bluuebunny/crossref_metadata_2025_split huggingface dataset:
Nitric oxide restores impaired healing in normoglycaemic diabetic rats
Authors: Schaffer M. , Bongartz M. , Fischer S. , Viebahn R. , Proksch B. 
Published: May 2014

Objective:Hyperglycaemia impairs wound healing. However, little is known about the underlying cellular mechanisms that lead to diminished wound repair in insulin-controlled and non-insulin-controlled diabetes. This study investigated the role of endogenous and exogenous nitric oxide on incisional wound healing in diabetic rats.Method:Groups of 10 wild-type Wistar control rats — 10 genetically diabetic BioBreeding rats and 10 genetically diabetic BioBreeding rats treated with subcutaneous insulin implants to render them normoglycaemic — underwent dorsal skin incision followed by subcutaneous insertion of polyvinyl alcohol sponges. The rats were sacrificed 10 days later to determine the wound-breaking strength and reparative collagen deposition. Nitric oxide, an important mediator in diabetic wound healing and collagen synthesis, was measured in wound fluid. Wound-derived fibroblasts were tested for ex vivo synthesis of nitric oxide and collagen. Exogenous nitric oxide was used for the therapeutic interventions.Results:Wound-breaking strength and wound collagen deposition were significantly impaired in the hyperglycaemic diabetic animals (p<0.01). Wound nitric-oxide synthesis and ex vivo wound fibroblast nitric-oxide production were reduced in the hyperglycaemic rats (p<0.01). Insulin treatment partially reversed some of the effects of hyperglycaemia on wound repair (p<0.05). Exogenous nitric oxide further restored wound mechanical strength, collagen deposition and fibroblast collagen synthesis (p<0.01) in insulin-treated (normoglycaemic) diabetic animals.Conclusion:Wound healing is impaired in hyperglycaemic and normoglycaemic diabetic rats. This is reflected in impaired wound fibroblast nitric-oxide synthesis. Used in combination with insulin, exogenous nitric oxide further improves healing outcomes, making it a potential target for therapeutic intervention in insulin-treated normoglycaemic diabetes.Declaration of interest:This work was supported by a grant to MS from the Deutsche Forschungsgemeinschaft Scha 657/4–1.
Wound healing in guinea pigs after topical application of starfish Pentaceraster regulus extract
Authors: Gupta A. , Lakshmi V. , Jain G.K. , Raghubir R. 
Published: May 2014

Objective: To investigate the healing efficacy of Pentaceraster regulus (starfish) aqueous-methanol extract on cutaneous wounds in guinea pigs. Method: Freshly collected starfish were washed with distilled water and soaked in methanol for transportation. After filtering, soaking and concentration, the extract was fractionated into chloroform soluble (5g), 50% aqueous-methanol soluble (20g) and insoluble fractions (25g). Primary screening demonstrated moderate wound-healing activity in male Swiss-strain guinea pigs, so further fractionation into chloroform, 50% aqueous-methanol and insoluble fractions was undertaken. Wound-healing activity was concentrated only in the aqueous-methanol fraction, so this was used for the study. Animals received either 1% aqueous-methanol extract, the vehicle alone or 5% providone-iodine. The following were measured: wound area, wound tensile strength, DNA, total protein and hydroxyproline levels in excised granulation tissue. Histological changes were observed under microscope. Results: Extract-treated wounds healed faster, indicated by a significant contraction in wound area (42%). Cellular proliferation and collagen synthesis at the wound site increased, demonstrated by increase in DNA (33%), protein (29%) and hydroxyproline (37%) content when compared with the controls and povidone-iodine-treated animals (standard care). These findings were confirmed by histological examination. Proper folding of collagen was demonstrated by a significant increase in tensile strength (34%). Conclusion: The results suggest that the aqueous-methanol extract of starfish P. regulus promotes wound-healing activity. Declaration of interest: None
Changes in leg ulcer management practice following training in an Irish community setting
Authors: Clarke-Moloney M. , Keane N. , Kavanagh E. 
Published: May 2014

