Factors affecting wound healing

A Scoping Review to Identify Clinical Signs, Symptoms and Biomarkers Reported in the Literature to Be Indicative of Biofilm in Chronic Wounds

The objective of this review was to identify clinical signs/symptoms reported in the literature to be indicative of biofilm in chronic wounds. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews, and the Joanna Briggs Institute Evidence Synthesis manual guided review conduct. Any article/study type reporting signs/symptoms of biofilm in adults with venous, diabetic, pressure and/or mixed arterial/venous ulcers was eligible. Medline, Embase, CINAHL, Cochrane CENTRAL and the Bielefeld Academic Search Engine were searched. Titles/abstracts and full-text articles were screened against eligibility criteria. One-hundred and eleven reports of 109 articles were included. They provided 830 accounts of clinical signs/ symptoms being indicative of biofilm. These were categorised into 26 statements. Visual indicators such as a shiny, slimy layer on a non-healing wound surface quickly reforming in the absence of frequent cleansing or debridement represented 24% of accounts, followed by failed response to antimicrobial therapies (15%), and failure of wound to close or progress to healing despite optimal management strategies (13%). Wound duration > 6 weeks and extreme tolerance to host defences represented 1% of accounts. Clinical signs/symptoms are recommended and used as indicators of biofilm presence in chronic wounds but with little supporting validation data.

Multifunctional (Co3Fe)(S2)4-ion-microneedle patch: Synergistic antimicrobial, anti-inflammatory and cell proliferation for accelerating wound healing

Preventing bacterial infection and accelerating wound closure are critical for wound healing. Herein, a novel multifunctional polyvinyl alcohol-polyvinylpyrrolidone (PVA-PVP) microneedle (MN) patch embedded with enzyme-like activity (Co3Fe)(S2)4 (CFS) nanoparticles and metal ions (Co2+ and Fe3+) was systematically synthesized for the management of bacteria-infected wounds. CFS regulated redox homeostasis and achieved bacterial eradication while concomitantly alleviating oxidative damage. Specifically, CFS generated reactive oxygen species (ROS) to eliminate bacteria and concurrently attenuated cellular inflammation by scavenging ROS through their superoxide dismutase-like (SOD) activity. Meanwhile, the results of RNA transcriptome sequencing and quantitative real-time polymerase chain reaction (qRT-PCR) analyses indicated that Co2+ and Fe3+ can inhibit inflammatory responses in mice by modulating the IL-17 and NF-κB signaling pathways. Therefore, CFS-ion-MN significantly enhanced the healing of wounds infected with methicillin-resistant Staphylococcus aureus (MRSA) in mice model without eliciting systemic toxicity. Overall, this study offers an innovative methodology for the development of composite materials for the effective treatment of wounds.

Highly Compatible Nanocomposite-Based Bacterial Cellulose Doped With Dopamine and Titanium Dioxide Nanoparticles: Study the Effect of Mode of Addition, Characterization, Antibacterial, and Wound Healing Efficiencies

Microbial resistance is an expenditure for a country's economy as a whole as well as its health systems. Metal oxide nanoparticles play a role in overcoming microbial resistance to antibiotics. Bacterial cellulose (BC) is a biopolymer that is friendly to the environment and has a wide range of economic uses, particularly in biomedicine. This work deals with the formulation of BC-doped titanium dioxide nanoparticles (TiO2NPs) and polydopamine (DOP), which are presented with antimicrobial activity. Additionally, the mode of addition of the doped materials was studied using physicochemical analysis, including Fourier transform infrared spectroscopy (FTIR) and x-ray diffraction (XRD). Moreover, the topographical study used scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX). The antimicrobial activity was studied and showed the efficiency of the BC/DOP/TiO2NP composite against Gram-positive (Staphylococcus aureus) and Gram-negative (Pseudomonas aeruginosa, Escherichia coli) strains. Additionally, the wound healing was examined on rats that had been purposely wounded. The results observed that the mode of addition contributed to the molecular structure of the formulated BC-doped samples according to the physicochemical and topographical analysis. Moreover, the BC/DOP/TiO2NP composite enhanced wound healing for about 95% closure by Day 14 compared to 50% in the control group. Based on the results, we can suggest BC/DOP/TiO2NP as an excellent candidate for wound dressings.

Microbial community and immune modulation enable effective treatment of methicillin-resistant Staphylococcus aureus skin infections with linalool

Methicillin-resistant Staphylococcus aureus (MRSA), as one of the main pathogens causing skin and soft tissue infections, poses challenges in treatment due to its high resistance to antibiotics. As one of the efficacious essential oil components in numerous traditional Chinese medicines, linalool was believed to possess antimicrobial activity against pathogenic microorganisms. Here, we investigated the therapeutic effects of linalool on MRSA-infected mice by examining their post-treatment outcomes. This was done through observations of physiological conditions, pathological sections, inflammatory factors, and changes in the skin microenvironment. We have confirmed the effectiveness of linalool in treating MRSA infections. Mice treated with linalool exhibited more pronounced signs of recovery, such as reduced skin necrosis, increased fibroplasia, greater neovascularization, and resolution of inflammatory infiltration. In addition, there was an improvement in the inflammatory environment, with a decrease in inflammatory factors. The microbial composition on the skin surface also confirmed this improvement. After linalool treatment, mice exhibited better species diversity on the skin, making it easier to maintain the skin's homeostasis. The excellent performance of linalool in combating MRSA infections provides a new direction for the search for new antibiotics against multidrug-resistant bacteria, highlighting the potential of linalool as a promising anti-MRSA drug.

Investigating the wound healing potential of low-power 661 nm laser light in a pigmented hairless murine model

Photobiomodulation (PBM) has emerged as a promising method for enhancing wound healing. However, a standardized therapeutic protocol has not yet been established. This study aimed to determine the optimal irradiation parameters for wound healing in pigmented hairless mice (SKH-hr2). Mice were irradiated daily with energy doses of 2 or 4 J/cm2, achieved with different power densities in each group: 20, 50, or 100 mW/cm2. Various methods were used to evaluate the therapeutic efficacy, including histopathological analysis, clinical observation, photo-documentation, assessment of biophysical skin parameters, and Fourier Transform infrared (FT-IR) spectroscopy. The results indicated that the most favorable outcomes regarding wound healing acceleration and inflammation reduction were achieved with an irradiation setting of 50 mW/cm2 and 2 J/cm2. However, the group subjected to prolonged irradiation times with a power density of 20 mW/cm2 and energy of 4 J/cm2 exhibited subcutaneous bleeding. The FT-IR spectral absorption bands of amide groups provided important molecular-level information about the secondary structure of collagen, particularly in relation to skin regeneration and the response to applied energy, in agreement with histological data. This study highlights the critical need for further investigation into the parameters of photobiomodulation to ensure its effective application to the different skin phototypes and to mitigate potential adverse effects arising from incorrect usage.

The Impact of Diagnostic Delay on Wound Healing-A Cohort Study in a Primary Care Setting

The impact of diagnostic delays on wound healing has not been investigated in the primary care setting. The aim of this cohort study was to examine how diagnostic delays influence the healing of a chronic wound. This is a retrospective study on patients who were assessed by a specialized wound care team of a primary health care unit, aiming to reduce diagnostic and treatment delays among patients with chronic wounds. The data consist of 197 consecutive patients who had their first appointment with the wound care team in 2016. Patients whose wounds had appeared less than one year prior to the diagnosis (n = 182) were included in the analyses. Primary and secondary outcome measures: The primary outcome measure was wound healing and its association with a diagnostic delay. Delays were categorized into three groups by the date of the diagnosis: (1) less than 4 weeks (n = 33), (2) 4-12 weeks (n = 94) and (3) over 12 weeks (n = 55) after the appearance of the wound. A diagnostic delay had a significant effect on the wound healing time. Wounds had a shorter healing time if they were diagnosed early. The cumulative healing rate at 12 weeks was 54.5% in Group 1, 17.0% in Group 2 and 0% in Group 3. And 62.5% of the arterial ulcers and 47.8% of the diabetic ulcers were diagnosed within 4-12 weeks. Most of the venous leg ulcers were diagnosed within 4-12 weeks (54.2%). Our data clearly show that the earlier the diagnosis, the shorter the healing time in a primary care setting. The wounds that were diagnosed the earliest were mainly post-traumatic and venous leg ulcers. On the other hand, wounds requiring prompt diagnosis, such as diabetic foot ulcers and arterial ulcers, were not included in the group of early diagnosis. We conclude that a speedy diagnosis and aetiology-driven treatment of a wound has a direct impact on the wound healing time. Therefore, it is essential to improve the diagnostic pathways from the onset of the wound, starting from the primary care setting.

Secondary Intention Healing Time of Postoperative Surgical Cancer Skin Wounds With a Biosynthetic Porcine Type I Collagen Dressing: A 306-Patient Retrospective, Observational Study

BACKGROUND

Biosynthetic porcine type I collagen dressing is useful to close ulcers and secondary intention healing of surgical cancer wounds.

