Molecular Mechanism of Traditional Chinese Ointment of Xuzhou Qufu Shengji in Infected Wounds

Background. Xuzhou Qufu Shengji Ointment (QFSJO) has been used in hospital and private medication for more than 30 years to treat the infective wounds after trauma. However, molecular investigation is lacking. This study used rats to explore the healing mechanism of QFSJO in promoting wound healing in human. Methods. One circular incision was individually generated on the back of 30 rats in three groups and challenged with 108 CFU (0.3 mL) of Staphylococcus aureus. Then, one of the trauma groups was treated with QFSJO gauze, and the control group was covered with a piece of Vaseline gauze, while the western medicine group was treated with erythromycin in a similar way. The dressing change of all the groups was performed once a day for three weeks. The anti-inflammation and proangiogenesis of QFSJO were evaluated by enzyme-linked immunosorbent assay (ELISA). The levels of angiogenesis associated factors, vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (b-FGF), hydroxyproline, and hemoglobin, were measured according to ELISA. The immunohistochemistry of CD31 and CD34 expression in granulation tissue was demonstrated and quantitatively analyzed for angiogenesis in granulation tissue in sites. Results. A faster wound healing ratio was observed in QFSJO-dressing-treated group than Vaseline- and erythrocin-treated groups. ELISA results showed that QFSJO promoted VEGF and b-FGF levels significantly in early stage of wound healing. QFSJO dressing group also showed an enhanced hydroxyproline and hemoglobin in granulation tissue. The expressions of CD31 and CD34 in granulation tissue of QFSJO group were higher than in the Vaseline and erythrocin groups. Conclusion. QFSJO improved the healing rate of the infective wounds by promoting the angiogenesis of granulation tissue and inhibiting the inflammation of the trauma tissue. Our finding suggests that QFSJO is able to help angiogenic capillary sprouts for collagen accumulates in the granulation tissue.

Impact of acacia arabica topical gel on skin wound healing: An experimental study

Aim of the study: To estimate the influence of Acacia Arabica gel abstract on skin wound healing. Material and method: 28male adult rabbits were included, 2 incisions of 1cm length were made on the skin of the rabbit’s back, one is treated by acacia gel while another left for normal healing, histopathological examination was done at 24h, 3, 7 and 14 days intervals. Results: The inflammatory reactions showed no significant results for both the control group and the study group during the study intervals. Granulation tissue in the control group was absent after 24h but increased to become profound after 7 days then become moderate, while the study group showed scanty granulation tissue from the first day and increased through study intervals. Re-epithelialization mean scores in the study group were higher than control one. Conclusions: Acacia arabica has the efficacy of hastening the wound healing process.

Evaluation of Effect of Biologically Synthesized Ethanolic Extract of Propolis-Loaded Poly(-Lactic-co-Glycolic Acid) Nanoparticles on Wound Healing in Diabetic Rats

Wound healing is interaction of a complex cascade of cellular/biochemical actions leading to restoration of structural and functional integrity with regain of injured tissues strength. This study was aimed at evaluation of application of ethanolic extract of propolis-loaded poly(-lactic-co-glycolic acid) nanoparticles (EEP-PLGA NPs) on wound healing in diabetic rats. Sixty rats were randomized into four groups of 15 rats each: In control group (Control) diabetic wound was treated with normal saline. In Carrier 1 group diabetic wound was treated with PLGA nanoparticles based solution. In Carrier 2 group the diabetic wound was treated with EEP. In Treatment group animals received EEP-PLGA NPs on the wound. Wound size was measured on 7, 14 and 21 days after surgery. The expression of p53, bcl-2, Caspase III, were evaluated using reverse-transcription PCR and Immunohistochemical staining. The Treatment group had significantly reduced the wound size compared to other groups ( P = 0.001). histological and morphometric studies, and mean rank of the qualitative studies demonstrated that there was significant difference between Treatment group and other groups ( P < .05). Observations demonstrated that ethanolic extract of propolis-loaded PLGA nanoparticles significantly shortened the inflammatory phase and accelerated the cellular proliferation. Accordingly, the animals in Treatment group revealed significantly ( P < .05) higher fibroblast distribution/one mm2 of wound area and rapid re epithelialization. The mRNA levels of bcl-2, p53 and caspase III were remarkably ( P < .05) higher in Treatment group compared to control and animals. The immunohistochemical analyzes confirmed the RT-PCR findings. EEP-PLGA NPs offered potential advantages in wound healing acceleration and improvement through angiogenesis stimulation, fibroblast proliferation and granulation tissue formation in early days of healing phases, acceleration in diabetic wound repair associated with earlier wound contraction and stability of damaged area by rearrangement of granulation tissue and collagen fibers.

