NANOCELLULOSE MEMBRANE WITH VASCULAR ENDOTHELIUM GROWTH FACTOR (VEGF): FUTURE IN HEALING DEEP BURNS? / MEMBRANA DE NANOCELULOSE COM FATOR DE CRESCIMENTO DO ENDOTÉLIO VASCULAR (VEGF): FUTURO NA CICATRIZAÇÃO DE QUEIMADURAS PROFUNDAS?

Introduction: Burns are injuries caused by various agents that promote the destruction of the skin and can lead to the exposure of deeper tissues. To make better use of this variety of treatment options, it is important to know its causes, extent and treatment methods. Objective: Update the use of nanocellulose membranes with glycerol, vascular endothelial growth factor and other complements in burn healing. Method: Review carried out with material and analysis selected from research on virtual platforms (SciELO, Google Scholar, Virtual Health Library, Pubmed and Scopus) using the descriptors: "bacterial membrane proteins; vascular endothelial growth factor; VEGFR; biological dressings; dressings" with AND or OR search, considering the title and/or abstract. Afterwards, the articles were read in full. Result: 45 articles were included. Conclusion: Although more research is needed, published studies show that the enrichment of nanocellulose membranes with some additives such as Vascular Endothelial Growth Factor VEGF) and incorporation of sensors that can monitor wound conditions will result in highly effective dressings. Considering the technological advances to produce low-cost membranes, associated with artificial intelligence and the efforts of researchers, the benefit to public health will soon be evident.

Introdução: Queimaduras são lesões causadas por diversos agentes que promovem a destruição da pele podendo chegar à exposição de tecidos mais profundos. Para melhor uso desta variedade de opções de seu tratamento é importante conhecer-se suas causas, extensão e métodos de tratamento. Objetivo: Atualizar o uso de membranas de nanocelulose, fator de crescimento do endotélio vascular e outros complementos na cicatrização de queimaduras. Método: Revisão feita com material e análise  selecionados a partir de pesquisa em plataformas virtuais (SciELO, Google Scholar, Biblioteca Virtual em Saúde, Pubmed e Scopus) por meio dos descritores: "proteínas da membrana bacteriana; fator de crescimento do endotélio vascular; VEGFR; curativos biológicos; curativos" e seus equivalentes em inglês "bacterial outer membrane proteins; vascular endothelial growth fator; dressing; VEGFR; biological dressings" com busca AND ou OR, considerando o título e/ou resumo. Após, foi feita leitura na íntegra dos artigos. Resultado: Foram incluídos 45 artigos. Conclusão: Embora sejam necessárias mais pesquisas, estudos já publicados evidenciam que o enriquecimento das membranas de nanocelulose com alguns aditivos como o Fator de Crescimento do Endotélio Vascular VEGF) e incorporação de sensores que possam monitorar as condições das feridas resultará em curativos altamente eficazes. Considerando o avanço tecnológico para produzir membranas de baixo custo, associado à inteligência artificial e os esforços dos pesquisadores, em breve o benefício à saúde pública será evidente.

Skin donation for transplantation: Social representations of family members who (do not) give consent for collection.

Despite the advantages of using deceased donor skin in the treatment of burns, it is not easy to obtain these grafts due to low tissue donation rates. In order to discover the social representations of family members of organ donors regarding skin donation and to analyze the convergences and divergences of these representations between family members who consented and those who refused to allow skin to be donated for transplantation, we conducted interviews with 20 family members of organ donors in a situation of brain death. Data were obtained through interviews and submitted to the Collective Subject Discourse Analysis Technique. This study shows that in the opinion of family members who consented and those who did not authorize skin donation, the consideration contains both positive and negative representations, which can have different weights and influence decision-making. This study also highlights, in an unprecedented way, the representation of the animalization of the donor, which can be a reason for the refusal to allow skin to be donated.

Safety Considerations for Lyophilized Human Amniotic Membrane Impregnated with Colistin and Silver Nanoparticles.

