Overexpressing IRS1 in Endothelial Cells Enhances Angioblast Differentiation and Wound Healing in Diabetes and Insulin Resistance

The effect of enhancing insulin’s actions in endothelial cells (ECs) to improve angiogenesis and wound healing was studied in obesity and diabetes. Insulin receptor substrate 1 (IRS1) was overexpressed in ECs using the VE-cadherin promoter to create ECIRS1 TG mice, which elevated pAkt activation and expressions of vascular endothelial growth factor (VEGF), Flk1, and VE-cadherin in ECs and granulation tissues (GTs) of full-thickness wounds. Open wound and epithelialization rates and angiogenesis significantly improved in normal mice and high fat (HF) diet–induced diabetic mice with hyperinsulinemia in ECIRS1 TG versus wild type (WT), but not in insulin-deficient diabetic mice. Increased angioblasts and EC numbers in GT of ECIRS1 mice were due to proliferation in situ rather than uptake. GT in HF-fed diabetic mice exhibited parallel decreases in insulin and VEGF-induced pAkt and EC numbers by >50% without changes in angioblasts versus WT mice, which were improved in ECIRS1 TG mice on normal chow or HF diet. Thus, HF-induced diabetes impaired angiogenesis by inhibiting insulin signaling in GT to decrease the differentiation of angioblasts to EC, which was normalized by enhancing insulin’s action targeted to EC, a potential target to improve wound healing in diabetes and obesity

International lower limb collaborative (INTELLECT) study: a multicentre, international retrospective audit of lower extremity open fractures

Trauma remains a major cause of mortality and disability across the world1, with a higher burden in developing nations2. Open lower extremity injuries are devastating events from a physical3, mental health4, and socioeconomic5 standpoint. The potential sequelae, including risk of chronic infection and amputation, can lead to delayed recovery and major disability6. This international study aimed to describe global disparities, timely intervention, guideline-directed care, and economic aspects of open lower limb injuries

World Society of Emergency Surgery (WSES) guidelines for management of skin and soft tissue infections

Peer reviewe

Decellularized omentum as novel biologic scaffold for reconstructive surgery and regenerative medicine

Homologous tissues, such as adipose tissue, may be an interesting source of acellular scaffolds, maintaining a complex physiological three-dimensional (3D) structure, to be recellularized with autologous cells. The aim of the present work is to evaluate the possibility of obtaining homologous acellular scaffolds from decellularization of the omentum, which is known to have a complex vascular network. Adult rat and human omenta were treated with an adapted decellularization protocol involving mechanical rupture (freeze-thaw cycles), enzymatic digestion (trypsin, lipase, deoxyribonuclease, ribonuclease) and lipid extraction (2-propanol). Histological staining confirmed the effectiveness of decellularization, resulting in cell-free scaffolds with no residual cells in the matrix. The complex 3D networks of collagen (azan-Mallory), elastic fibers (Van Gieson), reticular fibers and glycosaminoglycans (PAS) were maintained, whereas Oil Red and Sudan stains showed the loss of lipids in the decellularized tissue. The vascular structures in the tissue were still visible, with preservation of collagen and elastic wall components and loss of endothelial (anti-CD31 and -CD34 immunohistochemistry) and smooth muscle (anti-alpha smooth muscle actin) cells. Fat-rich and well vascularized omental tissue may be decellularized to obtain complex 3D scaffolds preserving tissue architecture potentially suitable for recellularization. Further analyses are necessary to verify the possibility of recolonization of the scaffold by adipose-derived stem cells in vitro and then in vivo after re implantation, as already known for homologus implants in regenerative processes

Autologous injectable dermis: a clinical and histological study.

BACKGROUND: : No perfect solution yet exists for dermal fillers. The authors hypothesized that autologous dermis can be processed in an operator-friendly manner and adopted in selected patients as a filler, following the principle of replacing "like with like." METHODS: : The authors designed a prototype "cutting chamber" to morsel dermis into an injectable form. Autologous injectable dermis grafting was performed in 16 patients who underwent lip or labionasal fold correction concomitant with abdominoplasty or cesarean scar correction; patient dermis was used for the donor graft. Furthermore, injectable dermis grafting was performed in the subcutaneous tissue of three patients undergoing multistage reconstructive procedures for obesity. The grafts were harvested and examined histologically at 3, 7, and 12 months. RESULTS: : Dermis processing and injection proved feasible with limited effort. All 16 patients presented good volume maintenance by 12 months. Two reported transient palpable firmness for the first 6 months, which subsequently resolved. Histological examination of processed and injected dermis showed volume maintenance over time, effective revascularization of the mass, and structural reorganization with collagen bundles and nested fibroblasts reminiscent of reticular dermis. A transient inflammatory reaction was observed, consistent with the expected healing events. CONCLUSIONS: : Use of autologous dermis as a filler substance for both aesthetic and reconstructive procedures appears to be a feasible option. It could be advised for patients requiring filler correction who undergo concomitant procedures involving excision of potential donor dermis

Comparison of Transverse Carpal Ligament and Flexor Retinaculum Terminology for the Wrist

PURPOSE: To investigate the macroscopic anatomy and histological characteristics of the transverse carpal ligament and the flexor retinaculum of the wrist and to investigate their anatomical relationships and define appropriate terminology. METHODS: The volar regions of the wrists of 30 unembalmed subjects were examined by dissection and by histological and immunohistochemical staining. In vivo magnetic resonance imaging studies were also carried out on 10 subjects. RESULTS: The dissection study showed that the antebrachial fascia at the volar aspect of the wrist presents a reinforcement. From a histological point of view, it is composed of 3 layers of undulated collagen fiber bundles. Adjacent layers show different orientations of the collagen fibers. Many nerve fibers and Pacini and Ruffini corpuscles were found in all specimens. Under this fibrous plane is another fibrous structure, placed transversely between the ulnar-sided hamate and pisiform bones, and the radial-sided scaphoid and trapezium bones. The deeper fibrous structure shows completely different histological characteristics, having parallel, thicker collagen fiber bundles and few nerve fibers. Magnetic resonance images confirm the presence of 2 clearly distinguished fibrous structures in the wrist, the first in continuity with the antebrachial fascia and the second located in a deeper plane between the hamate and scaphoid. CONCLUSIONS: Two different fibrous structures with different histological characteristics are present in the volar wrist: the more superficial one is in continuity with the antebrachial fascia and could be considered its reinforcement; the deeper one is composed of strong lamina, with histological features similar to those of a ligament. For these reasons, we suggest that the term transverse carpal ligament should be used to indicate the fibrous lamina connecting the hamate and pisiform to the scaphoid and trapezium and that the term flexor retinaculum of the wrist should be abandoned because it does not correspond to any specific, autonomous structure