1
|
Shin YS, Hung KS, Tsai CT, Wu MH, Lin CL, Hsueh YY. Validation of multispectral imaging-based tissue oxygen saturation detecting system for wound healing recognition on open wounds. JOURNAL OF BIOMEDICAL OPTICS 2024; 29:086004. [PMID: 39139703 PMCID: PMC11321076 DOI: 10.1117/1.jbo.29.8.086004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/19/2024] [Accepted: 07/23/2024] [Indexed: 08/15/2024]
Abstract
Significance The multispectral imaging-based tissue oxygen saturation detecting (TOSD) system offers deeper penetration ( ∼ 2 to 3 mm) and comprehensive tissue oxygen saturation (StO 2 ) assessment and recognizes the wound healing phase at a low cost and computational requirement. The potential for miniaturization and integration of TOSD into telemedicine platforms could revolutionize wound care in the challenging pandemic era. Aim We aim to validate TOSD's application in detectingStO 2 by comparing it with wound closure rates and laser speckle contrast imaging (LSCI), demonstrating TOSD's ability to recognize the wound healing process. Approach Utilizing a murine model, we compared TOSD with digital photography and LSCI for comprehensive wound observation in five mice with 6-mm back wounds. Sequential biochemical analysis of wound discharge was investigated for the translational relevance of TOSD. Results TOSD demonstrated constant signals on unwounded skin with differential changes on open wounds. Compared with LSCI, TOSD provides indicative recognition of the proliferative phase during wound healing, with a higher correlation coefficient to wound closure rate (TOSD: 0.58; LSCI: 0.44).StO 2 detected by TOSD was further correlated with proliferative phase angiogenesis markers. Conclusions Our findings suggest TOSD's enhanced utility in wound management protocols, evaluating clinical staging and therapeutic outcomes. By offering a noncontact, convenient monitoring tool, TOSD can be applied to telemedicine, aiming to advance wound care and regeneration, potentially improving patient outcomes and reducing healthcare costs associated with chronic wounds.
Collapse
Affiliation(s)
- Yi-Syuan Shin
- National Cheng Kung University, College of Medicine, National Cheng Kung University Hospital, Department of Surgery, Division of Plastic and Reconstructive Surgery, Tainan, Taiwan
| | - Kuo-Shu Hung
- National Cheng Kung University, College of Medicine, National Cheng Kung University Hospital, Department of Surgery, Division of Plastic and Reconstructive Surgery, Tainan, Taiwan
- National Cheng Kung University, College of Medicine, Institute of Clinical Medicine, Tainan, Taiwan
| | - Chung-Te Tsai
- National Cheng Kung University, College of Medicine, National Cheng Kung University Hospital, Department of Surgery, Division of Plastic and Reconstructive Surgery, Tainan, Taiwan
| | - Meng-Hsuan Wu
- National Cheng Kung University, Department of Electrical Engineering, Tainan, Taiwan
| | - Chih-Lung Lin
- National Cheng Kung University, Department of Electrical Engineering, Tainan, Taiwan
| | - Yuan-Yu Hsueh
- National Cheng Kung University, College of Medicine, National Cheng Kung University Hospital, Department of Surgery, Division of Plastic and Reconstructive Surgery, Tainan, Taiwan
- National Cheng Kung University, College of Medicine, Institute of Clinical Medicine, Tainan, Taiwan
- National Cheng Kung University, College of Medicine, Department of Physiology, Tainan, Taiwan
| |
Collapse
|
2
|
Chen MY, Cao MQ, Xu TY. Progress in the application of artificial intelligence in skin wound assessment and prediction of healing time. Am J Transl Res 2024; 16:2765-2776. [PMID: 39114681 PMCID: PMC11301465 DOI: 10.62347/myhe3488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/22/2024] [Indexed: 08/10/2024]
Abstract
Since the 1970s, artificial intelligence (AI) has played an increasingly pivotal role in the medical field, enhancing the efficiency of disease diagnosis and treatment. Amidst an aging population and the proliferation of chronic disease, the prevalence of complex surgeries for high-risk multimorbid patients and hard-to-heal wounds has escalated. Healthcare professionals face the challenge of delivering safe and effective care to all patients concurrently. Inadequate management of skin wounds exacerbates the risk of infection and complications, which can obstruct the healing process and diminish patients' quality of life. AI shows substantial promise in revolutionizing wound care and management, thus enhancing the treatment of hospitalized patients and enabling healthcare workers to allocate their time more effectively. This review details the advancements in applying AI for skin wound assessment and the prediction of healing timelines. It emphasizes the use of diverse algorithms to automate and streamline the measurement, classification, and identification of chronic wound healing stages, and to predict wound healing times. Moreover, the review addresses existing limitations and explores future directions.
Collapse
Affiliation(s)
- Ming-Yao Chen
- Department of Anesthetic Pharmacology, School of Anesthesiology, Second Military Medical University/Naval Medical UniversityShanghai 200433, China
| | - Ming-Qi Cao
- Department of Anesthetic Pharmacology, School of Anesthesiology, Second Military Medical University/Naval Medical UniversityShanghai 200433, China
- College of Basic Medicine, Second Military Medical University/Naval Medical UniversityShanghai 200433, China
| | - Tian-Ying Xu
- Department of Anesthetic Pharmacology, School of Anesthesiology, Second Military Medical University/Naval Medical UniversityShanghai 200433, China
| |
Collapse
|
3
|
Wu J, Ma Q, Zhou X, Wei Y, Liu Z, Kang H. Segmentation and quantitative analysis of optical coherence tomography (OCT) images of laser burned skin based on deep learning. Biomed Phys Eng Express 2024; 10:045026. [PMID: 38718764 DOI: 10.1088/2057-1976/ad488f] [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] [Received: 02/28/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Evaluation of skin recovery is an important step in the treatment of burns. However, conventional methods only observe the surface of the skin and cannot quantify the injury volume. Optical coherence tomography (OCT) is a non-invasive, non-contact, real-time technique. Swept source OCT uses near infrared light and analyzes the intensity of light echo at different depths to generate images from optical interference signals. To quantify the dynamic recovery of skin burns over time, laser induced skin burns in mice were evaluated using deep learning of Swept source OCT images. A laser-induced mouse skin thermal injury model was established in thirty Kunming mice, and OCT images of normal and burned areas of mouse skin were acquired at day 0, day 1, day 3, day 7, and day 14 after laser irradiation. This resulted in 7000 normal and 1400 burn B-scan images which were divided into training, validation, and test sets at 8:1.5:0.5 ratio for the normal data and 8:1:1 for the burn data. Normal images were manually annotated, and the deep learning U-Net model (verified with PSPNe and HRNet models) was used to segment the skin into three layers: the dermal epidermal layer, subcutaneous fat layer, and muscle layer. For the burn images, the models were trained to segment just the damaged area. Three-dimensional reconstruction technology was then used to reconstruct the damaged tissue and calculate the damaged tissue volume. The average IoU value and f-score of the normal tissue layer U-Net segmentation model were 0.876 and 0.934 respectively. The IoU value of the burn area segmentation model reached 0.907 and f-score value reached 0.951. Compared with manual labeling, the U-Net model was faster with higher accuracy for skin stratification. OCT and U-Net segmentation can provide rapid and accurate analysis of tissue changes and clinical guidance in the treatment of burns.
Collapse
Affiliation(s)
- Jingyuan Wu
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
- College of Life Sciences, Hebei University, Baoding, Hebei 071002, People's Republic of China
| | - Qiong Ma
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Xun Zhou
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Yu Wei
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
- College of Life Sciences, Hebei University, Baoding, Hebei 071002, People's Republic of China
| | - Zhibo Liu
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| | - Hongxiang Kang
- Beijing Institute of Radiation Medicine, Beijing 100850, People's Republic of China
| |
Collapse
|
4
|
Yıldız M, Sarpdağı Y, Okuyar M, Yildiz M, Çiftci N, Elkoca A, Yildirim MS, Aydin MA, Parlak M, Bingöl B. Segmentation and classification of skin burn images with artificial intelligence: Development of a mobile application. Burns 2024; 50:966-979. [PMID: 38331663 DOI: 10.1016/j.burns.2024.01.007] [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] [Received: 09/26/2023] [Revised: 12/26/2023] [Accepted: 01/10/2024] [Indexed: 02/10/2024]
Abstract
AIM This study was conducted to determine the segmentation, classification, object detection, and accuracy of skin burn images using artificial intelligence and a mobile application. With this study, individuals were able to determine the degree of burns and see how to intervene through the mobile application. METHODS This research was conducted between 26.10.2021-01.09.2023. In this study, the dataset was handled in two stages. In the first stage, the open-access dataset was taken from https://universe.roboflow.com/, and the burn images dataset was created. In the second stage, in order to determine the accuracy of the developed system and artificial intelligence model, the patients admitted to the hospital were identified with our own design Burn Wound Detection Android application. RESULTS In our study, YOLO V7 architecture was used for segmentation, classification, and object detection. There are 21018 data in this study, and 80% of them are used as training data, and 20% of them are used as test data. The YOLO V7 model achieved a success rate of 75.12% on the test data. The Burn Wound Detection Android mobile application that we developed in the study was used to accurately detect images of individuals. CONCLUSION In this study, skin burn images were segmented, classified, object detected, and a mobile application was developed using artificial intelligence. First aid is crucial in burn cases, and it is an important development for public health that people living in the periphery can quickly determine the degree of burn through the mobile application and provide first aid according to the instructions of the mobile application.