Lyophilized human amniotic membrane (HAM) and silver nanoparticles (AgNPs) have multispectral applications as a biological dressing. The present study focuses on the safety aspects of HAM coated with colistin and AgNPs (HACoN) dressing in relation to its structural and hematological changes. Four dressing groups were designed for the study, HAM, HAM coated with colistin (HACo), HAM coated with AgNPs (HAN), and HAM coated with colistin (HACo) and HACoN. Scanning electron microscopy (SEM) and Fourier-transform infrared spectroscopy (FTIR) were utilized for constitutional analysis. Biological safety was checked by applying HAM of all groups on open excisional burn wounds on Sprague-Dawley rats for 21 days. The skin, kidneys, liver, and spleen were removed, and histological analysis was performed for detailed structural analysis. Oxidative stress was assessed using homogenate from newly generated skin. No structural or biochemical change was observed in any of the study groups as observed by SEM and FTIR. After 21 days of grafting, wounds were healed properly with normal skin, and no anomaly was observed in related to kidneys, spleen, and liver. Some of antioxidant enzymes were increased, while malondialdehyde which is a reactive oxygen species was reduced in the skin tissue homogenate of HACoN group. Impregnation of colistin and AgNPs in combination on HAM has no effects on hematological and structural constitution of HAM. It leaves no obvious change in vital organs of rats and improves oxidative stress and inflammation. Hence, it can be claimed that HACoN is a biologically safe antibacterial dressing.

Membranas amnióticas y su aplicación en el tratamiento de quemaduras: una revisión sistemática exploratoria

Las quemaduras son un problema de interés en salud pública ya que generan un alto índice de morbimortalidad a nivel mundial, las quemaduras térmicas son las más prevalentes y pueden alterar la integridad anatómica, funcional y estética de la piel, aspectos fundamentales para la autoestima del paciente y su capacidad para reintegrarse a la sociedad. Al revisar la literatura sobre el tratamiento de estas afecciones encontramos diversos tratamientos, entre ellos el uso de membrana amniótica humana, la cual ha tenido un impacto importante en el manejo de quemaduras al funcionar como andamio biológico con cualidades regenerativas y antiinflamatorias. El presente artículo tiene como objetivo sintetizar la información actual que describe las aplicaciones de membranas amnióticas humanas en quemaduras, realizamos una revisión exploratoria sistemática de la literatura desde 2010 hasta 2021.

Burns are a problem of interest in public health since they generate a high rate of morbidity and mortality worldwide, thermal burns are the most prevalent and can alter the anatomical, functional and aesthetic integrity of the skin, fundamental aspects for the patient's self-esteem and their ability to reintegrate into society. At review literature about the treatment of these conditions, we find various treatments, including the use of human amniotic membrane, which has had a significant impact on burn management by functioning as a biological scaffold with regenerative and anti-inflammatory qualities. The present article aims to synthesize the current information that describes the applications of human amniotic membranes in burns. We carry out a systematic exploratory review of the literature from 2010 to 2021.

Construction of Smart Biomaterials for Promoting Diabetic Wound Healing.

Diabetes mellitus is a complicated metabolic disease that has become one of the fastest-growing health crises in modern society. Diabetic patients may suffer from various complications, and diabetic foot is one of them. It can lead to increased rates of lower-extremity amputation and mortality, even seriously threatening the life and health of patients. Because its healing process is affected by various factors, its management and treatment are very challenging. To address these problems, smart biomaterials have been developed to expedite diabetic wound closure and improve treatment outcomes. This review begins with a discussion of the basic mechanisms of wound recovery and the limitations of current dressings used for diabetic wound healing. Then, the categories and characteristics of the smart biomaterial scaffolds, which can be utilized as a delivery system for drugs with anti-inflammatory activity, bioactive agency, and antibacterial nanoparticles for diabetic wound treatment were described. In addition, it can act as a responsive system to the stimulus of the pH, reactive oxygen species, and glucose concentration from the wound microenvironment. These results show that smart biomaterials have an enormous perspective for the treatment of diabetic wounds in all stages of healing. Finally, the advantages of the construction of smart biomaterials are summarized, and possible new strategies for the clinical management of diabetic wounds are proposed.

