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Verdin C, Zarick C, Steinberg J. Unique Challenges in Diabetic Foot Science. Clin Podiatr Med Surg 2024; 41:323-331. [PMID: 38388128 DOI: 10.1016/j.cpm.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
In the past 30 years, there has been a rapid influx of information pertaining to the diabetic foot (DF) coming from numerous directions and sources. This article discusses the current state of the DF literature and challenges it presents to clinicians with its associated increase in knowledge on their derivations, complications, and interventions. Further, we attempt to provide tips on how to navigate and criticize the current literature to encourage and maximize positive outcomes in this challenging patient population.
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Affiliation(s)
- Craig Verdin
- Department of Plastic Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington DC 20007, USA
| | - Caitlin Zarick
- Department of Plastic Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington DC 20007, USA
| | - John Steinberg
- Department of Plastic Surgery, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington DC 20007, USA.
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2
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Gheorghita D, Grosu E, Robu A, Ditu LM, Deleanu IM, Gradisteanu Pircalabioru G, Raiciu AD, Bita AI, Antoniac A, Antoniac VI. Essential Oils as Antimicrobial Active Substances in Wound Dressings. MATERIALS (BASEL, SWITZERLAND) 2022; 15:ma15196923. [PMID: 36234263 PMCID: PMC9570933 DOI: 10.3390/ma15196923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 05/13/2023]
Abstract
Wound dressings for skin lesions, such as bedsores or pressure ulcers, are widely used for many patients, both during hospitalization and in subsequent treatment at home. To improve the treatment and shorten the healing time and, therefore, the cost, numerous types of wound dressings have been developed by manufacturers. Considering certain inconveniences related to the intolerance of some patients to antibiotics and the antimicrobial, antioxidant, and curative properties of certain essential oils, we conducted research by incorporating these oils, based on polyvinyl alcohol/ polyvinyl pyrrolidone (PVA/PVP) biopolymers, into dressings. The objective of this study was to study the potential of a polymeric matrix for wound healing, with polyvinyl alcohol as the main material and polyvinyl pyrrolidone and hydroxypropyl methylcellulose (HPMC) as secondary materials, together with additives (plasticizers poly(ethylene glycol) (PEG) and glycerol), stabilizers (Zn stearate), antioxidants (vitamin A and vitamin E), and four types of essential oils (fennel, peppermint, pine, and thyme essential oils). For all the studied samples, the combining compatibility, antimicrobial, and cytotoxicity properties were investigated. The obtained results demonstrated a uniform morphology for almost all the samples and adequate barrier properties for contact with suppurating wounds. The results show that the obtained samples containing essential oils have a good inhibitory effect on, or antimicrobial properties against, Staphylococcus aureus ATCC 25923, Enterococcus faecalis ATCC 29212, Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, and Candida albicans ATCC 10231. The MTT assay showed that the tested samples were not toxic and did not lead to cell death. The results showed that the essential oils used provide an effective solution as active substances in wound dressings.
