Pharmacological efficacy of Aloe vera in wound healing: a narrative review / Eficacia farmacológica del Aloe vera en la cicatrización de heridas: una revisión narrativa

Aloe Vera has different therapeutic effects, including wound healing. The aim of this review is to determine the potential efficacy of topical use of Aloe Vera in skin wound healing. A bibliographic search of preclinical and clinical studies from 1999 to 2020 was carried out, which included the therapeutic use of Aloe vera in the healing of: burns, surgical wounds, lactation disorders, anal fissure and anal fistula; in the databases of the VHL Regional Portal, PubMed and Google Scholar. It was obtained that the topical administration of Aloe vera was effective in the healing of the mentioned wounds by mainly increasing epithelialization and collagen content. In conclusion, the properties and pharmacological presentation, chemical components and the effectiveness of Aloe vera to reduce the time of wound healing, make this plant a great therapeutic alternative. Key words: Aloe vera, wound healing, burns, surgical wounds, fissure in ano. (source: MeSH NLM)

El Aloe Vera tiene distintos efectos terapéuticos, entre ellos, la cicatrización de heridas. El objetivo de esta revisión es determinar la potencial eficacia del uso tópico del Aloe Vera en la cicatrización de heridas cutáneas. Se realizó una búsqueda bibliográfica de estudios preclínicos y clínicos desde 1999 hasta el 2020, que incluyeran el uso terapéutico del Aloe vera en la cicatrización de: quemaduras, heridas quirúrgicas, trastornos de la lactancia, fisura anal y fístula anal; en las bases de datos del Portal regional de la BVS, PubMed y Google Scholar. Se obtuvo que la administración tópica del Aloe vera fue eficaz en la cicatrización de las heridas mencionadas al aumentar principalmente la epitelización y el contenido de colágeno. En conclusión, las propiedades y presentación farmacológica, componentes químicos y la eficacia del Aloe vera para disminuir el tiempo de la cicatrización de las heridas, hacen de esta planta una gran alternativa terapéutica. Palabras clave: Aloe vera, cicatrización de heridas, quemaduras, heridas quirúrgicas, fisura anal. (fuente: DeCS BIREME)

Colgajo bigemelar para lesiones extensas de rodilla / Bigemelar flap for extensive knee injuries

El traumatismo de miembros inferiores representa un reto para el cirujano plástico en cuanto a su reconstrucción cuando no se dispone de técnicas microquirúrgicas. En el presente trabajo se presentan tres casos de reconstrucción de rodilla con doble colgajo muscular de gemelo en donde se demuestra que la utilización simultánea de los dos gemelos puede ser aplicada sin dejar ninguna secuela en la parte funcional y estética en la deambulación de los pacientes. No existe en la literatura nacional ni internacional un reporte de casos con esta aplicación, ya que siempre se ha limitado al uso de un solo músculo precisamente por el temor de alterar la función en cuanto a la flexoextensión del pie.

Lower limb trauma is a challenge for plastic surgeons in their reconstruction when microsurgical techniques are available. In this paper we present three cases of reconstruction of the knee with twin double-muscle flap where it is shown that the simultaneous use of the twins can be applied without leaving any sequel partly functional and aesthetics in ambulation of patients. For there is in the national or international literature a repost of cases with this application as it has always been limited to using just a single muscle for fear of disrupting the function in terms of flexion and extension of the foot.

The influence of motherhood on neural systems for reward processing in low income, minority, young women.

OBJECTIVE: Given the association between maternal caregiving behavior and heightened neural reward activity in experimental animal studies, the present study examined whether motherhood in humans positively modulates reward-processing neural circuits, even among mothers exposed to various life stressors and depression. METHODS: Subjects were 77 first-time mothers and 126 nulliparous young women from the Pittsburgh Girls Study, a longitudinal study beginning in childhood. Subjects underwent a monetary reward task during functional magnetic resonance imaging in addition to assessment of current depressive symptoms. Life stress was measured by averaging data collected between ages 8-15 years. Using a region-of-interest approach, we conducted hierarchical regression to examine the relationship of psychosocial factors (life stress and current depression) and motherhood with extracted ventral striatal (VST) response to reward anticipation. Whole-brain regression analyses were performed post-hoc to explore non-striatal regions associated with reward anticipation in mothers vs nulliparous women. RESULTS: Anticipation of monetary reward was associated with increased neural activity in expected regions including caudate, orbitofrontal, occipital, superior and middle frontal cortices. There was no main effect of motherhood nor motherhood-by-psychosocial factor interaction effect on VST response during reward anticipation. Depressive symptoms were associated with increased VST activity across the entire sample. In exploratory whole brain analysis, motherhood was associated with increased somatosensory cortex activity to reward (FWE cluster forming threshold p<0.001). CONCLUSIONS: These findings indicate that motherhood is not associated with reward anticipation-related VST activity nor does motherhood modulate the impact of depression or life stress on VST activity. Future studies are needed to evaluate whether earlier postpartum assessment of reward function, inclusion of mothers with more severe depressive symptoms, and use of reward tasks specific for social reward might reveal an impact of motherhood on reward system activity.

