A novel hydrogel loaded with plant exosomes and stem cell exosomes as a new strategy for treating diabetic wounds

Diabetic wound healing is constrained by various factors, including chronic inflammation, sustained oxidative stress, impaired angiogenesis, and abnormal wound microenvironments. Exosomes derived from mesenchymal stem cells (MSC-exo) contain a wealth of bioactive substances that play a positive role in promoting diabetic wound healing. Plant-derived exosomes, as a novel therapeutic approach, are continuously being explored. Momordica charantia (MC) has been shown to possess blood glucose-lowering effects, and its exosomes are of significant relevance for treating diabetic wounds. However, direct application of exosomes to wounds faces challenges such as poor stability and short retention time, limiting their therapeutic effectiveness and clinical applicability. Encapsulating exosomes in hydrogels is an effective strategy to preserve their bioactivity. In this study, we fabricated a hydrogel loaded with MSC-exo and MC exosomes (MC-exo) by photopolymerization of methacrylated gelatin (GelMA) and dopamine (MEMC-Gel). The resulting MEMC-Gel exhibited favorable mechanical properties, adhesion, degradability, absorbency, and biocompatibility. In vitro, MEMC-Gel demonstrated the ability to resist inflammation, counter oxidative stress, promote fibroblast migration, support endothelial cell angiogenesis, and regulate macrophage polarization. In a diabetic mouse wound model, MEMC-Gel accelerated wound healing by inhibiting inflammation and oxidative stress, modulating macrophage immune responses and hyperglycemia within the microenvironment, promoting angiogenesis, and enhancing epithelialization. In conclusion, MEMC-Gel is an outstanding hydrogel dressing that synergistically promotes repair by loading MSC-exo and MC-exo, significantly accelerating diabetic wound healing through multiple mechanisms. This multifunctional hydrogel, based on exosomes from two different sources, provides an innovative therapeutic strategy for diabetic wound repair with broad clinical application potential.

A review of advancements in antiseptics for wound care in diabetic and non-diabetic patients

Wounds affect many people and require a considerable annual cost to manage. Wound infections significantly delay the healing process, particularly in individuals with diabetes mellitus, due to impaired immunity and microvascular complications. The use of antiseptics is considered a way to reduce this problem. The study aims to assess the different antiseptic categories frequently employed in wound management, focusing on identifying and understanding their unique features. A comprehensive review of PubMed, Scopus, and EMBASE databases identified key antiseptics, including isopropyl alcohol, chlorhexidine, polyhexanide, octenidine, povidone-iodine, hypochlorous acid, silver-based products, hydrogen peroxide, triclosan, and benzalkonium chloride. These antiseptics exhibit varying efficacies and cytotoxicity profiles, necessitating tailored usage to optimize healing while preventing antimicrobial resistance. The primary indication for antiseptics is the prevention of Surgical Site Infections (SSIs), as recommended by guidelines. For diabetic foot ulcers, the strongest evidence supports the use of hypochlorous acid. There are no universal recommendations for antiseptic use; their application depends on specific circumstances. This review highlights the need for evidence-based, condition-specific antiseptic strategies to address unique patient needs effectively.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40200-025-01607-7.

Multifunctional hydrogel with mild photothermal properties enhances diabetic wound repair by targeting MRSA energy metabolism

BACKGROUND

Diabetic wound infections, exacerbated by multidrug-resistant pathogens like MRSA, remain a critical challenge due to biofilm persistence and dysregulated oxidative-inflammatory-metabolic crosstalk.

RESULTS

In this work, we engineered COG-Z@P200 hydrogel, a chitosan-based hydrogel integrating polydopamine-coated ZIF-8 nanoparticles, to synergize mild photothermal therapy (40-45 °C) with metabolic-immune reprogramming. Upon NIR irradiation, COG-Z@P200 disrupted MRSA through Zn2⁺-mediated membrane destabilization and localized hyperthermia, achieving >99.5% eradication via combined physical puncture and metabolic interference. Multi-omics analyses revealed suppression of glycolysis (eno, gap downregulation), TCA cycle arrested (sucC, sdhA, icd inhibition), and disruption of arginine biosynthesis (arcA, arcC, arcD downregulation), impairing biofilm formation and pathogenicity. Concurrent silencing of quorum sensing and virulence genes (agr, sec, lac, opp, sdrD) further destabilized MRSA, while upregulation of stress-response genes (yidD, nfsA, kdpA) indicated bacterial metabolic paralysis. In diabetic murine models, the hydrogel attenuated oxidative stress (DHE-confirmed ROS reduction), polarized macrophages to pro-healing M2 phenotypes (Arg-1⁺/TNF-α↓), and enhanced angiogenesis (VEGF/CD31↑) alongside aligned collagen deposition. This multifunctional action accelerated wound closure by 48% versus controls, outperforming clinical standards. By converging nanomaterial-enabled bactericidal strategies with host microenvironment recalibration, COG-Z@P200 hydrogel redefined diabetic wound management, offering an antibiotic-free solution against multidrug-resistant infections.

CONCLUSION

Our work established a biomaterial paradigm that concurrently targets pathogen vulnerabilities and restores tissue homeostasis, addressing the multidimensional complexity of chronic wounds.

Alternatives to Flaps and Grafts for Management of Forehead Mohs Defects

Patients have varying goals for reconstruction after Mohs micrographic surgery, and the operative plan should reflect these goals. Forehead reconstruction with immediate flaps and grafts may not always align with these goals, and alternative methods should be considered. Evidence suggests that secondary intention healing, delayed or augmented skin grafting, skin substitutes, and delayed reconstruction with tissue expansion are acceptable alternatives to standard flaps and grafts. When possible, these options should be included in shared decision-making before reconstruction.

Therapeutic effect and concomitant toxicity of hydrargyrum chloratum compositum on chronic difficult-to-heal wounds in rats

ETHNOPHARMACOLOGICAL RELEVANCE

Hydrargyrum chloratum compositum(Hcc) is a traditional Chinese medicine for external use, with the efficacy of 'transforming corrosion and pulling out toxins, removing corrosion and regenerating muscles'. The main components are mercuric chloride (HgCl2) and mercurous chloride (Hg2Cl2), which have antibacterial, corrosive and tissue repairing effects. However, the therapeutic mechanism and toxicity risk of its topical application for treating difficult-to-heal wounds have not been clearly explained.

AIMS OF THE STUDY

To investigate the therapeutic mechanism of Baishuidan on chronic non-healing wounds in rats and to assess the risk of mercury toxicity.

METHODS

The antimicrobial activity of Hcc against Staphylococcus aureus, Candida albicans, Pseudomonas aeruginosa, and Streptococcus-β haemolyticus was assessed by the circle of inhibition assay, Minimum inhibitory concentration(MIC) and Minimum bactericidal concentration(MBC) assay and 24-h inhibition curve. SD rats were used to establish a chronic difficult-to-heal wound model. The efficacy of C. albicans and its effects on inflammatory and angiogenic factors were assessed by wound healing rate, histopathological analysis, immunohistochemical staining, and Elisa assay. The pathological effects of Hcc on the principal organs of rats and the accumulation of mercury ions were detected by hematoxylin-eosin (H&E) staining and atomic absorption spectrophotometry (AAS).

RESULTS

Hcc showed different degrees of bacteriostatic effects on Staphylococcus aureus, Streptococcus-β haemolyticus, Pseudomonas aeruginosa, and Candida albicans. Among them, the most significant inhibitory effect was on S. aureus (MIC 4 μg/mL, MBC 8 μg/mL). Hcc significantly promoted the healing of skin wounds in rats, with the best effect in the middle-dose group. Pathological analysis showed that collagen fibre production and neocapillary formation increased and inflammatory cell infiltration decreased in the treatment group. Hcc improved the microenvironment of wounds by decreasing the level of the pro-inflammatory factor IL-6 and increasing the level of the anti-inflammatory factor IL-10. By activating the Pi3k - Akt and Notch1 - Vegfa signalling pathways, Hcc promotes cell proliferation and angiogenesis, accelerating wound healing. Hcc did not cause significant pathological damage to the major organs of rats at the therapeutic dose. However, a significant accumulation of mercury ions was detected in the kidneys, suggesting that long-term use may cause damage to renal function.

CONCLUSION

This study is the first to systematically investigate the multi-target, multi-pathway mechanism of action of Hydrargyrum Chloratum Compositum (Hcc) in treating chronic hard-to-heal wounds and to comprehensively assess its potential mercury toxicity risk. Through in vitro antimicrobial assays, animal models, histopathological analyses, protein expression and mercury ion accumulation assays, the present study revealed the unique mechanisms of Hcc in promoting wound healing, including inhibition of bacterial growth, modulation of immune-inflammatory responses, promotion of angiogenesis, and activation of key signalling pathways (Pi3k-Akt and Notch1-Vegfa pathways). In addition, this study is the first to evaluate the accumulation of mercury ions in Hcc in different organs, especially the significant accumulation in the kidney, which provides important safety data for clinical application. Compared with the existing literature, the present study verified the antimicrobial activity of Hcc, and revealed its specific mechanism in promoting wound healing, providing a scientific basis for the clinical use of Hcc.

