Day 1 :
Keynote Forum
Thomas E Serena
Serena Groups, USA
Keynote: TRANSLATIONAL MEDICINE IN WOUND HEALING: THE FUTURE IS BRIGHTling: The future is bright
Time : 09:15-10:00
Biography:
Thomas E Serena, Founder and Medical Director of SerenaGroup®, a family of wound, hyperbaric and research companies. Serena completed his residency in Surgery at the Hershey Medical Center. To date he has opened and operates wound care centers across the United Sates and globally. He has been the lead or Principal investigator in over 100 clinical trials and is recognized internationally as an expert in the field of wound healing: He has more than 100 published papers and has given more than 1000 invited lectures throughout the world. He has been a member of the Board of Directors of the Wound Healing Society and served two terms on the board of the Association for the Advancement of Wound Care (AAWC) and is now the President-Elect. He has also been Vice-President of the American College of Hyperbaric Medicine and President of the American Professional Wound Care Association.
Abstract:
Clinical research is an essential component of SerenaGroup’s ™ Center-of-Excellence model for wound and hyperbaric centers. We are one of the world’s leaders in clinical research on wound care and hyperbaric medicine, having conducted over 100 clinical trials involving growth factors, gene therapy, genomics, Cellular and Tissue Based products, and novel pharmaceuticals. In 2011 SerenaGroup™ clinics conducted the research that led to the first diagnostic in wound care; this diagnostic procedure was identified in the ensuing manuscript as the Serena Technique©. In conjunction with Harvard’s Wellman Institute we developed and performed the initial clinical studies on a painless, bedside epidermal skin-harvesting device that is functioning not only in hospitals in the US but in third-world clinics as well. We have filed numerous patents on novel products that were conceived in the clinics facing unmet needs, developed in our lab and returned to the clinic for clinical trials. Our emphasis on clinical research over the years has drawn a group of young clinicians and scientists who are dedicated to advancing the science of wound healing to participate in our research projects in the US and internationally. We formed the nation’s first wound healing cooperative group consisting of more than 30 centers in the US and worldwide that now conducts entire multinational clinical trials. In 2015 SerenaGroup Innovation™ opened a laboratory at Northeastern Ohio Medical School to conduct preclinical studies in wound healing. As a result of these efforts, our research team has filed numerous patents. Serena will review innovations in the field of wound care including therapies on the horizon, such as genomics and genetically modified products. He will review data from ongoing trials on indocyanine green fluorescent angiography and cellular-and-tissue-based products for wound care(CTP), examine advances in hyperbaric oxygen therapy, diagnostics and prognostics in wound care, present new pharmaceuticals on the horizon, and discuss the impact of quality measures on practice and reimbursement.
Keynote Forum
Joel E Michalek
UT Health San Antonio, USA
Keynote: A PROSPECTIVE, RANDOMIZED, DOUBLE-BLIND MULTICENTER STUDY COMPARING CONTINUOUS DIFFUSION OF OXYGEN THERAPY TO SHAM THERAPY IN THE TREATMENT OF DIABETIC FOOT ULCERS
Time : 10:00-10:45
Biography:
Joel E Michalek completed his PhD from Wayne State University. He has a broad background in biostatistics pertaining to theory and methods, preclinical and clinical trials, and epidemiology. He has written protocols and grants, analyzed data, and co-authored manuscripts arising from clinical studies in surgery, emergency medicine, cancer, and pediatrics and were formerly Principal Investigator of the Air Force Health Study, a 20-year prospective epidemiological study of veterans who sprayed Agent Orange and other herbicides in Vietnam. He has authored 180 journal articles and two book chapters.
