of dioxin in chicken embryos. Furthermore, NIR-LED light treatment prevents the development of oral mucositis in pediatric bone marrow transplant patients. The experimental results demonstrate that NIR-LED light treatment stimulates mitochondrial oxidative metabolism in vitro, and accelerates cell and tissue repair in vivo. NIR-LED light represents a novel, noninvasive, therapeutic intervention for the treatment of numerous diseases linked to mitochondrial dysfunction.
Objective: The purpose of this study was to assess the changes in gene expression of near-infrared light therapy in a model of impaired wound healing. Background Data: Light-Emitting Diodes (LED), originally developed for NASA plant growth experiments in space, show promise for delivering light deep into tissues of the body to promote wound healing and human tissue growth. In this paper we present the effects of LED treatment on wounds in a genetically diabetic mouse model. Materials and Methods: Polyvinyl acetal (PVA) sponges were subcutaneously implanted in the dorsum of BKS.Cg-m +/+ Leprdb mice. LED treatments were given once daily, and at the sacrifice day, the sponges, incision line and skin over the sponges were harvested and used for RNA extraction. The RNA was subsequently analyzed by cDNA array. Results: Our studies have revealed certain tissue regenerating genes that were significantly upregulated upon LED treatment when compared to the untreated sample. Integrins, laminin, gap junction proteins, and kinesin superfamily motor proteins are some of the genes involved during regeneration process. These are some of the genes that were identified upon gene array experiments with RNA isolated from sponges from the wound site in mouse with LED treatment. Conclusion: We believe that the use of NASA light-emitting diodes (LED) for light therapy will greatly enhance the natural wound healing process, and more quickly return the patient to a preinjury/illness level of activity. This work is supported and managed through the Defense Advanced Research Projects Agency (DARPA) and NASA Marshall Space Flight Center-SBIR Program.
Abstract The Wound Healing Foundation (WHF) recognised a need for an unbiased consensus on the best treatment of chronic wounds. A panel of 13 experts were invited to a virtual meeting which took place on 27 March 2021. The proceedings were organised in the sub‐sections diagnosis, debridement, infection control, dressings, grafting, pain management, oxygen treatment, outcomes and future needs. Eighty percent or better concurrence among the panellists was considered a consensus. A large number of critical questions were discussed and agreed upon. Important takeaways included that wound care needs to be simplified to a point that it can be delivered by the patient or the patient's family. Another one was that telemonitoring, which has proved very useful during the COVID‐19 pandemic, can help reduce the frequency of interventions by a visiting nurse or a wound care center. Defining patient expectations is critical to designing a successful treatment. Patient outcomes might include wound specific outcomes such as time to heal, wound size reduction, as well as improvement in quality of life. For those patients with expectations of healing, an aggressive approach to achieve that goal is recommended. When healing is not an expectation, such as in patients receiving palliative wound care, outcomes might include pain reduction, exudate management, odour management and/or other quality of life benefits to wound care.
The 2006 U.S. Food and Drug Administration Guidance for Industry emphasizes wound closure as the primary outcome for clinical trials in wound healing. Wound care professionals understand that complete wound healing is not always achievable when evaluating new treatments. FDA, Association for the Advancement of Wound Care, and Wound Healing Society are working collaboratively to identify scientifically achievable, clinically relevant, and patient-centered endpoints with sufficient support to serve as primary outcomes for clinical trials. The Opinion Survey from People with Wounds presented here addresses an important but understudied issue: the gap between clinician, healthcare insurance companies, government agencies, and patient perspectives regarding clinically meaningful and scientifically achievable primary endpoints for wound care. The survey, adapted from the clinician survey with adjustment for health literacy, was pilot tested and revised based on a limited number of patients in a single clinic. After central IRB approval, the on-line survey was administered in English and Spanish and submitted anonymously to a server with the cooperation of multiple wound clinics and societies. Four hundred and thirty-eight patients and caregivers from across the United States responded over a 10-month period. Based on this survey, the most valuable clinical endpoints were reduced infection, recurrence, and amputation. The most valuable quality of life outcomes were increased independence, reduced social isolation, and pain. The top five endpoints in terms of usefulness for measuring clinical trial success were time to heal, wound size, infection, recurrence, and pain. Narrative responses from wound patients emphasized the inability to perform activities of daily living and pain as major factors that impacted their daily lives. Engagement of patients in clinical trials and evaluation of potential treatments is critical to improving wound care. This survey provides insight into the needs of patients with wounds and provides a roadmap for structuring future clinical trials to better meet those needs.
Increasing evidence shows that limited energy and nutrient exchange is associated with age‐related impairment of wound healing. Ketone bodies, including β‐Hydroxybutyrate (βHB), are naturally occurring energy substrates, which may augment wound healing. We hypothesized that oral ketone supplementation without dietary restriction would enhance wound closure in young and aged Fisher rats by improving blood flow and supplying an alternative energy substrate. In our preliminary studies, we measured the magnitude and duration of ketosis following administration of a single 6.5g/kg dose of ketone precursors: R,S‐1,3‐Butanediol (KS1), Na+/K+ βHB salt and medium chain triglyceride (MCT) oil 1:1 mixture (KS2), or water in young and aged fisher 344 rats (n=6). Substances were administered through an intragastric gavage and whole blood samples (10 μl) were acquired for analysis of glucose and βHB at 0, 0.5, 1, 1.5, 2, 4, 8, and 12 hours following administration. Using an ischemic wound‐healing model, the ketogenic supplements were added to a standard diet fed ad libitum for 28 days. Laser Doppler imaging of the ischemic peri‐wound tissue every 7 days demonstrated significantly increased blood flow in young rats (n=10) fed KS1 at day 14 and 28 (p<0.001) and KS2 at day 7, 14, and 28 (p<0.01). In aged rats, blood flow was significantly increased in KS1‐fed at day 14 and KS2‐fed at days 7 and 14 (p<0.05). Wound size was significantly smaller in young rats fed KS1 and KS2 at 11 and 14 days following wound creation (p<0.05). In aged rats, KS1‐fed wounds were significantly smaller at days 11 and 14 (p<0.05) and in KS2‐fed at days 11, 14, and 28 (p<0.05). Wound healing improved by 3 days in aged KS1‐fed, 7 days in young KS2‐fed, and 10 days in aged KS2‐fed. Grant Funding Source : Funded by the Office of Naval Research
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