OBJECTIVE

To identify factors associated with the healing time of such wounds.

METHODS

We conducted a retrospective observational study of patients on oncological dermatological surgery in a cancer center. Healing time was studied based on age, sex, personal history of comorbidities, usual medication, anatomical location, type of surgery performed and size of the defect. Statistical analysis was performed using the ANOVA test and logistic regression.

RESULTS

A total of 306 patients were included with a median age of 73 years (62.4%, men). The statistically significantly characteristics associated with a healing time≤66 days were location-auricle, nose, inner canthus, hand, retroauricular region and nail bed-use of the Mohs technique and defect sizes≤5.28cm2.

LIMITATIONS

This is a retrospective study from a single center.

CONCLUSION

The use of biosynthetic porcine type I collagen dressings for the definitive closure of dermatological surgical cancer wounds seems particularly suitable for small defects of the inner canthus of the eye, hand, auricle, nose, forehead, retroauricular region, and nail bed.

Candidate Biomarkers for Hard-to-Heal Wounds Revealed by Single-Cell RNA Sequencing of Wound Fluid in Murine Wound Models

Wound healing is often hindered by hyperglycemia, chronic inflammation and ageing. Despite extensive research on the pathophysiology of hard-to-heal wounds, wound healing remains complex and poses challenges in treatment and management. Current wound treatments and care mostly target a single pathology, such as infection, while most hard-to-heal wounds are multifactorial. Therefore, exploring the factors that do not rely on a single pathology is crucial to fill the gap in current wound management. Despite containing more comprehensive information than commonly used wound tissue samples, cells in the wound fluid have not drawn much attention because of collection difficulties. This study aimed to use single-cell RNA sequencing (scRNA-seq) of cells from wound fluid to identify specific biomarkers for hard-to-heal wounds, with the hypothesis that common biomarkers among various wound models can be potentially applied to complex hard-to-heal wounds in clinical settings. Three representative delayed wound models, aged, diabetic and lipopolysaccharide-induced inflammatory wound models, were compared with normal young mice to explore commonly shared genes that exist in different pathological delayed wound healing models. The shared upregulation of cell cycle and cellular senescence-related genes such as Rpl11, Rpl26, Rps3, Rps15, Rps 20, Rps26, Ccl2, Cdk2ap2 and Ccnd3 and the downregulation of immune response regulation genes such as Tnfaip3, Junb, Il1r2, Plaur, Il1rn, Il1a, Cxcl2, Cd14, S100a8 and S100a9 in all delayed healing wound models were found in most immune cell subgroups, especially the macrophage subgroup. The results of this study suggested cellular senescence of cells in wound fluid could be related to hard-to-heal wounds.

Influence of anticoagulant concomitant medication on wound healing: Analysis of a multicentre cohort of 212 patients with a uniform wound model

AIMS

Various factors can impair wound healing by disrupting key stages of the process. This study evaluates the impact of concomitant anticoagulant medication on wound healing in a cohort of 212 patients.

METHODS

Data from 2 open-label, blindly evaluated, prospective, randomized, multicentre phase III trials (n = 212) were analysed. Healing durations of patients taking anticoagulants were compared to a control group (split-thickness skin graft donor site halves treated with standard moist wound dressing). Kaplan-Meier estimators and multivariable Cox regression were applied.

RESULTS

Kaplan-Meier analysis demonstrated significantly accelerated wound healing in patients treated with enoxaparin or nadroparin. Among monotherapies, 75% of patients on enoxaparin achieved wound closure within 16.5 days (95% confidence interval [CI]: 14-21), and those on nadroparin within 15 days (95% CI: 11.5-19), compared to 24 days (95% CI: 20-28) in patients receiving other anticoagulants (log-rank test: P < .001). Cox regression confirmed a significantly faster healing rate with enoxaparin or nadroparin (hazard ratio = 1.50, 95% CI: 1.02-2.19, P = .039).

CONCLUSION

Enoxaparin and nadroparin may enhance wound healing, whereas phenprocoumon, acetylsalicylic acid, and certain low-molecular-weight heparins (certoparin, tinzaparin, dalteparin, bemiparin) appear to delay wound healing. Anticoagulant monotherapy with enoxaparin or nadroparin should be considered postoperatively when feasible.

Recent Trends in the Application of Cellulose-Based Hemostatic and Wound Healing Dressings

Rapid hemostasis and wound healing are crucial severe trauma treatment. Natural mechanisms often prove insufficient, spurring research for innovative biomaterials. This review focuses on cellulose-based materials, which are promising due to their absorbency, biocompatibility, and processability. The novelty lies in exploring how these materials promote clotting and tissue regeneration. They operate via extrinsic and intrinsic mechanisms. Extrinsically, they create a matrix at the wound to activate coagulation; intrinsically, they maintain clotting factors. Additionally, they aid healing through physical, chemical, and biological means, such as maintaining moisture, incorporating antimicrobial agents, and stimulating cell activity. The innovative fabrication strategies include material selection and chemical modification. Techniques like oxidation enhance performance. Structural engineering methods like freeze-drying and 3D printing optimize porosity and alignment. Cellulose-based dressings are versatile and effective in various forms. They address different wound needs and show benefits like rapid coagulation and tissue repair. This review also covers challenges and future trends, emphasizing the need to enhance mechanical properties and biodegradability. Further, new technologies offer potential improvements to the nanocomposites. Overall, continued research on cellulose-based dressing is vital, and unlocking their potential could revolutionize wound care, providing suitable solutions for trauma management.

Rosae multiflorae fructus extracts regulate the differentiation and vascular endothelial cell-mediated proliferation of keratinocytes

Keratinocytes are the primary component of the epidermis, so maintaining the precise balance between proliferation and differentiation is essential for conserving epidermal structure and function. Rosae multiflorae fructus extract (RMFE) has wide application in the cosmetic industry, but the molecular mechanisms underlying beneficial effects on keratinocytes are still not fully understood. In this study, we found that RMFE promoted epidermal differentiation and enhanced the barrier function of normal human epidermal keratinocytes (NHEKs) and three-dimensional epidermis model in culture. In addition, RMFE promoted human umbilical vein endothelial cell (HUVEC) proliferation and angiogenesis, whereas the conditioned medium from RMFE-treated HUVECs further promoted NHEK proliferation and increased wound healing ability. Analysis of constituent bioactivities identified a quercetin derivative as a potential mediator of NHEK and HUVEC responses to RMFE. Taken together, these results suggest that RMFE enhances epidermal functions through both direct effects on keratinocytes and indirect effects mediated by endothelial cells.

Fabrication and evaluation of polylactic acid-curcumin containing carbon nanotubes (CNTs) wound dressing using electrospinning method with experimental and computational approaches

The development of advanced wound dressings has seen a significant leap with the integration of biodegradable nanofibers. This study introduces an innovative approach by designing polylactic acid (PLA)-curcumin nanofiber wound dressings enhanced with carbon nanotubes (CNTs). Using the electrospinning method, various formulations were crafted, incorporating diverse weight percentages of curcumin and CNTs. Comprehensive analyses, including FT-IR and SEM, confirmed the structural and physical integrity of the nanofibers, while tensile testing revealed a notable enhancement in mechanical strength with the addition of CNTs. Drug release evaluations highlighted a controlled and predictable release pattern of curcumin across all samples. Water absorption tests demonstrated the ability of PLA nanofibers to absorb up to 364%, with PLA-Cur-0.03%CNT samples absorbing 163%, showcasing their adaptability to wound exudates. Importantly, cytotoxicity assessments confirmed the biocompatibility of all samples, with high cell viability observed after 3 and 7 days. Antibacterial tests underscored the efficacy of CNT-incorporated samples, with PLA-Cur-0.05%CNT achieving the highest antibacterial activity at 78.95%. Additionally, using Density Functional Theory (DFT) calculations, the transition state, HOMO-LUMO energy, and equilibrium constant were explored, revealing higher equilibrium constants for keto-enol transformations compared to enol-keto in various solvents. Tautomeric conversion is easier in polar solvents due to the stability of charged species. HOMO-LUMO energy analysis revealed the stability and chemical activity of curcumin in solvents. This comprehensive research not only highlighted the mechanical, antibacterial, and drug delivery capabilities of the wound dressing but also provided an innovative approach for designing and optimizing pharmaceutical compounds under challenging chemical environments through advanced modeling and computational techniques.

Potential downsides of calorie restriction

Although the potential benefits of calorie restriction on human lifespan remain uncertain, it is currently one of the most extensively researched non-genetic approaches to extending both lifespan and healthspan in animals. Calorie restriction offers numerous health benefits, including a reduced incidence of age-related diseases. However, calorie restriction also produces a range of negative effects, which are not fully documented and require further investigation, particularly in humans. As the viability of calorie restriction in humans will depend on the balance of benefits and detrimental effects, it is crucial to understand the nature of these negative effects and what drives them. In this Review, we summarize the effects of calorie restriction on wound healing, hunger, cold sensitivity, bone health, brain size, cognition, reproductive performance and infection, primarily based on studies of rodents with some data from other species and from humans. Overall, the detrimental effects of calorie restriction seem to stem directly from prioritization of vital functions and downregulation or suppression of energy-demanding processes, which helps preserve survival but can also lead to impaired physiological performance and increased vulnerability to stressors. The exact mechanisms underlying these effects remain unclear. Whether it might be possible to engage in calorie restriction but avoid these negative effects remains uncertain.