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Affiliation(s)
- Daniela Gheorghita
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, 060042 Bucharest, Romania
| | - Elena Grosu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, 060042 Bucharest, Romania
| | - Alina Robu
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, 060042 Bucharest, Romania
| | - Lia Mara Ditu
- Faculty of Biology, University of Bucharest, 1-3 Intr. Portocalelor Street, 060101 Bucharest, Romania
| | - Iuliana Mihaela Deleanu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 1-7 Polizu Street, 011061 Bucharest, Romania
| | - Gratiela Gradisteanu Pircalabioru
- Research Institute of the University of Bucharest, 90 Sos. Panduri, 050663 Bucharest, Romania
- Academy of Romanian Scientists, 54 Splaiul Independentei Street, 050094 Bucharest, Romania
| | - Anca-Daniela Raiciu
- Faculty of Pharmacy, Titu Maiorescu University, 22 Dambovnicului Street, 040441 Bucharest, Romania
- S.C. Hofigal Import Export S.A., 2 Intrarea Serelor Street, 042124 Bucharest, Romania
| | - Ana-Iulia Bita
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, 060042 Bucharest, Romania
- Correspondence:
| | - Aurora Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, 060042 Bucharest, Romania
| | - Vasile Iulian Antoniac
- Faculty of Material Science and Engineering, University Politehnica of Bucharest, 313 Splaiul Independentei Street, 060042 Bucharest, Romania
- Academy of Romanian Scientists, 54 Splaiul Independentei Street, 050094 Bucharest, Romania
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3
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Flexible patch with printable and antibacterial conductive hydrogel electrodes for accelerated wound healing. Biomaterials 2022; 285:121479. [DOI: 10.1016/j.biomaterials.2022.121479] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 03/07/2022] [Accepted: 03/18/2022] [Indexed: 02/08/2023]
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Bull RH, Staines KL, Collarte AJ, Bain DS, Ivins NM, Harding KG. Measuring progress to healing: A challenge and an opportunity. Int Wound J 2021; 19:734-740. [PMID: 34374499 PMCID: PMC9013582 DOI: 10.1111/iwj.13669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/22/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022] Open
Abstract
Complete healing is problematic as an endpoint for evaluating interventions for wound healing. The great heterogeneity of wounds makes it difficult to match groups, and this is only possible with multivariate stratification and/or very large numbers of subjects. The substantial time taken for wounds to heal necessitates a very lengthy study. Consequently, high quality randomised controlled trials demonstrating an effect of an intervention to a satisfactory level of statistical significance and with a satisfactory level of generalisability are extremely rare. This study determines that the healing of venous leg ulcers receiving multi‐component compression bandaging follows a linear trajectory over a 4‐week period, as measured by gross area healed, percentage area healed, and advance of the wound margin. The linear trajectories of these surrogates make it possible to identify an acceleration in healing resulting from an intervention, and allows self‐controlled or crossover designs with attendant advantages of statistical power and speed. Of the metrics investigated, wound margin advance was the most linear, and was also independent of initial ulcer size.
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Affiliation(s)
| | - Karen Louise Staines
- Education and Research/Clinical Lead Wound Care, Accelerate CIC, Centenary Wing, St Joseph's Hospice, London, UK
| | - Agnes Juguilon Collarte
- North West Division (Central London, Hammersmith & Fulham and West London), St Charles Centre for Health & Wellbeing, London, UK
| | | | | | - Keith Gordon Harding
- Wound Healing Research, WWII Ltd (Welsh Wound Innovation Initiative), Welsh Wound Innovation Centre, Pontyclun, UK
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Cullell-Dalmau M, Otero-Viñas M, Ferrer-Solà M, Sureda-Vidal H, Manzo C. A toolkit for the quantitative evaluation of chronic wounds evolution for early detection of non-healing wounds. J Tissue Viability 2021; 30:161-167. [PMID: 33707158 DOI: 10.1016/j.jtv.2021.02.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 02/03/2021] [Accepted: 02/24/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chronic wounds resulting from a number of conditions do not heal properly and can pose serious health problems. Beyond clinician visual inspection, an objective evaluation of the wound is required to assess wound evolution and the effectiveness of therapies. AIM Our objective is to provide a methodology for the analysis of wound area vs. time for the early prediction of non-healing wounds evolution. METHODS We propose a two-step approach consisting of: i) wound area quantification from planimetries and ii) classification of wound healing through the inference of characteristic parameters. For the first step, we describe a user-friendly software (Woundaries) to automatically calculate the wound area and other geometric parameters from hand-traced planimetries. For the second, we use a procedure for the objective classification of wound time evolution and the early assessment of treatment efficacy. The methodology was tested on simulations and retrospectively applied to data from 85 patients to compare the effect of a biological therapy with respect to general basic therapeutics. RESULTS Woundaries provides measurements of wound surface equivalent to a validated device. The two-step methodology allows to determine if a wound is healing with high sensitivity, even with limited amount of data. Therefore, it allows the early assessment of the efficacy of a therapy. CONCLUSION The performance of this methodology for the quantification and the objective evaluation of wound area evolution suggest it as a useful toolkit to assist clinicians in the early assessment of the efficacy of treatments, leading to a timely change of therapy.