Linha do tempo da pele de tilápia (Oreochromis niloticus) na medicina regenerativa moderna: Da bancada ao paciente / Timeline of tilapia skin (Oreochromis niloticus) in modern regenerative medicine: From bench to patient

OBJETIVO: Descrever a trajetória de desenvolvimento dos curativos biológicos oriundos de pele de tilápia (Oreochromis niloticus) em glicerol e liofilizada para uso em cirurgias externas e, posteriormente, uma matriz proteica acelular (scaffold) para uso interno. RESULTADOS: A pele de tilapia no glicerol e liofilizada foi aplicada com sucesso em mais de 550 pacientes queimados. A pele de tilápia liofilizada obteve sucesso no tratamento de 53 mulheres em vaginoplastias, em 160 pacientes na redesignação sexual e na preparação do leito da ferida na autoenxertia em 15 portadores da Síndrome de Apert. O scaffold está sendo empregado na oftalmologia na medicina veterinária na reconstrução de córnea em 420 cães, nas duroplastias na neurocirurgia nos testes em animais, e em estudos para uso cirúrgico em 10 especialidades médicas. CONCLUSÕES: O curativo de pele de tilápia supera desafios do tratamento de queimados do Brasil. É barato, biossustentável, efetivo e reduz a dor do paciente, propiciando melhores resultados com potencial redução de custos, contribuindo para a qualidade de vida dos pacientes. O sucesso da pesquisa confirma a pele de tilápia como um novo biomaterial de grande potencial em medicina regenerativa.

OBJECTIVE: To describe the development trajectory of biological dressings made from tilapia (Oreochromis niloticus) skin in glycerol and freeze-dried for use in external surgeries and, subsequently, an acellular protein matrix (scaffold) for internal use. RESULTS: Tilapia skin in glycerol and freeze-dried was successfully applied to more than 550 burn patients. Freeze-dried tilapia skin was successful in the treatment of 53 women undergoing vaginoplasty, in 160 patients in sexual reassignment and in preparing the wound bed in self-grafting in 15 patients with Apert Syndrome. The scaffold is being used in ophthalmology, veterinary medicine in corneal reconstruction in 420 dogs, in duraplasty in neurosurgery in animal tests, and in studies for surgical use in 10 medical specialties. CONCLUSIONS: The tilapia skin dressing overcomes challenges in treating burns in Brazil. It is cheap, biosustainable, effective and reduces patient pain, providing better results with potential cost reduction, contributing to patients' quality of life. The success of the research confirms tilapia skin as a new biomaterial with great potential in regenerative medicine.

Modern Dressings in Prevention and Therapy of Acute and Chronic Radiation Dermatitis-A Literature Review.

Radiotherapy is an integral part of modern oncology, applied to more than half of all patients diagnosed with cancer. It can be used alone or in combination with surgery or chemotherapy. However, despite the high precision of radiation delivery, irradiation may affect surrounding healthy tissues leading to the development of toxicity. The most common and clinically significant toxicity of radiotherapy is acute and chronic radiation dermatitis, which could result in desquamation, wounds, nonhealing ulcers, and radionecrosis. Moreover, preoperative radiotherapy impairs wound healing after surgery and may lead to severe wound complications. In this review, we comprehensively discuss available types of dressings used in the management of acute and chronic radiation dermatitis and address their efficacy. The most effective ways of preventing acute radiation dermatitis are film dressings, whereas foam dressings were found effective in its treatment. Data regarding dressings in chronic radiation dermatitis are scarce. This manuscript also contains authors' consensus.

Uso de membrana amniótica en el tratamiento de la necrólisis epidérmica tóxica. Caso clínico / Use of amniotic membrane in the treatment of toxic epidermal necrolysis. Case report

La necrólisis epidérmica tóxica (NET) es una enfermedad caracterizada por una reacción de hipersensibilidad mediada por inmunocomplejos que genera la separación y/o desprendimiento de la unión dermoepidérmica mucocutánea, con compromiso de más del 30% de la superficie corporal. Es considerada multifactorial, y se desencadena principalmente por medicamentos. Su mortalidad alcanza el 30%. En la actualidad no hay un estándar para su manejo, y por su complejidad, se recomienda el tratamiento en unidad de quemados. En aras de resaltar una de las posibles formas de tratamiento, presentamos el caso de un paciente con NET tratado con membrana amniótica, con una rápida reepitelización y buen resultado. (AU)

Toxic epidermal necrolysis (TEN) is a disease charac- terized by a hypersensitivity reaction mediated by immunocomplexes that generates the separation and / or detachment of the dermoepidermal junction with a commitment of more than 30% of the body surface. It is considered multifactorial, being triggered in a greater proportion by drugs, and presents a mortality of up to 30. Currently, there is no standard management, and due to its complexity, treatment in a burn unit is recommended. To highlight one posible way of treatment, we present the case of a patient with TEN treated with an amniotic membrane with rapid reepithelialization and a good result. (AU)

