Day 1 :
Keynote Forum
Steven Jeffery
Queen Elizabeth Hospital
Keynote: Two years with MolecuLight i: X – two years of better patient outcomes
Time : 09:15-10:00
Biography:
Jeffery is a Consultant Burns and Plastic Surgeon at the Royal Centre for Defence Medicine in Birmingham, and is Professor of Wound Study at Birmingham City University. He joined the Royal Army Medical Corps as a medical student in 1986. He qualified from the Universities of St Andrews and Manchester in 1989, and served as a Medical Officer with the Argyll and Sutherland Highlanders before completing his basic surgical training, becoming a Fellow of the Royal College of Surgeons of Edinburgh and
of Glasgow. He developed an interest in burns and other soft tissue injuries, and soon realised that the best way to pursue this interest would be via plastic surgery. He completed his plastic surgical training in East Grinstead, Newcastle and Perth. He is a Patron of the Restoration of Appearance and Function Trust Charity, and has been
awarded Fellowship of the Royal College of Surgeons of England ad eundum. He is an expert adviser to NICE Medical Technologies Evaluation Programme. In 2011 heco-founded the Woundcare 4 Heroes charity, which is already making a big difference to the wound care of both serving and veteran personnel.
Abstract:
Statement of the Problem: Damage to skin and soft tissue allows opportunistic pathogens to complicate and impede the normal course of wound healing and skin repair1. The diagnosis of microbial infection in a wound, based on common clinical signs and symptoms is difficult, as there is no gold standard to predict bacterial activity in tissue and bacteria are invisible to the unaided eye. Furthermore, application of gold standard therapies such as debridement to remove bacterial load and selection of appropriate dressing to minimize further burden are currently sub-optimal. Fluorescence imaging has recently been used to visualize clinically significant levels of pathogenic bacteria in real-time at the bedside using a non-contact hand held device.
Methodology & Theoretical Orientation: Over the course of two years we have assessed the effectiveness of this device in the detection and management of bacterial load in patients with resulting from military combat, traumatic burns, and amputations.
Findings: 1 - Bacteria is heterogeneously distributed across a wound, leading to suboptimal swabbing according to clinical signs and symptoms. 2 - Early diagnosis of high bacterial burden allows for appropriate treatment to begin immediately.
3 - Most wounds do not contain large numbers of bacteria, meaning that antimicrobial dressings are being over used.
Conclusion & Significance: Bacterial fluorescence imaging informs clinical decisions with immediate information on bacterial presence or absence, identification of the type of bacteria to be treated (specific detection of P. aeruginosa), visualizing the location of bacterial presence for more accurate swabbing, targeting areas for debridement and re-debridement, antimicrobial and antibiotic decision making, and monitoring of treatment effectiveness. This tool has significant implications for improving overall wound healing, as early detection and intervention of bacterial presence could prevent bacterial levels from reaching critical colonization, infection, and sepsis.
Keynote Forum
Ryan Moseley
Cardiff University
Keynote: Development of epoxy-tigliane pharmaceuticals as novel therapeutics for dermal fibrosis
Time : 10:00-10:45
Biography:
Ryan Moseley graduated from Swansea University with a BSc (Honours) Degree in Biochemistry. Later, he obtained his PhD from the School of Dentistry, University of Wales College of Medicine, examining the role of oxidative stress in periodontal disease. He continues his research at Cardiff University, where he is currently a Reader in Tissue Repair and Director of the CITER MSc Programme in Tissue Engineering. He research focuses on the mechanisms underlying dermal and oral wound healing during health and disease; and the development of stem cell, biomaterial and pharmaceutical based strategies to address impaired healing in these tissues. He has been supported by funding bodies worldwide, including the MRC, NHMRC and Wellcome Trust, culminating in numerous published papers, filed patents with industrial partners
in the dermal wound healing sector (Convatec, Systagenix Wound Management, Peplin/LEO Pharma, QBiotics); and many conference prizes.