Abstract:
Background: Over the past generation, preclinical data have suggested that there is a potential physiologic benefit to applying oxygen topically to wounds. However, we are unaware of any studies in the literature that have robustly assessed whether this would lead to a higher proportion of healing in similarly treated people without oxygen. Therefore, the purpose of this study was to assess this in people being treated for diabetic foot ulcers (DFUs). Methods: We enrolled and randomized 100 subjects with DFUs (79% male, aged 58.3+/-12.1 years) to receive either active continuous diffusion of oxygen (CDO) therapy using an active CDO device, or an otherwise fully operational sham device that provided moist wound therapy (MWT) without delivering oxygen. Patients were followed until closure or 12 weeks, whichever was sooner. Patients, treating physicians and independent evaluators were blinded to the study arm. All patients received identical offloading, dressings and follow-up. Results: There were no significant differences in assessed descriptive characteristics between the treatment arms (p>0.05 for all). A significantly higher proportion of people healed in the active arm compared to sham (46% vs 22%, p=0.02). This relative effect became greater in more chronic wounds (42.5% vs 13.5%, p=0.006). The active arm experienced significantly faster rates of closure relative to the sham arm (p<0.001). Conclusions: The results of this study demonstrated that continuously diffused oxygen over a wound leads to significantly higher rates of closure, and faster time to closure, compared to similarly treated patients receiving good quality standard therapy coupled with a sham device. Furthermore, the relative efficacy appears to improve the more the therapy may be needed (more chronic and larger wounds).
Keynote Forum
Ching-Jen Wang
Chang Gung University, Taiwan
Keynote: EXTRACORPOREAL SHOCKWAVE THERAPY FOR TREATMENT OF KELOID SCARS
Time : 11:15-12:00
Biography:
Ching-Jen Wang, M.D. graduated from National Taiwan University, College of Medicine. He is a board certified orthopedic surgeon and currently holds a clinical faculty at Chang Gung University College of Medicine and serves as a consultant orthopedic surgeon of Kaohsiung Chang Gung Memorial hospital, Taiwan. He has published more than 236 papers in reputed journals and has been serving as the reviewer in man
Abstract:
The purpose of this investigation was to study the effectiveness of Extracorporeal Shockwave Therapy (ESWT) for the treatment of keloid scars, and compared the results with intra-lesional steroid injection. Thirty-nine patients were randomly divided into 22 in ESWT group and 17 in steroid group. The ESWT group received 3 ESWT treatments in 6 weeks. The steroid group received 3 intra-lesional triamcinolone injection in 6 weeks. The evaluations included gross morphology, functional outcome, local blood flow perfusion, biopsy for histopathological examination and immunohistochemical analysis. Both groups showed significant improvements in appearance with less discoloration, flatter and softer consistency and more elasticity of the lesions but unchanged size after treatment. Overall, there was no significant difference between two groups. Both groups showed comparable functional scores, POSAS patient and observer scales. The blood flow perfusion rates were statistically not significant between two groups before and after treatments. Histopathological findings revealed no significant difference in cell count, cell activity and cell concentration between two groups. After ESWT significant decreases in collagen type I, type III and Masson Trichrome stain were observed after ESWT as compared to steroid group. However, very little changes were noticed in angiogenesis, inflammatory cytokines, tissue proliferating and apoptosis, and no statistical significance was noticed between two groups before and after treatment. This study revealed that ESWT showed comparable functional outcome, POSAS patient and observer scales as compared to steroid injection for keloid scars. Treatment of keloid scars with ESWT resulted in significant decreases in collagen fibers and increases in MMP-13 enzyme.
- Wound and Wound Care |Wound Healing and Tissue Repair | Wound Care and Ulcers| Wound Care and Nursing |Burns and Advanced Wound Care
Location: Richardson
Chair
Thomas E Serena
Serena Groups, USA
Co-Chair
Joel E Michalek
UT health San Antonio, USA
Session Introduction
Thomas E Serena
Serena Groups, USA
Title: ADVANCES IN WOUND HEALING
Time : 12:00-13:00
Biography:
Thomas E Serena, Founder and Medical Director of SerenaGroup®, a family of wound, hyperbaric and research companies. Serena completed his residency in Surgery at the Hershey Medical Center. To date he has opened and operates wound care centers across the United Sates and globally. He has been the lead or Principal investigator in over 100 clinical trials and is recognized internationally as an expert in the fi eld of wound healing: He has more than 100 published papers and has given more than 1000 invited lectures throughout the world. He has been a member of the Board of Directors of the Wound Healing Society and served two terms on the board of the Association for the Advancement of Wound Care (AAWC) and is now the President-Elect. He has also been Vice-President of the American College of Hyperbaric Medicine and President of the American Professional Wound Care Association.