Peripheral ulcerative keratitis as presenting manifestation of systemic microscopic polyangiitis: a case report / Ceratite ulcerativa periférica como manifestação de poliangiíte microscópica sistêmica: relato de caso

ABSTRACT Microscopic polyangiitis is a rare autoimmune disease of unknown etiology, characterized by inflammation and necrosis of blood vessels. It forms a part of the antineutrophil cytoplasmic antibody-associated vasculitides-a heterogeneous group of disorders characterized by vasculitis. It is a systemic disease affecting multiple organs. The patients may present with a wide variety of symptoms. Ocular manifestations may present as its initial clinical symptoms, necessitating a multidisciplinary approach for reducing the morbidity and mortality. Early diagnosis aids in the formulation of appropriate treatment and prevention of further complications. Aggressive treatment, including surgery, is often necessary to limit structural damage and preserve visual function. We present the case of an 82-year-old woman who initially presented with peripheral ulcerative keratitis that led to the diagnosis of microscopic polyangiitis.

RESUMO A poliangeíte microscópica é uma doença autoimune rara de etiologia desconhecida, caracterizada por inflamação e necrose dos vasos sanguíneos. Faz parte das vasculites associadas a anticorpos citoplasmáticos antineutrófilos - um grupo heterogêneo de doenças caracterizadas por vasculite. É uma doença sistêmica que afeta vários órgãos. Os pacientes podem apresentar uma grande variedade de sintomas. As manifestações oculares podem apresentar-se como seus sintomas clínicos iniciais, necessitando de abordagem multidisciplinar para redução da morbimortalidade. O diagnóstico precoce ajuda na formulação do tratamento adequado e na prevenção de complicações futuras. O tratamento agressivo, incluindo cirurgia, muitas vezes é necessário para limitar o dano estrutural e preservar a função visual. Apresentamos o caso de uma mulher de 82 anos que inicialmente apresentou ceratite ulcerativa periférica que levou ao diagnóstico de poliangite microscópica.

Procuramiento y uso de aloinjertos cutáneos de piel total criopreservados obtenidos de pacientes sometidas a abdominoplastía / Procurement and use of cryopreserved whole skin cutaneous allografts obtained from patients undergoing abdominoplasty

Resumen Introducción: Los aloinjerto cutáneos (AC) son excelentes sustitutos cutáneos temporales, sin embargo, la donación y procura de piel cadavérica, fuente habitual de AC, es baja. Objetivo: Evaluar la factibilidad de utilizar la piel proveniente de abdominoplastías como fuente de AC y su eficacia clínica. Materiales y Método: Entre el 17 de agosto de 2020 al 28 de febrero de 2021 se analizó una cohorte prospectiva de 14 pacientes femeninas sometidas a abdominoplastía por motivos estéticos, que aceptaron donar la piel del colgajo cutáneo abdominal redundante, la cual fue criopreservada. Se utilizaron los AC de piel total criopreservados (ACPTC) en 10 pacientes con diagnósticos de: pie diabético (4), laparostomía contenida (2) herida compleja extremidad inferior (2), sarcoma de cuero cabelludo recidivado (1) y melanoma (1). Resultados: Se obtuvieron 14 colgajos de piel total, los cuales fueron procesados obteniendo una superficie promedio de 302 cm2 y 8,3 láminas de distintos tamaños de utilidad clínica por paciente. En todos los pacientes en que se utilizó ACPTC hubo un prendimiento inicial del AC para posteriormente, en promedio 21 días, presentar una escara necrótica que al ser retirada presentaba un tejido vital adherido al receptor rico en fibroblastos, siendo algunos pacientes auto injertados y otros manejados con cicatrización por segunda intención como tratamiento definitivo. Discusión: Los ACPTC proporcionan una cobertura intermedia, pues una parte se integra en forma definitiva, actuando como un andamiaje biológico para la formación de una interfase sobre la cual se puede autoinjertar o dejar evolucionar con cicatrización por segunda intención y una parte es rechazada. Conclusión: La procura de piel de donante vivo, en pacientes sometidos a cirugías de contorno corporal es un proceso factible, fuente de ACPTC, los cuales permiten una nueva cobertura intermedia con múltiples aplicaciones clínicas.