Collapse
Affiliation(s)
- Metin Yıldız
- Department of Nursing, Sakarya University, Sakarya, Turkey.
| | - Yakup Sarpdağı
- Department of Nursing Van Yuzuncu Yil University, Turkey
| | - Mehmet Okuyar
- Sakarya University of Applied Sciences Biomedical Engineering, Sakarya, Turkey
| | - Mehmet Yildiz
- Sakarya University of Applied Sciences, Distance Education Research and Application Center, Sakarya, Turkey
| | - Necmettin Çiftci
- Muş Alparslan University, Faculty of Health Sciences, Department of Nursing, 49100 Muş, Turkey
| | - Ayşe Elkoca
- Gaziantep Islamic University of Science and Technology Faculty of Health Sciences, Midwifery, Turkey
| | - Mehmet Salih Yildirim
- Vocational School of Health Services, Agri Ibrahim Cecen University School of Health, Agri, Turkey
| | | | - Mehmet Parlak
- Ataturk University, Department of Nursing, Erzurum, Turkey
| | - Bünyamin Bingöl
- Sakarya University, Electrical and Electronics Engineering, Sakarya, Turkey
| |
Collapse
|
5
|
Wang Y, Hua Z, Tang L, Song Q, Cui Q, Sun S, Yuan Y, Zhang L. Therapeutic implications of extracorporeal shock waves in burn wound healing. J Tissue Viability 2024; 33:96-103. [PMID: 38155029 DOI: 10.1016/j.jtv.2023.12.003] [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] [Received: 07/28/2023] [Revised: 11/24/2023] [Accepted: 12/22/2023] [Indexed: 12/30/2023]
Abstract
Burns are a common type of trauma that seriously affect not only the physical health, but also the mental health and quality of life of the patient. Extracorporeal shock wave therapy (ESWT) is an emerging treatment that has been used in clinical treatment. It has many advantages, including safety, non-invasiveness, efficiency, short treatment duration, fewer complications, and relatively low prices. In clinical settings, ESWT has played an important role in the healing process of burns and the prevention of sequelae. This article reviews the history of ESWT, the mechanism of ESWT to promote burn healing, and the application of ESWT in burns. Current status of ESWT treatment for burns as well as future perspectives for research have been summarized and proposed. However, patients with burns cannot be considered recovered when the wounds have healed, we need some new technology to adjust to the challenges of the future.
Collapse
Affiliation(s)
- Yashi Wang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Zuoyu Hua
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Liang Tang
- Department of Rehabilitation Medicine, Anshan Central Hospotal (6 Th Clinical College of China Medical University), Anshan, Liaoning Province, 114001, China
| | - Qifeng Song
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Qian Cui
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Shi Sun
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Yin Yuan
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China
| | - Lixin Zhang
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, Liaoning Province, 110000, China.
| |
Collapse
|
6
|
Ji S, Xiao S, Xia Z. Consensus on the treatment of second-degree burn wounds (2024 edition). BURNS & TRAUMA 2024; 12:tkad061. [PMID: 38343901 PMCID: PMC10858447 DOI: 10.1093/burnst/tkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Abstract
Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.
Collapse
Affiliation(s)
- Shizhao Ji
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Shichu Xiao
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Zhaofan Xia
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | | |
Collapse
|
7
|
Huang CX, Siwan E, Fox SL, Longfield M, Twigg SM, Min D. Comparison of digital and traditional skin wound closure assessment methods in mice. Lab Anim Res 2023; 39:25. [PMID: 37891640 PMCID: PMC10605778 DOI: 10.1186/s42826-023-00176-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/12/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Chronic skin wounds are a common complication of many diseases such as diabetes. Various traditional methods for assessing skin wound closure are used in animal studies, including wound tracing, calliper measurements and histological analysis. However, these methods have poorly defined wound closure or practical limitations. Digital image analysis of wounds is an increasingly popular, accessible alternative, but it is unclear whether digital assessment is consistent with traditional methods. This study aimed to optimise and compare digital wound closure assessment with traditional methods, using a diabetic mouse model. Diabetes was induced in male C57BL/6J mice by high-fat diet feeding combined with low dose (65 mg/kg of body weight) streptozotocin injections. Mice fed normal chow were included as controls. After 18 weeks, four circular full-thickness dorsal skin wounds of 4 mm diameter were created per mouse. The wounds were photographed and measured by callipers. Wound closure rate (WCR) was digitally assessed by two reporters using two methods: wound outline (WCR-O) and re-epithelialisation (WCR-E). Wounded skin tissues were collected at 10-days post-wounding and wound width was measured from haematoxylin and eosin-stained skin tissue. RESULTS Between reporters, WCR-O was more consistent than WCR-E, and WCR-O correlated with calliper measurements. Histological analysis supported digital assessments, especially WCR-E, when wounds were histologically closed. CONCLUSIONS WCR-O could replace calliper measurements to measure skin wound closure, but WCR-E assessment requires further refinement. Small animal studies of skin wound healing can greatly benefit from standardised definitions of wound closure and more consistent digital assessment protocols.
Collapse
Affiliation(s)
- Coco X Huang
- Greg Brown Diabetes and Endocrine Research Laboratory, Sydney Medical School (Central), Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Elisha Siwan
- Greg Brown Diabetes and Endocrine Research Laboratory, Sydney Medical School (Central), Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Sarah L Fox
- Greg Brown Diabetes and Endocrine Research Laboratory, Sydney Medical School (Central), Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Matilda Longfield
- Greg Brown Diabetes and Endocrine Research Laboratory, Sydney Medical School (Central), Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
| | - Stephen M Twigg
- Greg Brown Diabetes and Endocrine Research Laboratory, Sydney Medical School (Central), Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Danqing Min
- Greg Brown Diabetes and Endocrine Research Laboratory, Sydney Medical School (Central), Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Sydney, NSW, Australia.
- Department of Endocrinology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| |
Collapse
|
8
|
Gao Y, Pei W, Yang Y, Li M, Sun H, Chen M, Ma X, Zhang H, Qi D, Wu J. Multifunctional nanofibrous mats: toward antibacterial and anti-inflammatory applications, and visual bacterial diagnosis. J Mater Chem B 2023; 11:8046-8055. [PMID: 37539498 DOI: 10.1039/d3tb01235b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
In most circumstances, wounds face the challenges of bacterial invasions and inappropriate inflammatory responses when they lack proper wound management. Endowing dressings with both antibacterial and anti-inflammatory functions is a compelling strategy for resolving the above issues. However, seizing the right moment to change the dressings and providing satisfactory management of wounds are still urgently required. Herein, an antibacterial and anti-inflammatory nanofibrous mat is proposed by encapsulating antibiotic gentamicin sulfate (GS) and anti-inflammatory drug ibuprofen (IB) into nanofibers via a coaxial electrospinning technique and is further decorated with Prussian blue nanocrystals (PBNCs) to enhance anti-inflammatory activity and, more importantly, to monitor bacterial infections and guide dressing changes in a timely manner. Such a nanofibrous mat releases most of the therapeutic drugs within 120 min and reveals excellent antibacterial activity and anti-inflammatory ability. Specifically, it can destroy both Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli), as well as conspicuously reduce the production of reactive oxygen species (ROS) and the expression of pro-inflammatory cytokines in macrophages. In addition, the nanofibrous mat can be used for point-of-use diagnosis of living bacteria relying on the naked eye or color analysis, which exhibits the potential of monitoring wound infection and guiding dressing changes promptly. This finding demonstrates the theranostic applications of multifunctional nanofibrous mats in wound healing.
Collapse
Affiliation(s)
- Yujie Gao
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou, 310018, China.
| | - Wenxiang Pei
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou, 310018, China.
| | - Yang Yang
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou, 310018, China.
| | - Mengmeng Li
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou, 310018, China.
| | - Hengqiu Sun
- Department of Pediatric Surgery, Taizhou Women and Children's Hospital of Wenzhou Medical University, Taizhou, 318000, China
| | - Mingchao Chen
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou, 310018, China.
| | - Xiaoman Ma
- Zhejiang Accupath Smart Manufacturing Group Co., Ltd, Jiaxing, China
| | - Hui Zhang
- Zhejiang Accupath Smart Manufacturing Group Co., Ltd, Jiaxing, China
| | - Dongming Qi
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou, 310018, China.
| | - Jindan Wu
- MOE Key Laboratory of Advanced Textile Materials & Manufacturing Technology, Zhejiang Sci-Tech University, Hangzhou, 310018, China.
| |
Collapse
|
9
|
Iruela Sánchez M, García-Sierra R, Medrano-Jiménez R, Bonachela-Mompart D, Maella-Rius N, Soria-Martín E, Isnard-Blanchar M, Torán-Monserrat P. Use of Infrared Thermometry to Observe Temperature Variation Associated with the Healing Process in Wounds and Ulcers: TIHUAP Cohort Study Protocol. Healthcare (Basel) 2023; 11:1750. [PMID: 37372868 DOI: 10.3390/healthcare11121750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
We are interested in observing how temperature differences between the wound bed and perilesional skin are related to the healing process in primary care patients with wounds. Multisite prospective cohort study with one-year follow-up in the Metropolitan North area of Barcelona. Recruitment of patients over 18 years with an open wound will take place from January 2023 to September 2023. Temperature checks will be conducted on a weekly basis at control visits and wound care. The following variables will be measured: Percentage reduction of wound area over time, thermal index, the Kundin Wound Gauge, and the Resvech 2.0 Scale. The temperature will be measured weekly using a handheld thermometer and mesh grid to frame the temperature points. The healing trajectory will also be monitored on a monthly basis via photographic imaging, the Resvech Scale, calculation of wound size, percentage reduction of wound area over time, and thermal index for one year of follow-up or until the wound is cured. This study may represent a turning point for its introduction into primary care. Early diagnosis of wound complications would facilitate treatment decision-making for healthcare professionals, thus improving the management of resources related to chronic wounds.
Collapse
Affiliation(s)
- Mercè Iruela Sánchez
- Direcció Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08204 Sabadell, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS) (2021-SGR-0148), 08007 Barcelona, Spain
- Grup D'experts en Ferides, Institut Català de la Salut GEICS, 08007 Barcelona, Spain
| | - Rosa García-Sierra
- Multidisciplinary Research Group in Health and Society (GREMSAS) (2021-SGR-0148), 08007 Barcelona, Spain
- Research Institut, Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP JGol), 08303 Mataró, Spain
- Nursing Department, Faculty of Medicine, Campus Bellaterra, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Primary Care Group, Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
| | | | - Diana Bonachela-Mompart
- Direcció Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08204 Sabadell, Spain
| | - Natalia Maella-Rius
- Direcció Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08204 Sabadell, Spain
- Multidisciplinary Research Group in Health and Society (GREMSAS) (2021-SGR-0148), 08007 Barcelona, Spain
| | - Esther Soria-Martín
- Direcció Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08204 Sabadell, Spain
| | - Mar Isnard-Blanchar
- Direcció Atenció Primària Metropolitana Nord, Institut Català de la Salut, 08204 Sabadell, Spain
| | - Pere Torán-Monserrat
- Multidisciplinary Research Group in Health and Society (GREMSAS) (2021-SGR-0148), 08007 Barcelona, Spain
- Research Institut, Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP JGol), 08303 Mataró, Spain
- Primary Care Group, Germans Trias i Pujol Research Institute (IGTP), 08916 Badalona, Spain
- Department of Medicine, Faculty of Medicine, Universitat de Girona, 17004 Girona, Spain
| |
Collapse
|
10
|
Catalano O, Corvino A, Basile L, Catalano F, Varelli C. Use of new microcirculation software allows the demonstration of dermis vascularization. J Ultrasound 2023; 26:169-174. [PMID: 36001281 PMCID: PMC10063712 DOI: 10.1007/s40477-022-00710-2] [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] [Received: 04/26/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022] Open
Abstract
AIMS Current ultrasound (US) Doppler techniques cannot demonstrate the vascularization of the dermis. The purpose of this study was to investigate whether the new Superb Vascular Imaging (SMI) and Microvascular Flow (MV-Flow) techniques improve the detection of normal dermis vessels. SMI and MV-Flow were compared side-by-side to conventional power-Doppler (PD) imaging. METHODS By using US, 50 healthy volunteers were evaluated at level of five body areas: forehead, forearm, palm, buttock, and thigh. Two off-site operators evaluated the images to assess the difference between SMI and PD imaging and between MV-Flow and PD imaging in terms of dermis flow amount. A 0-3 scoring system was adopted. RESULTS SMI scored grade 0 in 0% of body areas, grade 1 in 58%, grade 2 in 33%, and grade 3 in 9%. In comparison with SMI, PD scored grade 0 in 38% of body areas, grade 1 in 56%, grade 2 in 6%, and grade 3 in 0%. MV-Flow scored grade 0 in 0% of body areas, grade 1 in 52%, grade 2 in 43%, and grade 3 in 6%. Comparted to MV-Flow, PD scored grade 0 in 53% of body areas, grade 1 in 34%, grade 2 in 13%, and grade 3 in 0%. The difference in terms of sensitivity was statistically significant for all the body areas investigated. CONCLUSIONS We found both SMI and MV-Flow to be superior to PD imaging and capable to demonstrate normal vascularization of the dermis.