Determinants of post-cesarean delivery surgical site infection in Mekelle public hospitals, Tigray, North Ethiopia, in 2024

BACKGROUND

Due to the increased frequency of cesarean deliveries, the number of women with surgical site infections (SSIs) is rising. Surgical site infections remain a concern in low-resource countries, despite the implementation of prevention and control measures, as they lead to extended hospital stays and significant additional costs for the patient. While studies on SSIs exist in the developing world and Africa, to the best of our knowledge, there is limited research specifically examining their determinants, particularly in Ethiopia.

OBJECTIVE

This study aimed to assess the determinants of SSI after cesarean delivery in Mekelle public hospitals, Northern Ethiopia.

METHODS

An institutional-based retrospective chart review case-control study was conducted from February 18, 2021, to March 14, 2021, using maternal records from July 8, 2018, to July 7, 2020. The required sample size was 237 (158 controls and 79 cases). Data were collected using a pretested and structured checklist with systematic sampling, then entered into EpiData 3.5.1 and analyzed using SPSS version 23. Binary logistic regression and multivariable logistic regression were used to determine the association of independent variables with the dependent variable. Variables with P-values <0.25 in bivariate logistic regression were exported to multivariable analysis, and variables with P-values <0.05 in multivariable analysis were considered significantly associated with the outcome variable.

RESULTS

The multivariable logistic regression revealed the significant determinants of post-cesarean delivery SSI were ruptured membranes before cesarean delivery (adjusted odds ratio [AOR] = 4.7, 95% confidence interval [CI] = 2.02, 10.91), prolonged operation time (AOR = 3.24, 95% CI = 1.19, 8.78), estimated blood loss greater than 500 mL (AOR = 4.7, 95% CI = 2.16, 10.40), and postoperation hemoglobin level of <11 g/dL (AOR = 4.2, 95% CI = 1.94, 9.20).

CONCLUSION

This study revealed that the determinants for developing post-cesarean delivery SSI were ruptured membranes before cesarean delivery, prolonged operation time, estimated blood loss greater than 500 mL, and postoperative hemoglobin levels less than 11 g/dL. Therefore, mothers with identified risk factors should receive preventive measures during the postoperative period until SSI is ruled out.

The active ingredient β-sitosterol in the anti-inflammatory agents alleviates perianal inflammation in rats by inhibiting the expression of Srebf2, activating the PPAR signaling pathway, and altering the composition of gut microbiota

BACKGROUND

Anti-inflammatory herbal formulations are common in traditional Chinese medicine for clearing heat and detoxifying; however, the specific active components and their mechanisms remain unclear.

OBJECTIVE

This study investigates the role of Sitosterol in alleviating perianal inflammation and its underlying mechanisms.

METHODS

Sitosterol was identified as a key active ingredient through the TCMSP database. Its structure was analyzed using PubChem, target genes were explored with STITCH, and KEGG pathways related to Srebf2 were revealed by STRING. An animal model of perianal inflammation was induced with 75 % acetic acid and treated with Sitosterol, water, normal saline, or antibiotics. The effects on gut microbiota were assessed using 16S rRNA sequencing, and inflammation was evaluated through HE stains, IHC, and TUNEL assays. In vitro, LPS-treated Caco-2 cells were used to measure proliferation, apoptosis, and cytokine levels, with PPAR pathway involvement examined using GW6471.

RESULTS

Sitosterol emerged as the primary active ingredient targeting Srebf2, with KEGG analysis highlighting the PPAR signaling pathway. In rats, Sitosterol reduced weight loss, inflammatory cell infiltration, edema, and vasodilation in perianal tissue. Additionally, it decreased PCNA levels, increased apoptosis, and elevated serum levels of IL-1β, IL-6, and TNF-α, particularly at high doses compared to antibiotics. Sitosterol also restored gut microbiota. Srebf2 knockdown improved tissue conditions and modulated cytokine levels, effects that were countered by GW6471. In LPS-treated Caco-2 cells, Sitosterol reversed reductions in cell viability and proliferation and modulated the expression of proteins and cytokines.

CONCLUSION

Sitosterol restores gut microbiota composition and further alleviates perianal inflammation in rats by inhibiting Srebf2 expression and activating the PPAR signaling pathway.

Research progress on the role of fascia in skin wound healing

The skin, the human body's largest organ, is perpetually exposed to environmental factors, rendering it vulnerable to potential injuries. Fascia, a vital connective tissue that is extensively distributed throughout the body, fulfils multiple functions, including support, compartmentalization, and force transmission. The role of fascia in skin wound healing has recently attracted considerable attention. In addition to providing mechanical support, fascia significantly contributes to intercellular signalling and tissue repair, establishing itself as a crucial participant in wound healing. This review synthesises the latest advancements in fascia research and its implications for skin wound healing.

Mechanism underlying the involvement of CXCR4/CXCL12 in diabetic wound healing and prospects for responsive hydrogel-loaded CXCR4 formulations

Diabetes mellitus is a prevalent chronic disease, often leading to complications, with chronic wounds being among the most challenging. Impairment of the CXCR4/CXCL12 signaling pathway, which plays a key role in cell mobilization, migration, and angiogenesis, significantly hampers the wound healing process in diabetic patients. Modulation of this pathway using CXCR4-targeted agents has shown promise in restoring wound repair capabilities. Additionally, the development of responsive hydrogels capable of adapting to external stimuli offers a powerful platform for drug delivery in chronic wound management. These hydrogels, when loaded with CXCR4 agonists or antagonists, enable controlled drug release and real-time therapeutic modulation. Integrating such hydrogels with existing wound healing strategies may provide an innovative and effective solution for overcoming the challenges associated with diabetic wound treatment.

Spray-drying-engineered CS/HA-bilayer microneedles enable sequential drug release for wound healing

High incidence and mortality rates of chronic wounds place a heavy burden on global healthcare systems. Achieving phased delivery of antimicrobial and regenerative drugs is crucial for promoting chronic wound healing. Herein, a microneedle (MN) patch with a biphasic release system was developed using a combination of solvent casting and spraying methods. Additionally, a copper/PDMS mold was introduced to address the issue of deformation in the chitosan material during drying on polydimethylsiloxane (PDMS). The MNs have a bilayer structure, with a hyaluronic acid (HA) coating loaded with doxycycline (DOX) for antibacterial action and a chitosan (CS) core loaded with vascular endothelial growth factor (VEGF) for promoting cell migration and proliferation. Notably, in vitro drug release studies showed that the coating drug was released by 98.8% within 10 hours, while the release of the core drug could be sustained for up to 70 hours. In vivo studies showed that chronic wounds on C57 mice treated with CS/HA-bilayer MNs achieved nearly complete healing by day 9. These wounds exhibited reduced inflammatory cell infiltration, increased epithelial tissue regeneration, and enhanced collagen deposition. This work integrates the staged management of bacterial infection and angiogenesis and offers promising prospects for enhancing chronic wound healing.

Skin and Wound Healing: Conventional Dosage versus Nanobased Emulsions Forms

The skin plays a crucial role in the body's homeostasis through its thermoregulation functions, metabolic activity, and, mainly, its barrier function. Once this system has its homeostasis disturbed, through the promotion of tissue discontinuity, an injury happens and a restoration process starts. Different products can be used to promote, accelerate, or stimulate the healing process, such as hydrogels, emulsions, and ointments (main conventional formulations). Despite the historical use and wide market and consumer acceptance, new systems emerged for wound management with the main challenge to overcome conventional form limitations, in which nanosystems are found, mainly nanobased emulsion forms (nano- and microemulsions, NE and ME). Here, we discuss the skin function and wound healing process, highlighting the cellular and molecular processes, the different wound classifications, and factors that affect physiological healing. We also investigated the recent patents (2012-2023) filed at the United States Patent and Trademark Office, where we found few patents for conventional forms (hydrogels = 5; emulsions = 4; ointments = 6) but a larger number of patents for nanobased emulsions filed in this time (NE = 638; ME = 4,072). Furthermore, we address the use of nanobased emulsions (NE and ME) and their particularities, differences, and application in wound treatment. This work also discusses the challenges, bottlenecks, and regulatory framework for nanosystems, industrial, academic, and government interest in nanotechnology, and future perspectives about this key factor for the nanosystems market and consumer acceptance.

Clinical course and prognostic disparities of pyoderma gangrenosum based on underlying disease: A long-term comparative study in 124 patients

BACKGROUND AND OBJECTIVES

Pyoderma gangrenosum (PG) is associated with inflammatory bowel disease (IBD), autoimmune and connective tissue diseases, and hematologic malignancies. The impact of these underlying diseases on the clinical course and outcomes of PG remains poorly understood. This study investigates the influence of systemic disease associations on the progression, treatment response, and prognosis of PG.

