Meta-analysis and systematic review of skin graft donor-site dressings with future guidelines.

Background: Many types of split-thickness skin graft (STSG) donor-site dressings are available with little consensus from the literature on the optimal dressing type. The purpose of this systematic review was to analyze the most recent outcomes regarding moist and nonmoist dressings for STSG donor sites. Methods: A comprehensive systematic review was conducted across PubMed/MEDLINE, EMBASE, and Cochrane Library databases to search for comparative studies evaluating different STSG donor-site dressings in adult subjects published between 2008 and 2017. The quality of randomized controlled trials was assessed using the Jadad scale. Data were collected on donor-site pain, rate of epithelialization, infection rate, cosmetic appearance, and cost. Meta-analysis was performed for reported pain scores. Results: A total of 41 articles were included comparing 44 dressings. Selected studies included analysis of donor-site pain (36 of 41 articles), rate of epithelialization (38 of 41), infection rate (25 of 41), cosmetic appearance (20 of 41), and cost (10 of 41). Meta-analysis revealed moist dressings result in lower pain (pooled effect size = 1.44). A majority of articles (73%) reported better reepithelialization rates with moist dressings. Conclusion: The literature on STSG donor-site dressings has not yet identified an ideal dressing. Although moist dressings provide superior outcomes with regard to pain control and wound healing, there continues to be a lack of standardization. The increasing commercial availability and marketing of novel dressings necessitates the development of standardized research protocols to design better comparison studies and assess true efficacy.R01 EB021308 - NIBIB NIH HHSPublished versio

The Diversity of CYP2C19 Polymorphisms in the Thai Population: Implications for Precision Medicine

Vorthunju Nakhonsri,1 Shobana John,2,3 Hathaichanok Panumasmontol,4,5 Manassanan Jantorn,4,5 Pongpipat Chanthot,4,5 Nuntachai Hanpramukkun,6 Supaporn Meelarp,7 Chonlaphat Sukasem,2,3 Sissades Tongsima,1 Sukhontha Hasatsri,4 Abhisit Prawang,8 Thanawat Thaingtamtanha,9,10 Natchaya Vanwong,11,12 Chalirmporn Atasilp,13 Monpat Chamnanphon,14 Pimonpan Jinda,2,3 Patompong Satapornpong4,5 1National Center for Genetic Engineering and Biotechnology, National Science and Technology Development Agency, Pathum Thani, Thailand; 2Division of Pharmacogenomics and Personalized Medicine, Department of Pathology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; 3Laboratory for Pharmacogenomics, Somdech Phra Debaratana Medical Center (SDMC), Ramathibodi Hospital, Bangkok, Thailand; 4Division of General Pharmacy Practice, Department of Pharmaceutical Care, College of Pharmacy, Rangsit University, Pathum Thani, Thailand; 5Excellence Pharmacogenomics and Precision Medicine Centre, College of Pharmacy, Rangsit University, Pathum Thani, Thailand; 6Division of Pharmaceutical Technology, Department of Industrial Pharmacy, College of Pharmacy, Rangsit University, Pathum Thani, Thailand; 7Ounjai Medical Clinic, Bangsue, Bangkok, Thailand; 8Division of Pharmacy Practice, Department of Pharmaceutical Care, College of Pharmacy, Rangsit University, Pathum Thani, Thailand; 9Department of Chemistry and Biology, University of Siegen, Siegen, Germany; 10Department of Chemistry and Biomolecular Sciences, University of Ottawa, Ottawa, ON, Canada; 11Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand; 12Department of Clinical Chemistry, SYstems Neuroscience of Autism & PSychiatric Disorders (SYNAPS) Research Unit, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand; 13Chulabhorn International College of Medicine, Thammasat University, Pathumthani, Thailand; 14Department of Pathology, Faculty of Medicine, Srinakharinwirot University, Nakornnayok, ThailandCorrespondence: Patompong Satapornpong, Director of Excellence Pharmacogenomics and Precision Medicine Centre, College of Pharmacy, Rangsit University, Pathum Thani, Thailand, Tel +66- 2-791-6000 1420, Fax +66- 2-791-6000 1403, Email [email protected]: CYP2C19 plays a major role in the metabolism of various drugs. The most common genetic variants were the CYP2C19&ast;2 and &ast;3 alleles (rs4244285 and rs4986893, non-functional variants). In previous studies, we found that genetic polymorphisms in CYP2C19 variants influenced the active metabolites of clopidogrel and caused major adverse cardiovascular and cerebrovascular effects. However, the distribution of CYP2C19 varies among ethnic groups and according to adverse drug reactions. This study aimed to investigate the frequency of CYP2C19 genetic polymorphisms in the Thai population and analyze the differences in the frequency of CYP2C19 genetic polymorphisms between Thai and other populations.Methods: This study enrolled 211 unrelated healthy Thai individuals in total. We performed a real-time polymerase chain reaction to genotype CYP2C19&ast;2 (681G > A) and CYP2C19&ast;3 (636G > A).Results: In the Thai population, the CYP2C19&ast;1 allele was the most prevalent at 70.14%, while the CYP2C19&ast;2 and &ast;3 alleles were found at frequencies of 25.36% and 4.50%, respectively. Conversely, the CYP2C19&ast;3 allele was not detected in Caucasian, Hispanic, African, Italian, Macedonian, Tanzanian, or North Indian populations. The phenotypic profile of this gene revealed that the frequency of intermediate metabolizers (IMs) is nearly equal to that of extensive metabolizers (EMs), at 42.65% and 48.82% respectively, with genotypes &ast;1/&ast;2 (36.02%) and &ast;1/&ast;3 (6.63%). Likewise, poor metabolizers (PMs) with genotypes &ast;2/&ast;2 (6.16%), &ast;2/&ast;3 (2.37%), and &ast;3/&ast;3 (< 1%) are more prevalent in our population as well.Conclusion: The distribution of CYP2C19 genotype and phenotype influenced by non-functional alleles has potential as a pharmacogenomics biomarker for precision medicine and is dependent on an ethnic-specific genetic variation database.Keywords: CYP2C19 gene, genetic diversity, Thai population, interethnic difference