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Affiliation(s)
- Marta Cullell-Dalmau
- The Quantitative BioImaging (QuBI) Lab, University of Vic - Central University of Catalonia (UVic-UCC), C. de La Laura, 13, 08500, Vic, Spain
| | - Marta Otero-Viñas
- Tissue Repair and Regeneration Laboratory (TR2Lab), University of Vic - Central University of Catalonia (UVic-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Spain; University of Vic - Central University of Catalonia, C. de La Laura, 13, 08500, Vic, Spain.
| | - Marta Ferrer-Solà
- Tissue Repair and Regeneration Laboratory (TR2Lab), University of Vic - Central University of Catalonia (UVic-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Spain; Fundació Hospital Universitari de la Santa Creu de Vic, Rambla de l'Hospital, 52, 08500, Vic, Spain
| | - Helena Sureda-Vidal
- Tissue Repair and Regeneration Laboratory (TR2Lab), University of Vic - Central University of Catalonia (UVic-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Spain; Fundació Hospital Universitari de la Santa Creu de Vic, Rambla de l'Hospital, 52, 08500, Vic, Spain
| | - Carlo Manzo
- The Quantitative BioImaging (QuBI) Lab, University of Vic - Central University of Catalonia (UVic-UCC), C. de La Laura, 13, 08500, Vic, Spain
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Jørgensen LB, Halekoh U, Jemec GB, Sørensen JA, Yderstræde KB. Monitoring Wound Healing of Diabetic Foot Ulcers Using Two-Dimensional and Three-Dimensional Wound Measurement Techniques: A Prospective Cohort Study. Adv Wound Care (New Rochelle) 2020. [DOI: 10.1089/wound.2019.1000] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Line Bisgaard Jørgensen
- Steno Diabetes Center Odense, Odense University Hospital and Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- OPEN, Odense Patient Data Explorative Network, Odense University Hospital, Odense, Denmark
- CIMT, Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
| | - Ulrich Halekoh
- Department of Epidemiology, Biostatistics and Biodemography, University of Southern Denmark, Odense, Denmark
| | - Gregor B.E. Jemec
- Department of Dermatology, Zealand University Hospital, Roskilde and Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jens Ahm Sørensen
- Department of Plastic Surgery, Odense University Hospital and Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Knud Bonnet Yderstræde
- Steno Diabetes Center Odense, Odense University Hospital and Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- CIMT, Centre for Innovative Medical Technology, Odense University Hospital, Odense, Denmark
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Haesler E, Swanson T, Ousey K, Carville K. Clinical indicators of wound infection and biofilm: reaching international consensus. J Wound Care 2019; 28:s4-s12. [PMID: 30840533 DOI: 10.12968/jowc.2019.28.sup3b.s4] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To achieve international consensus relating to clinical indicators for a chronic wound, wound infection and biofilm presence to inform the development of international clinical guidance for assessing and managing wound infection. METHOD An online Delphi consensus process of international key opinion leaders in infection was undertaken. A literature search underpinned the development of issue statements related to terminology, emerging topics and debate in the field of wound infection. Experts participated in three rounds of consensus voting, sharing their opinions and indicating their level of agreement with the issue statements. Votes were calculated using web-based software that implements a nominal group voting methodology previously published by Research and Development/University of California at Los Angeles. RESULTS A total of 14 experts took part in the development process. Consensus was reached on clinical indicators of wound chronicity, wound infection and biofilm presence. Agreement was also reached that the term 'critical colonisation' should no longer be used to refer to a stage in the wound infection continuum. CONCLUSION Outcomes from the consensus process were used to inform the development of international, evidence-informed guidance on the assessment and treatment of wound infection to promote improved outcomes for people with wounds.