PATIENTS AND METHODS

This study followed a cohort of 124 patients diagnosed with PG at a multidisciplinary referral institution between 2007 and 2024. Patients were stratified into four groups: IBD-associated PG (n = 52), autoimmune and connective tissue disease-associated PG (n = 24), hematologic malignancy-associated PG (n = 15), and idiopathic PG (n = 33). Outcomes, including remission and relapse rates, were analyzed using Kaplan-Meier survival curves and Cox proportional hazards models.

RESULTS

IBD-associated PG had the most favorable outcomes, with 75% of patients achieving remission at 12 months (M12) (Hazard Ratio [HR]: 2.56; 95% Confidence Interval [95%CI]: 1.49-4.35). Autoimmune and connective tissue disease-associated PG was the most treatment-refractory, with only 8.3% achieving remission at M12 (HR: 0.21; 95% CI: 0.10-0.50). Relapse occurred in 26.1% of patients, with no significant difference across the groups (p = 0.8). Bullous PG, predominantly linked to hematologic malignancies, exhibited accelerated healing but also a high rate of malignant transformations near PG onset.

CONCLUSIONS

IBD-associated PG followed a more favorable clinical course compared to autoimmune and connective tissue diseases or hematologic conditions, highlighting the importance of tailored treatment approaches based on underlying disease associations.

A clinical field trial on wound healing after disbudding of dairy calves with or without antimicrobial spray

Calves are routinely disbudded with hot iron disbudders in Netherlands. Disbudding wounds are frequently treated with antimicrobial wound spray with the aim of preventing infection and improving wound healing. Given the policy for the prudent use of antimicrobials, we decided to evaluate the effect of antimicrobial wound spray vs. non-antimicrobial wound spray after disbudding in a commercial setting. In this field trial, we treated 255 calves after disbudding with chlortetracycline (CTC) spray and Keno™Fix (KF) on alternating the left and right horn buds. At 1 week and 4 weeks after disbudding, we measured the healing rate (HR) in mm/week and the lesion score (LS) of the wounds. The field conditions on farms were also monitored and investigated for an effect on HR and LS. The HR of KF wounds was numerically lower than CTC wounds but did not pass the non-inferiority threshold of 0.5 mm/week. Lesion scores were worse for KF-treated wounds than for CTC-treated wounds. For both CTC and KF wounds, we found that a worse lesion score was associated with a lower HR. We found that lesion scores were worse for KF-treated wounds and calculated that five calves need to be treated with CTC to prevent one calf from developing an inferior wound score. Since the HR of KF was lower, though not inferior to CTC-treated wounds, we conclude that in certain circumstances, the use of an antibiotic spray after cautery disbudding of calves may not be necessary.

Interpretable deep learning method to predict wound healing progress based on collagen fibers in wound tissue

BACKGROUND AND OBJECTIVE

The dynamic evolution of collagen fibers during wound healing is crucial for assessing repair progression, guiding clinical treatment, and drug screening. Current quantitative methods analyzing collagen spatial patterns (density, orientation variance) lack established criteria to both stratify distinct healing periods and detect delayed healing conditions, necessitating the establishment of a novel classification method for wound healing status based on collagen fibers.

METHODS

We propose a deep learning method to classify various time points of wound healing and delayed healing using histological images of skin tissue. We fine-tune a pre-trained VGG16 model and enhance it with an interpretable framework that combines LayerCAM and Guided Backpropagation, leveraging model gradients and features to visually identify the tissue regions driving model predictions.

RESULTS

Our model achieved 85 % accuracy in a five-class classification task (normal skin, wound skin at 0, 3, 7, and 10 days) and 78 % in a three-class task (normal skin, wound skin at 0 days, diabetic wound skin at 10 days). Our interpretable framework accurately localizes collagen fibers without pixel-level annotations, demonstrating that our model classifies healing periods and delayed healing based on collagen regions in histological images rather than other less relevant tissue structures.

CONCLUSIONS

Our deep learning method leverages collagen fiber features to predict various time points of wound healing and delayed healing with high accuracy and visual interpretability, enhancing doctors' trust in model decisions. This could lead to more precise and effective wound treatment practices.

Analysis of cellular responses following interaction with extracellular vesicles derived from HEK293T and human adipose derived stem cells

Extracellular vesicles (EVs), particularly exosomes, are crucial mediators of intercellular communication that influence immune responses, cell proliferation, and angiogenesis. Their therapeutic potential has been explored for the treatment of chronic, non-healing wounds, especially in diabetic patients with chronic inflammation, impaired cellular proliferation, and poor angiogenesis. We investigated the role of exosomes derived from human embryonic kidney 293T (HEK293T) cells and human adipose-derived stem cells (hADSCs) on NIH3T3 fibroblast migration. Exosomes were characterized for size, concentration, and surface markers. Western blotting and scratch assays were used to assess ERK1/2 activation and cell migration. Characterization revealed that HEK293T exosomes were more abundant (3.1 × 10¹¹ ± 4.9 × 10⁹ particles/mL), larger (178 ± 4 nm), and exhibited stronger surface marker protein expression than exosomes from hADSCs (2.4 × 10⁹ ± 4.1 × 10⁸ particles/mL, 153 ± 5 nm). Both types of exosomes significantly enhanced NIH3T3 fibroblast migration with migration indices of 63.2 ± 4.3% and 48.9 ± 2.7% via ERK1/2 signaling, with HEK293T exosomes showing stronger effects because of their higher protein content. Western blot analysis revealed that robust ERK1/2 activation by both exosome types was crucial for fibroblast migration, with scratch assays highlighting their pro-migratory effects. Inhibition of the ERK1/2 pathway significantly reduced migration, with HEK293T exosomes showing a reduction to 9.6 ± 3.2% and hADSC exosomes to 2.6 ± 0.2% when treated with the MEK1/2 inhibitor PD98059. HEK293T exosomes induced more pronounced cell migration, and hADSC exosomes showed improved efficacy under stress, suggesting that both exosome types are promising candidates for targeted regenerative therapies in chronic wound healing.

Collagen-Based Wound Dressings: Innovations, Mechanisms, and Clinical Applications

Collagen-based wound dressings have developed as an essential component of contemporary wound care, utilizing collagen's inherent properties to promote healing. This review thoroughly analyzes collagen dressing advances, examining different formulations such as hydrogels, films, and foams that enhance wound care. The important processes by which collagen promotes healing (e.g., promoting angiogenesis, encouraging cell proliferation, and offering structural support) are discussed to clarify its function in tissue regeneration. The effectiveness and adaptability of collagen dressings are demonstrated via clinical applications investigated in acute and chronic wounds. Additionally, commercially accessible collagen-based skin healing treatments are discussed, demonstrating their practical use in healthcare settings. Despite the progress, the study discusses the obstacles and restrictions encountered in producing and adopting collagen-based dressings, such as the difficulties of manufacturing and financial concerns. Finally, the current landscape's insights indicate future research possibilities for collagen dressing optimization, bioactive agent integration, and overcoming existing constraints. This analysis highlights the potential of collagen-based innovations to improve wound treatment methods and patient care.

The Mevalonate Pathway in the Radiation Response of Cancer

The mevalonate (MVA) pathway plays a critical role in cholesterol biosynthesis, protein prenylation, and metabolic reprogramming, all of which contribute to cancer progression and therapy resistance. Targeting the MVA pathway with statins and other inhibitors has shown promise in preclinical studies; however, clinical outcomes remain controversial, raising concerns about translating these findings into effective treatments. Additionally, the interaction between the MVA pathway and radiation therapy (RT) is not yet fully understood, as RT upregulates the pathway, which can enhance tumor cell survival. This review summarizes the current literature on MVA pathway inhibition in cancer therapy, focusing on its potential to enhance the efficacy of RT. A better understanding of the pathway's role in radiation responses will be essential to translate combination therapies that target this pathway.

Harnessing the Power of Antimicrobial Peptides: From Mechanisms to Delivery Optimization for Topical Infections

Antimicrobial peptides (AMPs) have emerged as promising agents for treating topical infections due to their enhanced biocompatibility and resistance to systemic degradation. AMPs possess host immunomodulatory effects and disintegrate bacterial cell membranes, a mechanism less prone to microbial resistance compared to conventional antibiotics, making AMPs potential candidates for antimicrobial delivery. The review discusses the challenges posed by antimicrobial resistance (AMR) and explores the mechanisms by which bacteria develop resistance to AMPs. The authors provide a detailed analysis of the mechanisms of action of AMPs, their limitations, and strategies to improve their efficacy. Conventional AMP delivery systems, including polymeric, synthetic, and lipid-based nanoparticles and cubosomes, face challenges of microbial resistance mechanisms via efflux pump systems, bacterial cell membrane modifications, and protease enzyme release. This review explores strategies to optimize these delivery systems. Furthermore, market statistics and the growing interest in peptide antibiotics have been explored in this review. The authors provide future research directions, such as exploring gene-targeting approaches to combat emerging bacterial resistance against AMPs, and emphasize considering the conformational stability of peptides, the skin microbiome's nature at the infection site, and proteolytic stability for developing efficient AMP delivery systems for topical infections.