Vesicovaginal Reflux: A Masquerader

Vesicovaginal reflux (VVR) is a functional disorder seen in girls and women. It may be asymptomatic or cause incontinence and dribbling symptoms. It is often associated with high body mass index (BMI) and infrequent voiding or abnormal voiding position. It is important to be aware of this entity as it can be mistaken for a vesicovaginal or urethrovaginal fistula or hydrocolpos on imaging all of which require surgical treatment. The fluid collecting in the vagina in VVR is urine which refluxes during micturition via the introitus from the urinary bladder into the vagina and can leak out later. In a typical case, urocolpos is seen as an anechoic fluid collection in the vagina during transabdominal sonography of the pelvis with a full bladder. It usually diminishes in size and can disappear when the patient is reassessed after voiding the urine completely. Knowledge of this entity in a patient with the classical body habitus is helpful in preventing an unnecessary imaging odyssey and causing anxiety to the patient. Treatment of VVR is by modification of toileting behavior and weight loss.

Evaluation of the interactions of hydrazide derivatives with acetic acid and molecular modeling analysis of N-acetylated hydrazides

Acetic acid, as a weak organic acid, has a wide range of food, pharmaceutical, and industrial applications. It is also used as a green solvent, catalyst, and reagent in chemical experiments. Properties such as non-toxicity, safety, availability, and low cost have made it the preferred choice for acetylation processes. In this project, the interactions of a series of alkyl/aryl/heteroaryl hydrazides with acetic acid were investigated under reflux heating. A variety of reactions, including C- and N-acetylation, hydrolysis, and rearrangement, occurred in the presence of acetic acid. Most of the products were recrystallized in good to excellent yields under these conditions without the need for further purification. All synthesized compounds were characterized by NMR (1H and 13C), FT-IR, and CHNS analysis. In addition, a novel method was proposed for the preparation of products 2a and 2i-q. This method has the potential to be extended to similar reagents. To investigate the biological activity and drug-like properties, some in silico methods were employed on the synthesized compounds. Screening using the ChEMBL database revealed that out of 17 synthesized compounds, compounds 2b (ChEMBL93746), 2c (ChEMBL22425), and 2d (ChEMBL441343) exhibited significant activity against targets SIRT1, TPMT, and Tyrosinase, with measured values below 200 μM. Molecular docking demonstrated that compound 2o interacted with all three targets. These findings provide valuable insights into its potential as a promising multi-target drug candidate for future investigations.

Sub-Micrometer Polycaprolactone and Polyethylene Glycol-Based Fiber Mats With Iodine and Its Potential for Wound Healing

This study introduces an innovative approach to developing advanced antimicrobial wound dressings by engineering fiber mats of polycaprolactone (PCL) and polycaprolactone/polyethylene glycol (PCL/PEG) loaded with iodine using solution blow spinning (SBS). The mats exhibited a unique morphology, combining fibers and beads, with average fiber diameters of 570 nm for 12% (w/v) PCL and 470 nm for 1% (w/v) PEG in 12% (w/v) PCL, and bead diameters of 11.34 μm and 10.43 μm, respectively. PEG incorporation rendered the mats hydrophilic and significantly enhanced their swelling capacity, which is essential for wound exudate management. Remarkably, iodine was incorporated at a concentration specifically optimized to achieve its minimum inhibitory concentration (MIC) against a range of microorganisms while preserving the structural integrity and release profile of the mats. While PEG facilitated a higher initial iodine release rate, equilibrium was achieved after 5 days. UV-Vis spectroscopy unveiled the formation of transient iodine complexes with both PCL and PEG, underscoring their functional synergy. Biological assays revealed that PCL/PEG mats loaded with 4.26 mg/mL of iodine (PCL/PEG 3MIC) exhibited potent antimicrobial efficacy against gram-positive and gram-negative bacteria, as well as fungi, alongside significant in vitro wound healing potential. These findings underscore the promise of PCL/PEG iodine-loaded mats as an innovative platform for next-generation antimicrobial wound care, combining effective infection control with enhanced wound healing capabilities.

From Teeth to Body: The Complex Role of Streptococcus mutans in Systemic Diseases

Streptococcus mutans, the principal pathogen associated with dental caries, impacts individuals across all age groups and geographic regions. Beyond its role in compromising oral health, a growing body of research has established a link between S. mutans and various systemic diseases, including immunoglobulin A nephropathy (IgAN), nonalcoholic steatohepatitis (NASH), infective endocarditis (IE), ulcerative colitis (UC), cerebral hemorrhage, and tumors. The pathogenic mechanisms associated with S. mutans frequently involve collagen-binding proteins (CBPs) and protein antigens (PA) present on the bacterial surface. These components facilitate intricate interactions with the host immune system, thereby potentially contributing to various pathological processes. Specifically, CBP is implicated in the deposition of IgA and complement component C3, which exhibits characteristics reminiscent of IgAN-like lesions through animal models, recent clinical studies suggest a potential involvement of S. mutans in IgAN. In addition, CBP binds to complement component C1q, effectively inhibiting the classical activation pathway of the complement system. In addition, CBP promotes the induction of host cells to produce interferon-gamma (IFN-γ). Furthermore, CBP leads to direct inhibitory effects on platelets and the activation of matrix metalloproteinase-9 (MMP-9) at sites of vascular injury. Moreover, PA enhances the ability of S. mutans to invade hepatic tissue. Through utilization of its PAc, S. mutans excessively produces kynurenine (KYNA), which promotes the development and progression of oral squamous cell carcinoma (OSCC). This article synthesizes the latest advancements in understanding the mechanisms of intricate interactions between S. mutans and various systemic conditions in humans, expanding our perspective beyond the traditional focus on dental caries.

Carbon dot superoxide dismutase nanozyme enhances reactive oxygen species scavenging in diabetic skin wound repair

INTRODUCTION

The accumulation of reactive oxygen species (ROS) in diabetic wounds leads to inflammation and impaired neovascularization. Recent studies have indicated that carbon dot nanozymes (C-dots) exhibiting superoxide dismutase (SOD)-like activity can neutralize excessive ROS and mitigate diseases associated with oxidative stress.

OBJECTIVES

Our study was designed to evaluate the therapeutic impact of C-dots on the healing of diabetic wounds and to unravel the complex molecular mechanisms through which these nanozymes modulate oxidative stress and inflammatory responses within the wound microenvironment.

METHODS AND RESULTS

We synthesized C-dots from carbon fiber and confirmed their structure using transmission electron microscopy. The presence of carbon-carbon double bonds on the C-dots was verified with X-ray photoelectron spectroscopy. We assessed the scavenging capacity of C-dots for superoxide anion, hydroxyl radical, and nitric oxide radical using electron spin resonance spectroscopy. Their SOD-like activity and total antioxidant capacity were evaluated with commercial assay kits. In vitro experiments showed that C-dots effectively scavenged excessive ROS, protecting human keratinocytes, vascular endothelial cells, and fibroblasts from oxidative stress-induced damage. Concurrently, C-dots increased the migratory capacity of fibroblasts. In a streptozocin-induced diabetic mice model, C-dots application enhanced skin wound healing, evidenced by accelerated re-epithelialization and orderly collagen matrix assembly. Mechanistic investigations indicated that C-dots markedly suppressed ROS generation and diminished the levels of inflammatory cytokines in the wound environment. Additionally, C-dots induced an M2 polarization phenotype in macrophages and promoted neovascularization, indicating a transition from the inflammatory to the proliferative phase. Quantitative proteomic analysis was conducted to further clarify the underlying mechanisms of C-dots in ameliorating diabetic wounds.

CONCLUSION

C-dots represent a robust nanomaterial-based strategy for treating diabetic wounds, with the ability to accelerate healing by alleviating oxidative stress, mitigating harmful inflammatory responses, and fostering angiogenesis. This highlights their significant therapeutic potential in the field of biomedicine.

Conductive Hybrid Hydrogel of Carbon Nanotubes-Protein-Cellulose: In Vivo Treatment of Diabetic Wound via Photothermal Therapy and Tracking Real-Time Wound Assessment via Photoacoustic Imaging

Diabetic wounds pose significant challenges in healthcare due to their slow healing rates and susceptibility to infections, leading to severe complications. In this study, we developed a carbon nanotube-based conductive protein-cellulose hydrogel designed to enhance wound healing through photothermal therapy. The hydrogel's unique properties, including high electrical conductivity and biocompatibility, were assessed in vitro for cell viability, hemolysis, and histological evaluations. In vivo studies on diabetic rats revealed that the hydrogel significantly improved wound healing, with faster wound closure rates. These results were supported by noticeable reductions in inflammatory markers and enhanced blood vessel formation, as observed through immunohistochemical analysis. Additionally, photoacoustic imaging offered real-time data on blood flow and tissue oxygen levels, showing positive trends in the healing process. Overall, these findings point to the potential of this conductive hydrogel, especially when paired with photothermal therapy, to serve as an effective treatment for diabetic wounds, offering promising possibilities in wound care strategies.

