Hyaluronic Acid/Collagenase Ointment in the Treatment of Chronic Hard-to-Heal Wounds: An Observational and Retrospective Study

Abstract: Background: Wound bed preparation is an important concept in clinical practice and is related to adequate debridement. The use of proteolytic enzymes is an established method of enzymatic wound debridement, especially in hard-to-heal ulcers that are unresponsive to normal healing procedures and progress. The TIME framework (tissue, inflflammation/infection, moisture balance, and edge of wound) offers an appropriate strategy to eliminate resistance to healing, as well as maximizing the healing process. Maintenance debridement, as opposed to sporadic debridement, may be proposed in preserving an adequate wound bed towards complete recovery. Collagenase has been effective in debridement due to its ability to degrade collagen and elastin. In this clinical context, collagenase taken from Vibrio alginolitycus is the most favorably expressed enzymatic debriding agent. Methods: This retrospective observational study evaluates the effificacy of an ointment based on hyaluronic acid and collagenase (Bionect Start®), considering a reduced healing time and greater healing quality. We included 70 patients with chronic wounds of different etiologies, including diabetes mellitus (20), post-traumatic ulcers (35), chronic burns of degrees I and II (10), and pressure ulcers (5). We analyzed wound characteristics using the wound bed score (WBS) concept, healing time, as well as operator and patient satisfaction. Results: Frequency of debridement effificacy in terms of wound bed cleansing varied from 26% after 2 weeks to 93% after 4 weeks. We observed complete healing in 62 patients within an eight-week period. The overall operator and patient satisfaction after 8 weeks were 100% and 90%, respectively. Moreover, all patients reported less pain. Conclusions: A combined action of hyaluronic acid and collagenase ointment demonstrated a reduction in healing time while improving healing quality, with a decrease in pain.

Keywords: chronic wounds; hyaluronic acid; collagenase; Vibrio alginolitycus; Bionect Start; Hyalo4 Start

Contribution of antimicrobial photosonodynamic therapy in wound healing: an in vivo efect of curcumin-nisin-based poly (L-lactic acid) nanoparticle on Acinetobacter baumannii bioflms

Abstract

Background: The bioflm-forming ability of Acinetobacter baumannii in the burn wound is clinically problematic due to the development of antibiotic-resistant characteristics, leading to new approaches for treatment being needed. In this study, antimicrobial photo-sonodynamic therapy (aPSDT) was used to assess the anti-bioflm efcacy and wound healing activity in mice with established A. baumannii infections.

Methods: Following synthesis and confrmation of Curcumin-Nisin-based poly (L-lactic acid) nanoparticle (CurNisNp), its cytotoxic and release times were evaluated. After determination of the sub-signifcant reduction (SSR) doses of CurNisNp, irradiation time of light, and ultrasound intensity against A. baumannii, anti-bioflm activity and the intracellular reactive oxygen species (ROS) generation were evaluated. The antibacterial and anti-virulence efects, as well as, histopathological examination of the burn wound sites of treated mice by CurNisNp-mediated aPSDTSSR were assessed and compared with silver sulfadiazine (SSD) as the standard treatment group.

Results: The results showed that non-cytotoxic CurNisNp has a homogeneous surface and a sphere-shaped vesicle with continuous release until the 14th day. The dose-dependent reduction in cell viability of A. baumannii was achieved by increasing the concentrations of CurNisNp, irradiation time of light, and ultrasound intensity. There was a time-dependent reduction in bioflm growth, changes in gene expression, and promotion in wound healing by the acceleration of skin re-epithelialization in mice. Not only there was no signifcant diference between aPSDTSSR and SSD groups in antibacterial and anti-virulence activities, but also wound healing and re-epithelialization occurred more efciently in aPSDTSSR than in the SSD group.

Conclusions: In conclusion, CurNisNp-mediated aPSDT might be a promising complementary approach to treat burn wound infections.

Keywords: Antimicrobial photodynamic therapy, Antimicrobial sonodynamic therapy, Bioflms, Burn wound infection, Curcumin, Nisin, Silver sulfadiazine

Brucellosis relapse causing thoracic aortic ulcers and aneurysm formation: a case report

Abstract

Background: Brucellosis is an infectious disease caused by Brucella spp, which can involve the cardiovascular, digestive, and respiratory systems. Cardiovascular involvement is a rare occurrence, it has an extremely high mortality rate.