Extracellular vesicles: innovative cell-free solutions for wound repair

Chronic non-healing wounds are often associated with conditions such as diabetes and peripheral vascular disease, pose significant medical and socioeconomic challenges. Cell-based therapies have shown promise in promoting wound healing but have major drawbacks such as immunogenicity and tumor formation. As a result, recent research has shifted to the potential of extracellular vesicles (EVs) derived from these cells. EVs are nanosized lipid bilayer vesicles, naturally produced by all cell types, which facilitate intercellular communication and carry bioactive molecules, offering advantages such as low immunogenicity, negligible toxicity and the potential to be re-engineered. Recent evidence recognizes that during wound healing EVs are released from a wide range of cells including immune cells, skin cells, epithelial cells and platelets and they actively participate in wound repair. This review comprehensively summarizes the latest research on the function of EVs from endogenous cell types during the different phases of wound healing, thereby presenting interesting therapeutic targets. Additionally, it gives a critical overview of the current status of mesenchymal stem cell-derived EVs in wound treatment highlighting their tremendous therapeutic potential as a non-cellular of-the-shelf alternative in wound care.

MXenes and MXene-based composites for biomedical applications

MXenes, a novel class of two-dimensional materials, have recently emerged as promising candidates for biomedical applications due to their specific structural features and exceptional physicochemical and biological properties. These materials, characterized by unique structural features and superior conductivity, have applications in tissue engineering, cancer detection and therapy, sensing, imaging, drug delivery, wound treatment, antimicrobial therapy, and medical implantation. Additionally, MXene-based composites, incorporating polymers, metals, carbon nanomaterials, and metal oxides, offer enhanced electroactive and mechanical properties, making them highly suitable for engineering electroactive organs such as the heart, skeletal muscle, and nerves. However, several challenges, including biocompatibility, functional stability, and scalable synthesis methods, remain critical for advancing their clinical use. This review comprehensively overviews MXenes and MXene-based composites, their synthesis, properties, and broad biomedical applications. Furthermore, it highlights the latest progress, ongoing challenges, and future perspectives, aiming to inspire innovative approaches to harnessing these versatile materials for next-generation medical solutions.

Antioxidant and Anti-Inflammatory Impacts of Soft Tissue Crude Extract and Mucous of Snail Helix aspersa on an Excision Wound Model in Mice

Wound healing is a complex natural process in which tissue requires recovering injured tissue cells. Helix aspersa has a high nutritional value and is considered a rich natural source of antioxidants and anti-inflammatory agents. So, this study aimed to assess the effect of soft tissue crude extract and mucous of H. aspersa topically applied as a gel for 12 days. The wounds were observed and photographed twice a week. The inflammatory, oxidative stress markers and matrix metalloproteinases were evaluated in skin tissue homogenate and CD3+ and CD69+ T lymphocytes were detected in wound tissue. Data showed that a comparison of applying soft tissue crude extract and mucous of H. aspersa to skin wounds enhanced the healing process, resulting in a significant decrease in dermal inflammation compared to untreated mice. Also, they significantly increased the antioxidant enzyme activities with reduced malondialdehyde (MDA) levels in wound tissues. The levels of matrix metalloproteases-2 and -9 were significantly decreased and the immune status was enhanced in the wound environment by increasing proportions of CD3+ and CD69+ T lymphocytes. H. aspersa mucous and soft tissue crude extract are viable substitutes for synthetic topical wound therapies with anti-inflammatory, antioxidant, and immunomodulatory potencies, with a preference for the crude soft tissue extract based on the outcomes.

Electret-Inspired Charge-Injected Hydrogel for Scar-Free Healing of Bacterially Infected Burns Through Bioelectrical Stimulation and Immune Modulation

In this study, an electret-inspired, charge-injected hydrogel called QOSP hydrogel (QCS/OD/SDI/PANI/PS/Plasma) that promotes scar-free healing of bacteria-infected burns through bioelectrical stimulation and immune modulation, is presented. The hydrogel, composed of quaternized chitosan (QCS), oxidized dextran (OD), sulfadiazine (SDI), polystyrene (PS), and polyaniline nanowires (PANI), forms a conductive network capable of storing and releasing electric charges, emulating an electret-like mechanism. This structure delivers bioelectrical signals continuously, enhancing wound healing by regulating immune responses and minimizing fibrosis. In a mouse model of second-degree burns infected with Staphylococcus aureus (SA) and Pseudomonas aeruginosa (PA), the hydrogel accelerates wound healing by 32% and reduces bacterial load by 60%, significantly inhibited scar formation by 40% compared to controls. QOSP hydrogel modulates the Th1/Th2 immune balance toward a Th1-dominant antifibrotic state through quaternized chitosan, thereby reducing collagen deposition by 35%. Electro-dielectric characterization reveals a dielectric constant of 6.2, a 34% improvement in conductivity (3.33 × 10-5 S/m) and a 30 °C increase in thermal stability. Proteomic analysis highlights a 50% down-regulation of pro-inflammatory and pro-fibrotic pathways, suggesting a controlled immune response conducive to scar-free healing. This study underscores the potential of bioelectrically active hydrogels as a novel approach for treating infected wounds prone to scarring.

Chitosan membranes incorporating Aloe vera glycolic extract with joint synthesis of silver nanoparticles for the treatment of skin lesions

New wound dressings based on polymeric membranes have been widely exploited for clinical applications to assist in the healing process and prevent additional complications (e.g., bacterial infections). Here we propose the development of a new production method of polymeric membranes based on chitosan, incorporating glycolic extract of Aloe vera with joint synthesis of silver nanoparticles for use as a new bioactive dressing. The membranes were obtained by casting technique, and their morphological, physicochemical characteristics, degree of swelling, degradation profile and antimicrobial activity evaluated. Morphological analyzes confirmed the synthesis and presence of silver nanoparticles in the polymeric membrane. The chemical compatibility between the materials was demonstrated through thermal analysis (TGA and DSC) combined with ATR-FTIR tests, showing the complexation of the membranes (Mb-Ch-Ex.Av-NPs). All membranes were characterized as hydrophilic material (with a contact angle (ө) < 90°); however, the highest degree of swelling was obtained for the chitosan. (Mb-Ch) membrane (69.91 ± 5.75%) and the lowest for Mb-Ch-Ex.Av-NPs (26.62 ± 8.93%). On the other hand, the degradation profile was higher for Mb-Ch-Ex.Av-NPs (77.85 ± 7.51%) and lower for Mb-Ch (57.60 ± 2.29%). The manufactured bioactive dressings showed activity against Escherichia coli and Staphylococcus aureus. Our work confirmed the development of translucent and flexible chitosan-based membranes, incorporating Aloe vera glycolic extract with joint synthesis of silver nanoparticles for use as a new bioactive dressing, with proven antimicrobial activity.

Stimuli-responsive dual-drug loaded microspheres with differential drug release for antibacterial and wound repair promotion

The healing of infected wounds is a complex and dynamic process requiring tailored treatment strategies that address both antimicrobial and reparative needs. Despite the development of numerous drugs, few approaches have been devised to optimize the timing of drug release for targeting distinct phases of infection control and tissue repair, limiting the overall treatment efficacy. Here, a stimuli-responsive microsphere encapsulating dual drugs was developed to facilitate differential drug release during distinct phases of antibacterial and repair promotion, thereby synergistically enhancing wound healing. Specifically, zeolite imidazolate backbone in poly (lactic-co-glycolic acid) (PLGA) microsphere was employed for the encapsulation of ciprofloxacin (CIP), responding to acidic environment of bacteria and releasing antibiotic for antibacterial therapy. Meanwhile, curcumin (CUR) encapsulated in PLGA exhibited a gradual release profile, contributing to synergistic antibacterial effects. During the tissue repair phase, near-infrared light stimulation of Fe3O4 embedded in PLGA generated heat, elevating the temperature to the glass transition point of PLGA, which significantly enhanced the release of CUR thereby promoting tissue repair. In vitro experiments demonstrated that the release of CIP and CUR achieved significant antibacterial effects in the early stages of treatment. Additionally, CUR could effectively enhance fibroblast migration and proliferation. In vivo studies using a mouse abscess model revealed that the microspheres exhibited remarkable antibacterial and wound-healing capabilities, effectively enhancing the re-epithelialization of wound tissue and reducing the infiltration of inflammatory cells. This study provides novel strategies for constructing drug delivery systems that match dynamic stages of wound healing, offering improved therapeutic outcomes for infected wounds.

