In this paper, the use of ultrathin cellulose supports as platform for the incorporation of analgesic drugs in wound dressings is proposed. As a model drug, diclofenac (DCF) is chosen, which is ...commonly used in pain easing medical treatments. The DCF containing cellulose films are prepared by mixing solutions of trimethylsilyl cellulose (DSSᵢ:2.5) with DCF dissolved in THF. After depositing the material on a solid surface by spin-coating, the films are subjected to vapor-phase hydrolysis using 3 M HCl in order to achieve regeneration of cellulose. The release of DCF from these films over time is studied by UV–Vis. Upon deposition of additional layers of cellulose that do not contain DCF, the release from these films can be decelerated significantly. The release kinetics from these films is very similar to those of viscose fibers impregnated with DCF solutions. These studies indicate a potential use of cellulose thin films as model platform for viscose based wound dressings.
The purpose of the article is to present the results of the research aimed at establishing the current situation in the health care system in Slovenia and verifying whether the possibility and ...support exist for the introduction of a freelance medical specialist.
We conducted a survey among physicians and health care managers. The sample framework covered the total population of physicians and health care managers in Slovenia; surveys were completed by 318 physicians and 52 health care managers.
The results of the quantitative research analysis provided an essential basis for and feedback information about possible areas for improving the current state of the health care system. The conclusions of semistructured interviews also considerably contributed to the elaboration of the freelance medical specialist proposal.
The findings of the research point out the need for changes in the Slovenian health care system and the support of the research participants in the implementation of the freelance medical specialist proposal. In the participants' opinions, the possibility of introducing freelance medical specialists would change the work organisation, particularly in terms of additional formalised possibilities for practising in the medical profession, which would further contribute to the overall improvement of the health care system.
- The aim of the study was to evaluate the efficacy and safety of the new method of platelet-rich plasma activation in the form of platelet gel, used in the treatment of non-healing chronic lower leg ...ulcers. The study was prospectively randomized, double blind and placebo controlled. We treated 60 patients (42 males and 18 females, mean age 69.43 years, SD 14.74) with chronic lower leg ulcers of different etiologies. Thirty patients were treated with allogeneic platelet gel and 30 with hydrogel. Both groups were comparable for duration of ulcer and its size. Treatment was repeated once a week for three consecutive weeks and then the last examination was scheduled at 6 months of the first platelet gel application. The t-test was used to analyze independent samples. Healing of chronic wounds with platelet gel was statistically significantly more effective compared to the treatment with hydrogel (p<0.05). At 6 months of platelet gel application, the mean wound area in the experimental group decreased to 35.01% (SD 53.69) of the initial wound size. In the control group, the wound area decreased to 89.95% (SD 71.82) of the initial wound size (p=0.001). The circumference of the wounds diminished to 54.62% (SD 39.85) of the initial value in the experimental group, compared to 91.28% (SD 29.32) in the control group (p<0.001). Allogeneic platelet gel prepared by the new method used in this study was found to be a good treatment option for non-healing chronic wounds when other methods are ineffective.
Staphylococcus aureus is among the most important human pathogens. It is associated with different infections and is a major cause of skin and soft tissue infections (SSTIs). The aim of our study was ...to compare S. aureus isolates associated with SSTIs with isolates obtained from healthy carriers in the Central Slovenia region in terms of antimicrobial susceptibility, genetic diversity by clonal complex (CC)/sequence type, spa type, and by toxin gene profiling. In total, 274 S. aureus isolates were collected prospectively by culturing wound samples from 461 SSTI patients and nasal samples from 451 healthy carriers. We have demonstrated high heterogeneity in terms of CCs and spa type in both groups of isolates. The main clone among SSTI strains was Panton–Valentine leukocidin gene (pvl) positive CC121, whereas the main clone among carrier strains was CC45 carrying a large range of toxin genes. The main spa type in both groups was t091. Pvl was more frequently present in SSTI strains (31.2% SSTI vs 3.6% carrier strains) and staphylococcal enterotoxin C was more frequently present in carrier strains (1.6% SSTI vs 17.0% carrier strains). We have also demonstrated that methicillin‐resistant S. aureus was a rare cause (2.8%) of SSTIs in our region.