Introduction: Skin allografts (SA) are outstanding temporary skin substitutes; however, cadaveric skin donation and procurement, a common source of SA, remains low. Aim: To evaluate the feasibility and clinical efficacy of using skin from abdominoplasties as a source of SA. Materials and Method: A prospective cohort was analyzed from August 17th, 2020 and February 28th, 2021, with 14 female patients submitted to abdominoplasty surgeries for aesthetic motives, who authorized skin donation from the redundant abdominal flap which was posteriorly cryopreserved. Cryopreserved total skin allografts (CTSA) was used in 10 patients with the following diagnoses: diabetic foot (4), contained laparostomy (2) complex wound of the lower limb (2), relapsing sarcoma of the scalp (1), and melanoma (1). Results: 14 CTSA were obtained, which were processed, obtaining an average area of 302 cm2 and 8.3 sheets of different sizes and clinical applications from each patient. In all patients who received CTSA, an initial attachment was observed, followed by the appearance of a necrotic scar in an average of21 days. The peeling of the latter revealed a vital tissue tightly adhered to the receptor and rich in fibroblasts. Some of the patients received autografts, and others were managed with secondary intention scarring as a definite treatment. Discussion: CTSA provide an intermediate coverage since one part is definitely adhered to, acting as a biologic scaffolding for the formation of an interface that can be autografted or left for a secondary intention scarring, and the host rejects the other portion. Conclusión: skin procurement from a living donor in patients submitted to body contour surgeries is a feasible process and significant source of CTSA, which permits a new intermediate coverage with multiple clinical uses.

Utilidad del apósito liofilizado de piel de cerdo en el manejo de cicatrización de úlcera de pie diabético / Usefulness of lyophilized pig skin dressings in wound healing as treatment for diabetic foot ulcer

Resumen Objetivo: Mostrar la utilidad del apósito liofilizado de piel de cerdo comparado con el manejo conservador con sulfadiazina de plata en el proceso de cicatrización de la úlcera de pie diabético. Materiales y Método: Estudio cuasiexperimental en pacientes con diagnóstico de pie diabético, se establecieron 2 grupos de estudio utilizando una relación 2:1, el grupo de exposición (10 pacientes) tratado con apósito liofilizado de piel de cerdo y el grupo de control (5 pacientes) manejado con sulfadiazina de plata. La utilidad se midió con la cicatrización en semanas de tratamiento. El análisis estadístico incluyó prueba de t, prueba de z, regresión logística simple y cálculo de la probabilidad del evento. Resultados: El tiempo de cicatrización fue más corto en el grupo manejado con apósito liofilizado de piel de cerdo (10,20 semanas) que en el grupo con manejo a base de sulfadiazina de plata (13,8 semanas). A las 9 semanas de iniciado el tratamiento, la mitad de las pacientes con apósito de piel de cerdo ya habían cicatrizado comparado con la cicatrización en el grupo manejado con sulfadiazina de plata (20%). La probabilidad de cicatrización a las 11 semanas en paciente manejados con sulfadiazina de plata es 20% y con apósito liofilizado de piel de cerdo 80%. Conclusión: El apósito liofilizado de piel de cerdo tuvo mejores resultados en el estudio, comparado con el manejo estándar con sulfadiazina de plata. Es necesario realizar un estudio aleatorizado para determinar la efectividad de este material como herramienta terapéutica.

Aim: To demonstrate the usefulness of lyophilized pig skin dressings versus usual management with silver sulfadiazine in wound healing treatment for diabetic foot ulcers. Materials and Method: In this quasi-experimental study, we included patients diagnosed with diabetic foot. We established two groups with a distribution (2:1), the exposure group treated with lyophilized pig skin dressings (10 patients) and the control group (5 patients), the standard of care with silver sulfadiazine. Usefulness was measured with wound healing in treatment weeks. Statistical analysis included t-test, z-test, simple logistic regression, and calculation of probability of an event. Results: Wound healing time was shorter in the group treated with lyophilized pig skin dressing (10.20 weeks) than in the group treated with silver sulfadiazine (13.8 weeks). At 9 weeks after treatment started, 50% of patients treated with lyophilized pig skin dressings had complete wound healing compared with the patients in the group managed with silver sulfadiazine. (20%). The probability of wound healing been completed at 11 weeks in a patient managed with silver sulfadiazine is 20%, compared to lyophilized pig skin dressings is 80%. Conclusion: Lyophilized pig skin dressings had better outcomes than silver sulfadiazine in wound healing treatment for diabetic foot ulcers inside the study. Is mandatory develop another study with a randomized design to determinate the effectiveness as a therapeutic alternative.