Abstract:
Excessive dermal scarring/fibrosis poses major challenges to Healthcare Services worldwide, confounded by existing therapies being unsatisfactory at treating fibrosis. Therefore, there is significant need for novel anti-fibrotic therapies with improved efficacy. We are evaluating the novel healing properties of epoxy-tiglianes (EBC-46, EBC-211), isolated from the Fontain’s Blushwood Tree indigenous to Queensland’s tropical rainforest. EBC-46 possesses potent anti-cancer properties and stimulates exceptional healing following tumour destruction, manifested as accelerated wound re-epithelialisation, closure and minimal scarring. To elucidate their anti-scarring properties, we assessed epoxy-tigliane effects on fibroblast proliferation, migration; and transforming growth factor-β1 (TGF-β1)-driven myofibroblast differentiation/behaviour. Dermal fibroblasts were treated with EBC-46 or EBC-211 (0-10μg/ml). Cell cycle progression/proliferation were assessed by Flow Cytometry
and MTT assay. Migration was assessed using in vitro scratch wounds/Time-Lapse Microscopy. TGF-β1-driven, fibroblastmyofibroblast differentiation was examined by immuno-cytochemical/QRT-PCR detection of α-smooth muscle actin
(α-SMA) expression/stress fibre formation. Epoxy-tigliane-induced gene expression changes were quantified by Microarrays, confirmed by protein level analyses. Both epoxy-tiglianes significantly retarded fibroblast proliferation, although neither affected migration. Although α-SMA expression/stress fibre organization and myofibroblast formation were unaffected at 0.001-0.01μg/ml or 1-10μg/ml EBC-46, EBC-46 significantly inhibited α-SMA expression/stress fibre formation at 0.1μg/ml, with cells retaining normal fibroblast morphologies. EBC-211 induced similar effects at 10μg/ml. Epoxy-tiglianes up-regulated proteinase, anti-fibrotic matrix component and TGF-β1 inhibitor genes; and down-regulated proteinase inhibitors, pro-fibrotic matrix component and TGF-β1 signalling genes. Epoxy-tiglianes also increased high molecular weight hyaluronan synthesis. Therefore, epoxy-tiglianes modulate fibroblast proliferation, differentiation and matrix composition/turnover, inducing scar resolution. Findings support epoxy-tigliane development as novel anti-fibrotic therapeutics against dermal scarring/fibrosis
Keynote Forum
Regina Folster-Holst
University Medical Centre Schleswig-Holstein
Keynote: Epidermal barrier structure and function in atopic dermatitis and ichthyosis
Time : 11:00-11:45
Biography:
Regina Folster-Holst completed her PhD in 1984 from Christian-Albrechts-University, Kiel, Germany. After a Medical Assistant time in a children's clinic for Cystic Fibrosis and Allergy at Amrum, Germany, she began her specialist training for dermatologists at the Department of Dermatology, Kiel, Germany, in November 1985. In 1992, she was recognized as a Specialist in Dermatology and Allergology. Her habilitation was in 2003, at the Medical Faculty of the Christian-Albrechts-University of Kiel and the appointment as a Professor took place in 2007. Since 1992, she works as a Senior Physician at the University Medical Center Schleswig-Holstein, Department of Dermatology in Kiel, Germany. Clinical activity and research are priority for her, primarily in the area of Atopic Dermatitis, Pediatric Dermatology, Exanthems in Childhood
and Parasitosis
Abstract:
The clinical phenotype of atopic dermatitis (AD) results from complex interactions between genetic and environmental factors, which influence the epidermal structure and function, as well as the immune system. In addition, neurogenic disturbances and loss of the diversity of microbiome (intestinal and cutaneous) are causes of exacerbation. Epidermal barrier defects seem to be a hallmark of pathogenesis of AD. The quality of the skin barrier can be assessed by using a new semiquantitative method to measure intercellular lipid lamellae. This procedure was used to evaluate the influence of emollients and also the topical application of drugs like corticosteroid and calcineurin inhibitors
Keynote Forum
Marissa J. Carter
Strategic Solutions, Inc.