Mechanisms of Huhuang decoction in treating diabetic wounds: a network pharmacological and experimental study

Background: Huhuang (HH) decoction, a composition of seven traditional Chinese medicines, has demonstrated clinical efficacy in wound healing. However, its pharmacological foundation and potential mechanisms remain unclear. This study aimed to elucidate the mechanisms of action of HH decoction in the treatment of diabetic wounds. Methods: The chemical composition of HH decoction was analysed using ultra-high-performance liquid chromatography-quadrupole time-of-flight mass spectrometry. The targets of the HH decoction in treating diabetic wounds were predicted using network pharmacology. The gene ontology and pathway enrichment analyses were performed using the DAVID functional annotation tool. The compound targets and PPI networks were established using Cytoscape. Molecular docking was implemented using the AutoDock Vina software. Experimental verification was performed on the target prediction of the HH decoction in treating diabetic wounds, both in vivo and in vitro. Results: The study identified 53 chemical components in HH decoction, with tetrahydropalmatine, emodin, rosmarinic acid, citric acid, berberine, and cryptotanshinone as key components for treating diabetic wounds. Twenty-one target genes were identified as core genes. Gene ontology analysis indicated that the therapeutic effects of HH on diabetic foot ulcers may occur through the regulation of cell proliferation, migration, and inflammation. Pathway enrichment was found to be mainly related to the HIF-1 and TNF signalling pathways. HH promoted proliferation, migration, and tube formation in vascular endothelial cells in vitro. Compared with the control group, the expression levels of HIF-1α, VEGF-α, cyclinD1 in the HH group were higher while the phosphorylation level of p65 in the HH group was significantly lower. The concentrations of IL-6, TNF-α, and IL-1β in wound tissue in the HH group were significantly lower than those in the control group. The expression levels of CD31, VEGF-α, Ki67 and HIF-1α in the wounds of diabetic rats in the HH group were higher than those in the control group. Conclusions: The HH decoction promotes diabetic wound healing via multiple components, targets, and pathways. It may enhance vascular endothelial cell proliferation via cyclinD1, promote vascularization through the HIF-1α/VEGF-α signalling pathway, and inhibit inflammation through NF-κB signalling pathways.

South African Medicinal Plants Traditionally Used for Wound Treatment: An Ethnobotanical Systematic Review

Microbial contamination of chronic wounds complicates their treatment. Traditional knowledge systems and the diversity of indigenous medicinal plants create a haven for traditional medicine practices in South Africa (SA). This systematic review aims to present a comprehensive ethnobotanical report of traditional medicines used in the documented empirical wound healing studies in SA. Google Scholar, PubMed, Medline EBSCOhost, Science Direct, and Scopus were sourced using the keywords/terminologies "South Africa", "medicinal plants", "traditional medicine" "indigenous", "skin", "wound", "ethnobotany", "survey", "interview", and "treatment" in different combinations. Relevant and unpublished records were retrieved from the Global Electronic Thesis Database. The searching process identified 32,419 records, of which 4005 studies were screened. Following the removal of 1795 duplicates, the remaining 2210 sources were screened by title and abstract, and 133 full-text reports were accessed and evaluated. Plants traditionally used for wound-healing purposes comprised 222 species belonging to 71 families, namely Asteraceae (predominantly the Helichrysum species), Asphodelaceae, Fabaceae, Solanaceae, and Euphorbiaceae. Plant organs used for medicinal remedies included leaves, roots, and bark prepared as poultices, infusions, decoctions, gel/ointments/lotions, and pastes. This review provides a valuable reference for future phytochemical and pharmacological studies and highlights the need for further ethnobotanical research to treat wounds in SA.

The Relationship Between Plasma Fibrinogen Levels and the Severity of Diabetic Foot Ulcers in Diabetic Patients

Background Diabetic foot ulcers (DFUs) are a common and debilitating complication of diabetes mellitus, often leading to hospitalization, amputation, and reduced quality of life. Monitoring biomarkers that reflect inflammatory processes can be crucial for assessing DFU severity and guiding treatment. This study explores the relationship between plasma fibrinogen levels and DFU severity, along with its association with various clinical and inflammatory biomarkers. Objective To assess the relationship between plasma fibrinogen levels and DFU severity, vascular health, infection risk, and other biomarkers in diabetic patients, with the aim of improving the prediction and management of DFU outcomes. Methods A cross-sectional, observational study was conducted at Mardan Medical Complex from June 2024 to January 2025, involving 93 diabetic patients with active DFUs. The severity of DFUs was classified using the Wagner system, and vascular health was assessed using the Ankle-Brachial Index (ABI) and Doppler ultrasound. Plasma fibrinogen levels, along with other biomarkers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and fasting blood glucose, were measured through fasting blood samples. Data analysis included statistical tests such as Kruskal-Wallis, Mann-Whitney, ANOVA, Decision Trees, Box Plots, Violin Plot, Histograms, and Regression models to explore the associations between fibrinogen levels and DFU severity, vascular impairment, and inflammatory markers. Significance was set at p < 0.05. Results The study examined 93 diabetic patients (mean age: 59.02 ± 7.86 years), comprising 49 males (52.68%) and 44 females (46.32%). Among the participants, 28 (30.11%) presented with severe ulcers (Wagner Grade 5), and 53 (56.99%) exhibited critical ischemia. Bacterial infections were identified in 71 (76.34%) of the patients. The mean plasma fibrinogen level was significantly elevated at 681 ± 160 mg/dL, surpassing the normal range. Plasma fibrinogen levels increased with ulcer severity, with medians of 503.51 mg/dL for Wagner Grade 2, 623.45 mg/dL for grade 3, 627.32 mg/dL for grade 4, and 720.77 mg/dL for grade 5 ulcers. Higher fibrinogen levels were also associated with greater ulcer depth (p = 0.046). Additionally, vascular impairment was significantly correlated with fibrinogen levels, with non-palpable pedal pulses and severe peripheral arterial disease showing associations with elevated fibrinogen levels (p = 0.0083 and p = 0.0478, respectively). Furthermore, fibrinogen levels were positively correlated with CRP (r = 0.50) and with comorbidities such as hypertension in 66 (70.97%) patients and chronic kidney disease in 20 (21.51%) patients. Conclusion Plasma fibrinogen levels are strongly associated with DFU severity and could serve as an effective biomarker for predicting disease progression. Monitoring fibrinogen, along with other biomarkers, may help clinicians stratify patients based on their risk of complications and guide more targeted treatment strategies.

Fatuamide A, a Hybrid PKS/NRPS Metallophore from a Leptolyngbya sp. Marine Cyanobacterium Collected in American Samoa

A structurally novel metabolite, fatuamide A (1), was discovered from a laboratory cultured strain of the marine cyanobacterium Leptolyngbya sp., collected from Faga'itua Bay, American Samoa. A bioassay-guided approach using NCI-H460 human lung cancer cells directed the isolation of fatuamide A, which was obtained from the most cytotoxic fraction. The planar structure of fatuamide A was elucidated by integrated NMR and MS/MS analysis, and a combination of bioinformatic and computational approaches was used to deduce the absolute configuration at its eight stereocenters. A putative hybrid PKS/NRPS biosynthetic gene cluster responsible for fatuamide A production was identified from the sequenced genomic DNA of the cultured cyanobacterium. The biosynthetic gene cluster possessed elements that suggested fatuamide A binds metals, and this metallophore property was demonstrated by native metabolomics and indicated a preference for binding copper. The producing strain was found to be highly resistant to toxicity from elevated copper concentrations in culture media.

Immunoresponsive gene 1 facilitates TLR4 agonist-induced augmentation of innate antimicrobial immunity

Treatment with the toll-like receptor 4 agonist monophosphoryl lipid A conditions innate immunocytes to respond robustly to subsequent infection, a phenotype termed innate immune memory. Our published studies show that metabolic reprogramming of macrophages is a prominent feature of the memory phenotype. We undertook studies to define the functional contributions of tricarboxylic acid cycle reprogramming to innate immune memory. We observed that priming of wild-type mice with monophosphoryl lipid A potently facilitated accumulation of the tricarboxylic acid cycle metabolite itaconate at sites of infection and enhanced microbial clearance. Augmentation of itaconate accumulation and microbial clearance was ablated in Irg1-deficient mice. We further observed that monophosphoryl lipid A potently induces expression of Irg1 and accumulation of itaconate in macrophages. Compared to wild-type macrophages, the ability of Irg1-deficient macrophages to kill Pseudomonas aeruginosa was impaired. We further observed that itaconate is directly antimicrobial against P. aeruginosa at pH 5, which is characteristic of the phagolysosome, and is facilitated by reactive oxygen species. Monophosphoryl lipid A-induced augmentation of glycolysis, oxidative phosphorylation, and accumulation of the tricarboxylic acid cycle metabolites succinate and malate was decreased in Irg1 knockout macrophages compared to wild-type controls. RNA sequencing revealed suppressed transcription of genes associated with phagolysosome function and increased expression of genes associated with cytokine production and chemotaxis in Irg1-deficient macrophages. This study identifies a contribution of itaconate to monophosphoryl lipid A-induced augmentation of innate antimicrobial immunity via facilitation of microbial killing as well as impact on metabolic and transcriptional adaptations.

The efficacy and safety of acids as topical antimicrobial agents: a review

OBJECTIVE

Infected wounds, refractory to conventional therapy, are a major burden on the healthcare system. Available data show that many commonly used antiseptic agents may be toxic to the cells involved in the healing process and may affect the normal tissue repair. The topical use of different acids to control wound infections effectively and promote healing is well known. The present review aims to summarise the safety and efficacy of various acids as topical agents for treating wound infections.

METHOD

A literature search was performed in PubMed and manually from other sources (cross references and journal sites).

RESULTS

We reviewed 116 articles, from which data from 86 relevant articles were analysed. The studies showed that various organic acids were clinically effective in treating wound infections.