Collapse
Affiliation(s)
- Orlando Catalano
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy.
| | - Antonio Corvino
- Motor Science and Wellness Department, University of Naples Parthenope, Naples, Italy
| | - Luigi Basile
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Fabio Catalano
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy
| | - Carlo Varelli
- Radiology Unit, Istituto Diagnostico Varelli, via Cornelia dei Gracchi 65, 80126, Naples, Italy
| |
Collapse
|
11
|
Khani ME, Harris ZB, Osman OB, Singer AJ, Hassan Arbab M. Triage of in vivo burn injuries and prediction of wound healing outcome using neural networks and modeling of the terahertz permittivity based on the double Debye dielectric parameters. BIOMEDICAL OPTICS EXPRESS 2023; 14:918-931. [PMID: 36874480 PMCID: PMC9979665 DOI: 10.1364/boe.479567] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/19/2022] [Accepted: 12/20/2022] [Indexed: 06/18/2023]
Abstract
The initial assessment of the depth of a burn injury during triage forms the basis for determination of the course of the clinical treatment plan. However, severe skin burns are highly dynamic and hard to predict. This results in a low accuracy rate of about 60 - 75% in the diagnosis of partial-thickness burns in the acute post-burn period. Terahertz time-domain spectroscopy (THz-TDS) has demonstrated a significant potential for non-invasive and timely estimation of the burn severity. Here, we describe a methodology for the measurement and numerical modeling of the dielectric permittivity of the in vivo porcine skin burns. We use the double Debye dielectric relaxation theory to model the permittivity of the burned tissue. We further investigate the origins of dielectric contrast between the burns of various severity, as determined histologically based on the percentage of the burned dermis, using the empirical Debye parameters. We demonstrate that the five parameters of the double Debye model can form an artificial neural network classification algorithm capable of automatic diagnosis of the severity of the burn injuries, and predicting its ultimate wound healing outcome by forecasting its re-epithelialization status in 28 days. Our results demonstrate that the Debye dielectric parameters provide a physics-based approach for the extraction of the biomedical diagnostic markers from the broadband THz pulses. This method can significantly boost dimensionality reduction of THz training data in artificial intelligence models and streamline machine learning algorithms.
Collapse
Affiliation(s)
- Mahmoud E. Khani
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Zachery B. Harris
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Omar B. Osman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Adam J. Singer
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - M. Hassan Arbab
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| |
Collapse
|
12
|
Shi J, Li G, Yuan X, Wang Y, Gong M, Li C, Ge X, Lu S. Exploration and verification of COVID-19-related hub genes in liver physiological and pathological regeneration. Front Bioeng Biotechnol 2023; 11:1135997. [PMID: 36911196 PMCID: PMC9997844 DOI: 10.3389/fbioe.2023.1135997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 02/13/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives An acute injury is often accompanied by tissue regeneration. In this process, epithelial cells show a tendency of cell proliferation under the induction of injury stress, inflammatory factors, and other factors, accompanied by a temporary decline of cellular function. Regulating this regenerative process and avoiding chronic injury is a concern of regenerative medicine. The severe coronavirus disease 2019 (COVID-19) has posed a significant threat to people's health caused by the coronavirus. Acute liver failure (ALF) is a clinical syndrome resulting from rapid liver dysfunction with a fatal outcome. We hope to analyze the two diseases together to find a way for acute failure treatment. Methods COVID-19 dataset (GSE180226) and ALF dataset (GSE38941) were downloaded from the Gene Expression Omnibus (GEO) database, and the "Deseq2" package and "limma" package were used to identify differentially expressed genes (DEGs). Common DEGs were used for hub genes exploration, Protein-Protein Interaction (PPI) network construction, Gene Ontology (GO) functional enrichment, and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. The real-time reverse transcriptase-polymerase chain reaction (RT-qPCR) was used to verify the role of hub genes in liver regeneration during in vitro expansion of liver cells and a CCl4-induced ALF mice model. Results: The common gene analysis of the COVID-19 and ALF databases revealed 15 hub genes from 418 common DEGs. These hub genes, including CDC20, were related to cell proliferation and mitosis regulation, reflecting the consistent tissue regeneration change after the injury. Furthermore, hub genes were verified in vitro expansion of liver cells and in vivo ALF model. On this basis, the potential therapeutic small molecule of ALF was found by targeting the hub gene CDC20. Conclusion We have identified hub genes for epithelial cell regeneration under acute injury conditions and explored a new small molecule Apcin for liver function maintenance and ALF treatment. These findings may provide new approaches and ideas for treating COVID-19 patients with ALF.
Collapse
Affiliation(s)
- Jihang Shi
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China.,Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China.,Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Guangya Li
- MOE Key Laboratory of Cell Proliferation and Differentiation, College of Life Sciences, Peking-Tsinghua Center for Life Sciences, Peking University, Beijing, China.,Peking University-Tsinghua University-National Institute of Biological Science Joint Graduate Program, College of Life Science, Peking University, Beijing, China
| | - Xiandun Yuan
- Department of Rheumatology and Immunology, Peking University Third Hospital, Beijing, China
| | - Yafei Wang
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China.,Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China.,Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Ming Gong
- Medical School of Chinese People's Liberation Army (PLA), Beijing, China.,Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China.,Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Chonghui Li
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China.,Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Xinlan Ge
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China.,Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| | - Shichun Lu
- Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China.,Institute of Hepatobiliary Surgery of Chinese PLA, Beijing, China
| |
Collapse
|
13
|
Khani ME, Osman OB, Harris ZB, Chen A, Zhou JW, Singer AJ, Arbab MH. Accurate and early prediction of the wound healing outcome of burn injuries using the wavelet Shannon entropy of terahertz time-domain waveforms. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-220119GR. [PMID: 36348509 PMCID: PMC9641274 DOI: 10.1117/1.jbo.27.11.116001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 10/14/2022] [Indexed: 05/06/2023]
Abstract
Significance Severe burn injuries cause significant hypermetabolic alterations that are highly dynamic, hard to predict, and require acute and critical care. The clinical assessments of the severity of burn injuries are highly subjective and have consistently been reported to be inaccurate. Therefore, the utilization of other imaging modalities is crucial to reaching an objective and accurate burn assessment modality. Aim We describe a non-invasive technique using terahertz time-domain spectroscopy (THz-TDS) and the wavelet packet Shannon entropy to automatically estimate the burn depth and predict the wound healing outcome of thermal burn injuries. Approach We created 40 burn injuries of different severity grades in two porcine models using scald and contact methods of infliction. We used our THz portable handheld spectral reflection (PHASR) scanner to obtain the in vivo THz-TDS images. We used the energy to Shannon entropy ratio of the wavelet packet coefficients of the THz-TDS waveforms on day 0 to create supervised support vector machine (SVM) classification models. Histological assessments of the burn biopsies serve as the ground truth. Results We achieved an accuracy rate of 94.7% in predicting the wound healing outcome, as determined by histological measurement of the re-epithelialization rate on day 28 post-burn induction, using the THz-TDS measurements obtained on day 0. Furthermore, we report the accuracy rates of 89%, 87.1%, and 87.6% in automatic diagnosis of the superficial partial-thickness, deep partial-thickness, and full-thickness burns, respectively, using a multiclass SVM model. Conclusions The THz PHASR scanner promises a robust, high-speed, and accurate diagnostic modality to improve the clinical triage of burns and their management.