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Affiliation(s)
- Emily Haesler
- Adjunct Associate Professor, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia; Honorary Associate, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,Honorary Senior Lecturer, Australian National University, ANU Medical School, Canberra, Australia.,Subcommittee Chair for Education of International Wound Infection Institute, UK
| | - Terry Swanson
- Nurse Practitioner, Warnambool, Victoria, Australia.,Vice Chair of International Wound Infection Institute, UK
| | - Karen Ousey
- Professor of Skin Integrity, Director for the Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK.,Chair of International Wound Infection Institute, UK
| | - Keryln Carville
- Professor of Primary Health Care and Community Nursing, Silver Chain Group and Curtin University, School of Nursing Midwifery and Paramedicine, Curtin University, Perth, Australia.,Subcommittee Chair for Evidence of International Wound Infection Institute, UK
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Jenkins DA, Mohamed S, Taylor JK, Peek N, van der Veer SN. Potential prognostic factors for delayed healing of common, non-traumatic skin ulcers: A scoping review. Int Wound J 2019; 16:800-812. [PMID: 30821117 PMCID: PMC6563199 DOI: 10.1111/iwj.13100] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 02/04/2019] [Indexed: 01/08/2023] Open
Abstract
Healing of non-traumatic skin ulcers is often suboptimal. Prognostic tools that identify people at high risk of delayed healing within the context of routine ulcer assessments may improve this, but robust evidence on which factors to include is lacking. Therefore, we scoped the literature to identify which potentially prognostic factors may warrant future systematic reviews and meta-analyses. We conducted electronic searches in MEDLINE and Embase to identify studies in English published between 1997 and 2017 that tested the association between healing of the three most common non-traumatic skin ulcers encountered by health care professionals (venous leg, diabetic foot, and pressure ulcers) and patient characteristics, ulcer characteristics, and results from clinical investigations. We included 42 studies that investigated factors which may be associated with the healing of venous leg ulcers (n = 17), diabetic foot ulcers (n = 15), and pressure ulcers (n = 10). Across ulcer types, ulcer characteristics were most commonly reported as potential prognostic factors for healing (n = 37), including the size of the ulcer area (n = 29) and ulcer duration at first assessment (n = 16). A total of 35 studies investigated the prognostic value of patient characteristics (n = 35), including age (n = 31), gender (n = 30), diabetes (n = 22), smoking status (n = 15), and history of deep vein thrombosis (DVT) (n = 13). Of these studies, 23 reported results from clinical investigations as potential prognostic factors, with the majority regarding vessel quality. Age, gender, diabetes, smoking status, history of DVT, ulcer area, and ulcer duration at time of first assessment warrant a systematic review and meta-analysis to quantify their prognostic value for delayed ulcer healing.