Comparative Efficacy of Autolytic and Collagenase-Based Enzymatic Debridement in Chronic Wound Healing: A Comprehensive Systematic Review

Chronic wounds, including diabetic foot ulcers, pressure ulcers, and burn injuries, present significant challenges for healthcare systems, with debridement being crucial for healing. This review compares the efficacy of autolytic and enzymatic debridement techniques. The objective was to assess clinical outcomes related to both methods, focusing on wound size reduction, granulation tissue formation, epithelialisation, complete healing, and adverse events. A systematic review of randomised controlled trials (RCTs) was performed across multiple databases, identifying five eligible studies involving 236 patients. Results indicated that enzymatic debridement was more effective, showing faster wound size reduction in four out of five studies, with Baloorkar et al. reporting a 65% size reduction compared to 50% for autolytic debridement (p < 0.05). Granulation tissue formation and epithelialisation rates were also significantly higher with enzymatic methods. Complete healing occurred in 65% of cases using enzymatic debridement versus 50% for autolytic methods (p = 0.04). Mild irritation was the most common adverse event noted in the enzymatic group. In conclusion, enzymatic debridement proved to be superior for severe wounds, while autolytic debridement remains beneficial for less severe cases due to its non-invasive nature. Both methods were well tolerated, but further research is needed for definitive clinical guidelines.

The preparation of methacrylated oxidized konjac glucomannan hydrogel system and its treatment for diabetic wounds

The management of diabetic wounds has become an important task for the public health system. Hydrogels are highly anticipated as modern wound dressings for the treatment of diabetic wounds, hence we have prepared a MOK-Gel using methacrylated oxidized konjac glucomannan (MOK) crosslinked with acrylamide (AM). On this basis, we have incorporated drugs such as UiO-66 loaded with sodium ferulate (SF) and deferoxamine (DFO) to develop the hydrogel wound dressing DUS@MOK-Gel (a hydrogel composed of methacrylated oxidized konjac glucomannan, loaded with DFO and UiO-66 loaded with sodium ferulate). It not only has excellent physical properties, including swelling capacity, moisture retention, and water vapor permeability; but also possesses bioactivity functions such as antioxidant, anti-inflammatory, macrophage polarization regulation, promotion of anti-inflammatory factor release, and angiogenesis to accelerate the healing of diabetic wounds. Therefore, DUS@MOK-Gel has great development prospects and market value in the field of diabetic wound treatment.

Outcomes of Distal Radius Fractures in Solid Organ Transplant Recipients

PURPOSE

Distal radius fractures (DRFs) are one of the most common conditions that musculoskeletal providers treat. As the frequency of solid organ transplants (SOT) increases, these providers are often called upon to manage DRFs in these patients. These patients are at increased risk for osteopenia and osteoporosis, given the altered bone metabolism after SOT and frequent use of glucocorticoid and immunosuppressive medications. This study aimed to examine both surgical and nonsurgical treatment outcomes of DRFs in the SOT population and the prevalence of decreased bone mineral density.

METHODS

A retrospective review of patients treated at a single institution who had previously undergone SOT and subsequently sustained DRF between 2013 and 2022 was completed. Patients were excluded for incomplete documentation and treatment initiation at an outside institution. Demographic variables, clinical outcomes, organ transplant, steroid use, and second metacarpal cortical percentage were collected for both groups. A telephone survey with the QuickDASH questionnaire was conducted for all available patients.

RESULTS

A total of 34 DRFs in 33 patients were included in the analysis. Of these, 15 fractures in 14 patients underwent surgical intervention, and 19 fractures in 19 patients were managed nonsurgically. The following three adverse events were observed in the patients managed operatively: hardware failure, postoperative carpal tunnel syndrome, and tendon irritation. No reported treatment complications were recorded in the patients managed nonsurgically. Of the 33 included patients, 32 had radiographic evidence of decreased bone mineral density and five were receiving treatment for osteoporosis.

CONCLUSIONS

Management of DRFs in SOT patients is challenging, given their increased medical complexity. Decreased bone mineral density was nearly universal and undertreated in this patient population. Most of these patients in both groups had good or excellent functional outcomes with both surgical and nonsurgical management. Additionally, surgery was well tolerated with no reported anesthesia complications, wound-healing issues, or infections.

TYPE OF STUDY/LEVEL OF EVIDENCE

Therapeutic IV.

Factors associated with severity and outcomes of diabetic foot ulcers: A single center hospital-based cross-sectional observational study in Eastern India

Background

Diabetes mellitus (DM) affects millions globally and is associated with high morbidity, risk of infection, and potential for severe outcomes. In India, where the prevalence of diabetic foot complications is notably high, data on factors influencing the severity and outcomes of diabetic foot ulcers (DFUs) in specific regions, particularly Eastern India, remain sparse.

Methods

This hospital-based cross-sectional study included Type 2 DM patients aged over 18 years, excluding those unwilling to participate and those with ulcers classified as Wagner grade less than 2. The study involved the complete enumeration of eligible patients presenting with DFUs. Clinical and demographic data were collected, including glycemic control, physical activity levels, and microbial cultures from ulcer specimens.

Results

The study included 90 patients with a mean age of 56.1 years. Most participants were male (76.7%), with 47.8% receiving regular diabetes treatment and only 10% achieving good glycemic control. Positive swab cultures were found in 68.9% of patients, predominantly mono-microbial. Higher grade ulcers were associated with male gender (AOR 5.715), and positive swab cultures (AOR 17.470). Moderate-to-severe physical activity (AOR 9.683) and paresthesia (AOR 0.101) were significant predictors of gangrene, with absent distal pulses (COR 13.818) also indicating a higher risk for gangrene. Good glycemic control was associated with a reduced risk of gangrene (COR 0.125).

Conclusions

Maintaining good glycemic control is crucial in preventing complications such as gangrene. Physical activity is generally beneficial in DM; however, excessive or high-impact activities may exacerbate existing foot ulcers and increase the risk of gangrene.

A targeted and synergetic nano-delivery system against Pseudomonas aeruginosa infection for promoting wound healing

Purpose

Pseudomonas aeruginosa infection is the most common pathogen in burn wound infections, causing delayed wound healing and progression to chronic wounds. Therefore, there is an urgent need to develop antimicrobial agents that can promote wound healing for effectively treating infected wounds.

Patients and methods

Using magnetic stirring and ultrasound to synthesize Apt-pM@UCNPmSiO2-Cur-CAZ. The nanosystems were characterized using transmission electron microscopy (TEM), dynamic light scattering (DLS), and ultraviolet-visible spectrophotometry (UV-Vis). Flow cytometry, bacterial LIVE/DEAD staining and scanning electron microscopy were performed to assess the in vitro antibacterial and anti-biofilm effects of the nanosystems. The wound healing potential and in vivo toxicity of the nanosystems were evaluated in a mouse skin wound model.

Results

The Apt-pM@UCNPmSiO2-Cur-CAZ synthesized exhibited uniform circular shape with a Zeta potential of -0.8 mV. In vitro, Apt-pM@UCNPmSiO2-Cur-CAZ demonstrated superior antibacterial effects compared to standalone antibiotics. Bacteria treated with Apt-pM@UCNPmSiO2-Cur-CAZ showed varying degrees of deformation and shrinkage, resulting in severe damage to the bacterial cells. Additionally, Apt-pM@UCNPmSiO2-Cur-CAZ can inhibit and eradicate bacterial biofilms, while also targeting bacteria for enhanced antibacterial efficacy. Interestingly, the NIR light could enhance the antibacterial and anti-biofilm effects of Apt-pM@UCNPmSiO2-Cur-CAZ due to the photodynamic action. In a mouse skin wound infection model, the nanosystem effectively eliminated wound bacteria, promoting the healing of Pseudomonas aeruginosa-infected wounds without significant toxic effects.

Conclusion

Apt-pM@UCNPmSiO2-Cur-CAZ is a novel targeted nano-delivery system with promising potential in combating Pseudomonas aeruginosa infections, and it may serve as a new therapeutic approach for treating skin wound infections.

Dynamic Prediction of Time to Wound Healing at Routine Wound Care Visits

Objective: Having a wound decreases patients' quality of life and brings uncertainty, especially if the wound does not show a healing tendency. The objective of this study was to develop and validate a model to dynamically predict time to wound healing at subsequent routine wound care visits. Approach: A dynamic prediction model was developed in a cohort of wounds treated by nurse practitioners between 2017 and 2022. Potential predictors were selected based on literature, expert opinion, and availability in the routine care setting. To assess performance for future wound care visits, the model was validated in a new cohort of wounds visited in early 2023. Reporting followed TRIPOD guidelines. Results: We analyzed data from 92,098 visits, corresponding to 14,248 wounds and 7,221 patients. At external validation, discriminative performance of our developed model was comparable with internal validation (concordance statistic = 0.70 [95% confidence interval 0.69, 0.71]), and the model remained well calibrated. Strong predictors were wound-level characteristics and indicators of the healing process so far (e.g., wound surface area). Innovation: Going beyond previous prediction studies in the field, the developed model dynamically predicts the remaining time to wound healing for many wound types at subsequent wound care visits, in line with the dynamic nature of wound care. In addition, the model was externally validated and showed stable performance. Conclusion: The developed model can potentially contribute to patient satisfaction and reduce uncertainty around wound healing times when implemented in practice. When the predicted time of wound healing remains high, practitioners can consider adapting their wound management.