The Erroneous Appearance of Silver Nitrate on CT Imaging in Patients with Severe Otitis Externa; A Case Series

Introduction Silver nitrate is commonly used within otolaryngology to treat granulation tissue in severe otitis externa. It appears radio-opaque on CT (computed tomography) imaging and therefore can mimic bony fragments and foreign bodies. This is particularly cumbersome when the phenomena correlates to the clinical complaint. Discussion We report two cases of 73-year-old and 75-year-old males who presented with chronic otalgia and discharge. Granulation tissue in the external auditory canal was identified and chemically cauterised with silver nitrate. Subsequent CT petrous bones demonstrated an unidentified foreign body in the canal with extensive soft tissue swelling giving an impression of a wick in situ and “minor bony erosion in the left external acoustic canal” respectively. An additional CT of a 57-year-old female who had been treated with silver nitrate for granulomatous tissue reported “multiple highly radiopaque foci in the external auditory canal, suggestive of foreign body”. Though relatively unknown, this phenomenon has been reported in literature. However, there are few reports of silver nitrate artefacts in CT images of the head no cases in the context of otitis externa. Our patients avoided further imaging or surgery following clarification with the radiologists and symptomatic improvement with long-term intravenous antibiotics. Conclusion Given the prevalence of CT imaging and cauterization in otolaryngology, we recommend contemporaneously documenting the use of silver nitrate and highlighting this on request forms to avoid alarming erroneous reports, unnecessary investigation and surgical procedures. We also recommend, where clinically acceptable, to use silver nitrate prior to imaging.

Phytosomes of Naphthoquinone enriched Extract of Root bark of Onosma echioides exhibit wound healing activity in Rats

The present study is aimed at evaluation of phytosomal gel of the petroleum ether extract of root bark of Onosma echiodes for wound healing activity in rats. Extract of root bark of O. echioides was standardized by isolated naphthoquinone dimer using HPTLC. Phytosomes (equivalent to 2% w/w of naphthoquinones) of the standardized extract were prepared by thin film hydration technique. The wound healing efficacy of the formulation was evaluated in rats by inflicting excision and incision wounds followed by treatment of the wounds topically. The parameters evaluated for healing included determination of breaking strength and tensile strength of healed skin for incision model and percentage wound contraction, hydroxyproline content, granulation tissue free radicals and catalase in excision wound model. The formulation treated group showed a significant healing (p<0.005) of both the excision and incision wounds with respect to wound contraction and tensile strength respectively, as compared to vehicle treated group. The oxidative stress of the granulation tissue was also found to be reduced as indicated by reduced lipid peroxidation and increase in catalase activity. The phytosomal gel of O. echioides effectively exhibited wound healing effect.

Postoperative Inhaled Steroids Following Glottic Airway Surgery Reduces Granulation Tissue Formation

Objectives: Transoral laser surgery for glottic stenosis (transverse cordotomy and anteromedial arytenoidectomy (TCAMA)) is often complicated by granulation tissue (GT) formation. GT can cause dyspnea and may require surgical removal to alleviate airway obstruction. Inhaled corticosteroids (ICS) have been shown to reduce benign vocal fold granulomas, however its use to prevent GT formation has not been described. We aimed to analyze the effect of immediate postoperative ICS on GT formation in patients undergoing transoral laser surgery for glottic stenosis. Methods: A retrospective analysis of patients that had transoral laser surgery for glottic stenosis from 2000 to 2019 was conducted. Surgical instances were grouped into those that received postoperative ICS and those that did not. Demographics, diagnosis, comorbidities, intraoperative adjuvant therapy, and perioperative medications were collected. Differences in GT formation and need for surgical removal were compared between groups. A multivariate exact logistic regression model was performed. Results: Forty-four patients were included; 16 required 2 glottic airway surgeries (60 surgical instances). Of the 23 instances where patients received immediate postoperative ICS, 0 patients developed GT; and of the 37 instances that did not receive postoperative ICS, 15 (40.5%) developed GT ( P < .0001). Eight (53.3%) of these cases returned to the OR for GT removal. ICS use was solely associated with the absence of GT formation ( P = .042) in the multivariate analysis. Conclusions: Immediate postoperative use of ICS seems to be a safe and effective method to prevent granulation tissue formation and subsequent surgery in patients following transoral laser airway surgery for glottic stenosis.

Burn Care in the Era of Rapid Enzymatic Debridement: Challenging the Dogma that Healing Beyond 21 Days Results in Hypertrophic Scarring

Deep burns are characterized by the presence of a necrotic eschar that delays healing and results in a local and systemic inflammatory response and following healing by secondary intention: heavy scarring. Early surgical debridement followed by grafting was a major advance in deep burn care and is now the standard of care, reducing mortality and hypertrophic scarring. Eschars have alternatively been managed by non-surgical, autolytic debridement, which often results in infection-inflammation, slow epithelialization, granulation tissue formation and subsequent scarring. Studies based on these traditional approaches have demonstrated an association between delayed wound closure (beyond 21 days) and scarring. Early enzymatic debridement with NexoBrid (NXB) followed by appropriate wound care is a novel minimally invasive modality that challenges the well-accepted dictum of a high risk of hypertrophic scarring associated with wound closure that extends beyond 21 days. This is not surprising since early and selective removal of only the necrotic eschar often leaves enough viable dermis and skin appendages to allow healing by epithelialization over the dermis. In the absence of necrotic tissue, healing is similar to epithelialization of clean dermal wounds (like many donor sites) and not healing by the secondary intention that is based on granulation tissue formation and subsequent scarring. If and when granulation islands start to appear on the epithelializing dermis, they and the inflammatory response generally can be controlled by short courses (1-3 days) of topically applied low strength corticosteroid ointments minimizing the risk of hypertrophic scarring, albeit with wound closure delayed beyond the magic number of 21 days. Results from multiple studies and field experience confirm that while deep burns managed with early enzymatic debridement often require more than 21 days to reepithelialize, long-term cosmetic results are at least as good as with excision and grafting.