Modifications of bacterial cellulose in wound care.

Wound infection may occur in acute and chronic wounds, wounds resulting from surgery or traffic accidents, and burns. Regardless of the extent and cause of the wound, prompt treatment is essential in reducing the patient's pain and limiting the spread of contamination. Improper wound care and associated chronic diseases may hinder the therapeutic success. Bacterial cellulose (BC) is highly biocompatible and has no cytotoxic effect on cells engaged in wound healing, such as fibroblasts and keratinocytes. Its high hydration level guarantees the maintenance of a moist wound environment. High mechanical strength, flexibility and resistance to damage make BC a promising material for dressings. Unfortunately, it does not display an inhibitory effect on bacterial growth. Introducing antimicrobial agents into the structure of BC has been a subject of many studies. This paper aims to present the latest reports on the possibility of the absorption of bacteriostatic and bactericidal agents in BC, such as metal particles, essential oils, antibiotics, antiseptics, and wound irrigation solutions. Moreover, the modifications in BC culture and post-production treatments in order to improve its physical properties are discussed.

Comparative evaluation of the efficacy of wound healing with and without dehydrated human amniotic/chorionic membrane in alveoloplasty: a pilot study.

OBJECTIVES: Wound healing is an integral part of any surgical procedure. Appropriate wound closure is critical to any successful surgical procedure, especially intraoral procedures. Various factors aid in wound healing, both pharmacological and non-pharmacological. Dehydrated human amniotic/chorionic membrane (dHACM) is an emerging bioinert material that contains anti-inflammatory properties, angiogenetic properties, osteogenic potential, and various growth factors. The purpose of this study was to evaluate the efficacy of wound healing properties of dHACM in bilateral alveoloplasty patients. MATERIALS AND METHODS: A prospective split-mouth study was conducted on 10 patients. Site A received sutures with dHACM and site B was sutured without dHACM. Wound healing was assessed with the Landry, Turnbull, and Howley Index. RESULTS: Sites A and site B were compared. A P<0.05 and a test value of 22 was obtained, indicating a statistical difference between the two sites. CONCLUSION: Our study showed better healing with dHACM than without.

Treatment of Chronic Venous Ulcers With Heterologous Fibrin Sealant: A Phase I/II Clinical Trial.

Background: Heterologous fibrin sealant (HFS) consists of a fibrinogen-rich cryoprecipitate extracted from Bubalus bubalis buffalo blood and a thrombin-like enzyme purified from Crotalus durissus terrificus snake venom. This study evaluated the safety and immunogenicity of HFS, estimated the best dose, and assessed its preliminary efficacy in the treatment of chronic venous ulcers (CVU). Methods: A phase I/II non-randomized, single-arm clinical trial was performed on 31 participants, accounting for a total of 69 active CVUs. All ulcers were treated with HFS, essential fatty acid, and Unna boot for 12 weeks. The outcomes assessed were: (1) primary safety, immunogenicity analyses, and confirmation of the lowest safe dose; (2) secondary promising efficacy by analyzing the healing process. Immunogenicity was evaluated using the serum-neutralizing (IgM and IgG) and non-neutralizing (IgA and IgE) antibody techniques against the product. The immuno-detection of IgE class antibodies was assessed using dot-blot assay before and at the end of treatment. Positive samples on dot-blot assays were subsequently analyzed by western blotting to verify the results. Results: No severe systemic adverse events related to the use of HFS were observed. Local adverse events potentially related to treatment include ulcer pain (52%), peri-ulcer maceration (16%), peri-ulcer pruritus (12%), critical colonization (8%), peri-ulcer eczema (4%), the opening of new ulcers (4%), and increased ulcerated area 4%). Neutralizing and non-neutralizing antibodies did not show significant deviations at any of the evaluated time points. Blot assays showed that all patients presented negative immunological reactions, either before or after treatment, with the thrombin-like enzyme component. In addition, two participants showed a positive immunological reaction to the cryoprecipitate component, while another two were positive before and during treatment. Regarding the secondary outcomes of preliminary efficacy, a total healing and significant reduction of the area was observed in 47.5 and 22%, respectively. A qualitative improvement was observed in the wound beds of unhealed ulcers. Conclusions: The investigational HFS bioproduct proved to be safe and non-immunogenic with a good preliminary efficacy for the treatment of CVU, according to the protocol and doses proposed. A multicentric phase III clinical trial will be necessary to verify these findings.