Objective: To identify regional changes in leg ulcer management following leg ulcer training for community-based nurses which incorporated Doppler ankle brachial pressure index (ABPI) assessment. Methods: This was a two-part study conducted in the Irish Health Service Executive, Mid-Western Area. An initial audit in 2005 gathered details on all leg ulcer patients treated in the community in one week, including patient demographics, ulcer aetiology, assessment and treatment1. The first audit was carried out before the introduction of a training course for community-based nurses in leg ulcer assessment and management. The training programme was delivered in 2005 and again in 2006. In total 30 public health nurses and community registered nurses from this region completed the course. The second part of the study involved repeating the audit in 2007. By comparing the results from 2005 with 2007 we were able to identify changes in leg ulcer assessment and management. Results: A total of 426 and 449 leg ulcers were identified, with a prevalence of 0.12% and 0.1% in 2005 and 2007 respectively. Prevalence increased to 1.2% (2005) and 1.1% (2007) in those aged over 70 years. Most ulcers were venous in origin (63.3% in 2005 versus 68.8% in 2007). From 2005 to 2007 the number of venous leg ulcers treated with high compression increased significantly, by almost 16% (p<0.0001). Once-weekly dressing changes increased by a significant 10%, reducing the number of dressings requiring more frequent changes (p=0.002). Conclusion: Significant improvements in leg-ulcer practices were noted in the 18-month study period. The results show very significant increases in number of patients treated with high compression and a significant reduction in more than once-weekly dressing changes. These positive changes may be partly attributed to the enhanced knowledge and skills nurses gained by participating in training. Declaration of interest: None.
An in vitro examination of the antioxidant and anti-inflammatory properties of buckwheat honey
Authors: van den Berg A.J.J. , van den Worm E. , Quarles van Ufford H.C. , Halkes S.B.A. , Hoekstra M.J. , Beukelman C.J. 
Published: May 2014

Objective: Hydroxyl radical and hypochlorite anion formed at the wound site from superoxide anion produced by activated polymorphonuclear neutrophils (PMNs) are considered important factors in impaired wound healing. Superoxide anion may also react with nitric oxide produced by macrophages to form peroxynitrite, a third strong oxidant that damages surrounding tissue. In order to select honey for use in wound-healing products, different samples were compared for their capacity to reduce levels of reactive oxygen species (ROS) in vitro. Method: Honey samples were tested in assays for inhibition of ROS production by activated human PMNs, antioxidant activity (scavenging of superoxide anion in a cell-free system) and inhibition of human complement (reducing levels of ROS by limiting formation of complement factors that attract and stimulate PMNs). For buckwheat honey (New York, US), moisture and free acid content were determined by refractive index measurement and potentiometric titration respectively. Honey constituents other than sugars were investigated by thin layer chromatography, using natural product reagent to detect phenolic compounds. Constituents with antioxidant properties were detected by spraying the chromatogram with DPPH. Results: Although most honey samples were shown to be active, significant differences were observed, with the highly active honey exceeding the activities of samples with minor effects by factors of 4 to 30. Most pronounced activities were found for American buckwheat honey from the state of New York. Phenolic constituents of buckwheat honey were shown to have antioxidant activity. Conclusion: As buckwheat honey was most effective in reducing ROS levels, it was selected for use in wound-healing products. The major antioxidant properties in buckwheat honey derive from its phenolic constituents, which are present in relatively large amounts. Its phenolic compounds may also exert antibacterial activity, whereas its low pH and high free acid content may assist wound healing. Declaration of interest: Research was financed by Greystone Medical Group.
Microbiology of amputation wound infection in a Nigerian setting
Authors: Akinyoola A.L. , Ojo O.D. , Oginni L.M. 
Published: May 2014