CONCLUSION

This study found that various organic acids can act as a substitute for antiseptics to control wound infections refractory to conventional antibiotic therapy and local wound care. Various organic acids differ in efficacy, safety and limitations as topical agents to control wound infections and promote healing. Some acids deliver better results than others, particularly in those cases in which antibiotics and routine antiseptic agents yield little lasting success, especially in controlling hospital strains with multiple antibiotic resistance. Among topically used acids, citric acid and acetic acid are associated with better results.

Ulcerated tophaceous gout of the foot: a case report and retrospective chart review

Ulcerated tophaceous gout is an uncommon presentation of the lower limbs. Treatment of these wounds can be a challenge, as their optimal management remains to be determined. Therefore, a retrospective analysis of medical charts between 2015 and 2021 was conducted at a wound clinic of a university-affiliated hospital to determine the characteristics of patients treated for tophaceous wounds, their evolution and treatment. We report a total of five patients with ulcerated tophaceous gout of the foot who initially presented predominantly with soft tissue infection or osteomyelitis. All progressed well with local wound care, including conservative sharp debridement of the tophi and rapid initiation of urate-lowering therapy. Therefore, a diagnosis of tophi should be considered in an ulceration of the first metatarsophalangeal joint or other toes when whitish-chalky material is present, even if the patient was not previously known to have gout. Tophi ulceration is a rare complication; however, prompt diagnosis and management are important to avoid destruction of the underlying bone structures.

Current developments and prospects of the antibiotic delivery systems

Antibiotics have remained the cornerstone for the treatment of bacterial infections ever since their discovery in the twentieth century. The uproar over antibiotic resistance among bacteria arising from genome plasticity and biofilm development has rendered current antibiotic therapies ineffective, urging the development of innovative therapeutic approaches. The development of antibiotic resistance among bacteria has further heightened the clinical failure of antibiotic therapy, which is often linked to its low bioavailability, side effects, and poor penetration and accumulation at the site of infection. In this review, we highlight the potential use of siderophores, antibodies, cell-penetrating peptides, antimicrobial peptides, bacteriophages, and nanoparticles to smuggle antibiotics across impermeable biological membranes to achieve therapeutically relevant concentrations of antibiotics and combat antimicrobial resistance (AMR). We will discuss the general mechanisms via which each delivery system functions and how it can be tailored to deliver antibiotics against the paradigm of mechanisms underlying antibiotic resistance.

Bacterial cellulose/thiolated chitosan nanoparticles hybrid antimicrobial dressing for curcumin delivery

Thiolated chitosan (Cs-SH) nanoparticles were synthesized and incorporated into bacterial cellulose (BC) membranes through vacuum-assisted confinement. Thiolation significantly enhanced the intrinsic adhesion capacity of chitosan (Cs) as well as its solubility in neutral aqueous solutions. Subsequently, Cs-SH nanoparticles were successfully loaded with curcumin (Cur-Cs-SH), with nanoparticle sizes of 121 ± 2 nm for Cs-SH and 152 ± 6 nm for Cur-Cs-SH. Stability assessments revealed improved pH tolerance and colloidal stability due to the introduction of thiol groups and curcumin encapsulation. Notably, the retention yield of nanoparticles in BC was calculated to be 99 % (w/v) within 45 min. Nanoparticle and curcumin in vitro release studies demonstrated pH-dependent profiles, indicating controlled release kinetics influenced by initial loading and environmental acidity. Moreover, the enhanced adhesive properties of the developed BC membranes, verified by mucin disks and porcine skin adhesion tests, suggested their potential for targeted drug delivery to human tissue. Additionally, antimicrobial assays suggested a synergistic effect between Cs-SH and encapsulated curcumin, exhibiting antibacterial activity against S. aureus and E. coli. In this research, the bioavailability of curcumin was increased by encapsulating it in Cur-Cs-SH nanoparticles, which enhanced its antimicrobial properties and improved the adhesion of BC membranes, thereby expanding their applications in biomedicine.

Zeolite-Loaded Hydrogels as Wound pH-Modulating Dressings for Diabetic Wound Healing

Wound pH has emerged as a promising therapeutic target in diabetic foot ulcers (DFU). Here, we aimed to develop a microparticle-loaded hydrogel for pH modulation in wound fluid. In a screen of polymeric and inorganic microparticles, zeolites were identified as pH-modulating microparticles. Zeolites were encapsulated in a calcium cross-linked alginate hydrogel, a biocompatible matrix clinically used as a wound dressing. This hydrogel potently neutralized hydroxide ions in serum-containing simulated wound fluid. These findings encourage a further development of this pH-modulating device as a molecular therapeutic system for DFUs.

Psychological stress level surveys in patients with diabetic foot ulcers and the application effect of using loofah sponges during VSD treatment

OBJECTIVE

To investigate the psychological stress levels in patients with diabetic foot ulcer (DFU) and evaluate the effects of using a luffa sponge in vacuum sealing drainage (VSD) treatment.

METHODS

This retrospective study analyzed the clinical data from 110 DFU patients treated with VSD at The First People's Hospital of Zunyi (The Third Affiliated Hospital of Zunyi Medical University) between September 2021 and October 2023. Patients were categorized into two groups based on psychological stress levels: an observation group (with psychological stress, n=42) and a control group (without psychological stress, n=68). Baseline data were analyzed to identify factors influencing psychological stress. The observation group was further divided into the conventional care group and the loofah fiber care group, each with 21 patients, to evaluate the effect of using a loofah sponge during VSD treatment.

RESULTS

Logistic regression analysis identified Wagner classification and diabetes-related distress levels as significant factors influencing psychological stress (P<0.05). Post-intervention, the loofah fiber care group showed significantly lower scores on HQ-9, GAD-7, and SRSS (all P<0.05). Additionally, the loofah fiber care group showed lower frequencies of ASD dressing changes, shorter wound healing times, shorter hospital stays, and lower VAS pain scores (all P<0.05). Quality of life scores were significantly higher in the loofah fiber care group across all dimensions (P<0.05), and DASS-21 scores were significantly lower post-intervention (P<0.05). The loofah fiber care group also demonstrated significantly better outcomes in Wagner classification and diabetes-related distress levels, with higher patient satisfaction (all P<0.05).

CONCLUSION

This study highlights significant factors influencing psychological stress in patients with DFU and demonstrates that loofah fiber nursing interventions during VSD treatment improve psychological stress, wound healing, and quality of life. This method provides a promising approach to enhance patient outcomes and satisfaction.

Antibiofilm, Anti-Inflammatory, and Regenerative Properties of a New Stable Ozone-Gel Formulation

Background/Objectives: Chronic skin wounds are characterized by inflammation, persistent infections, and tissue necrosis. The presence of bacterial biofilms prolongs the inflammatory response and delays healing. Ozone is a potent antimicrobial molecule, and many formulations have been used in the advanced therapeutic treatment of chronic wounds. The aim of this work was to determine the antimicrobial, anti-inflammatory, and regenerative activity of a stable ozone-gel formulation over time. Methods: The antimicrobial property was assessed by measuring the minimal inhibitory concentration and the antibiofilm activity. The anti-inflammatory effect was evaluated by TNF-α determination, and the regenerative effect was measured by scratch assay. Results: The ozone gel demonstrated antimicrobial and antibiofilm activity in all ATCC microorganisms examined and on most clinical isolates. Higher concentrations of the ozone gel were also useful in the dispersion of preformed biofilm. The ozone gel also showed anti-inflammatory activity by reducing the production of TNF-α and regenerative activity in human fibroblasts and keratinocytes. Conclusions: Given all these antimicrobial, anti-inflammatory, and regenerative characteristics, the ozone gel could be, in this formulation, used in the treatment of wounds. The ozone-gel formulation described here retains stability for over 30 months, which facilitates its use compared to formulations that lose efficacy quickly.

Exploring links between oral health and infective endocarditis

Infective endocarditis (IE) is a bacterial infection of the heart's inner lining. A low incidence rate combined with a high mortality rate mean that IE can be difficult to treat effectively. There is currently substantial evidence supporting a link between oral health and IE with the oral microbiome impacting various aspects of IE, including pathogenesis, diagnosis, treatment, and mortality rates. The oral microbiome is highly diverse and plays a crucial role in maintaining oral health by providing protective functions. However, when dysbiosis occurs, conditions such as periodontal or peri-implant disease can arise, offering a pathway for bacteraemia to develop. The role of the oral microbiome as a coloniser, facilitator and driver of IE remains to be uncovered by next-generation sequencing techniques. Understanding the dysbiosis and ecology of the oral microbiome of IE patients will allow improvements into the diagnosis, treatment, and prognosis of the disease. Furthermore, an increased awareness amongst those at high-risk of developing IE may encourage improved oral hygiene methods and lower incidence rates. This narrative review examines current findings on the relationship between oral health and IE. It draws from key studies on both topics, with manuscripts selected for their pertinence to the subject. It highlights the link between the oral microbiome and IE by exploring diagnostic techniques and treatments for IE caused by oral commensals.