Calcaneal fractures are relatively rare and difficult to treat. Treatment options vary based on the type of fracture and the surgeon's experiences. In recent years, surgical procedures have ...increasingly been used due to the better long-term results. We present a case where guided tissue regeneration was performed in a calcaneal fracture that needed primary subtalar arthrodesis. We used the principles of guided tissue regeneration from oral surgery to perform primary subtalar arthrodesis and minimize the risk of non-union. We used a heterologous collagen membrane, which acts as a mechanical barrier and protects the bone graft from the invasion of unwanted cells that could lead to non-union. The collagenous membrane also has osteoconductive properties and is therefore able to increase the osteoblast proliferation rate.
A 62-year-old Caucasian woman sustained multiple fractures of her lower limbs and spine after a fall from a ladder. Her left calcaneus had a comminuted multifragmental fracture (Sanders type IV) with severe destruction of the cartilage of her subtalar joint and depression of the Böhler's angle. Therefore, we performed primary arthrodesis of her subtalar joint with elevation of the Böhler's angle using a 7.3 mm titanium screw, a heterologous cortico-cancellous collagenated pre-hydrated bone mix, a heterologous cancellous collagenated bone wedge, and a heterologous collagen membrane (Tecnoss®, Italy). The graft was fully incorporated 12 weeks after the procedure and a year and a half later our patient walks without limping. We present a new use of guided tissue regeneration with heterologous materials that can be used to treat extensive bone defects after bone injuries.
We believe that guided tissue regeneration using heterologous materials, including a heterologous collagen membrane that presents a mechanical barrier between soft tissues and bone as well as a stimulative component that enhances bone formation, could be more often used in bone surgery.
Wound dressings, capable of local controlled delivery of non-steroid anti-inflammatory pain-killing drugs (NSAIDs) to the wound bed, offer great potential to accelerate wound healing, hence increase ...the quality of patient life. With local NSAID delivery, unwanted side effects encountered in their systemic delivery, are drastically diminished. In this study, four functional fibrous wound dressing materials, namely viscose, alginate, sodium carboxymethyl cellulose (Na-CMC) and polyethylene terephthalate (PET) loaded with a NSAID, diclofenac sodium (DCF) are prepared, and their suitability to tune the release rate of DCF is evaluated. Through careful examination of material–drug combinations, in terms of their physicochemical properties (air permeability, wettability and water retention) and structural/morphological properties (infrared spectroscopy, wide angle X-ray scattering and scanning electron microscopy), possible wound care applications are proposed. In vitro release studies using an automated Franz diffusion cell system, combined with UV-Vis absorption spectroscopy for drug release profile determination, are performed as the final pre-formulation test. Results showed significant differences in the release profiles between different material–drug combinations, making the examined materials highly applicable for several wound care applications. The present study presents a novel cost effective approach for preparation of drug loaded wound dressing materials without a sacrifice in patient safety. Additionally, novel methods and material–drug combinations are introduced, paving the way for possible future wound treatment options.