Keynote: How are we going to pay for advanced therapeutics in wound care?
Time : 11:45-12:30
Biography:
Marissa Carter is the President of Strategic Solutions, Inc., and has an extremely broad science background, which includes work in several medical fields, as well as physical and engineering disciplines. Her expertise includes health economics modeling, evidence-based medicine, biostatistics, and clinical trial design and analysis. Although she works mostly in wound care research, she has also worked in epidemiology, ophthalmology, orthopedics, neurology, and psychology. She holds an MA in biochemistry from Oxford University and a PhD in chemistry from Brandeis University. She is the author or coauthor of over 100 peer-reviewed articles and book chapters in medicine and her studies have won several awards.
Abstract:
The clinical phenotype of atopic dermatitis (AD) results from complex interactions between genetic and environmental Although wound care is not a recognized specialty, the cost of treating wounds, especially chronic wounds, is phenomenal.Most wound care products categorized by the FDA as devices have been approved as adjunctive treatments based on the concept that these products may accelerate wound healing directly or indirectly. Many new products such as CTPs (cellular and/or tissue-based products) are expensive, and may need to have several applications. At the same time, in the USA the Centers for Medicare and Medicaid are exerting pressure in regard to reimbursement amounts for these products. Current reimbursement amounts for the application of some products may not be sufficient to keep a dedicated wound care clinic profitable when half of all patients are on Medicare or Medicaid and a further 10-15% have no medical insurance. Indeed,
some patients may not receive any such products due to poor or no medical insurance. The majority of device clinical trials are post-market because of 510(k) approval and are frequently limited to non-severe wounds in indication (although many patients may have serious comorbidities). Thus, and most important, the performance of many products used to treat more severe wounds is unknown due to a scarcity of randomized controlled trials. Payers are also fixated on “episodes of care,” which is hard to define when half of all patients have multiple wounds that overlap over long periods of time (many years). Part of this chaos has resulted from lack of will at the national level to officially use health economic studies to weed out cost-inefficient products, and lack of understanding of health economics by payers. The situation will only get better when trials involving more severe wounds are commonplace, we have more FDA–approved endpoints appropriate for some products, and we are
willing to formally include health economic analyses in our decision-making
- Burns and Advanced Wound Care | Advances in Skin and Wound Care | Skin and Wound Healing | Wound Healing and Tissue Repair
Location: Olimpica 1+2
Chair
Marissa J. Carter
Strategic Solutions, Inc., USA
Session Introduction
Seung-Kyu Han
Korea University College of Medicine
Title: Clinical experience of cell therapy for tissue restoration
Time : 12:30-12:55
Biography:
Han is a Professor of Plastic Surgery at the Korea University College of Medicine. He received BS degree from the Korea University College of Medicine and MSc degree and PhD degree in medicine from the Korea University Graduate School of Medicine. He is Director of the Diabetic Wound Center and the Cell Therapy Laboratory at the Korea University Guro Hospital. He specializes in the diabetic wound healing and cell therapy. He continues to provide state of the art skin and soft tissue reconstruction for skin cancers. He is an author for 4 books (Innovations and Advances in Wound Healing, Management of Diabetic Wound, Advances in Wound Repair, Asian Rhinoplasty), 8 book chapters, and over 200 scientific articles including 62 articles published in the SCI journals as a principal author. He has also edited 5 books. He is Founding Member and current President of the Korean Wound Management Society.