Moderation of the Relationship Between Reward Expectancy and Prediction Error-Related Ventral Striatal Reactivity by Anhedonia in Unmedicated Major Depressive Disorder: Findings From the EMBARC Study.

OBJECTIVE: Anhedonia, disrupted reward processing, is a core symptom of major depressive disorder. Recent findings demonstrate altered reward-related ventral striatal reactivity in depressed individuals, but the extent to which this is specific to anhedonia remains poorly understood. The authors examined the effect of anhedonia on reward expectancy (expected outcome value) and prediction error- (discrepancy between expected and actual outcome) related ventral striatal reactivity, as well as the relationship between these measures. METHOD: A total of 148 unmedicated individuals with major depressive disorder and 31 healthy comparison individuals recruited for the multisite EMBARC (Establishing Moderators and Biosignatures of Antidepressant Response in Clinical Care) study underwent functional MRI during a well-validated reward task. Region of interest and whole-brain data were examined in the first- (N=78) and second- (N=70) recruited cohorts, as well as the total sample, of depressed individuals, and in healthy individuals. RESULTS: Healthy, but not depressed, individuals showed a significant inverse relationship between reward expectancy and prediction error-related right ventral striatal reactivity. Across all participants, and in depressed individuals only, greater anhedonia severity was associated with a reduced reward expectancy-prediction error inverse relationship, even after controlling for other symptoms. CONCLUSIONS: The normal reward expectancy and prediction error-related ventral striatal reactivity inverse relationship concords with conditioning models, predicting a shift in ventral striatal responding from reward outcomes to reward cues. This study shows, for the first time, an absence of this relationship in two cohorts of unmedicated depressed individuals and a moderation of this relationship by anhedonia, suggesting reduced reward-contingency learning with greater anhedonia. These findings help elucidate neural mechanisms of anhedonia, as a step toward identifying potential biosignatures of treatment response.

Accounting for Dynamic Fluctuations across Time when Examining fMRI Test-Retest Reliability: Analysis of a Reward Paradigm in the EMBARC Study.

Longitudinal investigation of the neural correlates of reward processing in depression may represent an important step in defining effective biomarkers for antidepressant treatment outcome prediction, but the reliability of reward-related activation is not well understood. Thirty-seven healthy control participants were scanned using fMRI while performing a reward-related guessing task on two occasions, approximately one week apart. Two main contrasts were examined: right ventral striatum (VS) activation fMRI BOLD signal related to signed prediction errors (PE) and reward expectancy (RE). We also examined bilateral visual cortex activation coupled to outcome anticipation. Significant VS PE-related activity was observed at the first testing session, but at the second testing session, VS PE-related activation was significantly reduced. Conversely, significant VS RE-related activity was observed at time 2 but not time 1. Increases in VS RE-related activity from time 1 to time 2 were significantly associated with decreases in VS PE-related activity from time 1 to time 2 across participants. Intraclass correlations (ICCs) in VS were very low. By contrast, visual cortex activation had much larger ICCs, particularly in individuals with high quality data. Dynamic changes in brain activation are widely predicted, and failure to account for these changes could lead to inaccurate evaluations of the reliability of functional MRI signals. Conventional measures of reliability cannot distinguish between changes specified by algorithmic models of neural function and noisy signal. Here, we provide evidence for the former possibility: reward-related VS activations follow the pattern predicted by temporal difference models of reward learning but have low ICCs.

Disrupted posterior cingulate-amygdala connectivity in postpartum depressed women as measured with resting BOLD fMRI.

Disengagement of emotion regulation circuits was previously shown in depressed mothers and was hypothesized to underlie the impaired maternal-infant sensitivity described in postpartum depression (PPD). We hypothesized similarly reduced resting-state functional connectivity in default mode network (DMN) regions involved in social cognition in PPD. Resting-state functional MRI, clinical and mother-infant attachment data were obtained from 14 unmedicated postpartum women with major depression and 23 healthy postpartum women. Posterior cingulate cortex (PCC) time series were extracted, filtered between 0.007 and 0.08 Hz and used as regressors in a whole brain general linear model analysis. PCC-right amygdala connectivity was significantly disrupted in depressed compared to healthy mothers for low-frequency neural activity, showing a negative (inverse) coupling in the depressed group but not in the controls. PCC-right amygdala connectivity was positively correlated with PCC-parahippocampus connectivity. Resting connectivity patterns of positive co-activations in postpartum women mirrored the canonical DMN. These findings of reduced PCC-amygdala coupling raise the possibility that PPD might involve the disruption of outward, preventative aspects of self-relevant thought and theory of mind/empathy processes. Further integrated studies of neural connectivity and these cognitive/behavioral dimensions are warranted.