Case presentation: A 67-year-old Chinese man presented with thoracic aortic multiple ulcers and partial aneurysm formation that caused symptoms of left waist and left buttock pain. The man was admitted to our hospital due to abdominal aorta pseudoaneurysms 5 years ago. The diagnosis was made by thoracic computed tomography angiography (CTA), previous history, and positive culture of Brucella, and the patient was successfully treated by thoracic aortic covered stent-graft implantation and specifc medical treatment.

Conclusions: People who have a history of contact with cattle and sheep, should beware of the possibility of Brucella infection. If chest and abdominal pain occur, timely medical treatment is recommended, aortic aneurysm, the disease with a high risk of death, can be identifed or excluded by CTA. Early treatment and prevention of disease progression are more benefcial to patients.

Keywords: Brucellosis, Relapse, Thoracic aortic ulcer, Aneurysm

心脏直视手术患者采取标准化防护流程降低 术中压疮发生率的效果研究

摘 要：目的：将标准化防护流程用于进行心脏直视手术患者中后，对其降低压疮发生率的效果进行探析。方法：本研究一共纳入90例实验对象，均为在蚌埠医学院第一附属医院进行心脏直视手术的患者，实验开展时间2019年10月至2020年08月。按随机法分为对照组与观察组，每组各45例患者，前者实施传统护理干预模式，后者实施标准化防护流程模式，对比两组患者术后不同时间段的压疮发生率。结果：观察组与对照组实施不同护理模式后，前者术后即刻与术后2d、4d压疮发生率2.22%、4.44%、8.89%均明显低于后者13.33%、17.78%、24.44%，前者均显著低于后者（P＜0.05）。结论：对进行心脏直视手术的患者应用标准化防护流程模式课后，能获得较为理想的护理效果，对降低患者发生压疮的风险具有非常积极的意义，值得临床应用。

关键词：心脏直视手术，标准化防护流程，压疮

协助偏瘫患者翻身预防压疮的护理研究进展

摘 要：偏瘫患者因肌力下降极易发生压疮，而翻身可间歇性减轻身体局部压力的压迫，是临床上最经济、有效的预防压疮的方法，故该文结合近年来护理人员帮助偏瘫患者翻身预防压疮的护理研究，从翻身的方法、翻身角度、翻身间隔时间及翻身辅助用具的使用等角度做出综述，为临床护理人员在有效预防压疮的基础上减轻翻身操作带来的职业性腰背痛提供一定的参考。

关键词：压力性损伤 偏瘫 护理 翻身

脉复生联合杏芎氯化钠注射液治疗下肢动脉硬化闭塞症的 临床研究

【摘 要】 目的 观察脉复生联合杏芎氯化钠注射液治疗下肢动脉硬化闭塞症患者的临床疗效。方法 将 206 例下肢动脉硬化闭塞症患者随机分为治疗组和对照组各 103 例。两组均在常规治疗基础上给予杏芎氯化钠注射液

( 100 mL 静滴，qd) ，治疗组加服用脉复生( 30 mL，bid) ，治疗 15 d 后，观察治疗前后患者创面愈合率、疼痛程度 VAS 评分、血脂水平、血液流变学、患肢经皮氧负压( TcPO2 ) 、踝肱指数( ABI) 的变化。结果 治疗组总有效率为 96. 11% ，显著高于对照组的 77. 1% ( P ＜ 0. 05) ; 治疗组疼痛减轻程度大于对照组( P ＜ 0. 05) ，经皮氧负压高于对照组( P ＜ 0. 05) 。结论 脉复生联合杏芎氯化钠注射液治疗下肢动脉硬化闭塞症患者有显著疗效，有助于减轻患者溃疡疼痛、提高患肢经皮氧分压、促进患肢溃疡愈合。

【关键词】 下肢动脉硬化闭塞症; 脉复生; 杏芎氯化钠注射液; 下肢溃疡; 经皮氧分压 ABI