Abstract:
The art and science of tissue restoration are complex and intriguing. During the last 20 years, the speaker has been interested in the development of new techniques and materials that can improve functional and aesthetic results in wound repair and/or soft tissue restoration through a procedure of the least degree of invasiveness based on cell therapy. The aim of the talk is to share the speaker's clinical experience with cell therapy for skin and soft tissue restoration. This talk is organized into three major sections. First part covers cell therapy to repair acute wounds on the face and the hand. Especially, cases of skinand soft tissue restoration after removal of skin cancer, fingertip reconstruction, and phalangeal bone reconstruction after trauma will be presented. Second part presents treatment options to successfully close non- and/or delayed- healing chronic wounds, diabetic foot ulcers in particular. Diabetic wounds respond poorly to conventional treatments due to the involvement of multiple factors. It is imperative that the most problematic matters should be identified in each patient so that patients can receive patient-customized treatments. The speaker's personal experience of cell transplantation for stimulation of wound healing with a variety of cells is presented. Last part addresses soft tissue augmentation using injectable tissue.
John Edward Greenwood AM
Royal Adelaide Hospital Australia
Title: NovoSorb biodegradable temporising matrix (BTM) - A paradigm shift in burn care
Time : 13:55-14:20
Biography:
John Greenwood AM is an English-trained plastic surgeon who graduated from the University of Manchester in 1989 and now working full-time in burn care as the Medical Director of the Adult Burn Centre of the Royal Adelaide Hospital in Adelaide, South Australia. He has been developing skin replacement products, utilising the NovoSorb biodegradable polyurethane platform, since 2004. He was appointed Member of the Order of Australia (AM) following his work leading Australia’s only Burns Assessment Team after the carnage of the 2002 Bali Bombings which killed 202 civilians. He was the 2016 South Australian of the Year.
Abstract:
Introduction: NovoSorb BTM is a completelysynthetic, bilayer ‘active’ temporizer. It buys time for patient and surgeon to allow recruitment of resources for definitive closure whilst improving the wound bed for definitive closure.
Methods/Results: We had noticed consistently improved surgical course and outcomes in burn patients treated with BTM and subsequent skin grafting. However, we had not fully appreciated the differences side to side until the 13th patient. In this 29 year old with 71% TBSA burns, initial complete debridement on Day 0 was followed by 1:2 meshed split skin graft to the
chest and abdomen 3 days post burn. With insufficient donor sites, BTM was applied to his limbs at the same time. On Day 38 (5 weeks later), 1:2 meshed graft was applied to the integrated BTM on Day 38. At 9 months, markedly reduced mesh pattern and a softer, more supple result where BTM was implanted, even better by a year. This finding changed our practice. The
next two big burn patients had similar courses. A 150Kg man with 70% TBSA full thickness burns injury to bilateral hands, forearms, arms, chest, abdomen, posterior trunk, thighs and circumferential left leg underwent tangential excision on Day 0. BTM was applied to all wounds on Day 3. Four serial grafting operations occurred between Day 42 to Day 72. He was
discharged to inpatient rehabilitation at Day 91 and went home (converted to outpatient rehabilitation) three weeks later.
Conclusions: A better functional and cosmetic result with delayed grafting on BTM at 5 weeks compared to early grafting on fat made us question the traditional wisdom of early wound closure at all costs. Additionally, if a delay is desirable, definitive closure using autologous composite cultured skin becomes a viable option, raising the possibility of not needing skin grafts at
all for closure!
Holly Kirkland-Kyhn
University of California
Title: Hospital acquired pressure ulcers-vs-community acquired pressure ulcers- Etiology and prevention
Time : 14:20-14:45
Biography:
Kirkland-Kyhn Graduated from University of California, San Francisco, with major studies in obesity, geriatrics, and wound care. She currently works as the
Director of Wound Care, at UC Davis Medical Center. Her phenomenon of interest includes wound care in low resource settings, prevention of pressure ulcers in hospital and in the community. She has worked in England, Ireland, and the US with additional wound experience in Cameroon, Belize and Haiti. Her research has continued in the occurance of pressure ulcers in poorly perfused patients. Presently she has been working on pressure ulcers as compared to community acquired pressure ulcers
Abstract:
Background: Why do Deep Tissue Injuries (DTIs) develop in critically ill patients, despite all Braden risk related interventions implemented on admission?