The Acid-Buffered Engineered Gel Promotes In Vitro Cutaneous Healing and Fights Resistant Bacteria in Wounds

Background: Treatment of cutaneous wound infections is becoming a major clinical challenge due to the growing problem of antimicrobial resistance associated with existing wound treatments. Two prevalent pathogens in wound infections, Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa), continue to present a serious challenge, underscoring the critical need for new therapeutic alternatives. Methods: Novel alginate acid-buffered gels (ABF-1, ABF-2, and ABF-3) were developed using a combination of organic acids in various concentrations and buffered at a pH of 4.5. The acid-buffering capacity of the gels was evaluated against sodium hydroxide solution and simulated wound fluid (SWF) at different wound pHs, mimicking infected and non-infected wound environments. The in vitro antibacterial activity was assessed against resistant bacterial strains (Gram-positive and Gram-negative) using a microdilution method and wound biofilm assay. The rheological properties and cell viability of the gels were evaluated and the gel showing positive cell viability was further investigated for healing ability using an in vitro wound scratch assay. Results: The gels showed promising in vitro antibacterial activity against Staphylococcus epidermidis, S. aureus, and P. aeruginosa. Gels with higher acid concentrations (ABF-1 and ABF-2) were highly effective in reducing the bacterial load in chronic biofilms of S. aureus and P. aeruginosa, while the gel with a lower acid concentration (ABF-3) showed positive effects on the viability of skin cells (over 80% cells viable) and for promoting wound closure. All three gels demonstrated excellent acid-buffering capabilities. Conclusions: The acid-buffered gels demonstrate promising in vitro antibacterial effects, indicating their potential for enhancing wound healing.

Volatiles extracted from Melaleuca Rugulosa (Link) Craven leaves: comparative profiling, bioactivity screening, and metabolomic analysis

BACKGROUND

Melaleuca species (family Myrtaceae) are characterized by their wide-ranging applications as antimicrobials and in skin-related conditions. Herein, we estimated the volatile profile and biological significance of M. rugulosa (Link) leaves for the first time supported by a dereplication protocol.

MATERIALS AND METHODS

Volatile components were extracted using hydrodistillation (HD), supercritical fluid (SF), and headspace (HS) techniques and identified using GC/MS. The variations among the three extracts were assessed using principal component analysis and orthogonal partial least square discriminant analysis (OPLS-DA). The extracted volatiles were tested for radical scavenging activity, anti-aging, and anti-hyperpigmentation potential. Finally, disc diffusion and broth microdilution assays were implemented to explore the antibacterial capacity against Streptococcus pyogenes, Staphylococcus aureus, Clostridium perfringens, and Pseudomonas aeruginosa.

RESULTS

The yield of the SF technique (0.8%) was three times higher than HD. GC/MS analysis revealed that the oxygenated compounds are the most proponents in the three extracts being 95.93% (HD), 80.94% (HS), and 48.4% (SF). Moreover, eucalyptol (1,8-cineol) represents the major component in the HD-EO (89.60%) and HS (73.13%) volatiles, while dl-α-tocopherol (16.27%) and α-terpineol (11.89%) represent the highest percentage in SF extract. Regarding the bioactivity profile, the HD-EO and SF-extract showed antioxidant potential in terms of oxygen radical absorbance capacity, and β- carotene assays, while exerting weak activity towards DPPH. In addition, they displayed potent anti-elastase and moderate anti-collagenase activities. The HD-EO exhibited potent anti-tyrosinase activity, while the SF extract showed a moderate level compared to tested controls. OPLS-DA and dereplication studies predicted that the selective antibacterial activity of HD-EO to S. aureus was related to eucalyptol, while SF extract to C. perfringens was related to α-tocopherol.

CONCLUSIONS

M. rugulosa leaves are considered a vital source of bioactive volatile components that are promoted for controlling skin aging and infection. However, further safety and clinical studies are recommended.

Sodium alginate/carboxymethylcellulose gel formulations containing Capparis sepieria plant extract for wound healing

Aim: Using appropriate wound dressings is crucial when treating burn wounds to promote accelerated healing.Materials & methods: Sodium alginate (SA)-based gels containing Carboxymethyl cellulose (CMC) and Pluronic F127 were prepared. The formulations. SA/CMC/Carbopol and SA/CMC/PluronicF127 were loaded with aqueous root extract of Capparis sepiaria. The formulations were characterized using appropriate techniques.Results: The gels' viscosity was in the range of 676.33 ± 121.76 to 20.00 ± 9.78 cP and in vitro whole blood kinetics showed their capability to induce a faster clotting rate. They also supported high cell viability of 80% with cellular migration and proliferation. Their antibacterial activity was significant against most bacteria strains used in the study.Conclusion: The gels' distinct features reveal their potential application as wound dressings for burn wounds.

Emerging technologies for the management of diabetic foot ulceration: a review

Diabetic foot ulcers (DFUs) and infections are common complications that frequently result in reduced quality of life and even morbidity for patients with diabetes. This paper highlights significant findings in DFU treatments and emerging advanced technologies for monitoring ulceration in patients with diabetes. The management of DFUs requires a multidisciplinary approach that involves patient education. It is well-established that poor glycemic control significantly contributes to diabetic foot ulcer complications, presenting global challenges in quality of life, economics, and resource allocation, affecting approximately half a billion people and potentially leading to lower limb amputation or mortality. Therefore, effective DFU management necessitates a multidisciplinary approach that includes patient education. However, current clinical guidelines for DFU treatment are not performing effectively, resulting in unnecessary increases in financial and emotional burden on patients. Researchers have experimented with advanced technologies and methods, including traditional approaches, to address complications related to DFU healing. This paper also presents the evolution of patents in the field of DFU medication and advanced diagnostic methods, showcasing relevant innovations that may benefit a wide range of researchers.

Chemical analysis, antibacterial and anti-inflammatory effect of Achillea fragrantissima essential oil growing wild in Egypt

BACKGROUND

Achillea fragrantissima (F. Asteraceae) is traditionally used to treat skin infections and inflammation. The present work intended to prepare essential oils (EOs) from A. fragrantissima aerial parts growing widely in Egypt and investigate its antibacterial activity against skin-related pathogens and in vitro cell-based anti-inflammatory activity.

METHODS

EOs of the fresh aerial parts were extracted by hydrodistillation (HD), microwave-assisted hydrodistillation (MAHD), and head-space (HS), while those of the dried ones were prepared by supercritical fluid (SF). The result EOs were analyzed using GC/MS. The antibacterial activity was evaluated alongside Pseudomonas aeruginosa ATCC 9027, Escherichia coli ATCC 8739, Staphylococcus aureus ATCC 25923, Streptococcus pyogenes ATCC 12344, Clostridium perfringens ATCC 13124 by agar diffusion, microwell dilution, and biofilm formation tests. The anti-inflammatory activity was evaluated by measuring tumor necrosis factor-alpha (TNF-α), interleukin 2 (IL-2), and 6 (IL-6) in lipopolysaccharides (LPS)- stimulated RAW 264.7 cells using ELISA assays in addition, expression of nitric oxide synthase (iNOS) was measured via western blot.

RESULTS

The SF method gave the highest EO yield (1.50 mL v/w). Oxygenated components constituted the highest percentage in the four methods, 84.14, 79.21, 73.29 and 33.57% in the HS, HD, MAHD, and SF, respectively. Moreover, variation in the amount of identified compounds was apparent; in HS EO α-thujone (29.37%), artemisia ketone (19.59%), and santolina alcohol (14.66%) are major components, while α-thujone (20.38%) and piperatone (12.09%) were significant in HD. Moreover, ( +)-spathulenol (12.22%) and piperatone (10.48%) were significant in MAHD, while piperatone (14.83%) and β-sitosterol (11.07%) were significant in SF EO. HD, MAHD, and SF EOs exhibited susceptibility against P. aeruginosa (IZ = 9-14 mm), E. coli (11-13 mm), and C. perfringens (IZ = 10-14 mm) in agar diffusion assay. MAHD EOs demonstrated potent growth inhibition (MICs = 0.25-2 mg/mL), followed by HD EOs (MICs = 13-52 mg/mL) to all tested microorganisms in well microdilution assay. Also, they exert MBC values equal to or higher than the MICs. Furthermore, SF EOs inhibited the biofilm formation of all tested microorganisms by 65.12-80.84%. Specifically, MAHD and HD EOs efficiently suppress the biofilm of S. pyogenes (77.87%) and P. aeruginosa (60. 29%), respectively. Ultimately, HD and SF EOs showed anti-inflammatory activity by suppressing the TNF-α, IL-2, and IL-6 release and iNOS expression in LPS-stimulated RAW 264.7 macrophages.

CONCLUSION

A. fragrantissima EO is rich in oxygenated volatile compounds with antibacterial and anti-inflammatory activities. It is encouraged as a bioactive agent for adjusting skin infections, though additional studies are essential for their safety in clinical settings.

Increased antimicrobial resistance of acid-adapted pathogenic Escherichia coli, and transcriptomic analysis of polymyxin-resistant strain

This study investigated the acid adaptation and antimicrobial resistance of seven pathogenic Escherichia coli strains and one commensal strain under nutrient-rich acidic conditions. After acid adaptation, three pathogenic E. coli survived during 100 h incubation in tryptic soy broth at pH 3.25. Acid-adapted (AA) strains showed increased resistance to antimicrobials including ampicillin, ciprofloxacin and especially polymyxins (colistin and polymyxin B), the last resort antimicrobial for multidrug-resistant Gram-negative bacteria. Enterotoxigenic E. coli strain (NCCP 13717) showed significantly increased resistance to acids and polymyxins. Transcriptome analysis of the AA NCCP 13717 revealed upregulation of genes related to the acid fitness island and the arn operon, which reduces lipopolysaccharide binding affinity at the polymyxin site of action. Genes such as eptA, tolC, and ompCF were also upregulated to alter the structure of the cell membrane, reducing the outer membrane permeability compared to the control, which is likely to be another mechanism for polymyxin resistance. This study highlights the emergence of antimicrobial resistance in AA pathogenic E. coli strains, particularly polymyxin resistance, and the mechanisms behind the increased antimicrobial resistance, providing important insights for the development of risk management strategies to effectively control the antimicrobial resistant foodborne pathogens.