Collapse
Affiliation(s)
- Mahmoud E. Khani
- Stony Brook University, Department of Biomedical Engineering, Stony Brook, New York, United States
| | - Omar B. Osman
- Stony Brook University, Department of Biomedical Engineering, Stony Brook, New York, United States
| | - Zachery B. Harris
- Stony Brook University, Department of Biomedical Engineering, Stony Brook, New York, United States
| | - Andrew Chen
- Stony Brook University, Department of Biomedical Engineering, Stony Brook, New York, United States
| | - Juin W. Zhou
- Stony Brook University, Department of Biomedical Engineering, Stony Brook, New York, United States
| | - Adam J. Singer
- Renaissance School of Medicine at Stony Brook University, Department of Emergency Medicine, Stony Brook, New York, United States
| | - Mohammad Hassan Arbab
- Stony Brook University, Department of Biomedical Engineering, Stony Brook, New York, United States
| |
Collapse
|
14
|
Mortada H, Al Mazrou F, Alghareeb A, AlEnezi M, Alalawi S, Neel OF. Overview of the role of ultrasound imaging applications in plastic and reconstructive surgery: is ultrasound imaging the stethoscope of a plastic surgeon? A narrative review of the literature. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01981-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
|
15
|
Sciarrone DFG, McLaughlin RA, Argarini R, To M, Naylor LH, Bolam LM, Carter HH, Green DJ. Visualising and quantifying microvascular structure and function in patients with heart failure using optical coherence tomography. J Physiol 2022; 600:3921-3929. [PMID: 35869823 PMCID: PMC9541462 DOI: 10.1113/jp282940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/19/2022] [Indexed: 11/08/2022] Open
Abstract
Abstract Key points
Collapse
Affiliation(s)
- David F. G. Sciarrone
- Cardiovascular Research Group School of Human Sciences (Exercise and Sport Science) University of Western Australia Perth Australia
| | - Robert A. McLaughlin
- Australian Research Council Centre of Excellence for Nanoscale Biophotonics School of Biomedicine Faculty of Health and Medical Sciences University of Adelaide Adelaide Australia
- Institute for Photonics and Advanced Sensing University of Adelaide Adelaide Australia
- School of Engineering University of Western Australia Perth Australia
| | - Raden Argarini
- Cardiovascular Research Group School of Human Sciences (Exercise and Sport Science) University of Western Australia Perth Australia
- Department of Medical Physiology and Biochemistry Faculty of Medicine Airlangga University Surabaya Indonesia
| | - Minh‐Son To
- Flinders Health and Medical Research Institute Flinders University Bedford Park Australia
- Department of Neurosurgery Flinders Medical Centre Bedford Park Australia
| | - Louise H. Naylor
- Cardiovascular Research Group School of Human Sciences (Exercise and Sport Science) University of Western Australia Perth Australia
| | - Lucy M. Bolam
- Cardiovascular Research Group School of Human Sciences (Exercise and Sport Science) University of Western Australia Perth Australia
| | - Howard H. Carter
- Cardiovascular Research Group School of Human Sciences (Exercise and Sport Science) University of Western Australia Perth Australia
| | - Daniel J. Green
- Cardiovascular Research Group School of Human Sciences (Exercise and Sport Science) University of Western Australia Perth Australia
| |
Collapse
|
16
|
Weigelt MA, Lev-Tov HA, Tomic-Canic M, Lee WD, Williams R, Strasfeld D, Kirsner RS, Herman IM. Advanced Wound Diagnostics: Toward Transforming Wound Care into Precision Medicine. Adv Wound Care (New Rochelle) 2022; 11:330-359. [PMID: 34128387 PMCID: PMC8982127 DOI: 10.1089/wound.2020.1319] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/29/2021] [Indexed: 11/01/2022] Open
Abstract
Significance: Nonhealing wounds are an ever-growing global pandemic, with mortality rates and management costs exceeding many common cancers. Although our understanding of the molecular and cellular factors driving wound healing continues to grow, standards for diagnosing and evaluating wounds remain largely subjective and experiential, whereas therapeutic strategies fail to consistently achieve closure and clinicians are challenged to deliver individualized care protocols. There is a need to apply precision medicine practices to wound care by developing evidence-based approaches, which are predictive, prescriptive, and personalized. Recent Advances: Recent developments in "advanced" wound diagnostics, namely biomarkers (proteases, acute phase reactants, volatile emissions, and more) and imaging systems (ultrasound, autofluorescence, spectral imaging, and optical coherence tomography), have begun to revolutionize our understanding of the molecular wound landscape and usher in a modern age of therapeutic strategies. Herein, biomarkers and imaging systems with the greatest evidence to support their potential clinical utility are reviewed. Critical Issues: Although many potential biomarkers have been identified and several imaging systems have been or are being developed, more high-quality randomized controlled trials are necessary to elucidate the currently questionable role that these tools are playing in altering healing dynamics or predicting wound closure within the clinical setting. Future Directions: The literature supports the need for the development of effective point-of-care wound assessment tools, such as a platform diagnostic array that is capable of measuring multiple biomarkers at once. These, along with advances in telemedicine, synthetic biology, and "smart" wearables, will pave the way for the transformation of wound care into a precision medicine. Clinical Trial Registration number: NCT03148977.
Collapse
Affiliation(s)
- Maximillian A. Weigelt
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Hadar A. Lev-Tov
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marjana Tomic-Canic
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - W. David Lee
- Precision Healing, Inc., Newton, Massachusetts, USA
| | | | | | - Robert S. Kirsner
- Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Ira M. Herman
- Precision Healing, Inc., Newton, Massachusetts, USA
- Graduate School of Biomedical Sciences, Tufts University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
17
|
Chen D, Wu Z, Wu LN, Jiang J, Hu GN. Theaflavin Attenuates TBHP-Induced Endothelial Cells Oxidative Stress by Activating PI3K/AKT/Nrf2 and Accelerates Wound Healing in Rats. Front Bioeng Biotechnol 2022; 10:830574. [PMID: 35309982 PMCID: PMC8924520 DOI: 10.3389/fbioe.2022.830574] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/02/2022] [Indexed: 01/26/2023] Open
Abstract
The treatment of wounds remains a clinical challenge because of poor angiogenesis under the wound bed, and increasingly, the patients’ need for functional and aesthetically pleasing scars. Previous reports have shown that Theaflavin can induce angiogenesis and terminate the progression of ischemic cardiovascular disease, but limited therapy is available for the management of cutaneous wounds. In this study, our in vitro work discovered that human umbilical vein endothelial cells (HUVECs) exposed to Theaflavin can alleviate apoptosis and cell dysfunction induced by tert-butyl hydroperoxide (TBHP). The cellular activity of HUVECs were assessed by cell tube formation, migration and adhesion. Mechanistically, Theaflavin protected HUVECs from TBHP-stimulated cell apoptosis through the activation of the phosphatidylinositol-3-kinase (PI3K)/protein kinase B (AKT)/nuclear factor (erythroid-derived 2)-like 2 (Nrf2) axis, so Nrf2 silencing can partly eliminate the cytoprotective effect of Theaflavin treatment. In in vivo experiments, administering Theaflavin orally can enhance vascularization in regenerated tissues and accelerate wound healing. In summary, our data served as a novel evidence for the wound healing treatment with Theaflavin, and certified the potential mechanism of Theaflavin, which can be used as a potential agent for cutaneous wound therapy.
Collapse
Affiliation(s)
- Dalei Chen
- Department of Thyroid and Breast Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Zhijian Wu
- Department of Thyroid and Breast Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Lu-Ning Wu
- Department of Thyroid and Breast Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
| | - Jingtao Jiang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University, Wenzhou, China
| | - Gui-Nv Hu
- Department of Thyroid and Breast Surgery, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, China
- *Correspondence: Gui-Nv Hu,
| |
Collapse
|
18
|
Iddins CJ, DiCarlo AL, Ervin MD, Herrera-Reyes E, Goans RE. Cutaneous and local radiation injuries. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2022; 42:10.1088/1361-6498/ac241a. [PMID: 34488201 PMCID: PMC8785213 DOI: 10.1088/1361-6498/ac241a] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 09/06/2021] [Indexed: 06/13/2023]
Abstract
The threat of a large-scale radiological or nuclear (R/N) incident looms in the present-day climate, as noted most recently in an editorial in Scientific American (March 2021). These large-scale incidents are infrequent but affect large numbers of people. Smaller-scale R/N incidents occur more often, affecting smaller numbers of people. There is more awareness of acute radiation syndrome (ARS) in the medical community; however, ionising radiation-induced injuries to the skin are much less understood. This article will provide an overview of radiation-induced injuries to the skin, deeper tissues, and organs. The history and nomenclature; types and causes of injuries; pathophysiology; evaluation and diagnosis; current medical management; and current research of the evaluation and management are presented. Cutaneous radiation injuries (CRI) or local radiation injuries (LRI) may lead to cutaneous radiation syndrome, a sub-syndrome of ARS. These injuries may occur from exposure to radioactive particles suspended in the environment (air, soil, water) after a nuclear detonation or an improvised nuclear detonation (IND), a nuclear power plant incident, or an encounter with a radioactive dispersal or exposure device. These incidents may also result in a radiation-combined injury; a chemical, thermal, or traumatic injury, with radiation exposure. Skin injuries from medical diagnostic and therapeutic imaging, medical misadministration of nuclear medicine or radiotherapy, occupational exposures (including research) to radioactive sources are more common but are not the focus of this manuscript. Diagnosis and evaluation of injuries are based on the scenario, clinical picture, and dosimetry, and may be assisted through advanced imaging techniques. Research-based multidisciplinary therapies, both in the laboratory and clinical trial environments, hold promise for future medical management. Great progress is being made in recognising the extent of injuries, understanding their pathophysiology, as well as diagnosis and management; however, research gaps still exist.
Collapse
Affiliation(s)
- Carol J Iddins
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
| | - Andrea L DiCarlo
- Radiation and Nuclear Countermeasures Program (RNCP), National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Bethesda, MD, United States of America
| | - Mark D Ervin
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
| | | | - Ronald E Goans
- Radiation Emergency Assistance Center/Training Site (REAC/TS), Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, United States of America
- MJW Corporation, Buffalo, NY, United States of America
| |
Collapse
|
19
|
Bhamidipati T, Kumar M, Verma SS, Mohanty SK, Kacar S, Reese D, Martinez MM, Kamocka MM, Dunn KW, Sen CK, Singh K. Epigenetic basis of diabetic vasculopathy. Front Endocrinol (Lausanne) 2022; 13:989844. [PMID: 36568089 PMCID: PMC9780391 DOI: 10.3389/fendo.2022.989844] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 11/21/2022] [Indexed: 12/13/2022] Open
Abstract
Type 2 diabetes mellitus (T2DM) causes peripheral vascular disease because of which several blood-borne factors, including vital nutrients fail to reach the affected tissue. Tissue epigenome is sensitive to chronic hyperglycemia and is known to cause pathogenesis of micro- and macrovascular complications. These vascular complications of T2DM may perpetuate the onset of organ dysfunction. The burden of diabetes is primarily because of a wide range of complications of which nonhealing diabetic ulcers represent a major component. Thus, it is imperative that current research help recognize more effective methods for the diagnosis and management of early vascular injuries. This review addresses the significance of epigenetic processes such as DNA methylation and histone modifications in the evolution of macrovascular and microvascular complications of T2DM.