Methods: Twenty-five variables were collected over a 5-year period on all DTIs that evolved into pressure ulcers; 10 variables were identified as risk factors for the development of DTIs. The variable data was collected for patients with sacral DTIs (n=47) that evolved into stage 3, 4 or unstageable pressure ulcers. The general adult ICU patient data was collected for comparison (n=72). The analysis of the data was compared to determine specific parameters of patient related risk factors in patients who developed DTIs that evolved into stage 3, 4 or unstageable pressure injuries. Once all variables were entered into the model, a backwards regression was performed to find the most significant risk factors in the development of a DTI in ICU patients.
Results: We found a decrease in perfusion (hypotension) as the most significant contributor to DTI. Patients with diastolic blood pressure below 49mmHg had 10 times greater chance of developing a DTI. Patients on dialysis had 4 times greater chance of developing a DTI. Surgical patients were at higher risk of DTI; for every 1 hour in surgery the likelihood of a DTI
increased by 20%. We did not find any significant difference in the Braden Score between those patients that developed DTI and those patients who did not develop DTI
Conclusion: This study found that patients with low perfusion developed DTIs despite all Braden related nursing interventions
Michel Laurence
Hospital Saint-Louis
Title: Study of the molecular and functional effects of wound dressings on human dermal fibroblasts
Time : 14:45-15:10
Biography:
Laurence MICHEL is a team research group manager at Inserm Unit U976, Paris Saint-Louis Hospital. She works in the Skin Research Center conducted by Professor Martine BAGOT, head of the Saint-Louis Dermatology Department and director Armand BENSUSSAN, U976 director. During her carrier, she has been carried out clinical research in collaboration with the hospital Clinic Investigative Center, studying mechanisms of allergic and inflammatory cutaneous diseases in patients and providing her expertise in pharmacology for in vivo testing of new therapies in collaboration with pharmaceutics/cosmetics laboratories. She also worked as a fundamental researcher studying the mechanism of signalling pathways involved in inflammatory skin disorders and cutaneous cell resistance to treatment. Focus has been done on skin aging, dermal fibrosis, xerosis (dry skin), hair greying, depigmentation and hair loss, besides cutaneous pathologies (atopy,
cutaneous T cell lymphoma). External expert in national and international academic institutions. Author of 68 articles and 3 patents.
Abstract:
The process of cutaneous healing/repair is characterized by three major phases, closely related: Coagulation (A) and inflammation (B) during the first hours involving immune cells of the innate response, followed over time by a regeneration phase and a remodeling/maturation phase (C) mainly conducted by dermal fibroblasts. To promote tissue repair, there is a multitude of dressings targeting the different phases of healing including calcium alginates and high absorbency fibers. The aim of the present study was to determine the effects of these wound dressings subtypes on human dermal fibroblasts, knowing that some of them do act on the coagulation and hemostasis phase as well as on the wound debridement Primary cultures of dermal fibroblasts were established from human surgical normal skin residues (n=6 to 12) and were studied for their molecular and functional responses to conditioned media from three wound dressings: Calcium alginate Algosteril®, Biatain® Alginate and UrgoClean®. The results showed that Algosteril® dressing among the 3 dressings significantly promoted the cell migration and consequently the closure of the dermal wounds as demonstrated by scratching experiments. No alteration of the viability of dermal fibroblasts was depicted with Algosteril® and Biatain® Alginate, whereas UrgoClean® did. Concerning gene macro-arrays induced in TGFβ-activated fibroblasts, Algosteril® significantly increased the synthesis of main collagens, extracellular matrix-remodeling enzymes, cytokines promoting fibroblast migration and proliferation, as well as allowing the recruitment of immune cells and thus promoting the development of an innate response that ensures the debridement of the wound. Biatain® Alginate was less efficient than Algosteril® Stimulation of pro-inflammatory cytokine production was also significantly increased with Algosteril® whereas it was not with other studied dressings. Altogether, our results about these different parameters pointed out that Algosteril® among other dressings will facilitate the repair of the tissue matrix and prepare an effective healing phase