Research progress in amniotic membrane transplantation for diabetic foot management / 中国基层医药

The purpose of this review is to evaluate the promoting effects of amniotic membrane tissue on ulcer healing and investigate the underlying mechanism, providing new ideas for diabetic foot management. A computer-based online search of CNKI, PubMed and other databases to screen multi-center, randomized controlled trials published in high-impact journals using biological dressings, diabetic foot and other search terms. The retrieved data were analyzed and summarized. Amniotic membrane tissue and its derivatives can greatly shorten the time taken for healing of ulcer surface. This occurs possibly because they can promote angiogenesis and neural repair and prevent against infection. Moreover, the new derivatives provide great ease in use. Therefore, amniotic membrane and its derivatives provide a new tool for diabetic foot management.

Development and Characterization of Biointeractive Gelatin Wound Dressing Based on Extract of Punica granatum Linn.

Punica granatum Linn (pomegranate) extracts have been proposed for wound healing due to their antimicrobial, antioxidant, and anti-inflammatory properties. In this work, we designed biointeractive membranes that contain standard extracts of P. granatum for the purpose of wound healing. The used standard extract contained 32.24 mg/g of gallic acid and 41.67 mg/g of ellagic acid, and it showed high antioxidant activity (the concentration of the extract that produces 50% scavenging (IC50) 1.715 µg/mL). Compared to the gelatin-based membranes (GEL), membranes containing P. granatum extracts (GELPG) presented a higher maximal tension (p = 0.021) and swelling index (p = 0.033) and lower water vapor permeability (p = 0.003). However, no difference was observed in the elongation and elastic modulus of the two types of membranes (p > 0.05). Our wound-healing assay showed that a GELPG-treated group experienced a significant increase compared to that of the control group in their wound contraction rates on days 3 (p < 0.01), 7 (p < 0.001), and on day 14 (p < 0.001). The GELPG membranes promoted major histological changes in the dynamics of wound healing, such as improvements in the formation of granular tissue, better collagen deposition and arrangement, and earlier development of cutaneous appendages. Our results suggest that a biointeractive gelatin-based membrane containing P. granatum extracts has a promising potential application for dressings that are used to treat wounds.

Amniotic membrane transplantation in ocular surface diseases / Transplante de membrana amniótica em doenças da superfície ocular

Abstract Objective: To evaluate the clinical effectiveness of amniotic membrane transplantation for ocular surface reconstruction. Methods: Prospective study including 23 eyes of 21 patients who underwent amniotic membrane transplantation at Hospital de Clínicas da Universidade Federal do Paraná (HC-UFPR) and at Cirurgia e Diagnose em Oftalmologia do Paraná (CDOP) clinic, located in Curitiba, PR, Brazil, from may 2015 to july 2019. The amniotic membrane was collected from elective and term cesarean delivery, and conserved in preservation medium and glycerol 1:1, stored at -80° Celsius. The membrane was fixed on the ocular surface with 10-0 nylon, 8-0 vicryl, biological glue or a combination of these materials. Results: The ocular surface reconstruction was successful in 22 eyes (95.6%). Failure was observed only in 1 case (bullous keratopathy) in which the condition was maintained postoperatively. Patients' age ranged from 11-82 years, with a mean age of 37.4 years. There was a higher incidence in males (66.6%). A difference was perceived in the distribution of the affected eye (which was greater in the right eye - 65.2%). As for the previous ophthalmic surgery history, 12 of the 23 eyes had a positive history (52.2%). It was observed that all patients who had preoperative visual acuity assessed showed improvement or maintenance of corrected visual acuity. In the postoperative period, complications associated with the underlying disease were observed, although not particularly related to the amniotic membrane transplantation. There were not any cases of postoperative infection. Conclusions: There was an improvement in the general state of the ocular surface in almost all of the cases in which the transplant was performed. Therefore, the amniotic membrane can be considered a good alternative for reconstructing the ocular surface, as a single or supporting treatment.