Abstract:
The science of wound healing strives to meet the ever-expanding numbers of patients suffering from chronic wounds. Problem wounds have eclipsed cancer as the most dreaded malady with greater morbidity and mortality and far greater numbers of victims. This lecture addresses advances in the field that have improved diagnosis, enabled better delivery of care and permitted the analysis of large amounts of data. These developments improve the quality of life for our patients. If total Contact casting is the gold standard for off-aoding the diabetic foot, why haven’t physicians incorporated TCC into their practices? We struggled with this question for years. We discovered several factors that contributed to this phenomenon: unfamiliarity with cast saws, the weight of the cast, the strength of the cast and drying time. In this workshop, we will demonstrate a novel TCC that solves all of these problems.
Biography:
Dev completed his undergraduate studies at Texas Tech University and Cal State University, Long Beach. He studied Medical Ethics at Oxford and Biomedical Sciences at UCSD, and earned his M.D. degree at Ross University in New Jersey. Dev is an assistant clinical professor at the Aesthetic Plastic Surgery Institute at the University of California, Irvine. Dev has enjoyed a distinguished academic career and has authored or co-authored greater than thirty publications in General Surgery, Reconstructive and Plastic Surgery, and aesthetic techniques. Dev has provided medical expertise to a number of our armed forces men and women who have returned from Iraq with serious injuries. Dev is Chairman and Chief Executive Offi cer of Health Universe (HLUN). Dev is the Wound Center Medical Director of Memorial Hospital in Bakersfi eld, CA, and Chief Medical Offi cer for ManukaMed USA. He is the Medical Director of Physicians Care of California, and Dev serves as the Research Director of the Mesotherapy Institute of Technology. He joins. Jordan and Jennings as Clinical Instructors of MIT’s mini-Fellowship training program.
Abstract:
This is a retrospective study of 2,252 chronic wounds in four rehab and skilled nursing facilities comparing wound healing rates for nine diff erent wound care products over a 10 year period. Th e data clearly demonstrates superior healing rates for Manuka Pli when compared with other products such as Santyl, silver products, other manuka honey products, and vac therapy among others. Th e study also indicates superior debriding capabilities of Manuka pli when compared with santyl and other debriding agents as measured by improved wound surface area aft er 15 treatments. With concerns about biofi lm formation and reduction to assist wound healing it should also be noted that Manuka Pli when compared to silver dressings shows impressive antimicrobial activity. Given the superior outcomes and the lower expense of Manuka Pli, this product should be the preferred wound care product from beginning to end in the treatment of chronic wounds in rehab and skilled nursing facilities.
Jinsong Hao
Marshall University, USA
Title: CARDIOTONIC STEROIDS AND WOUND HEALING
Time : 14:30-15:00
Biography:
Jinsong Hao is currently an associate professor in the School of Pharmacy at Marshall University. She obtained her Bachelor of Engineering degree in Pharmaceutics and Ph.D. in Pharmaceutics from Shenyang Pharmaceutical University, Liaoning Province, PR China. Upon her graduation, she started her academic career at the same university as an assistant professor and associate professor. Prior to her joining the Marshall University in 2013, she worked at the National University of Singapore, Nova Southeastern University, and University of Cincinnati. Hao’s research has been in the area of drug formulation and delivery, with experience in transdermal and topical formulations; drug delivery to the nail, eye, and inner ear; siRNA delivery; and pharmacokinetic study. She has over 50 publications in peer-reviewed journals and published several book chapters.
Abstract:
Statement of the Problem: Chronic wound healing has been a clinical challenge. Th ere is an urgent need to develop novel wound healing therapeutics. Cardiotonic steroids (CTS) have been used for the treatment of cardiac diseases and their mechanisms of action are associated with Na/K-ATPase. It was reported that the binding of CTS with the Na/K-ATPase resulted in increased collagen synthesis by dermal fi broblasts. Th e objective of this study was to determine the wound healing eff ect of a model cardiotonic steroid in a wound model. Methodology: Full-thickness wounds were created in rats by a biopsy punch. Th e vehicle alone or a testing CTS solution was applied to the wounds. Findings: Increased collagen synthesis by dermal fi broblasts aft er exposure to the CTS was observed. Th e wound closure rate was signifi cantly increased following the treatment with the CTS. Conclusion & Signifi cance: Th e CTS primarily elicited a wound healing eff ect in the proliferation phase and might be a potential wound healing therapeutics.