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Affiliation(s)
- David A. Jenkins
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
| | - Sundus Mohamed
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
| | - Joanne K. Taylor
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
- Manchester University NHS Foundation TrustManchesterUK
| | - Niels Peek
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
- NIHR Manchester Biomedical Research Centre, Faculty of Biology Medicine and HealthThe University of ManchesterManchesterUK
| | - Sabine N. van der Veer
- NIHR Greater Manchester Patient Safety Translational Research CentreThe University of ManchesterManchesterUK
- Health e‐Research Centre, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, School of Health Sciences, Manchester Academic Health Science CentreThe University of ManchesterManchesterUK
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9
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Brown-Etris M, Milne CT, Hodde JP. An extracellular matrix graft (Oasis ® wound matrix) for treating full-thickness pressure ulcers: A randomized clinical trial. J Tissue Viability 2018; 28:21-26. [PMID: 30509850 DOI: 10.1016/j.jtv.2018.11.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/19/2018] [Accepted: 11/26/2018] [Indexed: 01/29/2023]
Abstract
AIM The purpose of the study was to evaluate clinical safety and effectiveness of Oasis® Wound Matrix as a treatment for full-thickness pressure ulcers and compare it to Standard Care. METHODS A total of 130 adults with Stage III or Stage IV pressure ulcers were randomly assigned, received either multiple topical treatments of SIS plus standard care (n = 67), or standard care alone (n = 63), and were subsequently evaluated. Ulcer size was determined at enrollment and weekly throughout treatment. Healing was assessed at each visit for a period of up to 12 weeks, with incidence of complete healing and 90% reduction in ulcer area being the primary outcome measures. RESULTS The proportion of complete healing in the SIS group was 40% as compared to 29% in the standard of care group (p = 0.111); the percentage of patients having a 90% reduction in ulcer surface area was 55% in the SIS group versus 38% in the standard of care group (p = 0.037). CONCLUSIONS The results of this study suggest that within the setting of a comprehensive wound care program, weekly treatment of chronic pressure ulcers with SIS wound matrix increases the incidence of 90% reduction in wound size versus standard of care alone.
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Affiliation(s)
- Marie Brown-Etris
- Etris Associates, Inc, 14450 Bustleton Avenue, Philadephia, PA, 19116, USA.
| | - Catherine T Milne
- Connecticut Clinical Nursing Associates, LLC, 204 Keegan Rd, Plymouth, CT, 06782, USA.
| | - Jason P Hodde
- Cook Biotech Incorporated, 1425 Innovation Place, West Lafayette, IN, 47906, USA.
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Abstract
We know little about the individual pain experience of patients recovering from surgery in the first weeks after hospital discharge. Here, we examine individual differences in the day-to-day experience after 2 major surgeries: lower limb total major joint arthroplasty (TJA) and cesarean delivery (CD). Fifty-five TJA patients and 157 CD patients were recruited to complete questionnaires and record their daily pain experiences after surgery. After hospital discharge, patients recorded their pain intensity once daily for 60 days (CD) or twice daily for 2 weeks, once daily for 2 weeks, weekly for 8 weeks, and monthly for 3 months (TJA). Pain scores were modeled using growth curve and Bayesian change-point models. Individual differences in the model fits were examined for evidence of day-to-day differences in pain. A log time model was the simplest model that fit the data, but examination of the residuals revealed high autocorrelation representing misspecification. A change-point model fit the data better and revealed that the form of recovery fundamentally changed between days 10 and 21 after surgery. These data add meaningfully to our understanding of recovery from pain after surgery by extending the period of frequent observations a few days after surgery to a 2-month period. These high time resolution data suggest that there is a typical experience of pain resolution after surgery, but that meaningful subpopulations of experience may exist. They also indicate that a transition occurs within 1 month after surgery from 1 pattern of change in pain over time to another.
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Vidal A, Mendieta Zerón H, Giacaman I, Camarillo Romero MDS, López SP, Meza Trillo LE, Pérez Pérez DA, Concha M, Torres-Gallegos C, Orellana SL, Oyarzun-Ampuero F, Moreno-Villoslada I. A Simple Mathematical Model for Wound Closure Evaluation. J Am Coll Clin Wound Spec 2016; 7:40-49. [PMID: 28053868 DOI: 10.1016/j.jccw.2016.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The incidence of ulcers associated to type 2 diabetes mellitus (T2DM) increases every year. We introduce and explore a new mathematical algorithm to evaluate wound-healing in foot ulcers associated to T2DM. Fifteen patients (nine women and six men), mean age of 70 ± 16 years were included. The evolution of their wounds followed-up for a period of 18-45 days. According to the Wagner grading system the ulcers were grade I (5 patients), grade II (9 patients), and grade III (1 patient). Clinically, the type of the ulcers was neuroischemic (12 patients) and neuropathic (3 patients). A new parameter is introduced, the "continuous linear healing rate" Dc that was more accurate with higher values and requires less quantifications than usual formulas to make a wound-healing projection.