Objective:To identify the microbial pathogens responsible for amputation wound infections, their distribution and antibiotic-sensitivity patterns.Method:Consecutive patients who had limb amputations from April 2002 to March 2006 in an Nigerian hospital were recruited into this prospective observational study. The patients’ demographic features, indications for amputation, microbiology of stump wound infections and the effects on length of hospital stay were reported.Results:Fifty-seven patients (mean age 34.6 ± 19.2 years) had amputations in 58 limbs. Trauma leading to limb gangrene following treatment by traditional bone setters was the most common indication for amputation (64%). Approximately 76% of the amputations were in the lower limbs. Wound infection occurred in 48% of the stumps, of which 71% had been amputated because of a trauma injury. Pseudomonas aeruginosa was the most commonly isolated pathogen (40%). There was a very low correlation between the aetiologic bacterial agents and the age of patient, source of referral, indication for amputation and level of amputation. Amputation wound infections significantly prolonged the patients’ length of hospital stay (p=0.002).Conclusion:Amputation wound infection constitutes a serious morbidity in our practice. Most of the causes are preventable.Declaration of interest:None.
Combined use of an ibuprofen-releasing foam dressing and silver dressing on infected leg ulcers
Authors: Jørgensen B. , Gottrup F. , Karlsmark T. , Bech-Thomsen N. , Sibbald R.G. 
Published: May 2014

Objective: To investigate the effect and safety of an ibuprofen-releasing foam (Biatain-Ibu, Coloplast A/S) combined with an ionised silver-releasing wound contact layer (Physiotulle Ag, Coloplast A/S) on painful, infected venous leg ulcers. Method: This open non-comparative study involved 24 patients with painful, exuding, locally infected, and stalled venous leg ulcers. Persistent pain and pain at dressing change were monitored using a 11-point numerical box scale (NBS). The composition of the wound bed, the dressing combination’s ability to absorb exudate and minimise leakage, ibuprofen content in the exudate, reduction in wound area and adverse effects were also recorded. Results: Persistent wound pain decreased from a mean of 6.3 ± 2.2 to 3.0 ± 1.7 after 12 hours and remained low thereafter. Pain at dressing change also decreased and remained low. Forty-eight hours after the first dressing application, the mean concentration of ibuprofen in the wound exudate reached a constant level of 35 ± 21µg/ml. After 31 days, the relative wound area had reduced by 42%, with an associated decrease in fibrin and an increase in granulation tissue. The number of patients with wound malodour decreased from 37% to 4%. No serious adverse events were reported. Conclusion: The combined use of the ibuprofen-releasing foam dressing and silver-releasing contact layer reduced wound pain and promoted healing without compromising safety. Declaration of interest: This study was supported by Coloplast A/S, Humlebæk, Denmark and its affiliates. However, Coloplast A/S cannot be held responsible for the opinions expressed in this paper by the authors.
Bacteriological changes in sloughy venous leg ulcers treated with manuka honey or hydrogel: an RCT
Authors: Gethin G. , Cowman S. 
Published: May 2014

Objective:To determine the qualitative bacteriological changes that occurred during a four-week treatment period with either manuka honey or a hydrogel dressing. This was the secondary outcome of a randomised controlled trial (RCT) that compared the efficacy of the two treatments in desloughing venous leg ulcers.Method:This was a prospective open label multicentre RCT with blinded microbiological outcome analysis. Randomisation was conducted via remote telephone. To be included, the wound bed needed to comprise at least 50% slough. Wound swabs were taken at the start of treatment and after four weeks.Results:In all, 108 patients (35 males, 73 females) aged 24–89 years (mean 68) enrolled into the study. Both groups were comparable at baseline. Eighteen patients (17%) were withdrawn due to a wound infection: six in the honey group and 12 in the hydrogel group. Staphylococcus aureus was the most common isolate, being identified in 41 wounds (38%). At baseline, meticillin-resistant Staphylococcus aureus was identified in 16 wounds (10 honey versus six hydrogel). After four weeks 70% (n=7) of the manuka-honey treated wounds versus 16% (n=1) of the hydrogel treated wounds had MRSA eradicated. Pseudomonas aeruginosa was reported in 14% (n=16) of all wounds at baseline. After four weeks 33% (n=2) treated with honey and 50% (n=5) treated with hydrogel had this eliminated. The number of wounds (n=11 at baseline; n=15 at week 4) with ≥3 bacteria species remained constant over the four weeks.Conclusion:Manuka honey was effective in eradicating MRSA from 70% of chronic venous ulcers. The potential to prevent infection is increased when wounds are desloughed and MRSA is eliminated. This can be beneficial to prevent cross-infection.Declaration of interest:None.
Effects of biofilm treatments on the multi-species Lubbock chronic wound biofilm model
Authors: Dowd S.E. , Sun Y. , Smith E. , Kennedy J.P. , Jones C.E. , Wolcott R. 
Published: May 2014