Chronic wounds, especially in diabetic patients, represent a challenging health issue. Since standard treatment protocols often do not provide satisfactory results, additional treatment methods—like ...phototherapy using low-level light therapy—are being investigated. The aim of our study was to evaluate the effect of phototherapy with light-emitting diodes on chronic wound treatment in diabetic and non-diabetic patients. Since a sufficient blood supply is mandatory for wound healing, the evaluation of microcirculation in the healthy skin at a wound’s edge was the main outcome measure. Forty non-diabetic patients and 39 diabetics with lower limb chronic wounds who were referred to the University Medical Center Ljubljana between October 2012 and June 2014 were randomized to the treated and control groups. The treated group received phototherapy with LED 2.4 J/cm
2
(wavelengths 625, 660, 850 nm) three times a week for 8 weeks, and the control group received phototherapy with broadband 580–900 nm and power density 0.72 J/cm
2
. Microcirculation was measured using laser Doppler. A significant increase in blood flow was noted in the treated group of diabetic and non-diabetic patients (
p
= 0.040 and
p
= 0.033), while there was no difference in the control groups. Additional Falanga wound bed score evaluation showed a significant improvement in both treated groups as compared to the control group. According to our results, phototherapy with LED was shown to be an effective additional treatment method for chronic wounds in diabetic and non-diabetic patients.
The potential of alginate/carboxymethyl cellulose based thin films was demonstrated as a testing platform for evaluation of the influence of in situ incorporated growth factors into formulations ...intended for 3D bio-printed wound healing materials. Actual formation of blend films with and without included growth factors was analysed using ATR-IR spectroscopy. Surface morphology and topography were evaluated by atomic force and scanning electron microscopies, whereas the hydrophilicity of all tested materials was determined using the water contact angle measurement method. The inclusion of growth factors into blend films did not affect the films' formation, nor their morphology, whereas their highly hydrophilic character was even slightly enhanced by the added growth factors. Further, several aspects (viability, proliferation and cell morphology), in regard to the blend films included growth factors' influence on both of the most abundant skin cell types (keratynocytes and fibroblasts) were tested. A significantly improved cell viability was detected for films with incorporated growth factors. The prepared thin film-based testing platform could present an important tool to aid the development of novel printable (bio)inks.
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•Thin films can be an important model platform for development of advanced products.•Inclusion of Growth Factors into thin films does not affect the morphological properties.•EGF in thin films significantly improves the viability of keratinocytes.•Alginate/CMC thin films with FGF stimulate the viability of skin fibroblasts.
Development of drug-loaded wound dressings is often performed without systematic consideration of the changing wound environment that can influence such materials’ performance. Among the crucial ...changes are the wound pH and temperature, which have an immense effect on the drug release. Detailed release studies based on the consideration of these changing properties provide an important aspect of the
in vitro
performance testing of novel wound dressing materials. A sodium carboxymethyl cellulose-based wound dressing, with the incorporated non-steroidal anti-inflammatory drug diclofenac, was developed and characterised in regard to its physico-chemical, structural and morphological properties. Further, the influence of pH and temperature were studied on the drug release. Finally, the biocompatibility of the wound dressing towards human skin cells was tested. Incorporation of diclofenac did not alter important properties (water retention value, air permeability) of the host material. Changes in the pH and temperature were shown to influence the release performance and have to be accounted for in the evaluation of such dressings. Furthermore, the knowledge about the potential changes of these parameters in the wound bed could be used potentially to predict, and potentially even to control the drug release from the developed wound dressing. The prepared wound dressing was also proven biocompatible towards human skin cells, making it interesting for potential future use in the clinics.
Advanced therapies of skin injuries Maver, Tina; Maver, Uroš; Kleinschek, Karin Stana ...
Wiener Klinische Wochenschrift,
12/2015, Volume:
127, Issue:
Suppl 5
Journal Article
Peer reviewed
Summary
The loss of tissue is still one of the most challenging problems in healthcare. Efficient laboratory expansion of skin tissue to reproduce the skins barrier function can make the difference ...between life and death for patients with extensive full-thickness burns, chronic wounds, or genetic disorders such as bullous conditions. This engineering has been initiated based on the acute need in the 1980s and today, tissue-engineered skin is the reality. The human skin equivalents are available not only as models for permeation and toxicity screening, but are frequently applied
in vivo
as clinical skin substitutes. This review aims to introduce the most important recent development in the extensive field of tissue engineering and to describe already approved, commercially available skin substitutes in clinical use.
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