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Affiliation(s)
- Alejandra Vidal
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - Hugo Mendieta Zerón
- Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca, Estado de México, Mexico
| | - Israel Giacaman
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | | | - Sandra Parra López
- Facultad de Medicina, Universidad Autónoma del Estado de México, Toluca, Estado de México, Mexico
| | - Laura E Meza Trillo
- Facultad de Ciencias de la Salud, Universidad de Anáhuac, Huixquilucan, Estado de México, Mexico
| | | | - Miguel Concha
- Instituto de Anatomía, Histología y Patología, Facultad de Medicina, Universidad Austral de Chile, Valdivia, Chile
| | - César Torres-Gallegos
- Instituto de Ciencias Químicas, Facultad de Ciencias, Universidad Austral de Chile, Valdivia, Chile
| | - Sandra L Orellana
- Instituto de Ciencias Químicas, Facultad de Ciencias, Universidad Austral de Chile, Valdivia, Chile
| | - Felipe Oyarzun-Ampuero
- Departamento de Ciencias & Tecnologías Farmacéuticas, Universidad de Chile, Santiago, Chile
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Ceballos-Vasquez A, Caldwell JR, Faure PA. Seasonal and reproductive effects on wound healing in the flight membranes of captive big brown bats. Biol Open 2014; 4:95-103. [PMID: 25527646 PMCID: PMC4295170 DOI: 10.1242/bio.201410264] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The flight membranes of bats serve a number of physiological functions important for survival. Although flight membrane injuries are commonly observed in wild-caught bats, in most cases the damage heals completely. Previous studies examining wound healing in the flight membranes of bats have not taken into consideration energy constraints that could influence healing times. Wound healing results in increased energy demands, therefore we hypothesized that wound healing times would be slower during periods of energy conservation and/or energy output. In this study we used an 8 mm diameter circular punch tool to biopsy the wing membranes of healthy adult female big brown bats (Eptesicus fuscus) from a captive research colony to test the hypothesis that healing times will vary with seasonal temperature changes between the summer and winter seasons, and with reproductive condition between lactating and non-reproductive females. As expected, membrane biopsies took significantly longer to heal during the winter when bats were hibernating compared to the summer when bats were active. Surprisingly, no difference in healing time was observed between lactating and non-reproductive females. The wings of most bats fully healed, although some individuals showed wound expansion demonstrating that impaired healing is occasionally observed in otherwise healthy subjects.
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Affiliation(s)
| | - John R Caldwell
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4K1, Canada
| | - Paul A Faure
- Department of Psychology, Neuroscience & Behaviour, McMaster University, Hamilton, ON L8S 4K1, Canada
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13
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Growth patterns and scaling laws governing AIDS epidemic in Brazilian cities. PLoS One 2014; 9:e111015. [PMID: 25340796 PMCID: PMC4207789 DOI: 10.1371/journal.pone.0111015] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 09/17/2014] [Indexed: 11/23/2022] Open
Abstract
Brazil holds approximately 1/3 of population living infected with AIDS (acquired immunodeficiency syndrome) in Central and South Americas, and it was also the first developing country to implement a large-scale control and intervention program against AIDS epidemic. In this scenario, we investigate the temporal evolution and current status of the AIDS epidemic in Brazil. Specifically, we analyze records of annual absolute frequency of cases for more than 5000 cities for the first 33 years of the infection in Brazil. We found that (i) the annual absolute frequencies exhibit a logistic-type growth with an exponential regime in the first few years of the AIDS spreading; (ii) the actual reproduction number decaying as a power law; (iii) the distribution of the annual absolute frequencies among cities decays with a power law behavior; (iv) the annual absolute frequencies and the number of inhabitants have an allometric relationship; (v) the temporal evolution of the annual absolute frequencies have different profile depending on the average annual absolute frequencies in the cities. These findings yield a general quantitative description of the AIDS infection dynamics in Brazil since the beginning. They also provide clues about the effectiveness of treatment and control programs against the infection, that has had a different impact depending on the number of inhabitants of cities. In this framework, our results give insights into the overall dynamics of AIDS epidemic, which may contribute to select empirically accurate models.