Identification of Candida albicans and non-MRSA Staphylococcus aureus in free-living amoebae isolated from the hospital wards; an alarm for distribution of nosocomial infections via FLA

Free-living amoebae (FLA) are isolated from the hospital environments and known as Trojan horses for medical essential microorganisms. This study aimed to investigate the prevalence and the presence of FLA and two critical agents of nosocomial infections, in the hospital wards. Sixty samples were collected from four communities and cultured onto non-nutrient agar (NNA). After total DNA extraction, FLA were characterized using PCR and sequencing. The presence of Candida albicans and Staphylococcus aureus was evaluated using real-time and conventional PCR, respectively. Acanthamoeba sp. was characterized in 30 (50%) samples. Two (6.6%) and one (3.3%) samples were positive for Vahlkampfiidae and Vermamoeba vermiformis, respectively . S. aureus was detected in 13 (43.3%) of samples, while none of them were positive for methicillin-resistant gene. C. albicans DNA was detected in one (3.3%) FLA-positive sample. The isolation of FLA from hospital suggests an essential role these eukaryotes in the inter-ward circulation of nosocomial infections.

Physically Cross-Linked PVA Hydrogels as Potential Wound Dressings: How Freezing Conditions and Formulation Composition Define Cryogel Structure and Performance

Objectives: Hydrogels produced using the freeze-thaw method have demonstrated significant potential for wound management applications. However, their production requires precise control over critical factors including freezing temperature and the choice of matrix-forming excipients, for which no consensus on the optimal conditions currently exists. This study aimed to address this gap by evaluating the effects of the above-mentioned variables on cryogel performance. Methods: Mechanical properties, absorption capacity, and microstructure were assessed alongside advanced analyses using differential scanning calorimetry (DSC) and low-field nuclear magnetic resonance relaxometry (LF TD NMR). Results: The results demonstrated that fully hydrolyzed polyvinyl alcohol (PVA) with a molecular weight above 61,000 g/mol is essential for producing high-performance cryogels. Among the tested formulations, an 8% (w/w) PVA56-98 solution (Mw~195,000; DH = 98.0-98.8%) with 10% (w/w) propylene glycol (PG) provided the best balance of stretchability, durability, and low adhesion. Notably, while -25 °C is often used for cryogel preparation, freezing the gel precursor at -80 °C yielded superior results, producing materials with more open, interconnected structures and enhanced mechanical strength and elasticity-deviating from conventional practices. Conclusions: The designed cryogel prototypes exhibited functional properties comparable to or even surpassing commercial wound dressings, except for absorption capacity, which remained lower. Despite this, the cryogel prototypes demonstrated potential as wound dressings, particularly for use in dry or minimally exuding wounds. All in all, this study provides a comprehensive analysis of the physicochemical and functional properties of PVA cryogels, establishing a strong foundation for the development of advanced wound dressing systems.

Antipathogenic Activity of Betainized Polyethyleneimine Sprays Without Toxicity

Background/Objectives: The design of alternative antipathogenic sprays has recently attracted much attention due to the limitations of existing formulations, such as toxicity and low and narrow efficacy. Polyethyleneimine (PEI) is a great antimicrobial polymer against a wide range of pathogens, but toxicity limits its use. Here, betainized PEI (B-PEI) was synthesized to decrease the toxicity of PEI and protonated with citric acid (CA), boric acid (BA), and HCl to improve antimicrobial activity. Methods: Cytotoxicity of the PEI-based solutions was determined on L929 fibroblast cells. Antibacterial/fungal activity of PEI-based antipathogenic sprays was investigated by microtiter and disc diffusion assays, in addition to bacterial viability and adhesion % of common bacteria and fungi on the PEI-treated masks. Furthermore, the antiviral effect of the PEI-based solutions was determined against SARS-CoV-2 virus. Results: The biosafe concentration of PEI was determined as 1 μg/mL with 75 ± 11% cell viability, but B-PEI and its protonated forms had great biocompatibility even at 1000 μg/mL with more than 85% viability. The antibacterial/fungal effect of non-toxic B-PEI was improved by protonation with BA and HCl with 2.5-10 mg/mL minimum bactericidal/fungicidal concentrations (MBCs/MFCs). Bacterial/fungal viability and adhesion on the mask was almost eliminated by using 50 μL with 5-10 mg/mL of B-PEI-BA. Both protonated bare and betainized PEI show potent antiviral activity against SARS-CoV-2 virus. Conclusions: The toxicity of PEI was overcome by using betainized forms of PEI (B-PEI). Furthermore, the antimicrobial and antiviral efficacy of PEI and B-PEI was improved by protonation with CA, BA, and HCl of amine groups on B-PEI. B-PEI-BA spray solution has great potential as an antipathogenic spray with broad-spectrum antimicrobial potency against harmful bacteria, fungi, and viruses without any toxicity.

A hydrogen generator composed of poly (lactic-co-glycolic acid) nanofibre membrane loaded iron nanoparticles for infectious diabetic wound repair

Diabetic wound, which is chronic skin disease, poses a significant challenge in clinical practice because of persistent inflammation and impaired angiogenesis. Recently, hydrogen has emerged as a novel therapeutic agent due to its superior antioxidant and anti-inflammatory properties. In this study, we engineered a poly (lactic-co-glycolic acid) (PLGA) electrospun nanofibre membrane loaded with citric acid (CA) and iron (Fe) nanoparticles, referred to as Fe@PLGA + CA. Our in vitro assays demonstrated that the Fe@PLGA + CA membrane continuously generated and released hydrogen molecules via a chemical reaction between Fe and CA in an acidic microenvironment created by CA. We also discovered that hydrogen can ameliorate fibroblast migration disorders by reducing the levels of matrix metalloproteinase 9 (MMP9). Furthermore, we confirmed that hydrogen can scavenge or biochemically neutralise accumulated reactive oxygen species (ROS), inhibit pro-inflammatory responses, and induce anti-inflammatory reactions. This, in turn, promotes vessel formation, wound-healing and accelerates skin regeneration. These findings open new possibilities for using elemental iron in skin dressings and bring us one step closer to implementing hydrogen-releasing biomedical materials in clinical practice.

Development and Characterization of Film-Forming Solution Loaded with Syzygium cumini (L.) Skeels for Topical Application in Post-Surgical Therapies

BACKGROUND/OBJECTIVES

Considering the antioxidant and antimicrobial properties attributed to compounds in Syzygium cumini extract, this research aimed to advance postoperative therapeutic innovations. Specifically, the study assessed the physicochemical properties of a film-forming solution (FFS) incorporated with S. cumini, evaluating its therapeutic potential for postoperative applications.

METHODS

The S. cumini extract was meticulously characterized to determine its chemical composition, with particular emphasis on the concentration of phenolic compounds. Antioxidant and antimicrobial assays were conducted to assess the extract's efficacy in these domains. Following this, an FFS containing S. cumini was formulated and evaluated comprehensively for skin adhesion, mechanical and barrier properties, and thermal behavior.

RESULTS

The antioxidant and antimicrobial activities of the S. cumini extract demonstrated promising results, indicating its potential utility as an adjunct in postoperative care. The developed FFS exhibited favorable physicochemical properties for topical application, including adequate skin adhesion and appropriate pH levels. Moreover, chemical and thermal analyses confirmed the formulation's stability and the retention of the extract's beneficial properties.

CONCLUSIONS

Overall, the findings suggest that the S. cumini-loaded FFS holds significant potential as a valuable therapeutic tool for post-surgical management.

Pyrazinamide Resistance: A Major Cause of Switching Shorter to Longer Bedaquiline-based Regimens in Multidrug-resistant Tuberculosis Patients

BACKGROUND

All-oral regimens, including bedaquiline, are now standard in shorter treatment regimens (STRs) for multidrug-resistant tuberculosis (MDR-TB). Resistance or intolerance to drugs in STR often necessitates a switch to longer treatment regimens (LTRs). This study aims to identify the factors associated with this transition in MDR-TB patients.

METHODS

We conducted a retrospective analysis of medical records from MDR-TB patients treated with STR at Haji Hospital, Surabaya, between January 2022 and January 2023. Data on drug-resistance profiles, determined by drug-susceptibility testing (DST), and line probe assay, as well as adverse effects, were collected.

RESULTS

Among 20 eligible patients, 8 (40.0%) switched from STR to LTR within the first 4 months. Resistance was observed in 62.5% of these patients for pyrazinamide, 25.0% for high-dose isoniazid, and 12.5% for levofloxacin. The overall prevalence of pyrazinamide resistance was 25.0%. A history of prior antitubercular treatment was significantly associated with pyrazinamide resistance (P = 0.015; RR - 16.000; confidence interval 95% 1.274-200.917).

CONCLUSION

Pyrazinamide resistance is a major factor for switching from STR to LTR in MDR-TB patients, particularly among those with previous TB treatment. Rapid DST for pyrazinamide is essential for the early identification of resistance and timely adjustments to treatment regimens.

