Exploring Effect and Mechanism of Astragaloside on Repair and Healing in Chronic Non-healing Wound Rat Model Based on SIRT1 and PI3K/Akt Signaling Pathway / 中国实验方剂学杂志

ObjectiveTo investigate the promotional effect of astragaloside on the repair and healing of chronic non-healing wounds and its mechanism. MethodA total of 60 male SD rats were constructed with full-layer skin defect wounds on the back， and except for the control （Con） group， the rest were constructed with non-healing wounds， which were then randomly divided into the sham-operation （sham） group， the low-dose astragaloside group， the high-dose astragaloside group， the astragaloside + LY294002 ［phosphatidylinositol 3-kinase （PI3K） inhibitor］ group， and the astragaloside + EX527 ［silencing regulatory protein 1 （SIRT1） inhibitor］ group. The percentage of wound area in each group was observed on the 2nd， 4th， 6th， and 8th days after wound molding. Collagen type Ⅰ alpha 1 （COL1A1） and alpha smooth muscle actin （α-SMA） expressions in the wound tissue were detected by immunofluorescence. Hematoxylin and eosin （HE） staining was performed to determine the pathological structure of the wound. The mRNA expression of inflammatory factors in the wound was measured by real-time polymerase chain reaction （Real-time PCR）， and the expression of proteins related to the SIRT1/ nuclear factor （NF）-κB and PI3K/protein kinase B （Akt） signaling pathways in the wound was tested by Western blot. ResultCompared with the sham group， the percentage of postoperative wound area of rats in both low-dose and high-dose astragaloside groups gradually decreased with time， and the efficacy of the high-dose astragaloside group was better. Compared with the Con group， the fluorescence intensity of COL1A1 in wound tissue of the sham group decreased， while the expression of α-SMA increased. The epithelial tissue was severely damaged， with an increase in the thickness， and a large number of inflammatory cells were seen in the infiltration. The mRNA expression of tumor necrosis factor （TNF）-α， interleukin （IL）-1β， IL-6， and inducible nitric oxide synthase （iNOS） was elevated. The protein expression of NF-κB p65， p-PI3K/PI3K， and p-Akt/Akt was elevated， while SIRT1 expression was decreased （P<0.05）. Compared with the sham group， the fluorescence intensity of COL1A1 and α-SMA increased after astragaloside treatment. The number of epithelial cells increased， and the thickness decreased. The inflammatory cells decreased， and the amount of collagen increased. The mRNA expression of TNF-α， IL-1β， IL-6， and iNOS was decreased， and the protein expression of NF-κB p65， p-PI3K/PI3K， and p-Akt/Akt was decreased. SIRT1 was elevated， and the effect was better in the high-dose astragaloside group （P<0.05）. Compared with the high-dose astragaloside group， inhibition of the PI3K/Akt and SIRT1 pathways by LY294002 and EX527 prevented the therapeutic efficacy of astragaloside on chronic non-healing wounds. ConclusionThe topical application of astragaloside significantly promotes the healing of chronic non-healing wounds in rats， and the mechanism may be related to the activation of the PI3K/Akt pathway and the SIRT1/NF-κB pathway.

Efeitos da carboxiterapia na cicatrização de feridas cutâneas / Effects of carboxiterapy in the healing of skin wounds

INTRODUÇÃO: Novas terapêuticas para as lesões de difícil cicatrização têm-se tornado necessárias e estão sendo pesquisadas. Nesse contexto, a carboxiterapia tem se destacado pelos seus efeitos sobre a microcirculação tecidual. OBJETIVO: avaliar os efeitos da carboxiterapia, infusão no tecido subcutâneo de CO2 medicinal, na cicatrização de lesões cutâneas em ratos Wistars. MATERIAIS E MÉTODOS: Trata-se de um estudo experimental e quantitativo, com uma amostra de 10 animais, divididos em grupo controle e grupo carboxiterapia. Todos os animais sofreram uma lesão com punch metálico de 5mm de diâmetro na região dorsal e, o grupo com terapia, tratado por 10 dias consecutivos. A região foi fotografada em vários momentos da pesquisa e, em seguida, as imagens foram analisadas pelo software ImageJ. RESULTADOS: Na análise descritiva dos dados o GC apresentou redução progressiva da área de 0,205±0,025 para 0,155±0,017 no 3º dia, 0,109±0,034 no 7º dia e 0,028±0,092 após o 10º dia. O GCa apresentou aumento da área de 0,198±0,040 para 0,207±0,035 no 3º dia, com redução para 0,109±0,012 no 7º dia e 0,044±0,030 após o 10 dia, demonstrando ser menos eficiente na cicatrização de feridas cutâneas do que a ausência de tratamento. CONCLUSÃO: A carboxiterapia não mostrou resultado significativo para acelerar o processo de cicatrização de lesões cutâneas na fase aguda, sugerindo esse período como não ideal para sua utilização.

INTRODUCTION: New therapies for difficult-toheal injuries have become necessary and are being researched. In this context, carboxytherapy has been highlighted by its effects on tissue microcirculation. OBJECTIVE: evaluate the effects of carboxytherapy, infusion in the subcutaneous tissue of medicinal CO2, in the healing of skin lesions in Wistars rats. MATERIALS AND METHODS: This is an experimental and quantitative study, with a sample of 10 animals divided into a control group and a carboxytherapy group. All the animals suffered a metallic punch injury of 5mm diameter in the dorsal region and the group with therapy, treated for 10 consecutive days. The region was photographed at various times of the research and then the images were analyzed by ImageJ software. RESULTS: In the descriptive analysis of the data, the CG presented a progressive reduction of the area of 0.205 ± 0.025 to 0.155 ± 0.017 on the 3rd day, 0.109 ± 0.034 on the 7th day and 0.028 ± 0.092 after the 10th day, GCa presented an area increase of 0.198 ± 0.040 for 0.207 ± 0.035 on the 3rd day, with reduction to 0.109 ± 0.012 on the 7th day and 0.044 ± 0.030 after 10 days, demonstrating to be less efficient in the healing of cutaneous wounds than the absence of treatment. CONCLUSION: Carboxitherapy did not show significant results to accelerate the healing process of cutaneous lesions in the acute phase, suggesting this period as not ideal for its use.

