<?xml version="1.0" encoding="UTF-8"?><!DOCTYPE article  PUBLIC "-//NLM//DTD Journal Publishing DTD v3.0 20080202//EN" "http://dtd.nlm.nih.gov/publishing/3.0/journalpublishing3.dtd"><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" dtd-version="3.0" xml:lang="en" article-type="research article"><front><journal-meta><journal-id journal-id-type="publisher-id">JBNB</journal-id><journal-title-group><journal-title>Journal of Biomaterials and Nanobiotechnology</journal-title></journal-title-group><issn pub-type="epub">2158-7027</issn><publisher><publisher-name>Scientific Research Publishing</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.4236/jbnb.2019.104011</article-id><article-id pub-id-type="publisher-id">JBNB-95750</article-id><article-categories><subj-group subj-group-type="heading"><subject>Articles</subject></subj-group><subj-group subj-group-type="Discipline-v2"><subject>Biomedical&amp;Life Sciences</subject><subject> Chemistry&amp;Materials Science</subject></subj-group></article-categories><title-group><article-title>
 
 
  3-D Print Celulose Nanoskin: Future Diabetic Wound Healing
 
</article-title></title-group><contrib-group><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Mohamed</surname><given-names>M. Kanjou</given-names></name><xref ref-type="aff" rid="aff1"><sup>1</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Hassan</surname><given-names>Abdulhakim</given-names></name><xref ref-type="aff" rid="aff2"><sup>2</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Gabriel</surname><given-names>Molina de Olyveira</given-names></name><xref ref-type="aff" rid="aff3"><sup>3</sup></xref><xref ref-type="corresp" rid="cor1"><sup>*</sup></xref></contrib><contrib contrib-type="author" xlink:type="simple"><name name-style="western"><surname>Pierre</surname><given-names>Basmaji</given-names></name><xref ref-type="aff" rid="aff4"><sup>4</sup></xref></contrib></contrib-group><aff id="aff4"><addr-line>Innovatec’s-Biotechnology Research and Development, S&amp;amp;#227;o Carlos, Brazil</addr-line></aff><aff id="aff2"><addr-line>Sheikh Khalifa Hospital, Ajman, United Arab Emirates</addr-line></aff><aff id="aff1"><addr-line>SKGH Ajm., GEM International, Dubai, United Arab Emirates</addr-line></aff><aff id="aff3"><addr-line>Biomedical Engineering Department, UFABC University, S&amp;amp;#227;o Bernardo do Campo, Brazil</addr-line></aff><pub-date pub-type="epub"><day>20</day><month>09</month><year>2019</year></pub-date><volume>10</volume><issue>04</issue><fpage>190</fpage><lpage>195</lpage><history><date date-type="received"><day>18,</day>	<month>September</month>	<year>2019</year></date><date date-type="rev-recd"><day>13,</day>	<month>October</month>	<year>2019</year>	</date><date date-type="accepted"><day>16,</day>	<month>October</month>	<year>2019</year></date></history><permissions><copyright-statement>&#169; Copyright  2014 by authors and Scientific Research Publishing Inc. </copyright-statement><copyright-year>2014</copyright-year><license><license-p>This work is licensed under the Creative Commons Attribution International License (CC BY). http://creativecommons.org/licenses/by/4.0/</license-p></license></permissions><abstract><p>
 
 
  3D printing is the future. It will change the way in which we produce new materials—maybe much less in factories and much easier in shops. However, biobased materials have been difficult to 3D print. Most 3D printers use heat to melt the plastic or metal to be printed, and biobased materials are degraded. But cellulose nanofibrils have a solution to this problem: the printing paste is wet and dries out to a solid material. In this work, it was showed recent wound healing in Vinous Ulcer with kidney and other health complications using bacterial cellulose 3D print membranes.
 