Collapse
Affiliation(s)
- Theja Bhamidipati
- Department of Vascular Surgery, Jefferson-Einstein Medical Center, Philadelphia, PA, United States
| | - Manishekhar Kumar
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sumit S. Verma
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sujit K. Mohanty
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sedat Kacar
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Diamond Reese
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Michelle M. Martinez
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Malgorzata M. Kamocka
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Kenneth W. Dunn
- Division of Nephrology, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Chandan K. Sen
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Kanhaiya Singh, ; Chandan K. Sen,
| | - Kanhaiya Singh
- Department of Surgery, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States
- *Correspondence: Kanhaiya Singh, ; Chandan K. Sen,
| |
Collapse
|
20
|
Corvino A, Varelli C, Cocco G, Corvino F, Catalano O. Seeing the unseen with superb microvascular imaging: Ultrasound depiction of normal dermis vessels. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:121-127. [PMID: 34761407 DOI: 10.1002/jcu.23068] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 08/28/2021] [Accepted: 09/05/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Current color- and power-Doppler techniques cannot demonstrate vascularization of the dermis. Aim of this prospective study was to investigate whether the new superb vascular imaging (SMI) technique improves the ultrasound (US) depiction of dermis vessels in healthy volunteers. SMI was compared side-by-side to conventional power-Doppler (PD) imaging. METHODS Thirty adult subjects (18 men and 12 women, mean age 45 years old) were evaluated with US at level of five body areas: forehead, forearm, palm, buttock, and thigh. The vascular index (VI) was employed to objectively quantify the difference between SMI and PD imaging in terms of dermis flow amount. RESULTS Forehead VI was higher for SMI than for PD in 93% of cases, forearm VI was higher for SMI than for PD in 97% of cases, palm VI was higher for SMI than for PD in 87% of cases, buttock VI was higher for SMI than for PD in 100% of cases, thigh VI was higher for SMI than for PD in 100% of cases. SMI-detected vascular signals in 100% of the body areas. PD failed to show any flow signals from the forehead in 23% of cases, forearm in 37% of cases, palm in 33% of cases, buttock in 47% of cases, and thigh in 50% of cases. CONCLUSION SMI can demonstrate normal dermis vascularization whereas conventional PD cannot. SMI is a sensitive and promising technique in the study of dermis abnormalities, particularly when quantifying the disease activity is important.
Collapse
Affiliation(s)
- Antonio Corvino
- Motor Science and Wellness Department, University of Naples "Parthenope", Naples, Italy
| | - Carlo Varelli
- Radiology Unit, Istituto Diagnostico Varelli, Naples, Italy
| | - Giulio Cocco
- Unit of Ultrasound in Internal Medicine, Department of Medicine and Aging Sciences, University of Chieti G d'Annunzio, Chieti, Italy
| | - Fabio Corvino
- Vascular and Interventional Radiology Department, Cardarelli Hospital, Naples, Italy
| | | |
Collapse
|
21
|
Khoong YM, Huang X, Gu S, Zan T. Imaging for thinned perforator flap harvest: current status and future perspectives. BURNS & TRAUMA 2021; 9:tkab042. [PMID: 34926708 PMCID: PMC8677592 DOI: 10.1093/burnst/tkab042] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/24/2021] [Indexed: 11/12/2022]
Abstract
With advances in anatomical knowledge and technology, increased interest has been directed towards reconstruction with enhanced aesthetic and functional outcomes. A myriad of thinned perforator flap harvest approaches have been developed for this purpose; however, concerns about jeopardizing their vascularity remain. To ensure optimum reconstructive outcome without hampering the flap's microcirculation, it is important to make good use of the existing advanced imaging modalities that can provide clear visualization of perforator branches, particularly in the adipose layer, and an accurate assessment of flap perfusion. Therefore, this review will highlight the imaging modalities that have been utilized for harvesting a thinned perforator flap from these two perspectives, along with future insights into creating both functionally and aesthetically satisfying, yet simultaneously safe, thinned perforator flaps for the best reconstructive outcomes for patients.
Collapse
Affiliation(s)
- Yi Min Khoong
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shuchen Gu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Tao Zan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| |
Collapse
|
22
|
Lee S, Rahul, Lukan J, Boyko T, Zelenova K, Makled B, Parsey C, Norfleet J, De S. A deep learning model for burn depth classification using ultrasound imaging. J Mech Behav Biomed Mater 2021; 125:104930. [PMID: 34781225 DOI: 10.1016/j.jmbbm.2021.104930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 10/11/2021] [Accepted: 10/24/2021] [Indexed: 11/28/2022]
Abstract
Identification of burn depth with sufficient accuracy is a challenging problem. This paper presents a deep convolutional neural network to classify burn depth based on altered tissue morphology of burned skin manifested as texture patterns in the ultrasound images. The network first learns a low-dimensional manifold of the unburned skin images using an encoder-decoder architecture that reconstructs it from ultrasound images of burned skin. The encoder is then re-trained to classify burn depths. The encoder-decoder network is trained using a dataset comprised of B-mode ultrasound images of unburned and burned ex vivo porcine skin samples. The classifier is developed using B-mode images of burned in situ skin samples obtained from freshly euthanized postmortem pigs. The performance metrics obtained from 20-fold cross-validation show that the model can identify deep-partial thickness burns, which is the most difficult to diagnose clinically, with 99% accuracy, 98% sensitivity, and 100% specificity. The diagnostic accuracy of the classifier is further illustrated by the high area under the curve values of 0.99 and 0.95, respectively, for the receiver operating characteristic and precision-recall curves. A post hoc explanation indicates that the classifier activates the discriminative textural features in the B-mode images for burn classification. The proposed model has the potential for clinical utility in assisting the clinical assessment of burn depths using a widely available clinical imaging device.
Collapse
Affiliation(s)
- Sangrock Lee
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| | - Rahul
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA.
| | - James Lukan
- Department of Surgery, University at Buffalo-State University of New York, Buffalo, NY, 14215, USA
| | - Tatiana Boyko
- Department of Surgery, University at Buffalo-State University of New York, Buffalo, NY, 14215, USA
| | - Kateryna Zelenova
- Department of Surgery, University at Buffalo-State University of New York, Buffalo, NY, 14215, USA
| | - Basiel Makled
- U.S. Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, 32826, USA
| | - Conner Parsey
- U.S. Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, 32826, USA
| | - Jack Norfleet
- U.S. Army Futures Command, Combat Capabilities Development Command Soldier Center STTC, Orlando, FL, 32826, USA
| | - Suvranu De
- Center for Modeling, Simulation and Imaging in Medicine, Rensselaer Polytechnic Institute, Troy, NY, 12180, USA
| |
Collapse
|
23
|
Experimental Study on Wound Area Measurement with Mobile Devices. SENSORS 2021; 21:s21175762. [PMID: 34502653 PMCID: PMC8433956 DOI: 10.3390/s21175762] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 08/25/2021] [Accepted: 08/25/2021] [Indexed: 01/26/2023]
Abstract
Healthcare treatments might benefit from advances in artificial intelligence and technological equipment such as smartphones and smartwatches. The presence of cameras in these devices with increasingly robust and precise pattern recognition techniques can facilitate the estimation of the wound area and other telemedicine measurements. Currently, telemedicine is vital to the maintenance of the quality of the treatments remotely. This study proposes a method for measuring the wound area with mobile devices. The proposed approach relies on a multi-step process consisting of image capture, conversion to grayscale, blurring, application of a threshold with segmentation, identification of the wound part, dilation and erosion of the detected wound section, identification of accurate data related to the image, and measurement of the wound area. The proposed method was implemented with the OpenCV framework. Thus, it is a solution for healthcare systems by which to investigate and treat people with skin-related diseases. The proof-of-concept was performed with a static dataset of camera images on a desktop computer. After we validated the approach’s feasibility, we implemented the method in a mobile application that allows for communication between patients, caregivers, and healthcare professionals.
Collapse
|
24
|
Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Understand the basics of biofilm infection and be able to distinguish between planktonic and biofilm modes of growth. 2. Have a working knowledge of conventional and emerging antibiofilm therapies and their modes of action as they pertain to wound care. 3. Understand the challenges associated with testing and marketing antibiofilm strategies and the context within which these strategies may have effective value. SUMMARY The Centers for Disease Control and Prevention estimate for human infectious diseases caused by bacteria with a biofilm phenotype is 65 percent and the National Institutes of Health estimate is closer to 80 percent. Biofilms are hostile microbial aggregates because, within their polymeric matrix cocoons, they are protected from antimicrobial therapy and attack from host defenses. Biofilm-infected wounds, even when closed, show functional deficits such as deficient extracellular matrix and impaired barrier function, which are likely to cause wound recidivism. The management of invasive wound infection often includes systemic antimicrobial therapy in combination with débridement of wounds to a healthy tissue bed as determined by the surgeon who has no way of visualizing the biofilm. The exceedingly high incidence of false-negative cultures for bacteria in a biofilm state leads to missed diagnoses of wound infection. The use of topical and parenteral antimicrobial therapy without wound débridement have had limited impact on decreasing biofilm infection, which remains a major problem in wound care. Current claims to manage wound biofilm infection rest on limited early-stage data. In most cases, such data originate from limited experimental systems that lack host immune defense. In making decisions on the choice of commercial products to manage wound biofilm infection, it is important to critically appreciate the mechanism of action and significance of the relevant experimental system. In this work, the authors critically review different categories of antibiofilm products, with emphasis on their strengths and limitations as evident from the published literature.
Collapse
Affiliation(s)
- Chandan K Sen
- From the Indiana University Health Comprehensive Wound Center, the Indiana Center for Regenerative Medicine & Engineering, and the Indiana University School of Medicine
| | - Sashwati Roy
- From the Indiana University Health Comprehensive Wound Center, the Indiana Center for Regenerative Medicine & Engineering, and the Indiana University School of Medicine
| | - Shomita S Mathew-Steiner
- From the Indiana University Health Comprehensive Wound Center, the Indiana Center for Regenerative Medicine & Engineering, and the Indiana University School of Medicine
| | - Gayle M Gordillo
- From the Indiana University Health Comprehensive Wound Center, the Indiana Center for Regenerative Medicine & Engineering, and the Indiana University School of Medicine
| |
Collapse
|
25
|
Ceballos-Francisco D, García-Carrillo N, Cuesta A, Esteban MÁ. Ultrasonography study of the skin wound healing process in gilthead seabream (Sparus aurata). JOURNAL OF FISH DISEASES 2021; 44:1091-1100. [PMID: 33760262 DOI: 10.1111/jfd.13370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 06/12/2023]
Abstract
This work aimed to carry out an in vivo study of the skin healing process in gilthead seabream (Sparus aurata) after being experimentally wounded. Firstly, the structure of normal skin was studied by real-time ultrasonography (Vevo Lab, VisualSonics) and light microscopy. Besides this, experimental wounds were made on the left flank of each fish with a circular biopsy punch (8 mm diameter) below the lateral line. The healing process was assessed on live fish at 0, 6, 11 and 23 days post-wounding using the real-time ultrasonography in B-mode and Power Doppler mode (Vevo 3100 FUJIFILM, VisualSonics). Through the ultrasonography images, both the skin structure and the evolution of the changes that wounds originated in the surrounding tissues were studied in vivo over time. Concomitantly, the pattern of neovascularization in the wounded area was followed during the healing process and it was demonstrated that, although the neovascularization started very early after the skin damage, it was increased in wounded areas from day 11 post-wounding onwards. The results obtained proved the utility and power of using ultrasounds in fish to evaluate in vivo complex biological processes in real time, which are difficult to study by other methodologies. The present data shed some light on the reparation of external injuries in aquatic vertebrates.