Instrumentos para avaliação da cicatrização de lesões de pele: revisão integrativa / Assessment tools for the healing of wounds: an integrative review

A avaliação dos pacientes com feridas embasa a seleção de intervenções apropriadas; no entanto, a existência de instrumentos com diferentes parâmetros pode dificultar a escolha daquele mais adequado a cada necessidade. O objetivo do estudo foi identificar instrumentos utilizados e seus respectivos parâmetros para avaliação do processo de cicatrização. Trata-se de uma revisão integrativa, realizada nas bases de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, Cumulattive Index to Nursing and Allied Health Literarure, PubMed, Web of Science e Scopus. Foram considerados 35 estudos; o instrumento mais utilizado foi o PUSH, seguido da BWAT, DESING e DESIGN-R. As características mais avaliadas foram tamanho (área, volume, profundidade), exsudato, tipo de tecido, sinais de infecção ou inflamação. Os instrumentos evidenciaram a complexidade do processo de cicatrização e de sua avaliação, assim, o estudo contribui para embasar a escolha do melhor instrumento para cada necessidade.

The assessment of wounds in patients requires the selection of appropriate tools; however, it may be difficult to select the tool that is best suited to each case as each tool has a different set of parameters. This study aimed to identify the tools, and their respective parameters, that are used for evaluating wound healing. This integrative review was carried out using the following databasesLiteratura Latino-Americana e do Caribe em Ciências da Saúde, CumulativeIndex to Nursing and Allied Health Literature, PubMed, Web of Science, and Scopus. Thirty-five studies were considered; the most commonly used instrument was PUSH, followed by BWAT, DESIGN and DESIGN-R. The most frequently assessed components were size (area, volume, depth), exudate, tissue type, and signs of infection or inflammation. The tools revealed the complexity of both the process and the evaluation of healing. Thus, the study contributes to ensuring the selection of the best tool for each individual case.

Difference of morphology and proliferation ability between diabetes mellitus-derived ADSCs and normal ADSCs / 中华医学美学美容杂志

Objective To investigate the morphological characteristics and proliferation ability of diabetes mellitus-derived adipose-derived stem cells (ADSCs) by comparing with normal-derived ADSCs.Methods The ADSCs could be achieved from diabetes mellitus' adipose tissue by the similar method of normal ADSCs isolation and culture,and then the differnce was compared between the two groups about their morphologies under microscope,and the proliferation ability of two groups was determined by CCK-8.Results ADSCs in patients with diabetes were obvious hypertrophy and irregular in morphology.A values of ADSCs in diabetes and non-diabetes were 0.210+0.002 and 0.390+0.006 in 1st day;0.250+0.015 and 0.443+0.023 in 2nd day;0.368+0.014 and 0.726+0.033 in 3rd day;0.368+0.014 and 0.726+0.033 in 4th day;1.767+0.072 and 3.153+0.067 in 5th day and 1.810+0.072and 3.170+0.021 in 6th day,respectively.The difference was statstically significant at the beginning from 4th day (P＜0.05).Conclusions There is obvious difference of the microscopic morphology between the diabetes mellitus-derived ADSCs and normal-derived ADSCs.The proliferation ability of the diabetes mellitus-derived ADSCs is lower than normal-derived ADSCs.These difference could be closely related to ulcerous non-healing wounds in patients with diabetes mellitus.

Approach to Complex Wound Management and Adjunct Therapy

The ageing of our population and rise in chronic diseases has resulted in the complex profile of the patients in the community. Complex wounds such as diabetic foot ulcers, infected pressure ulcers and other complications of non-healing wounds are common encounters in the primary health settings. The challenges of these complex wounds lie in its multi-factorial nature of the person, the wound and the environment. This requires a team approach to care within the limited resources boundary. As part of the care continuum, it is essential for primary care physicians to be familiarized with the approach to care of complex wounds and the adjunct therapy. This article seeks to provide a broad framework using the systematic assessment framework via T.I.M.E (Tissue, Inflammation/Infection, Moisture imbalance, Epithelial edge of wound) for wound bed preparation to guide primary care physicians/clinicians in their approach to complex wounds. It also highlighted the complexities of chronic wound management pertaining to the person, the wound and the environment as well as the recent advances adjunct therapy in chronic wound care. In addition, it seeks to enable primary care physician and wound clinicians to translate wound-healing principles into effective management strategies to provide better clinical care to our patients.

Cicatrização de feridas decorrentes da hanseníase utilizando laser de baixa intensidade / Wound healing leprosy induced by low intensity laser

A hanseníase é causada pelo bacilo Mycobacterium leprae(M. leprae), apresentando grande capacidade de infectar vários indivíduos com contágio pelas vias aéreas superiores. A hanseníase considerada um problema de saúde pública, principalmente nos países subdesenvolvidos e nos em desenvolvimento, devido à presença de incapacidades e estigma social...

Leprosy is caused by the bacillus Mycobacterium leprae(M. leprae), presenting the capacity to infect multiple individuals with infection of the upper airways. Hansen considered a public health problem, especially in under developed countries and developing countries, due to the presence of disabilities and social stigma...