title: Clinical and immunohistopathological aspects of venous ulcers treatment by Low-Intensity Pulsed Ultrasound (LIPUS).
abstract: The immunological mechanisms that are triggered by Low-Intensity Pulsed Ultrasound (LIPUS) in wound healing are unknown. In the present study, experimental groups were used to assess the treatment of chronic venous ulcers with 30mW/cm(2) SATA peripheral LIPUS three times per week compared to a daily treatment of 1% silver sulfadiazine (SDZ). The ulcers of the SDZ group (n=7) (G1) and LIPUS group (n=9) (G2) were photographed five times three months, and the images were analyzed using ImageJ software to quantify the total area (S), fibrin/sphacel area (yellow) and granulation area (red). The healing process was evaluated by the wound healing rate (WHR), granulation tissue rate (GTR) and fibrin/sphacel tissue rate (FTR). The ulcers were biopsied on days 1 and 45 and stained for collagen fiber quantification (picrosirius) and CD68(+) protein and VEGF (vascular endothelial growth factor) expression using HRP-streptavidin (horseradish peroxidase-streptavidin). On day 90, G2 had a mean 41% decrease in the ulcer area, while no decrease was observed in G1 (p<0.05). An increased tendency toward positive labeling of collagen fibers and VEGF (p>0.05) was observed in G2 compared to G1, and the number of CD68(+) cells was greater in G2 than in G1 (p<0.05). LIPUS presents superior activity compared to SDZ in stimulating the inflammatory and proliferative (angiogenesis and collagenesis, respectively) phases of chronic venous wound healing.
authors.affiliation: Bioengineering Post-Graduate Program (EESC-IQSC-FMRP-USP), Trabalhador São-carlense Avenue, 400 Arnold Schimidt, São Carlos, São Paulo 13566-590, Brazil. luisianeas@gmail.com
authors.forename: Luísiane
authors.initials: L
authors.lastname: de Ávila Santana
authors.forename: José Marcos
authors.initials: JM
authors.lastname: Alves
authors.forename: Thiago Antônio Moretti
authors.initials: TA
authors.lastname: Andrade
authors.forename: João Kazuyuki
authors.initials: JK
authors.lastname: Kajiwara
authors.forename: Sérgio Britto
authors.initials: SB
authors.lastname: Garcia
authors.forename: Fernanda Guzzo
authors.initials: FG
authors.lastname: Gomes
authors.forename: Marco Andrey Cipriani
authors.initials: MA
authors.lastname: Frade
mesh_terms: D000368:Aged; D000891:Anti-Infective Agents, Local / Q000627:therapeutic use; D015703:Antigens, CD / Q000378:metabolism; D015214:Antigens, Differentiation, Myelomonocytic / Q000378:metabolism; D001706:Biopsy; D002908:Chronic Disease; D003094:Collagen / Q000378:metabolism; D005260:Female; D006097:Granulation Tissue / Q000378:metabolism; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007124:Immunoenzyme Techniques; D007871:Leg Ulcer / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010781:Photography; D012837:Silver Sulfadiazine / Q000627:therapeutic use; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods*; D014647:Varicose Ulcer / Q000188:drug therapy / Q000276:immunology* / Q000628:therapy*; D042461:Vascular Endothelial Growth Factor A / Q000378:metabolism; D014945:Wound Healing / Q000276:immunology*; D000097382:CD68 Molecule
chemical_list: D000891:Anti-Infective Agents, Local; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D003094:Collagen; D012837:Silver Sulfadiazine; D042461:Vascular Endothelial Growth Factor A; C067980:CD68 antigen, human; D000097382:CD68 Molecule