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Xu Y, Sun J, Carter RR, Bogie KM. Personalized prediction of chronic wound healing: an exponential mixed effects model using stereophotogrammetric measurement. J Tissue Viability 2014; 23:48-59. [PMID: 24810677 DOI: 10.1016/j.jtv.2014.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 03/16/2014] [Accepted: 04/01/2014] [Indexed: 10/25/2022]
Abstract
STUDY AIM Stereophotogrammetric digital imaging enables rapid and accurate detailed 3D wound monitoring. This rich data source was used to develop a statistically validated model to provide personalized predictive healing information for chronic wounds. MATERIALS 147 valid wound images were obtained from a sample of 13 category III/IV pressure ulcers from 10 individuals with spinal cord injury. METHODS Statistical comparison of several models indicated the best fit for the clinical data was a personalized mixed-effects exponential model (pMEE), with initial wound size and time as predictors and observed wound size as the response variable. Random effects capture personalized differences. RESULTS Other models are only valid when wound size constantly decreases. This is often not achieved for clinical wounds. Our model accommodates this reality. Two criteria to determine effective healing time outcomes are proposed: r-fold wound size reduction time, t(r-fold), is defined as the time when wound size reduces to 1/r of initial size. t(δ) is defined as the time when the rate of the wound healing/size change reduces to a predetermined threshold δ < 0. Healing rate differs from patient to patient. Model development and validation indicates that accurate monitoring of wound geometry can adaptively predict healing progression and that larger wounds heal more rapidly. Accuracy of the prediction curve in the current model improves with each additional evaluation. CONCLUSION Routine assessment of wounds using detailed stereophotogrammetric imaging can provide personalized predictions of wound healing time. Application of a valid model will help the clinical team to determine wound management care pathways.
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Affiliation(s)
- Yifan Xu
- Center for Statistical Research, Computing and Collaboration, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Jiayang Sun
- Center for Statistical Research, Computing and Collaboration, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Rebecca R Carter
- Center for Statistical Research, Computing and Collaboration, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH, USA
| | - Kath M Bogie
- Louis Stokes Cleveland Department of Veterans Affairs Medical Center (LSCDVAMC), Cleveland, OH, USA; Dept of Orthopaedics, Case Western Reserve University, Cleveland, OH, USA.
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Ambrózy E, Waczulíková I, Willfort A, Böhler K, Cauza K, Ehringer H, Heinz G, Koppensteiner R, Marić S, Gschwandtner ME. Healing process of venous ulcers: the role of microcirculation. Int Wound J 2012; 10:57-64. [PMID: 22313523 DOI: 10.1111/j.1742-481x.2012.00943.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In order to describe adequately the process of healing in the intermediate degrees, we investigated microcirculatory changes in the venous ulcers at well-defined stages of wound repair. We investigated dynamic changes in microcirculation during the healing process of venous ulcers. Ten venous ulcers were investigated in three consecutive clinical stages of wound healing: non granulation tissue (NGTA), GTA and scar. Subpapillary microcirculation was measured by laser Doppler perfusion (LDP) imaging and expressed using LDP values in arbitrary units. Nutritive perfusion by capillary microscopy and expressed as capillary density (CD) - the number of capillaries per square millimetre. Before the development of GTA the LDP was low (median 1·35; lower-upper quartiles 0·71-1·83) accompanied with zero CD in all but one patient who had a density of 1. With the first appearance of GTA in the same area, the LDP was improved (2·22; 1·12-2·33; P = 0·0024) when compared with NGTA, in combination with a significant increase in CD (1·75; 0-3; P = 0·0054). In scar, the LDP was similar to that in the NGTA (1·03; 0·77-1·83; P = 0·278), combined with the highest CD (5·75; 4·5-8) in comparison with the previous stages of the area (for both pairs, P < 0·0001). Venous ulcers are caused by poor nutritive and subpapillary perfusion. Subpapillary perfusion plays a major role in the formation of GTA. In a scar, the increased nutritive perfusion is sufficient to cover the blood supply and keep skin viable while subpapillary perfusion is low.