Resumo Objetivo: Avaliar a eficácia clínica do transplante de membrana amniótica na reconstrução da superfície ocular. Métodos: Estudo prospectivo incluiu 23 olhos de 21 pacientes que realizaram transplante de membrana amniótica no Hospital de Clínicas da Universidade Federal do Paraná (UFPR) e na clínica de Cirurgia e Diagnose em Oftalmologia do Paraná (CDOP), localizados em Curitiba, PR, Brasil, no período de maio de 2015 a julho de 2019. A membrana amniótica foi captada a partir de parto cesárea eletivo e a termo, conservada em meio de preservação e glicerol 1:1 e armazenada a -80° Celsius. A membrana foi fixada na superfície ocular com fio nylon 10-0 ou vicryl 8-0 e/ou cola biológica. Resultados: A idade dos pacientes variou de 11-82 anos, com média de 37,4 anos. Houve maior incidência no sexo masculino (66,6%). Ocorreu diferença na distribuição do olho acometido (maior no olho direito - 65,2%). Quanto à história de cirurgia oftalmológica prévia, 12 dos 23 olhos tinham história positiva (52,2%). Observamos que nos pacientes em que foi possível a avaliação da acuidade visual pré-operatória, todos apresentaram melhora ou manutenção da acuidade visual. No pós-operatório foi observado complicações associadas à doença de base e não propriamente ao transplante de membrana amniótica. Não foram registrados casos de infecção pós-operatória. Conclusão: Houve melhora do estado geral da superfície ocular em quase totalidade dos casos em que o transplante foi realizado. Portanto, a membrana amniótica pode ser considerada uma boa alternativa para reconstrução da superfície ocular, como tratamento único ou coadjuvante.

Lyophilised tilapia skin as a xenograft for superficial partial thickness burns: a novel preparation and storage technique.

Despite a considerable decrease in its incidence worldwide, burns remain the fourth most common type of trauma. The majority of burns are small, with 75% of injuries treated on an outpatient basis. Tilapia skin, as a biological material, has been suggested as an option for the management of burn wounds. After good results were obtained with the use of a glycerolised version of tilapia skin in burned children and adults, it was hypothesised that similar outcomes could be achieved with the use of a lyophilised version of tilapia skin. We report the case of a 33-year-old female patient with scalds to the upper abdomen, and both breasts, arms and forearms. Involvement of 10% of total body surface area with superficial partial thickness burns was calculated. The good adherence of tilapia skin to the wound bed, a 10-day period for complete re-epithelialisation of the wounds and the absence of side effects suggested that the lyophilised version of tilapia skin is effective for burn treatment. Compared with glycerolisation, lyophilisation is thought to permit extended storage of sterile tissue and decreased costs related to distribution and transport, but further studies are needed to confirm this.

Chronic venous ulcers: a review on treatment with fibrin sealant and prognostic advances using proteomic strategies.

Venous ulcers are the main causes of chronic lower-limb ulcers. The healing difficulties encourage the research and development of new products in order to achieve better therapeutic results. Fibrin sealant is one of these alternatives. Besides being a validated scaffold and drug delivery system, it possesses excellent healing properties. This review covered the last 25 years of the literature and showed that the fibrin sealant is used in various clinical situations to promote the healing of different types of ulcers, especially chronic ones. These are mostly venous in origin and usually does not respond to conventional treatment. Commercially, only the homologous fibrin sealants obtained from human blood are available, which are highly efficient but very expensive. The heterologous fibrin sealant is a non-commercial experimental low-cost product and easily produced due to the abundance of raw material. The phase I/II clinical trial is already completed and showed that the product is safe and promisingly efficacious for the treatment of chronic venous ulcers. In addition, clinical proteomic strategies to assess disease prognosis have been increasingly used. By analyzing liquid samples from the wounds through proteomic strategies, it is possible to predict before treatment which ulcers will evolve favorably and which ones will be difficult to heal. This prognosis is only possible by evaluating the expression of isolated proteins in exudates and analysis using label-free strategies for shotgun. Multicentric clinical trials will be required to evaluate the efficacy of fibrin sealant to treat chronic ulcers, as well as to validate the proteomic strategies to assess prognosis.