Objective: To evaluate the efficacy of several biofilm effectors in inhibiting biofilm formation in an in vitro multi-species chronic wound biofilm model. Method: The Lubbock Chronic Wound Biofilm (LCWB) model has been described in detail elsewhere. Pathogens used in the model are Pseudomonas aeruginosa, Enterococcus faecalis and Staphylococcus aureus. These are three of the most important species associated with biofilms. Here, the model was exposed to the following biofilm effectors: xylitol, salicylic acid, farnesol, erythritol and two proprietary, semi-solid, wound-dressing formulations currently under development (Sanguitec gels). Results: Biofilm formation was completely inhibited in the LCWB model following treatment with 20% xylitol, 10% erythritol, 1,000μg/ml farnesol, 20mM salicylic acid or 0.1% of either of the two Sanguitec gel formulations. Salicylic acid specifically inhibited S. aureus (p<0.01) at 10mM and 20mM, consequently increasing the ratios of P. aeruginosa and E. faecalis within the biofilm. Xylitol had an increasing inhibitory effect on P. aeruginosa (p<0.01) at all concentrations evaluated. Erythritol had an inhibitory effect on P. aeruginosa and S. aureus growth (p<0.01) at over 5% concentrations. The inhibitory effect of both Sanguitec gel formulations was more broadly effective, with an increasingly inhibitory effect on all LCWB species (p<0.01). Conclusion: The LCWB model provides a multi-species format with which to evaluate the effect of biofilm effectors on wound flora in a biofilm phenotype. These results suggest that different treatments can target specific populations within a biofilm. Salicylic acid preferentially targeted S. aureus, xylitol preferentially targeted P. aeruginosa, while erythritol preferentially targeted both P. aeruginosa and S. aureus. In contrast, the two Sanguitec gel formulations provided a broad, less preferential, inhibition of biofilm development. Declaration of interest: Research and Testing Laboratory is a for-profit enterprise that develops molecular methods and performs service research work on biofilms. Sanguitec gel was developed by JPK and CEJ.
Efficacy of a polyurethane dressing versus a soft silicone sheet on hypertrophic scars
Authors: Wigger-Albert W. , Kuhlmann M. , Wilhelm D. , Mrowietz U. , Eichhorn K. , Ortega J. , Bredehorst A. , Wilhelm K-P. 
Published: May 2014

Objective: To compare the efficacy and safety of a polyurethane dressing with a silicone sheet in the treatment of hypertrophic scars. Method: Sixty patients participated in this intra-individual 12-week clinical trial. Each scar was divided into two areas, to which the polyurethane dressing and the silicone sheet were randomly allocated. The primary outcome measure was the percentage change in the overall scar index (SI) between baseline and week 12. Secondary outcome measures included changes in skin redness, objectively measured by chromametry, and patients' views on the aesthetic outcome of treatment. Results: Both therapies achieved favourable results for all of the above outcome measures. Results were comparable for the primary outcome measure: 29.4% versus 33.7% for the silicone sheet and polyurethane product respectively. The decrease in the overall SI was significantly more pronounced for the polyurethane product after week 4 (5.6% versus 15.8% for the silicone sheet; p<0.0001) and week 8 (20.2% versus 27.1%; p=0.012). Conclusion: Both regimens were associated with a significant reduction in the clinical signs of hypertrophic scars over 12 weeks of treatment. The polyurethane dressing demonstrated a significantly more pronounced reduction in severity of these clinical signs after four and eight weeks of treatment and was better tolerated than the silicone sheet. Declaration of interest: This study was funded by Beiersdorf AG. proDERM is an independent research company, and none of the authors have an interest in the sponsor's commercial activities.
Superficial swab cultures in open fracture management: insights from a resource-poor setting
Authors: Ojo O.D. , Oluwadiya K.S. , Ikem I.C. , Oginni L.M. , Ako-Nai A.K. , Daniel F.V. 
Published: May 2014