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Affiliation(s)
- Ewald Ambrózy
- Unit of Medical Angiology, 2nd Department of Internal Medicine, Teaching Hospital, Comenius University, Bratislava, Slovak Republic.
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17
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Nonlinear modeling of venous leg ulcer healing rates. BMC DERMATOLOGY 2009; 9:2. [PMID: 19335882 PMCID: PMC2672927 DOI: 10.1186/1471-5945-9-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 03/31/2009] [Indexed: 11/15/2022]
Abstract
Background The purpose of this manuscript was to determine whether the change in wound surface area over time could be described through nonlinear mathematics. Methods We studied 3,588 serial wound tracings of 338 venous leg ulcers (VLUs) that had been followed during a controlled, prospective, randomized trial of two topical wound treatments. Results A majority (72%) of VLUs exhibited surface area reduction via an exponential decay model, particularly during the early stages of healing. These results were consistent with the mechanics of wound contraction and epithelial cell proliferation, supported by the higher frequency at which exponential surface area reduction associated with full wound closure (35% of wounds that fit the exponential model healed vs. 21% of wounds that did not fit the exponential model completely healed during the study period, p = 0.018). Goodness-of-fit statistics suggested that much of the individual variation in healing could be described as nonlinear variation from the exponential model. Conclusion We believe that parameter estimates from a mathematical model may provide a more accurate quantification of wound healing rates, and that similar models may someday reach routine use in comparing the efficacy of various treatments in routine practice and in product registration trials.
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Finnegan MJ, Gazzerro L, Finnegan JO, Lo P. Comparing the effectiveness of a specialized alternating air pressure mattress replacement system and an air-fluidized integrated bed in the management of post-operative flap patients: a randomized controlled pilot study. J Tissue Viability 2008; 17:2-9. [PMID: 18293765 DOI: 10.1016/j.jtv.2007.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Matthew J Finnegan
- Institute for Wound Healing and Limb Preservation,Cooper University Hospital, One Cooper Plaza, Camden, NJ 08103, USA.
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Moore K, McCallion R, Searle RJ, Stacey MC, Harding KG. Prediction and monitoring the therapeutic response of chronic dermal wounds. Int Wound J 2006; 3:89-96. [PMID: 17007340 PMCID: PMC7951240 DOI: 10.1111/j.1742-4801.2006.00212.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A significant proportion of chronic wounds fail to heal in response to treatment of underlying pathologies combined with good wound care practice. Current prognostic tests to identify these wounds rely on the use of algorithms based on clinically measurable parameters such as wound dimensions and wound duration. Venous leg ulcers may be stratified into healing/non healing at 24 weeks of compression therapy and diabetic foot ulcer treatment outcome assessed using a 3-parameter algorithm. Accurate and reproducible measurement of wound area is required for these algorithms to have clinical utility. Whilst a number of attempts have been made to develop computerised wound-assessment techniques, wound tracing by clinicians combined with planimetry remains the standard methodology. Once treatment has been initiated, it is important to continuously monitor the wound to assess efficacy of treatment. This can be achieved by measuring wound area change over the first weeks of treatment to identify whether re-assessment of treatment strategy is required. A number of algorithms for assessing rate of wound area change have been evaluated to determine a surrogate endpoint for healing. Retrospective analysis of large patient groups indicates that approximately 75% correct prediction of healing outcome can be achieved.
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