</p></abstract><kwd-group><kwd>Bacterial Cellulose</kwd><kwd> Natural Membrane</kwd><kwd> Diabetic Ulcer</kwd><kwd> Wound Healing</kwd><kwd> 3D Print</kwd><kwd> Tissue Regeneration</kwd></kwd-group></article-meta></front><body><sec id="s1"><title>1. Introduction</title><p>Cellulose nanofibrils (nanocellulose) are the smallest fibres into which we can decompose cellulose. They are made from wood or from bact&#233;ria from agricultural or food production; they are able for 3D printing pastes because an appropriate mix of cellulose nanofibrils and water is very viscous, and can contain much water, up to 50% [<xref ref-type="bibr" rid="scirp.95750-ref1">1</xref>] .</p><p>On drying out, these pastes produce very strong and biodegradable materials. The properties of the structure (moisture, strength and flexibility) can be modified through manipulation of the cross-links between the fibrils mainly using hyaluronic acid, condroitin sulfate and alginate with calcium [<xref ref-type="bibr" rid="scirp.95750-ref2">2</xref>] [<xref ref-type="bibr" rid="scirp.95750-ref3">3</xref>] .</p><p>Structures can now be made flexible, strong and porous, and something similar. Manufacturing a flexible structure of bio-based materials is one challenge, since the final object becomes hard and becomes more rigid as it dries [<xref ref-type="bibr" rid="scirp.95750-ref3">3</xref>] .</p><p>Nanocellulose increases the opportunities for creating new materials in wound healing therapy. But this development still requires moisture tests to develops 3D printing with cellulose nanofibrils for medical and biotechnology applications. There is research in developing a solution where a protein attached to a 3D-printed material can help to promote fibroblast around a wound. The aim is to obtain material for wound healing therapy to remain flexible instead of stiff [<xref ref-type="bibr" rid="scirp.95750-ref4">4</xref>] .</p><p>Another development in this area is to obtain conductive materials using 3D printing, cellulose nanofibrils and carbon nanotubes. Using two gels, one conductive and one isolant, keeping dry process, researchers produced three-dimensional circuits for eletronic applications [<xref ref-type="bibr" rid="scirp.95750-ref5">5</xref>] .</p><p>3D printing is a additive manufacturing that can make revolution in the industry. It is an efficient method for complex structure and fewer weight materials. The precision of the technology turns it possible to produce newest materials with high technology than older production techniques [<xref ref-type="bibr" rid="scirp.95750-ref6">6</xref>] [<xref ref-type="bibr" rid="scirp.95750-ref7">7</xref>] [<xref ref-type="bibr" rid="scirp.95750-ref8">8</xref>] .</p><p>Several articles were published by our group since 2015 using Nanoskin membranes for wound healing treatment with successful results in diabetic ulcers, car and other accidents, amputation required ulcers [<xref ref-type="bibr" rid="scirp.95750-ref4">4</xref>] [<xref ref-type="bibr" rid="scirp.95750-ref5">5</xref>] [<xref ref-type="bibr" rid="scirp.95750-ref6">6</xref>] .</p><p>In this work, it was showed recent wound healing in Vinous Ulcer with kidney and other health complications using bacterial cellulose 3D print.</p></sec><sec id="s2"><title>2. Materials and Methods</title><sec id="s2_1"><title>2.1. Materials</title><p>The bacterial cellulose raw material was provided from Innovatec’s (S&#227;o Carlos SP, Brazil). Chondroitin sulfate, hyaluronic acid, sodium alginate and calcium chloride were purchased from Sigma Aldrich.</p></sec><sec id="s2_2"><title>2.2. Methods</title><p>1) Synthesis of bacterial cellulose and bacterial cellulose/chondroitin sulfate/hyaluronic acid</p><p>The acetic fermentation process was achieved by using glucose as a carbohydrate source. Results of this process were vinegar and a nanobiocellulose biomass. The modifying process was based on the addition of hyaluronic acid and chondroitin sulfate (1% w/w) to the culture medium before bacteria inoculation. Bacterial cellulose (BC) was produced by Gram-negative bacteria Gluconacetobacter xylinus, which could be obtained from the culture medium in the pure 3-D structure, consisting of an ultra fine network of cellulose nanofibers [<xref ref-type="bibr" rid="scirp.95750-ref9">9</xref>] [<xref ref-type="bibr" rid="scirp.95750-ref10">10</xref>] [<xref ref-type="bibr" rid="scirp.95750-ref11">11</xref>] [<xref ref-type="bibr" rid="scirp.95750-ref12">12</xref>] .</p><p>2) Bionanocomposite preparation</p><p>In the present study, a novel biomaterial has been explored and different bacterial cellulose nanocomposites have been prepared; BC/chondroitin sulfate and hyaluronic acid cross linked with sodium alginate (0.5% w/w) and calcium chloride (0.25% w/w) for wound healing therapy [<xref ref-type="bibr" rid="scirp.95750-ref13">13</xref>] [<xref ref-type="bibr" rid="scirp.95750-ref14">14</xref>] [<xref ref-type="bibr" rid="scirp.95750-ref15">15</xref>] .</p></sec><sec id="s2_3"><title>2.3. Characterization</title><p>In vivo analysis—Evaluation-Clinical study under supervision of Dr. Mohamed M Kanjou and Hassan Abdulhakim. Evaluation model—geriatric patient of 60 years old with diabetic wound healing.</p></sec></sec><sec id="s3"><title>3. Results and Discussion</title>In Vivo Analysis<p>Patient enters in Sheikh Khalifa Hospital on 11/24/2016 under supervision of Dr. Mohamed M Kanjou and Hassan Abdulhakim, diagnosed with diabetic foot wound. Wound is infected and slough tissue is accumulated all over the wound. Classic dressing was used (silver dressing) but no progress. Patient is suffering from kidney failure doing kidney dialysis. In November 2016 started treatment with 3-D print Bacterial cellulose membranes (<xref ref-type="fig" rid="fig1">Figure 1</xref>).</p><p>After using the Bacterial cellulose material in alternate days by 1 month, it can be observed an excellent recovery of the edge and bottom of the wound and wound area reduction. Slough is easily removed. Red granulation healthy tissue is coming (<xref ref-type="fig" rid="fig2">Figure 2</xref>).</p><p>Then, after more 1 month, almost all slough tissue is removed by treating with 3-D print Bacterial cellulose only; granulation and building up of healthy tissue</p><p>is coming up with approximation of skin and the wound is closing (<xref ref-type="fig" rid="fig3">Figure 3</xref>).</p><p>Finally, after 4 months of treatment, there is complete healing with minimizing the scar in wound area and able to decrease with time (<xref ref-type="fig" rid="fig4">Figure 4</xref>).</p></sec><sec id="s4"><title>4. Conclusions</title><p>Bacterial cellulose was successfully modified by changing the fermentation medium with hyaluronic acid, chondroitin sulfate, besides of crosslinked with alginate sodium and calcium chloride, which produced suitable 3-D printed scaffolds (bacterial cellulose) for use with promissing cell viability/attachment.</p><p>Besides, it developed a new equipment for wound healing using 3-D print, which produced unique natural membranes with several applications in medicine and odontology.</p><p>In conclusion, 3-D print bacterial cellulose membranes apply to diabetic ulcers, with significant lesions and wound healing requirement; furthermore, natural membranes applications are for all population with different age.</p></sec><sec id="s5"><title>Conflicts of Interest</title><p>The authors declare no conflicts of interest regarding the publication of this paper.</p></sec><sec id="s6"><title>Cite this paper</title><p>Kanjou, M.M., Abdulhakim, H., de Olyveira, G.M. and Basmaji, P. 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