Polyphenol-Modified Mg-Zn Layered Hydroxide-Contained Microneedle Patch Enhance Mucosal Repair by Remolding Diabetic Oral Microenvironment

Diabetic oral ulcers pose a significant challenge in healing due to persistent inflammation. Despite local therapeutic interventions remaining the primary mode of treatment, the dynamic nature of the oral cavity, characterized by continuous muscular activity and salivary secretion, poses barriers to sustained drug retention and thereby limits therapeutic efficacy. To address this issue, an approach has been devised that aims to facilitate transdermal delivery of bioactive components to promote the healing of diabetic oral ulcers. A multifunctional soluble microneedle (MN) patch is prepared using γ-polyglutamic acid (γ-PGA), which is loaded with quercetin (Qu)-modified Mg-Zn layered hydroxide salt (LHS) nanosheets (LHSQ) with anti-inflammatory, antimicrobial and pro-angiogenic bioactivities to combat the diabetic oral ulcers. These findings demonstrate that the LHSQ-loaded MN (LHSQ-MN) patches are capable of effectively penetrating the oral mucosa. In a rat model of diabetic oral ulcers, the application of LHSQ-MN patches is found to facilitate the establishment of regeneration sites, regulate the inflammatory microenvironment of damaged tissues, exhibit potent antibacterial effects, expedite the reconstitution of the mucosal epithelium, and accelerate ulcer healing through the promotion of angiogenesis. These outcomes highlight the potential of LHSQ-MN patches as a promising therapeutic strategy for the management of oral ulcers in diabetic patients.

Targeting TGF-β/VEGF/NF-κB inflammatory pathway using the Polyphenols of Echinacea purpurea (L.) Moench to enhance wound healing in a rat model

The present study explores the metabolic profiling and molecular wound-healing mechanisms of Echinacea purpurea (L.) Moench (EP) flowers aqueous (AE) and ethanol (EE) extracts in an excision wound-healing model. Metabolic profiling of the extracts was investigated using UHPLC-ESI-TOF-MS and molecular networking. Antioxidant activity was carried out using the DPPH (1, 1-diphenyl-2-picrylhydrazyl) radical scavenging method and FRAP (ferric reducing antioxidant power). Carboxy methylcellulose gels of 5 and 10% of both aqueous (AE) and ethanol (EE) extracts were prepared. The wounds were explored macroscopically, histologically, and immunohistochemically. The UHPLC-ESI-TOF-MS method enabled the identification of 3 organic acids, 14 phenolic acids, 3 phenylethanoid glycosides, and 11 flavonoids from EP extracts. EE had significant antioxidant activity compared to AE. The EP treated wounds healed faster. The EE succeeded in improving healing properties and controlling the inflammatory response by reducing IL-6 and increasing IL-10 expression and enhancing angiogenesis and remodeling via increased NF-κB, TGF-β, VEGF, CD31 expression and α-SMA and collagen deposition. It is worth mentioning that the EE groups also showed improvement in the histopathological examination in a dose-dependent manner. The effectiveness of EE in wound-healing may be attributed to its higher content of polyphenols which also made the antioxidant potential of the EE and its capacity to donate electrons higher than that of AE. This study scientifically enables the understanding of the molecular mechanisms Echinacea purpurea extract in wound healing via modulating skin inflammatory response and indicates the potential usefulness of EP ethanol extract for wound healing.

Wound Healing in Older Adults after Major Lower Extremity Amputation

BACKGROUND

The higher prevalence of multiple chronic conditions and frailty among older adults may increase the physiologic demand required for wound healing after a major lower extremity amputation (LEA). After below knee amputations (BKA), patients generally have improved prosthetic fitting rates, postoperative ambulation, and quality of life compared to an above knee amputation (AKA). However, the benefit of a BKA must be weighed against the risk of wound complications. The purpose of this study is to examine the association between advanced age and wound healing in our contemporary cohort of patients who underwent LEA.

METHODS

Our study reviewed all patients who received LEA at 2 major academic healthcare systems between January 2015 and December 2022. Patients with prior ipsilateral LEA were excluded. The exposure of interest was advanced age, defined as age over 80 years old, and the primary outcome was time to wound healing (defined as clinical documentation of a healed amputation incision). Chi-squared test was used to evaluate advanced age and prosthetic fitting after LEA and Cox proportional hazard models were fit to examine the relationship between advanced age and time to wound healing after a LEA.

RESULTS

Among 597 patients who underwent LEA, 8.9% (n = 53) were over the age of 80. Over one-third of all patients underwent AKA (n = 235, 39.4%) and patients with advanced age represented 12.3% of this group. There was no statistically significant difference detected between the proportion of those with advanced age who were fit for prosthetic compared to those under age 79 who were fit for prosthetic (47.1% vs 58.5%, P = 0.11). The median time to wound healing was faster among those with advanced age, even when stratified by level of LEA (Table 1). Advanced age was associated with faster wound healing (hazard ratio [HR] 1.42; 95% CI, 1.06-1.87).

CONCLUSIONS

In our cohort of patients, those with advanced age healed faster than their younger counterparts at both levels of LEA and were equally likely to receive a prosthetic after LEA. Age alone should not be used as a factor in determining eligibility to undergo LEA or receipt of prosthetic. Future studies will evaluate other clinical characteristics that are associated with successful wound healing among adults 80 and older.

Impact of Previous Surgery and/or Radiation Therapy on Endoscopic Reconstruction Outcomes

BACKGROUND AND OBJECTIVES

The impact of prior local therapies, including radiation and surgery, on reconstruction outcomes after endonasal surgery is currently not well known. Reconstruction nuances in the preoperative setting merit further evaluation to avoid potential postoperative complications that can hinder overall tumor management and negatively impact patient outcome. We sought to determine whether prior treatments increase risk of reconstruction-related postoperative morbidity and to evaluate the effectiveness of our current treatment paradigm for skull base reconstruction.

METHODS

A retrospective review of all endonasal surgeries for tumor resection between March 2000 and March 2022 was performed. Patients were grouped based on treatment history. Patient demographics, operative, and postoperative reconstruction-related morbidity data were collected, including cerebrospinal fluid leak, sinonasal morbidity, and infectious complications. Variables significantly associated with postoperative complications in the univariate analysis were included in the multivariate Cox proportional hazards regression model. Complication-free survival curves were generated, and the log-rank test evaluated the relationship between complication-free survival and the different clinical, surgical, and treatment parameters. All statistical analyses were performed with SPSS 26 (IBM Corp) and Graph Pad 9.0 (GraphPad Software).

RESULTS

A total of 418 patients were included. 291 patients had no prior treatments, 49 patients had previously received radiation, and 78 patients had prior surgeries. Of the 49 patients who had prior radiation, 27% underwent reconstruction with tunneled pericranial flaps vs 16% of treatment-naïve patients. On multivariate analysis, prior treatment was not significantly associated with reconstruction-related complications. Negative smoking history, no leak or small intraoperative leak, and use of vascularized flap in reconstruction were protective factors.

CONCLUSION

In patients undergoing endonasal surgery, prior radiation and/or surgery does not appear to significantly increase the risk of immediate or delayed reconstruction complications using our current reconstructive management plan, which incorporates an upfront regional flap for high-risk cases.

In Situ-Gelling Antimicrobial Poly(oligoethylene glycol methacrylate)-Based Hydrogels Integrating Bound Quaternary Ammonia Compounds and Antibiotic Functionalities for Effective Infected Wound Healing

In situ-gelling antibacterial hydrogels are reported in which two antibacterial entities (quaternary ammonium (QA) groups and the antibiotic ciprofloxacin (CIP)) are tethered to a single precursor based on the anti-fouling polymer poly(oligoethylene glycol methacrylate) (POEGMA). Synergism between the QA and CIP tethers is demonstrated to enable broad-spectrum killing and/or disinfection of both gram-positive and gram-negative bacteria both in vitro and in vivo while also supporting improved functional recovery of uninjured skin morphology. Coupled with the suitable mechanics, swelling capacity, and stability of the gels, the multi-mechanism antibacterial properties of the hydrogels offer promise for treating or preventing infections of burn wounds.

Microenvironment of diabetic foot ulcers: Implications for healing and therapeutic strategies

Diabetic foot ulcers (DFUs) are a common yet serious complication in individuals with diabetes, often presenting as chronic, nonhealing wounds that significantly impair quality of life. The healing process of DFUs is largely influenced by the local microenvironment, which encompasses factors such as hypoxia, inflammation, and the involvement of various cell types. Poor blood circulation in the affected area results in hypoxia, compromising cellular function and restricting nutrient supply, thereby delaying wound healing. In addition, chronic inflammation disrupts immune system balance, with excessive pro-inflammatory cytokines not only failing to facilitate tissue repair but also exacerbating tissue damage. Moreover, key cell types, including fibroblasts, keratinocytes, and macrophages, play crucial roles at different stages of the healing process, contributing to collagen production and skin regeneration. A comprehensive understanding of the complex dynamics within the DFU microenvironment is essential for developing more precise therapeutic approaches, such as advanced drug delivery systems and bioactive materials, aimed at promoting wound healing and reducing the risk of recurrence.