Collapse
Affiliation(s)
- Diana Ceballos-Francisco
- Immunobiology for Aquaculture Group, Department of Cell Biology and Histology, Faculty of Biology, University of Murcia, Murcia, Spain
| | - Nuria García-Carrillo
- Integrated Center for Biomedical Research (CEIB), Health Sciences Campus, University of Murcia, Murcia, Spain
| | - Alberto Cuesta
- Immunobiology for Aquaculture Group, Department of Cell Biology and Histology, Faculty of Biology, University of Murcia, Murcia, Spain
| | - María Ángeles Esteban
- Immunobiology for Aquaculture Group, Department of Cell Biology and Histology, Faculty of Biology, University of Murcia, Murcia, Spain
| |
Collapse
|
26
|
Abstract
Wound care is a multidisciplinary field with significant economic burden to our healthcare system. Not only does wound care cost the US healthcare system $20 billion annually, but wounds also remarkably impact the quality of life of patients; wounds pose significant risk of mortality, as the five-year mortality rate for diabetic foot ulcers (DFUs) and ischemic ulcers is notably higher compared to commonly encountered cancers such as breast and prostate. Although it is important to measure how wounds may or may not be improving over time, the only relative "marker" for this is wound area measurement-area measurements can help providers determine if a wound is on a healing or non-healing trajectory. Because wound area measurements are currently the only readily available "gold standard" for predicting healing outcomes, there is a pressing need to understand how other relative biomarkers may play a role in wound healing. Currently, wound care centers across the nation employ various techniques to obtain wound area measurements; length and width of a wound can be measured with a ruler, but this carries a high amount of inter- and intrapersonal error as well as uncertainty. Acetate tracings could be used to limit the amount of error but do not account for depth, thereby making them inaccurate. Here, we discuss current imaging modalities and how they can serve to accurately measure wound size and serve as useful adjuncts in wound assessment. Moreover, new imaging modalities are also discussed and how up-and-coming technologies can provide important information on "biomarkers" for wound healing.
Collapse
|
27
|
Liu H, Yue K, Cheng S, Li W, Fu Z. A Framework for Automatic Burn Image Segmentation and Burn Depth Diagnosis Using Deep Learning. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:5514224. [PMID: 33880130 PMCID: PMC8046560 DOI: 10.1155/2021/5514224] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/24/2021] [Accepted: 03/22/2021] [Indexed: 12/02/2022]
Abstract
Burn is a common traumatic disease with high morbidity and mortality. The treatment of burns requires accurate and reliable diagnosis of burn wounds and burn depth, which can save lives in some cases. However, due to the complexity of burn wounds, the early diagnosis of burns lacks accuracy and difference. Therefore, we use deep learning technology to automate and standardize burn diagnosis to reduce human errors and improve burn diagnosis. First, the burn dataset with detailed burn area segmentation and burn depth labelling is created. Then, an end-to-end framework based on deep learning method for advanced burn area segmentation and burn depth diagnosis is proposed. The framework is firstly used to segment the burn area in the burn images. On this basis, the calculation of the percentage of the burn area in the total body surface area (TBSA) can be realized by extending the network output structure and the labels of the burn dataset. Then, the framework is used to segment multiple burn depth areas. Finally, the network achieves the best result with IOU of 0.8467 for the segmentation of burn and no burn area. And for multiple burn depth areas segmentation, the best average IOU is 0.5144.
Collapse
Affiliation(s)
- Hao Liu
- Key Laboratory of RF Circuits and Systems, Ministry of Education, Hangzhou Dianzi University, Zhejiang, China
| | - Keqiang Yue
- Key Laboratory of RF Circuits and Systems, Ministry of Education, Hangzhou Dianzi University, Zhejiang, China
| | - Siyi Cheng
- Key Laboratory of RF Circuits and Systems, Ministry of Education, Hangzhou Dianzi University, Zhejiang, China
| | - Wenjun Li
- Key Laboratory of RF Circuits and Systems, Ministry of Education, Hangzhou Dianzi University, Zhejiang, China
| | - Zhihui Fu
- The People's Hospital of Jianggan District, Hangzhou, Zhejiang, China
| |
Collapse
|
28
|
Topical Nifedipine for the Treatment of Pressure Ulcer: A Randomized, Placebo-Controlled Clinical Trial. Am J Ther 2021; 28:e41-e51. [PMID: 31241491 DOI: 10.1097/mjt.0000000000000936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Effect of nifedipine on pressure ulcer (PU) healing has not been evaluated in the human subjects yet. STUDY QUESTION In this study, the effect of topical application of nifedipine 3% ointment on PU healing in critically ill patients was investigated. STUDY DESIGN This was a randomized, double-blind, placebo-controlled clinical. MEASURES AND OUTCOMES In this study, 200 patients with stage I or II PU according to 2-digit Stirling Pressure Ulcer Severity Scale were randomized to receive topical nifedipine 3% ointment or placebo twice daily for 14 days. Changes in the size and stage of the ulcers were considered as primary outcome of the study. The stage of the ulcers at baseline and on day 7 and day 14 of study was determined by using 2-digit stirling scale. In addition, the surface area of the wounds was estimated by multiplying width by length. RESULTS In total, 83 patients in each group completed the study. The groups were matched for the baseline stage and size of PUs. Mean decrease in the stage of PU in the nifedipine group was significantly higher than the placebo group on day 7 (-1.71 vs. -0.16, respectively, P < 0.001) and day 14 (-0.78 vs. -0.09, respectively, P < 0.001). Furthermore, the mean decrease in the surface area of PU was significantly higher in the nifedipine group compared with the placebo group on day 7 (-1.44 vs. -0.32, respectively, P < 0.001) and day 14 (-2.51 vs. -0.24, respectively, P < 0.001) of study. CONCLUSIONS Topical application of nifedipine 3% ointment for 14 days significantly improved the healing process of stage I or II PUs in critically ill patients.
Collapse
|
29
|
Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020; 17:1840-1856. [PMID: 32830443 PMCID: PMC7949456 DOI: 10.1111/iwj.13474] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
Collapse
Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of MedicineUniversity of Southern California, Los AngelesCaliforniaCaliforniaCanada
| | - Keith Harding
- School of MedicineCardiff UniversityWalesUK
- A*STARSingapore
| |
Collapse
|
30
|
Gnyawali SC, Sinha M, El Masry MS, Wulff B, Ghatak S, Soto-Gonzalez F, Wilgus TA, Roy S, Sen CK. High resolution ultrasound imaging for repeated measure of wound tissue morphometry, biomechanics and hemodynamics under fetal, adult and diabetic conditions. PLoS One 2020; 15:e0241831. [PMID: 33227015 PMCID: PMC7682876 DOI: 10.1371/journal.pone.0241831] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 10/21/2020] [Indexed: 02/07/2023] Open
Abstract
Non-invasive, repeated interrogation of the same wound is necessary to understand the tissue repair continuum. In this work, we sought to test the significance of non-invasive high-frequency high-resolution ultrasound technology for such interrogation. High-frequency high-resolution ultrasound imaging was employed to investigate wound healing under fetal and adult conditions. Quantitative tissue cellularity and elastic strain was obtained for visualization of unresolved inflammation using Vevo strain software. Hemodynamic properties of the blood flow in the artery supplying the wound-site were studied using color Doppler flow imaging. Non-invasive monitoring of fetal and adult wound healing provided unprecedented biomechanical and functional insight. Fetal wounds showed highly accelerated closure with transient perturbation of wound tissue cellularity. Fetal hemodynamics was unique in that sharp fall in arterial pulse pressure (APP) which was rapidly restored within 48h post-wounding. In adults, APP transiently increased post-wounding before returning to the pre-wounding levels by d10 post-wounding. The pattern of change in the elasticity of wound-edge tissue of diabetics was strikingly different. Severe strain acquired during the early inflammatory phase persisted with a slower recovery of elasticity compared to that of the non-diabetic group. Wound bed of adult diabetic mice (db/db) showed persistent hypercellularity compared to littermate controls (db/+) indicative of prolonged inflammation. Normal skin strain of db/+ and db/db were asynchronous. In db/db, severe strain acquired during the early inflammatory phase persisted with a slower recovery of elasticity compared to that of non-diabetics. This study showcases a versatile clinically relevant imaging platform suitable for real-time analyses of functional wound healing.
Collapse
Affiliation(s)
- Surya C. Gnyawali
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Mithun Sinha
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Mohamed S. El Masry
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
- Department of Plastic and Reconstructive Surgery, Zagazig University, Zagazig, Egypt
| | - Brian Wulff
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Subhadip Ghatak
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Fidel Soto-Gonzalez
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Traci A. Wilgus
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
| | - Sashwati Roy
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Chandan K. Sen
- Department of Surgery, Davis Heart and Lung Research Institute, Center for Regenerative Medicine & Cell-Based Therapies, The Ohio State University Wexner Medical Center, Columbus, OH, United States of America
- Department of Surgery, IUH Comprehensive Wound Center, Indiana Center for Regenerative Medicine and Engineering, Indiana University School of Medicine, Indianapolis, IN, United States of America
| |
Collapse
|
31
|
Saiko G, Lombardi P, Au Y, Queen D, Armstrong D, Harding K. Hyperspectral imaging in wound care: A systematic review. Int Wound J 2020. [PMID: 32830443 DOI: 10.1111/iwj.13474.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Multispectral and hyperspectral imaging (HSI) are emerging imaging techniques with the potential to transform the way patients with wounds are cared for, but it is not clear whether current systems are capable of delivering real-time tissue characterisation and treatment guidance. We conducted a systematic review of HSI systems that have been assessed in patients, published over the past 32 years. We analysed 140 studies, including 10 different HSI systems. Current in vivo HSI systems generate a tissue oxygenation map. Tissue oxygenation measurements may help to predict those patients at risk of wound formation or delayed healing. No safety concerns were reported in any studies. A small number of studies have demonstrated the capabilities of in vivo label-free HSI, but further work is needed to fully integrate it into the current clinical workflow for different wound aetiologies. As an emerging imaging modality for medical applications, HSI offers great potential for non-invasive disease diagnosis and guidance when treating patients with both acute and chronic wounds.