Rachael L Moses
Cardiff University
Title: Stimulation of keratinocyte wound healing responses and re-epithelialization by novel epoxy-tiglianes via protein kinase C activation
Time : 15:10-15:35
Biography:
Rachael Moses completed her PhD at Cardiff University in 2016 and is currently a Postdoctoral Research Associate at Cardiff University, UK. Her research focuses on elucidating the mechanisms underlying the novel epoxy-tigliane pharmaceuticals exceptional dermal wound healing responses. She was awarded a travel bursary to visit a medical research institute in Queensland, Australia, to undertake Microarray Analysis determining key genotypic changes following epoxy-tigliane treatment. She has filed patents with an industrial partner in this sector (QBiotics Ltd.); and has been awarded conference prizes relating to this area
Abstract:
Novel epoxy-tiglianes, EBC-46 and EBC-211, are sourced from seeds of the Fountain’s Blushwood Tree, indigenous to Queensland. EBC-46 possess potent tumouricidal properties, through classical PKC activation, and is under development by our industrial partner, QBiotics Ltd., as a human and veterinary anti-cancer pharmaceutical. In clinical studies, EBC-46 also
stimulated exceptional dermal healing, manifested as accelerated wound re-epithelialisation, closure and minimal scarring. This work describes epoxy-tigliane effects on keratinocyte wound healing responses and their underlying mechanisms of action. Immortalized human epidermal keratinocytes (HaCaTs) were treated with EBC-46 or EBC-211 (0-10μg/ml). Cell cycle progression/proliferation were assessed by FACS analysis and MTT assay. HaCaT migration was assessed using in vitro scratch wound assays. Global gene expression changes induced by epoxy-tiglianes were quantified by Microarray analysis, with differentially expressed genes confirmed by protein level analysis. As epoxy-tiglianes mediate responses via classical protein
kinase (PKC) activation, mechanistic studies were performed with BIM-1 (pan-PKC), Gö6976 (classical-PKC) and LY317615 (PKC-βI/PKC-βII) inhibitors. Western blotting confirmed phospho-PKC activation following epoxy-tigliane treatment. Both epoxy-tiglianes induced significant HaCaT cell cycle progression and proliferation; and also promoted significant HaCaT
scratch wound closure. Microarray analyses identified key genes differentially expressed in EBC-46/EBC-211-treated HaCaTs, which contribute to their stimulatory effects on keratinocyte proliferation and migration. Enhanced proliferative and migratory responses were significantly abrogated by BIM-1 and Gö6976, although LY317615 exhibited minimal inhibitory effects. PKC
activation increased following epoxy-tigliane treatment. Such findings explain the enhanced re-epithelialization responses in epoxy-tigliane-treated skin; and provide justification for their translational development as novel therapeutics for impaired wound re-epithelialisation.
- Skin Infections and Disorders | Wound Care and Nursing | Atopic Dermatitis | Pediatric Dermatology
Location: Olimpica 1+2
Chair
Milton D Moore
Moore Unique Dermatology and Spa, USA
Co-Chair
Mariusz Czernik
Centre for Medical Sciences and Research, UK
Session Introduction
John Edward Greenwood AM
Royal Adelaide Hospital
Title: NovoSorb biodegradable temporising matrix (BTM) - Use in complex burn wounds
Biography:
John Greenwood AM is an English-trained plastic surgeon who graduated from the University of Manchester in 1989 and now working full-time in burn care as the Medical Director of the Adult Burn Centre of the Royal Adelaide Hospital in Adelaide, South Australia. He has been developing skin replacement products, utilising the NovoSorb biodegradable polyurethane platform, since 2004. He was appointed Member of the Order of Australia (AM) following his work leading Australia’s only Burns Assessment Team after the carnage of the 2002 Bali Bombings which killed 202 civilians. He was the 2016 South Australian of the Year.