Objective To identify bacterial isolates from superficial swabs of open fracture wounds at presentation and after infection has been established, and to determine if there are correlations between them. Method Patients who presented with open fractures at the Wesley Guild Hospital, Ilesa, Nigeria between December 2004 and May 2006 were recruited into this prospective study. Superficial wound swabs were taken at presentation and if patient showed evidence of wound infection. Results Sixty patients had open fractures. The initial bacteria culture of wound swabs taken on the day of presentation was positive in 41 (68.3%) patients. Of these, 19 (46.3%) yielded one bacteria isolate, 17 (41.5%) yielded two and 5 (12.2%) yielded three, making a total of 68 organisms. The most common organism was Staphylococcus aureus. However, as a group, more aerobic Gram-negative rods were isolated than any other bacteria groups. Eleven (18.3%) patients developed wound infections, all of which were polymicrobial. In 10 (90.9%) of these, the microbial isolate of the final wound swab included at least one organism that was present in the initial wound culture. No patient with an initial negative culture went on to develop a wound infection. The mean presentation interval of patients with wounds that became infected was 15.2 ± 7.9 hours (95% CI 9.8–20.5 hours) compared with 2.9 ± 3.1 hours (95% CI 2.0–3.8 hours) for those who did not develop a wound infection (p>0.01). Conclusion In a resource-poor setting, where pre-hospital care is unavailable and patients present late, superficial wound swabs are effective in predicting subsequent organisms that may cause wound infections. Conflict of interest None.
Treatment of symptomatic abnormal skin scars with electrical stimulation
Authors: Perry D. , Colthurst J. , Giddings P. , McGrouther D.A. , Morris J. , Bayat A. 
Published: May 2014

Objective To evaluate the effect of non-invasive biofeedback electrical stimulation on symptomatic abnormal skin scars. Method Thirty patients with over 140 scars with long-term pain and itch were recruited into the study. Patients monitored the intensity of symptoms (pain and itching) on a numerical rating scale. In addition, a modified Manchester scar scale was used to objectively assess digital photographs of each scar in terms of colour, contour, distortion and texture, while a non-invasive spectrophotometric intracutaneous analysis was used to monitor the scars' physical characteristics. Results The electrical stimulation device resulted in a clinically and statistically significant (p<0.05) reduction of symptoms and scar scores. Pain and itch scores were both reduced to a median score of 0 by 2 months, from a baseline of 7 and 6 respectively. Scar scores were reduced from a baseline of 14 to a median score of 11 by 2 months. Conclusion These results give a preliminary indication of the potential role of non-invasive biofeedback electrical stimulation in the management of chronic scar pain and itch. However, further large scale controlled studies are warranted to elucidate its overall efficacy and mechanistic action. Conflict of interest Funding was provided from Fenzian Ltd for this study.
The effect of stochastic electrical noise on hard-to-heal wounds
Authors: Ricci E. , Afaragan M. 
Published: May 2014

Objective: To evaluate the effect of electrical stochastic noise stimulation on hard-to-heal wounds. Method: This open-label observational case series aimed to evaluate the effect of the Bioelectrical Signal Therapy (BST) device on the treatment of hard-to-heal (recalcitrant) wounds. The study group comprised nine patients (three males and six females), with a total of 11 ulcers that had not healed (ulcer duration range: 18 months to 20 years) despite being treated with other standard methods. Ulcer aetiologies were: EPUAP grade IV pressure ulcers (n=6) and grade III pressure ulcer (n=1), vasculitic ulcer (n=1), post-actinic lesion (n=1), ischaemic (n=1) and post-surgical lesion (n=1). The median patient age was 75. Treatment was delivered for 30 minutes, three times a day for 60 days. Results: Four patients (five ulcers) closed completely. Ulcers in three patients reduced in size with signs of epithelialisation. No imp0rovement was observed in one patient (who had paraplegia). One patient stopped treatment due to skin irritation at electrode sites. No other adverse effects were observed and all of the treated patients defined the treatment as painless. Conclusion: Stochastic white noise applied to hard-to-heal ulcers for 60 consecutive days reduced the wound surface area by an overall mean closure rate of 82.5% (SD=25.2%). This open-label observational case series provides preliminary indication of the possible role of stochastic resonance in wound healing. Declaration of interest: This study was supported by Vivisol (Italy), a distributor of Lifewave's BST.