Collapse
Affiliation(s)
| | | | | | | | - David Armstrong
- Keck School of Medicine, University of Southern California, Los Angeles, California, California, Canada
| | - Keith Harding
- School of Medicine, Cardiff University, Wales, UK.,A*STAR, Singapore
| |
Collapse
|
32
|
|
33
|
Asif M, Chin AGM, Lagziel T, Klifto KM, Modica AD, Duraes E, Caffrey J, Hultman CS. The Added Benefit of Combining Laser Doppler Imaging With Clinical Evaluation in Determining the Need for Excision of Indeterminate-Depth Burn Wounds. Cureus 2020; 12:e8774. [PMID: 32742824 PMCID: PMC7384459 DOI: 10.7759/cureus.8774] [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: 06/03/2020] [Accepted: 06/22/2020] [Indexed: 11/23/2022] Open
Abstract
Background Managing indeterminate-depth burn wounds remains challenging. Laser Doppler Imaging (LDI) has been validated for burn wound depth and can influence the clinical assessment. Our study investigated the value of LDI as an adjunct in determining the need for excision. Methods Seventy American Burn Association (ABA)-verified burn centers were surveyed. A controlled pre-test assessment without LDI and post-test assessment with LDI of 100 indeterminate-depth burn wounds was conducted to evaluate the influence on the clinical judgment among different health professionals. Relative risk, analysis of variance (ANOVA), paired t-test, and intention-to-treat were used for analysis. A p-value [Formula: see text] 0.05 was considered significant. Results Among 32 burn centers, three confirmed using LDI. Six thousand grader-image interactions were analyzed. There was a significant difference in the predictive accuracy for pre-LDI and post-LDI assessments when all graders were considered (51.9% ± 7.0 vs. 72.9% ± 7.9; p < 0.0001). Post-LDI assessment added 20.9% more accuracy than the pre-LDI assessment. The post-LDI assessment was 1.4 times more likely to correctly predict the need for excision and skin-grafting than the pre-LDI assessment. All groups had an improved performance post-LDI: Group 1 (physicians), 51.9 ± 7.5 versus 76.4±5; Group 2 (nurses), 52.1 ± 6.1 versus 72.7±7.7; and Group 3 (others), 51.7 ± 9.2 versus 68.6 ± 10.1. No statistical difference was observed between groups (p = 0.92). Conclusion LDI makes the clinical examination of indeterminate-depth burn wounds more accurate. For every five LDI evaluations performed, one assessor changed their treatment plan as a result of this imaging technique. LDI is cost-effective and increases the accuracy of determining the severity of indeterminate-depth burn wounds.
Collapse
Affiliation(s)
- Mohammed Asif
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | | | - Tomer Lagziel
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
- Medicine, Tel-Aviv University, Sackler School of Medicine, Tel-Aviv, ISR
| | - Kevin M Klifto
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Ashley D Modica
- Plastic Surgery, University of South Florida (USF) Health, Tampa, USA
| | - Eliana Duraes
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Julie Caffrey
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Charles S Hultman
- Plastic Surgery, Johns Hopkins University School of Medicine, Baltimore, USA
| |
Collapse
|
34
|
Li S, Mohamedi AH, Senkowsky J, Nair A, Tang L. Imaging in Chronic Wound Diagnostics. Adv Wound Care (New Rochelle) 2020; 9:245-263. [PMID: 32226649 PMCID: PMC7099416 DOI: 10.1089/wound.2019.0967] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/14/2019] [Indexed: 01/18/2023] Open
Abstract
Significance: Chronic wounds affect millions of patients worldwide, placing a huge burden on health care resources. Although significant progress has been made in the development of wound treatments, very few advances have been made in wound diagnosis. Recent Advances: Standard imaging methods like computed tomography, single-photon emission computed tomography, magnetic resonance imaging, terahertz imaging, and ultrasound imaging have been widely employed in wound diagnostics. A number of noninvasive optical imaging modalities like optical coherence tomography, near-infrared spectroscopy, laser Doppler imaging, spatial frequency domain imaging, digital camera imaging, and thermal and fluorescence imaging have emerged over the years. Critical Issues: While standard diagnostic wound imaging modalities provide valuable information, they cannot account for dynamic changes in the wound environment. In addition, they lack the capability to predict the healing outcome. Thus, there remains a pressing need for more efficient methods that can not only indicate the current state of the wound but also help determine whether the wound is on track to heal normally. Future Directions: Many imaging probes have been fabricated and shown to provide real-time assessment of tissue microenvironment and inflammatory responses in vivo. These probes have been demonstrated to noninvasively detect various changes in the wound environment, which include tissue pH, reactive oxygen species, fibrin deposition, matrix metalloproteinase production, and macrophage accumulation. This review summarizes the creation of these probes and their potential implications in wound monitoring.
Collapse
Affiliation(s)
- Shuxin Li
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
| | - Ali H. Mohamedi
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
| | | | | | - Liping Tang
- Department of Bioengineering, University of Texas at Arlington, Arlington, Texas
| |
Collapse
|
35
|
Abstract
Burn injuries are under-appreciated injuries that are associated with substantial morbidity and mortality. Burn injuries, particularly severe burns, are accompanied by an immune and inflammatory response, metabolic changes and distributive shock that can be challenging to manage and can lead to multiple organ failure. Of great importance is that the injury affects not only the physical health, but also the mental health and quality of life of the patient. Accordingly, patients with burn injury cannot be considered recovered when the wounds have healed; instead, burn injury leads to long-term profound alterations that must be addressed to optimize quality of life. Burn care providers are, therefore, faced with a plethora of challenges including acute and critical care management, long-term care and rehabilitation. The aim of this Primer is not only to give an overview and update about burn care, but also to raise awareness of the ongoing challenges and stigmata associated with burn injuries.
Collapse
Affiliation(s)
- Marc G Jeschke
- Ross Tilley Burn Center, Department of Surgery, Sunnybrook Health Science Center, Toronto, Ontario, Canada.
- Departments of Surgery and Immunology, University of Toronto, Toronto, Ontario, Canada.
| | - Margriet E van Baar
- Association of Dutch Burn Centres, Maasstad Hospital, Rotterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Public Health, Rotterdam, Netherlands
| | - Mashkoor A Choudhry
- Burn and Shock Trauma Research Institute, Alcohol Research Program, Stritch School of Medicine, Loyola University Chicago Health Sciences Division, Maywood, IL, USA
| | - Kevin K Chung
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Nicole S Gibran
- Department of Surgery, University of Washington School of Medicine, Seattle, WA, USA
| | - Sarvesh Logsetty
- Departments of Surgery and Psychiatry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| |
Collapse
|
36
|
Korambayil P, Ambookan P, Karangath R. Portable indocyanine green perfusion assessment: An adjunct to visual assessment in burn wound healing in second-degree burns. INDIAN JOURNAL OF BURNS 2019. [DOI: 10.4103/ijb.ijb_5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
37
|
Korambayil P, Ambookan P, Karangath R. Role of infrared thermography in the assessment of burn wounds treated with and without hyperbaric oxygen therapy. INDIAN JOURNAL OF BURNS 2019. [DOI: 10.4103/ijb.ijb_23_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
38
|
Karim AS, Yan A, Ocotl E, Bennett DD, Wang Z, Kendziorski C, Gibson ALF. Discordance between histologic and visual assessment of tissue viability in excised burn wound tissue. Wound Repair Regen 2018; 27:150-161. [PMID: 30585657 DOI: 10.1111/wrr.12692] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/03/2018] [Accepted: 12/04/2018] [Indexed: 12/27/2022]
Abstract
The regenerative capacity of burn wounds, and the need for surgical intervention, depends on wound depth. Clinical visual assessment is considered the gold standard for burn depth assessment but it remains a subjective and inaccurate method for tissue evaluation. The purpose of this study was to compare visual assessment with microscopic and molecular techniques for human burn depth determination, and illustrate differences in the evaluation of tissue for potential regenerative capacity. Using intraoperative visual assessment, patients were identified as having deep partial thickness or full thickness burn wounds. Tangential excisions of burn tissue were processed with hematoxylin and eosin to visualize tissue morphology, lactate dehydrogenase assay to ascertain cellular viability, and Keratin-15 and Ki67 to identify epidermal progenitor cells and proliferative capacity, respectively. RNA from deep partial and full thickness burn tissue as well as normal tissue controls were submitted for RNA sequencing. Lactate dehydrogenase, Keratin-15, and Ki67 were found throughout the excised burn wound tissue in both deep partial thickness burn tissues and in the second tangential excision of full thickness burn tissues. RNA sequencing demonstrated regenerative capacity in both deep partial and full thickness burn tissue, however a greater capacity for regeneration was present in deep partial thickness compared with full thickness burn tissues. In this study, we highlight the discordance that exists between the intraoperative clinical identification of burn injury depth, and microscopic and molecular determination of viability and regenerative capacity. Current methods utilizing visual assessment for depth of injury are imprecise, and can lead to removal of viable tissue. Additionally, hematoxylin and eosin microscopic analysis should not be used as the sole method in research or clinical determination of depth, as there are no differences in staining between viable and nonviable tissue.
Collapse
Affiliation(s)
- Aos S Karim
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Amy Yan
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Edgar Ocotl
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Daniel D Bennett
- Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Ziyue Wang
- Department of Statistics, University of Wisconsin, Madison, Wisconsin
| | - Christina Kendziorski
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin
| | - Angela L F Gibson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
39
|
Menchisheva Y, Mirzakulova U, Yui R. Use of platelet-rich plasma to facilitate wound healing. Int Wound J 2018; 16:343-353. [PMID: 30440099 DOI: 10.1111/iwj.13034] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 10/17/2018] [Accepted: 10/21/2018] [Indexed: 12/20/2022] Open
Abstract
Platelet-rich plasma (PRP) is widely used nowadays in different fields of medicine, affecting physiological processes including tissue regeneration. The use of PRP in maxillofacial surgical interventions and its efficiency in the improvement of postoperative wound healing were analysed. Patients undergoing plastic and reconstructive surgeries in the maxillofacial region were recruited: 50 patients were enrolled into a control group (received no PPRP injection) and 50 patients were enrolled into a treatment group, where PRP was applied during the surgical procedure. Evaluation of treatment outcomes was carried out by determination of IL-1β, TNFα, and IL-6 cytokines levels in the wound-drain fluid. The stages of wound healing were assessed by cytological analyses and ultrasound within a month period. The use of the PRP has substantially positive effects, contributing to the improvement of the healing process. In the treatment group, fibroblasts, macrophages, and collagen fibres appeared and their quantities increased earlier than when compared with control group patients. The concentration of IL-1β and TNFα in wound fluid on day 1 and day 5 after operation was higher for the treatment group as opposed to the control group, which was linked to the influence of PRP on inflammatory and granulation phases of the healing process. An ultrasound examination showed less oedema and infiltration in the tissues around the wound of the treatment group.