Abstract:
Introduction: The NovoSorb BTM is a completely synthetic bilayer material comprising a dermal component (2mm thick biodegradable polyurethane foam) bonded to a pseudoepidermis of non-biodegradable polyurethane film. Its primary function is to ‘temporise’ wounds, buying time for a definitive closure option to become available. Since the dermal foam becomes integrated and creates a neodermis, it is an ‘active’ temporiser, improving the wound bed for definitive closure.
Methods: During a pilot trial of BTM in 5 significant burn injured patients, and in 13 patients subsequently, several complex problems emerged. With careful planning and meticulous surgical technique, BTM has been used to overcome these problem wounds. Where bone has been exposed, denuded of periosteum or paracranium, two strategies have allowed BTM use, integration and successful closure with split skin grafts. Either the cortex has been drilled to allow granulation from the medulla within) or dermabraded off (exposing medulla, or calvarial diploie). BTM has also been used to reconstruct amputation stumps, where the extent of the burn has left poor coverage (allowing more distal amputation) and providing a significantly better and
more robust stump for prosthesis application. Additionally, in several patients, part of, or the whole back, have been treated by BTM application, integrating despite allowing the patient to lie on them continually. Since the BTM is not yet regulated in Australia, these were treated under the Therapeutic Goods Administration (TGA) Authorised Prescriber Scheme. In all cases a photographic (and sometimes video) record has been taken at every procedure and review and each case will be discussed.
Results/Conclusions: The matrix integrated completely in all cases and graft take was uniformly excellent. There was noincidence of loss or problems with infection. Using BTM the matrix avoided major flap reconstructions in some patients, and yielded a far better result than graft alone in others
Regina Folster-Holst
University Medical Centre Schleswig-Holstein
Title: Epidermal barrier structure and function in atopic dermatitis and ichthyosis
Time : 16:15-17:00
Biography:
Regina Folster-Holst completed her PhD in 1984 from Christian-Albrechts-University, Kiel, Germany. After a Medical Assistant time in a children's clinic for Cystic Fibrosis and Allergy at Amrum, Germany, she began her specialist training for dermatologists at the Department of Dermatology, Kiel, Germany, in November 1985. In 1992, she was recognized as a Specialist in Dermatology and Allergology. Her habilitation was in 2003, at the Medical Faculty of the Christian-Albrechts-University of Kiel and the appointment as a Professor took place in 2007. Since 1992, she works as a Senior Physician at the University Medical Center Schleswig-Holstein, Department of Dermatology in Kiel, Germany. Clinical activity and research are priority for her, primarily in the area of Atopic Dermatitis, Pediatric Dermatology, Exanthems in Childhood
and Parasitosis.
Abstract:
Pediatric dermatology shows a very broad spectrum. This includes infections, inflammatory dermatoses, allergies, autoimmune diseases, auto-inflammatory syndromes and tumors. Some diseases, such as the erythema toxicum neonatorum, occur only in neonatal age. The many diverse diseases all have a specific pattern, which includes morphology, distribution, history (of the patient and the family), cutaneous and extracutaneous symptoms. The pediatric dermatology quiz will reflect these patterns.
Helma Fernandez
MTF Biologics
Title: Looking underneath the surface, effective innovative treatment modalities in wound care
Time : 17:00-17:25
Biography:
Abstract:
Debarati Shome
Leibniz Institute for Plasma Science & Technology
Title: The effect of cold atmospheric pressure plasma (CAP) on cell migratory behaviors and molecular markers of wound healing machinery
Time : 17:25-17:50
Biography:
Abstract:
Introduction: Cold atmospheric pressure plasma (CAP) is a promising tool for biomedical and clinical application. Cold physical plasma are partially ionized gases that mediate biological response generating ROS and RNS species.1-3In this study, we used the medical device class 2a kINPen MED®; it is clinically approved atmospheric argon plasma jet. Typical active agents being generated include ions, electrons, and reactive oxygen and nitrogen species (ROS/RNS). Electric and magnetic fields, light (visible, in-frared, UV), and neutral particles are being generated 4. It is well known, that wound oxygenation is an
important factor of wound healing and scavenging reactive species could impair wound healing In this study, we examined the extent of wound healing and the underlying cellular mechanism in vitro induced by CAP. Our group had also collected wound exudates before and after CAP treatment from 7 ambulant diabetic patients with chronic wounds from ‘Competence Center Diabetes’ in Karlsburg. These wound exudates were also analyzed.