Antibacterial properties of photo-crosslinked chitosan/methacrylated hyaluronic acid nanoparticles loaded with bacitracin

The current treatments for wounds often fail to induce adequate healing, leaving wounds vulnerable to persistent infections and development of drug-resistant microbial biofilms. New natural-derived nanoparticles were studied to impair bacteria colonization and hinder the formation of biofilms in wounds. The nanoparticles were fabricated through polyelectrolyte complexation of chitosan (CS, polycation) and hyaluronic acid (HA, polyanion). UV-induced photo-crosslinking was used to enhance the stability of the nanoparticles. To achieve this, HA was methacrylated (HAMA, degree of modification of 20 %). Photo-crosslinked nanoparticles obtained from HAMA and CS had a diameter of 478 nm and a more homogeneous size distribution than nanoparticles assembled solely through complexation (742 nm). The nanoparticles were loaded with the antimicrobial agent bacitracin (BC), resulting in nanoparticles with a diameter of 332 nm. The encapsulation of BC was highly efficient (97 %). The BC-loaded nanoparticles showed significant antibacterial activity against gram-positive bacteria Staphylococcus aureus, Methicillin-resistant S. aureus and S. epidermidis. Photo-crosslinked HAMA/CS nanoparticles loaded with BC demonstrated inhibition of biofilm formation and a positive effect on the proliferation of mammalian cells (L929). These crosslinked nanoparticles have potential for the long-term treatment of wounds and controlled antibiotic delivery at the location of a lesion.

An audit of pre-operative dental radiographs in patients who received no pre-operative dental input before cardiovalvular surgery

Purpose To radiographically characterise dental disease burden and related characteristics of referred patients awaiting cardiovalvular surgery (CVS) in the context of infective endocarditis (IE) risk.Methods Radiographic evidence of dental disease levels was assessed for patients referred for dental assessment pre-CVS using available orthopantomographs (OPTs) prescribed by the cardiology team. This group did not receive any pre-CVS dental intervention or treatment.Results The majority of OPTs were Quality Standard 2 (87.5%). There was radiographic evidence of dentoalveolar disease in those patients proceeding to CVS. Periodontal disease was most prominent, with 79% of patients having advanced bone loss. The mean number of apical lesions was 0.71. Overall decayed, missing, and filled teeth score was 16.4, along with mean missing teeth scores of 7.9. None of the patients have so far developed IE at a minimum of six-month follow-up.Conclusions In our context, the quality of the radiographs requested by non-dental clinicians and delivered by non-dental-school-based radiographic departments is suboptimal and needs to be addressed. This audit should help to inform the debate around the timing and delivery of evidence-based, specialist dental care for CVS patients.

A pro-reparative bioelectronic device for controlled delivery of ions and biomolecules

Wound healing is a complex physiological process that requires precise control and modulation of many parameters. Therapeutic ion and biomolecule delivery has the capability to regulate the wound healing process beneficially. However, achieving controlled delivery through a compact device with the ability to deliver multiple therapeutic species can be a challenge. Bioelectronic devices have emerged as a promising approach for therapeutic delivery. Here, we present a pro-reparative bioelectronic device designed to deliver ions and biomolecules for wound healing applications. The device incorporates ion pumps for the targeted delivery of H+ and zolmitriptan to the wound site. In vivo studies using a mouse model further validated the device's potential for modulating the wound environment via H+ delivery that decreased M1/M2 macrophage ratios. Overall, this bioelectronic ion pump demonstrates potential for accelerating wound healing via targeted and controlled delivery of therapeutic agents to wounds. Continued optimization and development of this device could not only lead to significant advancements in tissue repair and wound healing strategies but also reveal new physiological information about the dynamic wound environment.

Wound pH-Modulating Strategies for Diabetic Wound Healing

Significance: Chronic diabetic wounds on the lower extremities (diabetic foot ulcers, DFU) are one of the most prevalent and life-threatening complications of diabetes, responsible for significant loss of quality of life and cost to the health care system. Available pharmacologic treatments fail to achieve complete healing in many patients. Recent studies and investigational treatments have highlighted the potential of modulating wound pH in DFU. Recent Advances: Data from in vitro, preclinical, and clinical studies highlight the role of pH in the pathophysiology of DFU, and topical administration of pH-lowering agents have shown promise as a therapeutic strategy for diabetic wounds. In this critical review, we describe the role of pH in DFU pathophysiology and present selected low-molecular-weight and hydrogel-based pH-modulating systems for wound healing and infection control in diabetic wounds. Critical Issues: The molecular mechanisms leading to pH alterations in diabetic wounds are complex and may differ between in vitro models, animal models of diabetes, and the human pathophysiology. Wound pH-lowering bandages for DFU therapy must be tested in established animal models of diabetic wound healing and patients with diabetes to establish a comprehensive benefit-risk profile. Future Directions: As our understanding of the role of pH in the pathophysiology of diabetic wounds is deepening, new treatments for this therapeutic target are being developed and will be tested in preclinical and clinical studies. These therapeutic systems will establish a target product profile for pH-lowering treatments such as an optimal pH profile for each wound healing stage. Thus, controlling wound bed pH could become a powerful tool to accelerate chronic diabetic wound healing.

Evaluation of Neutralizing Capacity of Tixagevimab plus Cilgavimab (AZD7442) against Different SARS-CoV-2 Variants: A Case Report Study with Comparison to a Vaccinated Population

AZD7442 (150 mg of tixagevimab plus 150 mg of cilgavimab) has been approved for the preexposure prophylaxis of COVID-19 and for the treatment of adults and adolescents with COVID-19 who do not require supplemental oxygen and who are at increased risk of severe COVID-19. Thus, the aim of the present study is to evaluate the neutralizing capacity of tixagevimab and cilgavimab across different SARS-CoV-2 variants in two patients who received AZD7442 for immunoprophylaxis. A cohort of subjects (n = 45) who had received the BNT162b2 mRNA COVID-19 vaccine has been included to compare these two preventive strategies. Neutralizing antibody (NAb) titers against several variants were assessed against the wild-type, alpha, beta, gamma, delta, omicron BA.5, and XBB.1.5 variants. Binding antibodies have also been measured. NAbs T 1/2 for AZD7442 was 8.1 days (95% CI: 5.1-19.5 days) and was 11.8 days (95% CI: 7.9-23.7 days) for the primo-vaccination cohort. The time to reach neutralization negativity was 108.3 days (95% CI: 66.9-130.7) for AZD7442 compared to 95.4 days (95% CI: 31.0-119.7 days) for the primo-vaccination cohort. The time to reach NAbs' negativity differs between variants with the maximum value obtained for alpha (i.e., 101.1 days (95% CI: 30.0-135.4 days)) and the minimum obtained for beta (i.e., 61.2 days (95% CI: 37.8-77.1 days)). Our results reinforce the need of reviewing the use of AZD7442 in relation to variants of concern and potentially adapting its administration schedule. AZD7442 could be indicated for short-term prophylaxis in frail patients who may be acutely exposed to SARS-CoV-2.

Electrospun nanofibrous wound dressings with enhanced efficiency through carbon quantum dots and citrate incorporation

Nanofibers show promise for wound healing by facilitating active agent delivery, moisture retention, and tissue regeneration. However, selecting suitable dressings for diverse wound types and managing varying exudate levels remains challenging. This study synthesized carbon quantum dots (CQDs) from citrate salt and thiourea using a hydrothermal method. The CQDs displayed antibacterial activity against Staphylococcus aureus and Escherichia coli. A nanoscaffold comprising gelatin, chitosan, and polycaprolactone (GCP) was synthesized and enhanced with silver nanoparticle-coated CQDs (Ag-CQDs) to form GCP-Q, while citrate addition yielded GCP-QC. Multiple analytical techniques, including electron microscopy, FT-IR spectroscopy, dynamic light scattering, UV-Vis, photoluminescence, X-ray diffraction, porosity, degradability, contact angle, and histopathology assessments characterized the CQDs and nanofibers. Integration of CQDs and citrate into the GCP nanofibers increased porosity, hydrophilicity, and degradability-properties favorable for wound healing. Hematoxylin and eosin staining showed accelerated wound closure with GCP-Q and GCP-QC compared to GCP alone. Overall, GCP-Q and GCP-QC nanofibers exhibit significant potential for skin tissue engineering applications.

Plant growth promoting bacteria (PGPB)-induced plant adaptations to stresses: an updated review

Plants and bacteria are co-evolving and interact with one another in a continuous process. This interaction enables the plant to assimilate the nutrients and acquire protection with the help of beneficial bacteria known as plant growth-promoting bacteria (PGPB). These beneficial bacteria naturally produce bioactive compounds that can assist plants' stress tolerance. Moreover, they employ various direct and indirect processes to induce plant growth and protect plants against pathogens. The direct mechanisms involve phytohormone production, phosphate solubilization, zinc solubilization, potassium solubilization, ammonia production, and nitrogen fixation while, the production of siderophores, lytic enzymes, hydrogen cyanide, and antibiotics are included under indirect mechanisms. This property can be exploited to prepare bioformulants for biofertilizers, biopesticides, and biofungicides, which are convenient alternatives for chemical-based products to achieve sustainable agricultural practices. However, the application and importance of PGPB in sustainable agriculture are still debatable despite its immense diversity and plant growth-supporting activities. Moreover, the performance of PGPB varies greatly and is dictated by the environmental factors affecting plant growth and development. This review emphasizes the role of PGPB in plant growth-promoting activities (stress tolerance, production of bioactive compounds and phytohormones) and summarises new formulations and opportunities.