Collapse
Affiliation(s)
- Yuliya Menchisheva
- Department of Surgical Dentistry, S.D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Ulmeken Mirzakulova
- Department of Surgical Dentistry, S.D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - Rudolf Yui
- Department of Hystology, S.D. Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| |
Collapse
|
40
|
Radowsky JS, Neely R, Forsberg JA, Lisboa FA, Dente CJ, Elster EA, Crane NJ. Preclosure spectroscopic differences between healed and dehisced traumatic wounds. PLoS One 2018; 13:e0204453. [PMID: 30261011 PMCID: PMC6160065 DOI: 10.1371/journal.pone.0204453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 09/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The complexity and severity of traumatic wounds in military and civilian trauma demands improved wound assessment, before, during, and after treatment. Here, we explore the potential of 3 charge-coupled device (3CCD) imaging values to distinguish between traumatic wounds that heal following closure and those that fail. Previous studies demonstrate that normalized 3CCD imaging values exhibit a high correlation with oxygen saturation and allow for comparison of values between diverse clinical settings, including utilizing different equipment and lighting. METHODS We screened 119 patients at Walter Reed National Military Medical Center and at Grady Memorial Hospital with at least one traumatic extremity wound of ≥ 75 cm2. We collected images of each wound during each débridement surgery for a total of 66 patients. An in-house written computer application selected a region of interest in the images, separated the pixel color values, calculated relative values, and normalized them. We followed patients until the enrolled wounds were surgically closed, quantifying the number of wounds that dehisced (defined as wound failure or infection requiring return to the operating room after closure) or healed. RESULTS Wound failure occurred in 20% (19 of 96) of traumatic wounds. Normalized intensity values for patients with wounds that healed successfully were, on average, significantly different from values for patients with wounds that failed (p ≤ 0.05). Simple thresholding models and partial least squares discriminant analysis models performed poorly. However, a hierarchical cluster analysis model created with 17 variables including 3CCD data, wound surface area, and time from injury predicts wound failure with 76.9% sensitivity, 76.5% specificity, 76.6% accuracy, and a diagnostic odds ratio of 10.8 (95% confidence interval: 2.6-45.9). CONCLUSIONS Imaging using 3CCD technology may provide a non-invasive and cost-effective method of aiding surgeons in deciding if wounds are ready for closure and could potentially decrease the number of required débridements and hospital days. The process may be automated to provide real-time feedback in the operating room and clinic. The low cost and small size of the cameras makes this technology attractive for austere and shipboard environments where space and weight are at a premium.
Collapse
Affiliation(s)
- Jason S. Radowsky
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (USUHS-Walter Reed Surgery), Bethesda, Maryland, United States of America
- * E-mail:
| | - Romon Neely
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (USUHS-Walter Reed Surgery), Bethesda, Maryland, United States of America
| | - Jonathan A. Forsberg
- Orthopaedics, USUHS-Walter Reed Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland, United States of America
- Orthopaedics, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Felipe A. Lisboa
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (USUHS-Walter Reed Surgery), Bethesda, Maryland, United States of America
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, United States of America
- Surgical Critical Care Initiative, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Christopher J. Dente
- Surgical Critical Care Initiative, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
- Trauma/Surgical Critical Care, Grady Memorial Hospital, Atlanta, Georgia, United States of America
| | - Eric A. Elster
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (USUHS-Walter Reed Surgery), Bethesda, Maryland, United States of America
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, United States of America
- Surgical Critical Care Initiative, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
| | - Nicole J. Crane
- Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center (USUHS-Walter Reed Surgery), Bethesda, Maryland, United States of America
- Regenerative Medicine Department, Naval Medical Research Center, Silver Spring, Maryland, United States of America
| |
Collapse
|
41
|
Wahabzada M, Besser M, Khosravani M, Kuska MT, Kersting K, Mahlein AK, Stürmer E. Monitoring wound healing in a 3D wound model by hyperspectral imaging and efficient clustering. PLoS One 2017; 12:e0186425. [PMID: 29216188 PMCID: PMC5720791 DOI: 10.1371/journal.pone.0186425] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 09/29/2017] [Indexed: 11/18/2022] Open
Abstract
Wound healing is a complex and dynamic process with different distinct and overlapping phases from homeostasis, inflammation and proliferation to remodelling. Monitoring the healing response of injured tissue is of high importance for basic research and clinical practice. In traditional application, biological markers characterize normal and abnormal wound healing. Understanding functional relationships of these biological processes is essential for developing new treatment strategies. However, most of the present techniques (in vitro or in vivo) include invasive microscopic or analytical tissue sampling. In the present study, a non-invasive alternative for monitoring processes during wound healing is introduced. Within this context, hyperspectral imaging (HSI) is an emerging and innovative non-invasive imaging technique with different opportunities in medical applications. HSI acquires the spectral reflectance of an object, depending on its biochemical and structural characteristics. An in-vitro 3-dimensional (3-D) wound model was established and incubated without and with acute and chronic wound fluid (AWF, CWF), respectively. Hyperspectral images of each individual specimen of this 3-D wound model were assessed at day 0/5/10 in vitro, and reflectance spectra were evaluated. For analysing the complex hyperspectral data, an efficient unsupervised approach for clustering massive hyperspectral data was designed, based on efficient hierarchical decomposition of spectral information according to archetypal data points. It represents, to the best of our knowledge, the first application of an advanced Data Mining approach in context of non-invasive analysis of wounds using hyperspectral imagery. By this, temporal and spatial pattern of hyperspectral clusters were determined within the tissue discs and among the different treatments. Results from non-invasive imaging were compared to the number of cells in the various clusters, assessed by Hematoxylin/Eosin (H/E) staining. It was possible to correlate cell quantity and spectral reflectance during wound closure in a 3-D wound model in vitro.
Collapse
Affiliation(s)
| | - Manuela Besser
- Department of Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
| | - Milad Khosravani
- Department of Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
| | | | - Kristian Kersting
- CS Department, Technical University of Darmstadt, Darmstadt, Germany
| | - Anne-Katrin Mahlein
- INRES-Phytomedicine, University of Bonn, Nussalle 9, Bonn, Germany
- Institute of Sugar Beet Research (IfZ), Göttingen, Germany
| | - Ewa Stürmer
- Department of Translational Wound Research, Centre for Biomedical Education and Research (ZBAF), University Witten/Herdecke, Witten, Germany
| |
Collapse
|
42
|
Rink CL, Wernke MM, Powell HM, Tornero M, Gnyawali SC, Schroeder RM, Kim JY, Denune JA, Albury AW, Gordillo GM, Colvin JM, Sen CK. Standardized Approach to Quantitatively Measure Residual Limb Skin Health in Individuals with Lower Limb Amputation. Adv Wound Care (New Rochelle) 2017; 6:225-232. [PMID: 28736682 DOI: 10.1089/wound.2017.0737] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 05/01/2017] [Indexed: 12/29/2022] Open
Abstract
Objective: (1) Develop a standardized approach to quantitatively measure residual limb skin health. (2) Report reference residual limb skin health values in people with transtibial and transfemoral amputation. Approach: Residual limb health outcomes in individuals with transtibial (n = 5) and transfemoral (n = 5) amputation were compared to able-limb controls (n = 4) using noninvasive imaging (hyperspectral imaging and laser speckle flowmetry) and probe-based approaches (laser doppler flowmetry, transcutaneous oxygen, transepidermal water loss, surface electrical capacitance). Results: A standardized methodology that employs noninvasive imaging and probe-based approaches to measure residual limb skin health are described. Compared to able-limb controls, individuals with transtibial and transfemoral amputation have significantly lower transcutaneous oxygen tension, higher transepidermal water loss, and higher surface electrical capacitance in the residual limb. Innovation: Residual limb health as a critical component of prosthesis rehabilitation for individuals with lower limb amputation is understudied in part due to a lack of clinical measures. Here, we present a standardized approach to measure residual limb health in people with transtibial and transfemoral amputation. Conclusion: Technology advances in noninvasive imaging and probe-based measures are leveraged to develop a standardized approach to quantitatively measure residual limb health in individuals with lower limb loss. Compared to able-limb controls, resting residual limb physiology in people that have had transfemoral or transtibial amputation is characterized by lower transcutaneous oxygen tension and poorer skin barrier function.
Collapse
Affiliation(s)
- Cameron L. Rink
- Department of Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Heather M. Powell
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio
| | - Mark Tornero
- Department of Physical Medicine and Rehabilitation, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Surya C. Gnyawali
- Department of Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Jayne Y. Kim
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
- Department of Materials Science and Engineering, The Ohio State University, Columbus, Ohio
| | | | | | - Gayle M. Gordillo
- Department of Plastic Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | | | - Chandan K. Sen
- Department of Surgery, Comprehensive Wound Center and Davis Heart and Lung Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio
| |
Collapse
|
43
|
Retooling Laser Speckle Contrast Analysis Algorithm to Enhance Non-Invasive High Resolution Laser Speckle Functional Imaging of Cutaneous Microcirculation. Sci Rep 2017; 7:41048. [PMID: 28106129 PMCID: PMC5247692 DOI: 10.1038/srep41048] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 12/15/2016] [Indexed: 12/30/2022] Open
Abstract
Cutaneous microvasculopathy complicates wound healing. Functional assessment of gated individual dermal microvessels is therefore of outstanding interest. Functional performance of laser speckle contrast imaging (LSCI) systems is compromised by motion artefacts. To address such weakness, post-processing of stacked images is reported. We report the first post-processing of binary raw data from a high-resolution LSCI camera. Sharp images of low-flowing microvessels were enabled by introducing inverse variance in conjunction with speckle contrast in Matlab-based program code. Extended moving window averaging enhanced signal-to-noise ratio. Functional quantitative study of blood flow kinetics was performed on single gated microvessels using a free hand tool. Based on detection of flow in low-flow microvessels, a new sharp contrast image was derived. Thus, this work presents the first distinct image with quantitative microperfusion data from gated human foot microvasculature. This versatile platform is applicable to study a wide range of tissue systems including fine vascular network in murine brain without craniotomy as well as that in the murine dorsal skin. Importantly, the algorithm reported herein is hardware agnostic and is capable of post-processing binary raw data from any camera source to improve the sensitivity of functional flow data above and beyond standard limits of the optical system.
Collapse
|