orabase and Diabetes-Mellitus--Type-1

To test the safety and effectiveness of carboxyl-methyl-cellulose dressing (Aquacel; ConvaTec, UK) in the management of deep diabetic foot ulcers, a group of consecutive out-patients attending the foot clinic of the Department of Metabolic Diseases was studied.. Patients were selected according to the following inclusion criteria: a foot ulcer deeper than 1 cm for > 3 weeks, good peripheral blood supply (palpable peripheral pulses or ABPI > 0.9). Exclusion criteria were as follows: active infection, as evident from clinical signs (purulent discharge, redness, swelling, tenderness) and confirmed by culture exams, plasma creatinine > 2 mg/dl, recent episodes of ketoacidosis, malignancies, and any therapy or pathology which might interfere with the healing process. Twenty patients were enrolled in the study and having obtained their informed consent, their lesions were surgically debrided with the complete elimination of all necrotic tissue and debris up to the bleeding healthy tissue; then ulcers were staged and measured, and patients were randomly assigned to two different treatment groups. Patients in group A were dressed with saline-moistened gauze, while patients in group B were dressed with Aquacel according to the manufacturer's instructions. All patients in both groups received special post-operative shoes (Podiabetes; Zeno Buratto, Treviso, Italy) and crutches until complete re-epithelialization. Ulcers were all left to heal by secondary intent. After 8 weeks patients were blindly evaluated for: the rate of reduction of lesional volume (RLV), rate of granulation tissue (GT), number of infective complications (IC). Intralesional (ILTC) and perilesional (PLTC) temperatures were also recorded with a thermocouple surface digital thermometer, and the difference between the two values (Delta TC) was calculated. Healing time (HT, days), was then compared between the two groups. Data were compared by analysis of variance (ANOVA), linear regression, Kaplan-Meier survival analysis and Fisher's exact test.. HT was significantly shorter in Group B than in Group A (P < 0.001). RLV was significantly (P < 0.01) higher in Group B patients compared with Group A, as well as GT (P < 0.05). IC were in 1/10 Group B and in 3/10 Group A (P = 0.582). In addition, both ILTC and Delta TC were higher in Group B compared with Group A ones (P < 0.01).. Carboxyl-methyl-cellulose dressings were shown to be safe, effective and well tolerated in the management of non-ischaemic, non-infected deep diabetic foot ulcers.

Topics: Adult; Aged; Amputation, Surgical; Bandages; Carboxymethylcellulose Sodium; Crutches; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Foot; Foot Ulcer; Glycated Hemoglobin; Humans; Middle Aged; Outpatients; Patient Selection; Shoes; Time Factors; Toes; Treatment Outcome; Wound Healing

This work aims to use carboxymethyl cellulose (CMC) as main structural and functional component of 3D printed scaffolds for healing of diabetic wounds. Differently from previous inks involving small contents in CMC, herein sterile (steam-heated) concentrated CMC solely dispersions (10-20%w/v) were screened regarding printability and fidelity properties. CMC (15%w/v)-citric acid inks showed excellent self-healing rheological properties and stability during storage. CMC scaffolds loaded with platelet rich plasma (PRP) sustained the release of relevant growth factors. CMC scaffolds both with and without PRP promoted angiogenesis in ovo, stem cell migration in vitro, and wound healing in a diabetic model in vivo. Transparent CMC scaffolds allowed direct monitoring of bilateral full-thickness wounds created in rat dorsum. CMC scaffolds facilitated re-epithelialization, granulation, and angiogenesis in full-thickness skin defects, and the performance was improved when combined with PRP. Overall, CMC is pointed out as outstanding component of active dressings for diabetic wounds.

Topics: Animals; Carboxymethylcellulose Sodium; Diabetes Mellitus, Type 1; Drug Delivery Systems; Intercellular Signaling Peptides and Proteins; Male; Particle Size; Platelet-Rich Plasma; Printing, Three-Dimensional; Rats; Rats, Sprague-Dawley; Tissue Scaffolds; Transforming Growth Factor beta1; Vascular Endothelial Growth Factors; Wound Healing

Chronic wound healing plagues thousands of diabetic patients and brings social and economic burdens. Plasma exosomes (P-Exos), regarded as nanosized therapeutic agents, have shown therapeutic efficacy in promoting diabetic wound healing. The present work prepared the P-Exos-loaded pH-responsive carboxymethylcellulose (P-Exos-loaded CMC) hydrogel to investigate its ability to accelerate diabetic wound healing and to explore its underlying mechanisms. The results showed that the P-Exos-loaded CMC hydrogel was an effective therapeutic agent for accelerating diabetic wound repair. It promoted the local wound healing process in diabetic type 1 mice and enhanced angiogenesis and re-epithelialization via activating angiogenesis-related pathways mediated by vascular endothelial growth factor (VEGF).

Topics: Animals; Carboxymethylcellulose Sodium; Diabetes Mellitus, Experimental; Diabetes Mellitus, Type 1; Exosomes; Hydrogels; Hydrogen-Ion Concentration; Mice; Signal Transduction; Vascular Endothelial Growth Factor A; Wound Healing

This article explores local barriers to diabetic foot ulcer healing, and describes the use of a dressing designed to manage exudate, infection and biofilm (AQUACEL® Ag+ dressing (AQAg+)) on recalcitrant diabetic foot ulcers. The authors consider four case studies that demonstrate how managing local barriers to wound healing with antimicrobial and anti-biofilm dressings in protocols of care can improve outcomes for patients.

Topics: Aged; Amputation Stumps; Anti-Infective Agents; Bandages; Bandages, Hydrocolloid; Biofilms; Carboxymethylcellulose Sodium; Debridement; Diabetes Mellitus, Type 1; Diabetes Mellitus, Type 2; Diabetic Foot; Disease Management; Female; Humans; Male; Middle Aged; Silver Compounds; Wound Healing; Wound Infection

A bioartificial pancreas (BAP) created through the encapsulation of islets of Langerhans (islets) in a semipermeable membrane has been proposed as a promising approach to treating insulin-dependent diabetes patients. A nonobese diabetic (NOD) mouse, which shares many features of human insulin-dependent diabetes mellitus, is an ideal model for evaluating the function of BAP. However, the functions of BAPs that have been developed have been limited in NOD mice. We propose novel microbeads that can realize long-term BAP function in NOD mice. The novel microbeads were composed of agarose and poly(styrene sulfonic acid) (PSSa) mixed gel. A polyion complex layer between PSSa and polycationic polybrene was formed on and just inside the microbead, and the microbead surfaces were further covered by polyanions to produce anionic surface charges. The islets in the novel microbeads were intraperitoneally implanted. Graft-functioning periods were dependent on both PSSa concentration and the kinds of polyanion. Islets in the microbeads composed of 5% agarose and 5% PSSa, which had an outermost surface covered by carboxymethyl cellulose, produced normoglycemic periods of more than 60 days in all five recipients. Control mice receiving either transplants of unenclosed islets or islets in agarose microbeads showed normoglycemic periods of less than 12 days. We believe that agarose/PSSa microbeads are promising for producing semipermeable membranes that enable xenotransplantation of islets in spontaneous diabetes mellitus.

Topics: Animals; Biocompatible Materials; Blood Glucose; Carboxymethylcellulose Sodium; Cricetinae; Diabetes Mellitus, Type 1; Female; Glucose Tolerance Test; Graft Survival; Humans; Islets of Langerhans Transplantation; Kinetics; Mice; Mice, Inbred NOD; Microspheres; Transplantation, Heterologous