Evaluating the Utility of Clinical Scores APACHE, CURB, SOFA, and NEWS2 at Admission and 5-Days after Symptom Onset in Predicting Severe COVID-19 in Patients with Diabetes

The elevated risk of severe COVID-19 outcomes in patients with diabetes underscores the need for effective predictive tools. This study aimed to assess the predictive accuracy of APACHE II, CURB-65, SOFA, and NEWS2 scores at critical time points in diabetic patients diagnosed with COVID-19, aiming to guide early and potentially life-saving interventions. In a prospective cohort study conducted from January 2021 to December 2023, adult patients with type 1 or type 2 diabetes and confirmed SARS-CoV-2 infection were evaluated. Clinical scores were calculated at admission and five days post-symptom onset, with data analyzed using receiver operating characteristic (ROC) curves and logistic regression to determine areas under the curve (AUC) and hazard ratios (HR) for severe outcomes. Among the 141 diabetic patients studied, ROC analysis revealed high AUC values for SOFA (0.771 at admission, 0.873 at day five) and NEWS2 (0.892 at admission, 0.729 at day five), indicating strong predictive accuracy for these scores. The APACHE II score's AUC improved from 0.698 at admission to 0.806 on day five, reflecting worsening patient conditions. Regression analysis showed significant HRs associated with exceeding threshold scores: The SOFA score HR at day five was 3.07 (95% CI: 2.29-4.12, p < 0.001), indicating a threefold risk of severe outcomes. Similarly, the APACHE II score showed an HR of 2.96 (95% CI: 2.21-3.96, p < 0.001) at day five, highlighting its utility in predicting severe disease progression. The SOFA and NEWS2 scores demonstrated excellent early predictive accuracy for severe COVID-19 outcomes in diabetic patients, with significant AUC and HR findings. Continuous score monitoring, especially of APACHE II and SOFA, is crucial for managing and potentially mitigating severe complications in this vulnerable population. These tools can effectively assist in the timely escalation of care, thus potentially reducing morbidity and mortality among diabetic patients during the COVID-19 pandemic.

Precision nutrition-based strategy for management of human diseases and healthy aging: current progress and challenges forward

Currently, the treatment of various human ailments is based on different therapeutic approaches including traditional and modern medicine systems. Precision nutrition has come into existence as an emerging approach considering the diverse aspects such as age, sex, genetic and epigenetic makeup, apart from the pathophysiological conditions. The continuously and gradually evolving disciplines of genomics about nutrition have elucidated the importance of genetic variations, epigenetic information, and expression of myriads of genes in disease progression apart from the involvement in modulating therapeutic responses. Further, the investigations have presented the considerable role of gut microbiota comprising of commensal and symbionts performing innumerable activities such as release of bioactive molecules, defense against pathogenic microbes, and regulation of immunity. Noteworthy, the characteristics of the microbiome change depending on host attributes, environmental factors, and habitat, in addition to diet, and therefore can be employed as a biomarker to unravel the response to given food. The specific diet and the components thereof can be suggested for supporting the enrichment of the desired microbial community to some extent as an important part of precision nutrition to achieve not only the goal of human health but also of healthy aging.

Advances and Challenges in Immune-Modulatory Biomaterials for Wound Healing Applications

Wound healing progresses through three distinct stages: inflammation, proliferation, and remodeling. Immune regulation is a central component throughout, crucial for orchestrating inflammatory responses, facilitating tissue repair, and restraining scar tissue formation. Elements such as mitochondria, reactive oxygen species (ROS), macrophages, autophagy, ferroptosis, and cytokines collaboratively shape immune regulation in this healing process. Skin wound dressings, recognized for their ability to augment biomaterials' immunomodulatory characteristics via antimicrobial, antioxidative, pro- or anti-inflammatory, and tissue-regenerative capacities, have garnered heightened attention. Notwithstanding, a lack of comprehensive research addressing how these dressings attain immunomodulatory properties and the mechanisms thereof persists. Hence, this paper pioneers a systematic review of biomaterials, emphasizing immune regulation and their underlying immunological mechanisms. It begins by highlighting the importance of immune regulation in wound healing and the peculiarities and obstacles faced in skin injury recovery. This segment explores the impact of wound metabolism, infections, systemic illnesses, and local immobilization on the immune response during healing. Subsequently, the review examines a spectrum of biomaterials utilized in skin wound therapy, including hydrogels, aerogels, electrospun nanofiber membranes, collagen scaffolds, microneedles, sponges, and 3D-printed constructs. It elaborates on the immunomodulatory approaches employed by these materials, focusing on mitochondrial and ROS modulation, autophagic processes, ferroptosis, macrophage modulation, and the influence of cytokines on wound healing. Acknowledging the challenge of antibiotic resistance, the paper also summarizes promising plant-based alternatives for biomaterial integration, including curcumin. In its concluding sections, the review charts recent advancements and prospects in biomaterials that accelerate skin wound healing via immune modulation. This includes exploring mitochondrial transplantation materials, biomaterial morphology optimization, metal ion incorporation, electrostimulation-enabled immune response control, and the benefits of composite materials in immune-regulatory wound dressings. The ultimate objective is to establish a theoretical foundation and guide future investigations in the realm of skin wound healing and related materials science disciplines.

Case report and review of literature: IgG4-gastroduodenitis in upper GI Crohn's disease: two separate entities or just a marker of disease severity?

A 20-year-old man was presented with ulcerative gastritis and duodenitis complicated by pyloric stenosis. Helicobacter pylori infection was excluded, and the lesions did not respond to treatment with proton pump inhibitors. No other parts of the intestinal tract showed signs of inflammation. Histopathological review showed signs of chronic inflammation with granuloma formation. A tentative diagnosis of isolated upper gastrointestinal (UGI) Crohn's disease was performed. However, additional work-up revealed significantly positive IgG4 staining as well as elevated IgG4 serum levels. Since granulomatous disease is unlikely in IgG4-related disease, an eventual diagnosis of overlapping IgG4-related disease and Crohn's disease (CD) was performed. Treatment with systemic steroids and anti-TNF in combination with azathioprine led to rapid symptomatic improvement. In this article, we review the available literature on IgG4-related gastroduodenitis, granulomatous gastritis, and upper GI CD. We suggest the possibility that IgG4-infiltration may be a marker of severely active inflammatory bowel disease rather than a separate disease entity.

Diabetic peripheral arterial disease in COVID-19 pandemic

Both diabetes and peripheral arterial disease (PAD) have complex interactions with COVID-19. PAD is one of the most important underlying factors in the development of diabetic foot. The COVID-19 pandemic has also caused an increase in cardiovascular complications in those with chronic diseases, including diabetics, due to both the thrombophilic course of the viral disease and the lockdown measures applied for prevention. Since both COVID-19 and diabetes mellitus predispose to thrombosis, PAD is likely to have a more severe course in diabetic patients with COVID-19. The aim of our study is to discuss the complications, prophylaxis, and treatment of PAD, which is a serious complication of diabetes, during the pandemic period.

Aloe vera-An Extensive Review Focused on Recent Studies

Since ancient times, Aloe vera L. (AV) has attracted scientific interest because of its multiple cosmetic and medicinal properties, attributable to compounds present in leaves and other parts of the plant. The collected literature data show that AV and its products have a beneficial influence on human health, both by topical and oral use, as juice or an extract. Several scientific studies demonstrated the numerous biological activities of AV, including, for instance, antiviral, antimicrobial, antitumor, and antifungal. Moreover, its important antidepressant activity in relation to several diseases, including skin disorders (psoriasis, acne, and so on) and prediabetes, is a growing field of research. This comprehensive review intends to present the most significant and recent studies regarding the plethora of AV's biological activities and an in-depth analysis exploring the component/s responsible for them. Moreover, its morphology and chemical composition are described, along with some studies regarding the single components of AV available in commerce. Finally, valorization studies and a discussion about the metabolism and toxicological aspects of this "Wonder Plant" are reported.

The Effects of Convalescent Plasma Transfusion on Serum Levels of Macrophage-Associated Inflammatory Biomarkers in Patients with Severe COVID-19

As an antibody-based therapy, plasma therapy has been used as an emergency therapeutic strategy against severe acute respiratory syndrome coronavirus type 2 infection. Due to the critical role of macrophages in coronavirus disease-19 (COVID-19)-associated hyperinflammation, the main objective of this study was to assess the effect of plasma transfusion on the expression levels of the inflammatory biomarkers involved in activation and pulmonary infiltration of macrophages. The target population included 50 severe hospitalized COVID-19 patients who were randomly assigned into 2 groups, including intervention and control. Serum levels of chemokine (C-C motif) ligand (CCL)-2, CCL-3, tumor necrosis factor (TNF)-α, and interleukin (IL)-6 were measured by enzyme-linked immunosorbent assay. Moreover, quantitative real-time polymerase chain reaction (PCR) was carried out to assess the relative expression of nuclear factor (NF)-κB1, NF-κB2, nuclear factor erythroid 2 p45-related factor 2 (NRF-2), and thioredoxin-interacting protein genes. Sampling was done at baseline and 72 h after receiving plasma. The intervention group demonstrated significantly lower serum levels of IL-6, TNF-α, and CCL-3. In addition, real-time PCR data analyses showed that the relative expression of NF-κB2 was significantly declined in the patients who received plasma. The use of convalescent plasma probably has a significant inhibitory effect on the cytokines, chemokines, and inflammatory genes related to macrophage activation, which are closely associated with the worsening of clinical outcomes in severe COVID-19.