Randomized Clinical Trial of the Innovative Bilayered Wound Dressing Made of Silk and Gelatin: Safety and Efficacy Tests Using a Split-Thickness Skin Graft Model

We developed the novel silk fibroin-based bilayered wound dressing for the treatment of partial thickness wounds. And it showed relevant characteristics and accelerated the healing of full-thickness wounds in a rat model. This study is the clinical evaluation of the bilayered wound dressing to confirm its safety and efficacy for the treatment of split-thickness skin donor sites. The safety test was performed using a patch model and no evidence of marked and severe cutaneous reactions was found. The efficacy test of the bilayered wound dressing was conducted on 23 patients with 30 split-thickness skin graft donor sites to evaluate healing time, pain score, skin barrier function, and systemic reaction in comparison to Bactigras. We found that the healing time of donor site wounds treated with the bilayered wound dressing (11 ± 6 days) was significantly faster than those treated with Bactigras (14 ± 6 days) (p=10-6). The wound sites treated with the bilayered wound dressing showed significantly less pain and more rapid skin functional barrier recovery than those treated with Bactigras (p=10-5). Therefore, these results confirmed the clinical safety and efficacy of the bilayered wound dressing for the treatment of split-thickness skin graft donor sites

Randomized Clinical Trial of the Innovative Bilayered Wound Dressing Made of Silk and Gelatin: Safety and Efficacy Tests Using a Split-Thickness Skin Graft Model

We developed the novel silk fibroin-based bilayered wound dressing for the treatment of partial thickness wounds. And it showed relevant characteristics and accelerated the healing of full-thickness wounds in a rat model. This study is the clinical evaluation of the bilayered wound dressing to confirm its safety and efficacy for the treatment of split-thickness skin donor sites. The safety test was performed using a patch model and no evidence of marked and severe cutaneous reactions was found. The efficacy test of the bilayered wound dressing was conducted on 23 patients with 30 split-thickness skin graft donor sites to evaluate healing time, pain score, skin barrier function, and systemic reaction in comparison to Bactigras. We found that the healing time of donor site wounds treated with the bilayered wound dressing (11 ± 6 days) was significantly faster than those treated with Bactigras (14 ± 6 days) ( = 10 −6 ). The wound sites treated with the bilayered wound dressing showed significantly less pain and more rapid skin functional barrier recovery than those treated with Bactigras ( = 10 −5 ). Therefore, these results confirmed the clinical safety and efficacy of the bilayered wound dressing for the treatment of split-thickness skin graft donor sites

Comparison of the Morphological and Physical Properties of Different Absorbent Wound Dressings

Good quality wound dressings should have exceptional properties for usage, such as being able to remove excess wound exudates, having rapid dehydration, and providing optimal water vapour permeability. This study evaluated and compared the morphological and physical properties of six different commercially absorbent wound dressings in Thailand: two hydrocolloids, two alginates, and two foams. These wound dressings are available in a variety of components and structures, some of which have a multilayer structure. The results showed that the calcium sodium alginate dressings had better absorption properties than the calcium alginate dressings, hydrocolloid dressings, hydrocolloid with foam layer dressings, foam with polyurethane film layer dressings, and foam with hydrogel and polyurethane film layer dressings. Furthermore, the calcium sodium alginate dressings had the highest rate of dehydration and provided an optimal water vapour transmission rate. However, the calcium sodium alginate dressings could not retain the original structure after being submerged with a wound exudate