Zhi Ren Liu
Georgia State University, USA
Title: EXTRACELLULAR PKM2 FACILITATES WOUND HEALING BY PROMOTING MYOFIBROBLAST DIFFERENTIATION
Time : 15:00-15:30
Biography:
Zhi-Ren Liu is a Professor in Department of Biology, Georgia State University, Atlanta, USA. He completed his Ph.D in Biochemistry from Florida State University in 1994. The goal of our research is to understand the molecular mechanism of cell abnormality, especially the conditions that are associated with many human diseases. We hope that our understanding will ultimately be converted to the development of new diagnostic and therapeutic strategies. Currently, we are focus on following two separate research projects: Function of p68 RNA helicase in cell developmental program and tumor progression. His research area of interest is Molecular Biology & Cancer Biology.
Abstract:
Injury induced tissue regeneration oft en starts with infl ammation responses. Th e infi ltrated neutrophils and/or macrophages release various diff erent cytokines and growth factors that promotes myofi broblast diff erentiation. Myofi broblast plays a key role in tissue regeneration and reconstruction. However, sustained myofi broblast diff erentiation and survival lead to fi brosis. We report here that infi ltration neutrophils at the wound site release PKM2, a glycolytic enzyme, by its secretive mechanisms during early stages of regeneration. Th e extracellular PKM2 facilitates wound healing by promoting early granulation and angiogenesis. PKM2 facilitates formation of early granulates by promoting fi broblast migration and myofi broblast diff erentiation. Extracellular PKM2 also protects myofubroblasts from apoptosis. We demonstrated that extracellular PKM2 promotes myofi broblast diff erentiation by a TGFβ independent pathway via activation of integrin ï¡vβ3 signaling. Our studies uncovered a novel mechansim of integrin activation. Extracellular PKM2 activates integrin ï¡vβ3 by binding to head open integrin and facilitating a “leg” separation conformation. Our studies reveal a new molecular linker between the early infl ammation response and proliferation phase in tissue regeneration process. Our studies also uncover a novel mechanism of promoting myofi broblast diff erentiation.
Louis Filhour
Albany Medical Center, USA
Title: THE LIVED EXPERIENCE OF SUFFERING OF MALES AFTER BLUNT TRAUMA: A PHENOMENOLOGICAL STUDY
Time : 15:30-16:00
Biography:
Louis Filhour has held executive positions as CNO and COO for more than 20 years. Although he is now the CEO for a system of hospitals and providers trying to transform care for the Medicaid population, he is also contributing to the science supporting the practice of professional nursing through his research. Working at a busy Level 1 trauma peaked his interest in the experience of suffering. He holds nursing degrees from Baylor University, Boston College, and the University of Phoenix.
Abstract:
Suff ering is a subjective human experience that is both complex and unique. Although relieving suff ering is a goal for nursing, the phenomenon of suff ering is poorly understood and even goes unrecognized. Using a phenomenological design, the researcher explored the question of what is the experience of suff ering as voiced by male patients seven to twelve months aft er hospitalization for blunt trauma. Seventeen male volunteers were interviewed and asked questions about how they suff ered, what made their suff ering more or less bearable, and how they were transformed through their suff ering. Participants experienced changes in patterns resulting in a perception of suff ering. Participants reported mostly experiencing physical, emotional, and social forms of suff ering while fewer experienced economic and spiritual suff ering. Experiences of suff ering resulted from the threat to their normal state or sense of wholeness because of their injuries. Intrinsic and extrinsic factors were identifi ed making the participants’ suff ering more or less bearable as they regained their lost state of normal. Positive attitude and motivation were signifi cant intrinsic factors while quality supportive care was the most signifi cant extrinsic factor. Poor quality care was a signifi cant negative extrinsic factor resulting in experiences of increased suff ering. Th rough their experiences of suff ering the participants were transformed, amending their previous state of normal. Knowledge gained through this phenomenological study may be useful to nurses in guiding their care to alleviate patients’ suff ering.