PVA and PVP nanofibers combined with Helichrysum italicum oil preserve skin cell interactions, elasticity and proliferation

Development of electrospun nanofibers with suitable properties to promote wound healing is an advantage in developing non-invasive skin treatments. We showed the potential application of Polyvinyl acetate (PVA) and Polyvinylpyrrolidone (PVP) combined with Helichrysum italicum oil (HO) in wound healing. During this process, Tight junctions (TJs) play a crucial role in maintaining skin integrity. TJs are intercellular junctions composed of a variety of transmembrane proteins, including Occludin (OCLN), observed also in migrating epithelial cells. Changes in OCLN expression affect epidermal permeability, indicating an active role in the healing process. Within this context, we studied the OCLN expression during healing after scratch assay on Keratinocytes (HaCaT), by a confocal microscopic analysis. In addition, we evaluated the effect of treatment after scratch on cell elasticity by Atomic Force Microscopy (AFM) analysis. All results show a positive trend in cell proliferation and viability on HaCaT treated with functionalized nanofibers. These results were confirmed by the expression of genes involved in the early stages of the regenerative process. Understanding the cell mechanisms involved in skin changes during repair process would allow future application of nanomaterials combined with HO in vivo.

Exuberant Granulation Complicating an Episiotomy Wound: Case Report on the Treatment Using Surgical Excision and Estrogen Vaginal Cream

Background

Poor wound healing may limit body functionality and is an indication for clinical intervention. Excessive formation of granulation tissue above the edge of the skin surrounding a wound without re-epithelization is termed exuberant granulation, or proud flesh. It is uncommonly reported as a complication of an episiotomy wound.

Aim

This study aimed to report exuberant granulation that complicates an episiotomy wound with a friable vaginal epithelium and to describe the successful treatment of the lesion with surgical excision and topical conjugated equine estrogen vaginal cream.

Case Report

A 24-year-old para 1 had spontaneous vaginal birth of a normal baby at term in a district hospital. Five months later, she presented to a regional hospital with complaints of pain and incomplete wound healing at the episiotomy site. She had used topical povidone-iodine ointment with no success. Following a physical examination, an exuberant granulation at the episiotomy wound was diagnosed. The lesions were located mostly at 5 to 7 o'clock position in the vagina which had a thin and friable mucosa. The patient was treated with surgical excision and postoperative topical conjugated equine estrogen vaginal cream 0.625 mg per 1 g at a dose of 0.5 g per intravaginal application twice weekly for two weeks, and thereafter once weekly for one week. A review after 6 weeks, 12 weeks, and 6 months confirmed complete wound healing and normal function of the genitalia.

Conclusion

Exuberant granulation that complicates an episiotomy wound with friable vaginal mucosa is amenable to surgical excision and postoperative intermittent intermediate doses of topical conjugated equine estrogen vaginal cream.

Advancing Therapeutic Solutions for Burn Wounds: Potential Use of Noninvasive Ultrasound-Driven Splenic Stimulation

Significance: Burn wound injuries are a global health challenge, affecting millions annually and resulting in significant morbidity, mortality, and economic burden. The urgent need for accessible and cost-effective therapeutic alternatives, especially for underserved populations, has driven interest in novel approaches such as noninvasive splenic stimulation using pulsed-focused ultrasound (pFUS). This technique targets systemic inflammation, a key factor in delayed wound healing, offering a potential shift in burn care management. Recent Advances: Preclinical studies have shown that pFUS applied to the spleen can accelerate wound healing by activating the cholinergic anti-inflammatory pathway, promoting pro-angiogenic and anti-inflammatory responses. While current treatments-including biologics, antioxidants, and growth factors-have limitations, pFUS presents a noninvasive alternative. One interventional study and ongoing clinical trials are now investigating its application in burn wound care, marking an important step toward clinical translation. Critical Issues: Despite encouraging results, research on splenic stimulation for wound healing remains limited. The small number of studies highlights the need for further investigation into the underlying mechanisms, optimal treatment parameters, and potential risks. Additionally, the scalability and cost-effectiveness of pFUS in diverse clinical settings require thorough evaluation. Future Directions: Ongoing clinical trials will provide critical data on the efficacy and safety of splenic pFUS in burn patients. Future research should focus on expanding clinical studies, refining stimulation protocols, and exploring its broader application in tissue repair. If validated, this approach could offer a cost-effective, noninvasive treatment, particularly valuable in socioeconomically challenged regions.

Impact of diabetes on recovery after radical gastrectomy for gastric cancer: A retrospective cohort study

BACKGROUND

Gastric cancer remains a significant global health concern. Radical gastrectomy is the primary curative treatment. Diabetes mellitus is a common comorbidity in patients undergoing surgery for gastric cancer, including radical gastrectomy. Previous studies have suggested that diabetes can negatively affect postoperative outcomes, such as wound healing, infection rates, and overall recovery. However, the specific impact of diabetes on recovery after radical gastrectomy for gastric cancer remains poorly understood. evaluate the influence of diabetes on postoperative recovery, including hospital stay duration, complications, and readmission rates, in patients undergoing gastrectomy for gastric cancer. Understanding these effects could help optimize perioperative management and improve patient outcomes.

AIM

To investigate the impact of diabetes on recovery after radical gastrectomy for gastric cancer and associated postoperative outcomes.

METHODS

This retrospective cohort study was performed at the Endocrinology Department of Xuanwu Hospital, Capital Medical University, Beijing, China. We examined patients who underwent radical gastrectomy for cancer between January 2010 and December 2020. The patients were divided into the diabetes and non-diabetes groups. The main outcomes included length of hospital stay, postoperative complications, and 30-day readmission rate. Secondary outcomes included quality of life indicators. Propensity score matching was used to adjust for potential confounding factors.

RESULTS

A total of 1210 patients were included in the study, with 302 diabetic patients and 908 non-diabetic patients. After propensity score matching, 280 patients were included in each group. Diabetic patients demonstrated significantly longer hospital stays (mean difference 2.3 days, 95%CI: 1.7-2.9, P < 0.001) and higher rates of postoperative complications (OR 1.68, 95%CI: 1.32-2.14, P < 0.001). The 30-day readmission rate was also higher in the diabetic group as compared to the non-diabetic group (12.5% vs 7.8%, P = 0.02).

CONCLUSION

Patients with diabetes mellitus undergoing radical gastrectomy for gastric cancer experience prolonged hospital stay, increased postoperative complications, and higher readmission rates, thus requiring optimized perioperative management strategies.

Insights into Liposomal and Gel-Based Formulations for Dermatological Treatments

Dermatological diseases pose a significant challenge due to their chronic nature, complex pathophysiology, and the need for effective, patient-friendly treatments. Recent advancements in liposomal and gel-based formulations have played a crucial role in improving drug delivery, therapeutic efficacy, and patient compliance. Liposomal formulations have garnered considerable attention in dermatology due to their ability to encapsulate both hydrophilic and lipophilic compounds, enabling controlled drug release and enhanced skin penetration. However, challenges such as formulation complexity, stability issues, and regulatory constraints remain. Similarly, gel-based formulations are widely used due to their ease of application, biocompatibility, and ability to retain active ingredients. However, they also face limitations, including restricted penetration depth, susceptibility to microbial contamination, and challenges in achieving sustained drug release. The integration of liposomal and gel-based technologies offers a promising strategy to overcome current challenges and optimize dermatological drug delivery. This review explores both well-established therapies and recent innovations, offering a comprehensive overview of their applications in the treatment of prevalent dermatological conditions. Ultimately, continued research is essential to refine these formulations, expanding their clinical utility and enhancing therapeutic effectiveness in dermatology.

Strain-Dependent Differences in Inflammatory/Immune Activity in Cutaneous Wound Tissue Repair in Rats: The Significance of Body Mass/Proneness to Obesity

Inflammatory/immune cells and mediators are substantial for wound healing because they orchestrate biological activities in this complex process. Among factors that affect wound healing, obesity, and metabolic diseases are among the most significant, particularly because of a relationship between obesity and a prediabetic state with immune reactivity. Using Dark Agouti (DA) and Albino Oxford (AO) rats, which differ in immune responses as well as in proneness to obesity, we examined the impact of these intrinsic factors on cutaneous wound healing. Dynamics of the process were monitored at days 3, 5, and 7 post-wounding parallel in both rat strains by analysis of selected basic aspects of the wound repair process (cytokine and growth factor responses) in granulation tissue. Strain-related differences in the extent of reduction of the wound area were shown, which coincided with differential proinflammatory and immune-regulatory cytokines, as well as growth factors response in these rats. Some of these differences seem related to their dissimilarities in the proneness to obesity. Results in this study extended so far known differences in inflammatory/immune responses to a variety of stimuli between AO and DA rats and showed, for the first time, immune-based differences in wound healing between rats that differ in body mass (BM) and obesity proneness (under ad libitum feeding conditions with normal rodent chow).