Features of engraftment and rejection of ear alatransplants in laboratory rats

A method for revealing genetic affinity between laboratory rats has been developed, which is based on the transplantation of ear skin-chondrocyte allografts onto the surface of a full-thickness skin defect. On the example of Wistar rats (laboratory rats were taken from three research institutes), it was shown that the rejection of allografts occurs in the interval between 8 and 21 days with the same genetic differences that existed between the animals. However, at the same time, only those structures of ear allografts such as the dermis, epidermis and its derivatives die and are rejected, but the layers of chondrocytes are submerged under the granulation tissue and remain in a viable position for at least 210 days. The latter phenomenon is probably due to the membranes that cover the chondrocytes and act as an immunological barrier.

The Granule Size Mediates the In Vivo Foreign Body Response and the Integration Behavior of Bone Substitutes

The physicochemical properties of synthetically produced bone substitute materials (BSM) have a major impact on biocompatibility. This affects bony tissue integration, osteoconduction, as well as the degradation pattern and the correlated inflammatory tissue responses including macrophages and multinucleated giant cells (MNGCs). Thus, influencing factors such as size, special surface morphologies, porosity, and interconnectivity have been the subject of extensive research. In the present publication, the influence of the granule size of three identically manufactured bone substitute granules based on the technology of hydroxyapatite (HA)-forming calcium phosphate cements were investigated, which includes the inflammatory response in the surrounding tissue and especially the induction of MNGCs (as a parameter of the material degradation). For the in vivo study, granules of three different size ranges (small = 0.355–0.5 mm; medium = 0.5–1 mm; big = 1–2 mm) were implanted in the subcutaneous connective tissue of 45 male BALB/c mice. At 10, 30, and 60 days post implantationem, the materials were explanted and histologically processed. The defect areas were initially examined histopathologically. Furthermore, pro- and anti-inflammatory macrophages were quantified histomorphometrically after their immunohistochemical detection. The number of MNGCs was quantified as well using a histomorphometrical approach. The results showed a granule size-dependent integration behavior. The surrounding granulation tissue has passivated in the groups of the two bigger granules at 60 days post implantationem including a fibrotic encapsulation, while a granulation tissue was still present in the group of the small granules indicating an ongoing cell-based degradation process. The histomorphometrical analysis showed that the number of proinflammatory macrophages was significantly increased in the small granules at 60 days post implantationem. Similarly, a significant increase of MNGCs was detected in this group at 30 and 60 days post implantationem. Based on these data, it can be concluded that the integration and/or degradation behavior of synthetic bone substitutes can be influenced by granule size.

Biogenic synthesis of nano-sulfur using Punica granatum fruit peel extract with enhanced antimicrobial activities for accelerating wound healing

Microbial wound infections leading to secondary complications in wound healing has resulted in high demand for therapeutic drugs with improved efficacy. Despite achieving enhanced bio-activity and higher bioavailability compared to its bulk form, nano-sulfur (SNP) has been explored to a very limited extent for wound healing applications. In this work, we prepare biogenic SNP (SNP-B) via simple biogenic technique using pomegranate (Punica granatum) peel extract and demonstrate its antimicrobial and wound healing activity. The SNP-B was characterized using powder x-ray diffractometer, FESEM, transmission electron microscopy and Raman spectroscopy. Different wound models (excision, incision, dead space and burn) were used to assess the wound healing potential of SNP-B. The 2% (w/w) SNP-B treated group exhibited enhanced wound contraction rate (excision wound, 99.62 ± 0.59%; burn wound, 99.46 ± 0.59%), breaking strength (393.2 ± 10.87 g cm−2), and granulation tissue weight (166.8 ± 9.45 mg) compared to the control group (excision wound, 84.24 ± 2.78%; burn wound, 90.58 ± 3.2%; breaking strength, 241.3 ± 16.11 g cm−2; granulation tissue weight, 91.17 ± 7.28 mg). The efficacy of 2% (w/w) SNP-B was comparable to that of standard (5% w/w povidone-iodine ointment) in all the wound models analyzed. The SNP-B showed enhanced antibacterial activity with a MIC value of 90, 80, 80, and 60 μg ml−1 for Pseudomonas aeruginosa, Escherichia coli, Bacillus subtilis and Staphylococcus aureus, respectively. The results obtained prove the potential of SNP-B as a multifunctional therapeutic agent for topical applications.