Methods: For our studies, we incorporated dermal keratinocytes, fibroblasts and co culture. An indirect treatment where
CAP treated media (RPMI) was added and a direct CAP treatment on the cells (different time points) were performed and
the migration assay was monitored. Matrix metalloproteinase play a pivotal role in wound re epithelization. The amount of
metalloproteinase and several cytokines (especially Interleukins) in the patient exudates were also monitored by ELISA.
Results and future direction: Short-term CAP treatment induces enhanced cell migration than longer treatment and
compared to untreated control. Co culture studies show an improved cell migration upon CAP treatment compared to
keratinocytes alone. Matrix metalloproteinases and Interleukins were also reduced in wound exudates after CAP treatment
which indicates improved wound healing. It was also evident with an average of more than 80 % reduction in the wound size
of the patients undergoing CAP treatment. Also, the signaling machinery of wound healing involving inflammatory (mediated
by interleukins) and regenerative pathways (mediated by HIPPO signaling) are currently being checked by quantative PCR and
western blot to identify an autocrine/paracrine signaling pathway induced by CAP.
Anna Polak
Academy of Physical Education
Title: Periwound skin blood flow and reduction of pressure ulcer size after anodal and cathodal high-voltage monophasic pulsed current. A preliminary report from a randomized clinical trial
Time : 17:50-18:15
Biography:
A Polak PT, PhD is a physiotherapist, lecturer and specialist in wound healing physical therapies.
Abstract:
Introduction: Electrical stimulation (ES) is recommended for treating Stage II-IV pressure ulcers (PUs) but optimal ES protocols for wound treatment have yet to be established.
Aim of study: To evaluate the effect of high-voltage monophasic pulsed current (HVMPC) on periwound skin blood flow (PSBF) and PU size reduction.
Methods: 38 individuals with Stage II-IV PUs were randomly assigned to anodal and cathodal ES groups (AG, CG), andplacebo ES group (PG). All groups received standard wound care. The AG and CG received additionally respectively anodal and cathodal HVMPC (154 μs; 100 Hz; 360 μC/sec), 50 minutes a day, five days per week, for 4 weeks. Wounds of the PG were
treated with sham ES. PSBF was measured at baseline and at weeks 2 and 4. Wound surface areas were measured at baseline,
and at week.
Results: 12 patients were treated in the AG (mean age of 52.83), 13 in the CG (mean age of 52.00), and 13 in the PG (meanage of 54.46). PSBF at weeks 2 and 4 was higher by, 105.71%±92.51) and 128.23% (SD 108.34) respectively, in the AG; 108.53% (SD 75.53) and 92.67% (SD 153.90) in the CG; 30.88% (SD 53.37) and 28.82% (SD 42.53) in the PG. The differences between
AG : PG and CG : PG were statistically significant at week 2 (p=0.038, p=0.037 respectively), and at week 4 (p=0.041, p=0.048 respectively). Wound percentage area reduction calculated at week 4 for the AG (58.25%; SD 32.29) and the CG (53.92%: SD 16.15) was significantly greater statistically than that obtained by the PG (26.46%; SD 19.29), p=0.036 and p=0.048. Changes in
PSBF and wound size reduction between the AG and CG were not statistically significant (p>0.05).
Conclusions: Anodal and cathodal HVMPC proved effective in improving PSBF and reducing the size.