Claudia F Benjamim
Federal University of Rio de Janeiro, Brazil
Title: ADP TREATMENT IMPROVES WOUND HEALING IN DIABETIC MICE
Time : 16:30-17:00
Biography:
Claudia Farias Benjamim has completed her MD in the Unit Basel University Hospital and she has worked as General Practitioner in occupational Disorders Ali Abaad Industrial Area, Garmsaar, three postdoctoral studies: 1999-2001 in the Pharmacology Department, Sao Paulo University; 2001-2004 in the Pathology Department, University of Michigan, MI, USA; and 2012-2013 in Myology Institute, University Pierre et Marie Curie, Paris, France. She is an associate professor/ researcher in Federal University of Rio de Janeiro, RJ, Brazil. She has published 45 papers in reputed journals and has been serving as an editorial board member of repute. Benjamim aims to understand cellular response in chronic infl ammatory disease as sepsis, pulmonary fi brosis and skin wound healing. Her group studies the pathophysiology of these diseases and searches for successful therapies. Her group expertise is cell and molecular biology.
Abstract:
Statement of the problem: Chronic wound is a public health problem worldwide, which aff ects 6.5 million patients in USA. Such problem, in association with high global prevalence of diabetes, refl ects the increase in diabetic ulcers. Considering the absence of an eff ective treatment for chronic wound, the purpose of this study is to investigate the possible benefi cial eff ects of a purinergic agonist in tissue repair of chronic wounds in diabetic mice. Methodology: Diabetics was induced by Aloxan (75 mg/Kg I.V). Seven days later mice were anesthetized and a full-thickness wound was induced surgically using a punch biopsy (1 cm of diameter). ADP (30 μM) was topically applied once a day for 5 days consecutively on the wound. Findings: We observed that ADP accelerated the wound contraction, improved tissue repair, increased collagen deposition and recruited neutrophils and eosinophils to the wound. Also, ADP increased the number of mast cells and myofi broblasts in the wound. Besides, ADP positively modulated its own receptors, VEGF and TGF-α in the wound. Th ese eff ects were only observed in diabetic mice. More interestingly, others nucleotides did not accelerate the wound healing as ADP. Clopidogrel treatment, a P2Y12 receptor antagonist, prevented all parameters evaluated, confi rming the role of the P2Y12 in ADP eff ects. Still, ADP seemed to increase the number of arginase+ cells and to reduce iNOS+ cells, which implies in the increase of M2 macrophages in the wound. In in vitro experiments, ADP increased fi broblasts proliferation and migration, which corroborate with the in vivo studies. Finally, ADP also accelarated the S. aureus-infected wound healing. Conclusion & Signifi cance: ADP seems to modulate cell activation and recruitment providing an adequate scenario for wound healing in diabetic mice, being. It seems to be a promising treatment for chronic wounds.
Saman Mohammadipour
Treata hospital, Iran
Title: NEGATIVE PRESSURE WOUND THERAPY FOR INFECTED SURGICAL SITE AND MESH EXPOSURE WITH SILVER BASE FOAM
Time : 17:00-17:30
Biography:
Saman Mohammadipour is a colorectal surgeon with a decade experience in wound management, using silver combined with all methods is one of his favorites. Vacuum therapy is one of best method to manage big wound combination with silver base gauze or foam, following his last article in wound therapy. He presents this article as a method for managing surgical site infection with mesh.
Abstract:
Surgical site infections (SSIs) are infections of the tissues, organs, or spaces exposed by surgeons during performance of an invasive procedure. Th e use of synthetic prosthetic mesh is well established as the surgical treatment of choice for repair of ventral incisional hernias. Use of these mesh materials may result in specifi c complications that range from minor to potentially life-threatening. Th e defi nitive treatment for any infected prosthetic material in the body is removal and substitution. Sometimes you can manage the infected wound without removal the mesh with open abdomen dressing and irrigation and control the infection with parallel antibiotic therapy. NPWT has been demonstrated to signifi cantly improve patient survival and facilitate earlier closure of the open abdomen. In this study we used npwt for management of open abdomen with infected mesh with silver-based foam. Th is article reviews the case of 64 year-old man with infected surgical wound and mesh with history of surgery due to big abdominal hernia and gastrointestinal fi stula. Aft er several irrigations, the wound was dressed by negative pressure wound therapy with silver-based foam without removal the mesh. Th e wound improved without any further surgery. We found that negative pressure wound therapy with silver-based foam could be used on infected prosthetic mesh in wound besides control of infection without further surgery for mesh removal.