1
|
Chen N, Li M, Yang J, Wang P, Song G, Wang H. Slow-sculpting graphene oxide/alginate gel loaded with platelet-rich plasma to promote wound healing in rats. Front Bioeng Biotechnol 2024; 12:1334087. [PMID: 38390356 PMCID: PMC10882075 DOI: 10.3389/fbioe.2024.1334087] [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: 11/06/2023] [Accepted: 01/25/2024] [Indexed: 02/24/2024] Open
Abstract
Wounds, especially chronic wounds, have become an important problem that endangers human health. At present, there are many repair methods, and among them combines materials science and biology is one of the important repair methods. This study explored the preparation method, physicochemical properties, biological activity and safety of Platelet-Rich plasma (PRP)-loaded slow-sculpting graphene oxide (GO)/alginate gel, and applied it to acute full-thickness skin defect wounds in rats to observe its role in wound healing. The results show that the slow-sculpting GO/alginate gel has excellent plasticity and is suitable for a variety of irregularly shaped wounds. At the same time, its porous structure and water content can maintain the activity of platelets and their released growth factors in PRP, thereby promoting wound collagen synthesis and angiogenesis to accelerate wound healing. This indicates that the slow-sculpting GO/alginate gel is an excellent loading material for PRP, and the combination of the two may become one of the methods to promote wound repair.
Collapse
Affiliation(s)
- Ningjie Chen
- Shandong University, Jinan, Shandong, China
- Department of Burns and Plastic Surgery, Weihai Municipal Hospital, Weihai, China
| | - Mengjie Li
- Binzhou Medical University, Binzhou, Shandong, China
| | - Jincun Yang
- Department of Burns and Plastic Surgery, Weihai Municipal Hospital, Weihai, China
| | - Peng Wang
- Ministry of Scientific and Technological Innovation, Yantai Hi-tech Industrial Development Zone, Yantai, Shandong, China
| | - Guodong Song
- Shandong University, Jinan, Shandong, China
- Department of Burns and Orthopedic Surgery, Jinan Central Hospital, Jinan, Shandong, China
| | - Haitao Wang
- Department of Burns and Plastic Surgery, Weihai Municipal Hospital, Weihai, China
| |
Collapse
|
2
|
Alabdulhafith M, Ba Mahel AS, Samee NA, Mahmoud NF, Talaat R, Muthanna MSA, Nassef TM. Automated wound care by employing a reliable U-Net architecture combined with ResNet feature encoders for monitoring chronic wounds. Front Med (Lausanne) 2024; 11:1310137. [PMID: 38357646 PMCID: PMC10865496 DOI: 10.3389/fmed.2024.1310137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/02/2024] [Indexed: 02/16/2024] Open
Abstract
Quality of life is greatly affected by chronic wounds. It requires more intensive care than acute wounds. Schedule follow-up appointments with their doctor to track healing. Good wound treatment promotes healing and fewer problems. Wound care requires precise and reliable wound measurement to optimize patient treatment and outcomes according to evidence-based best practices. Images are used to objectively assess wound state by quantifying key healing parameters. Nevertheless, the robust segmentation of wound images is complex because of the high diversity of wound types and imaging conditions. This study proposes and evaluates a novel hybrid model developed for wound segmentation in medical images. The model combines advanced deep learning techniques with traditional image processing methods to improve the accuracy and reliability of wound segmentation. The main objective is to overcome the limitations of existing segmentation methods (UNet) by leveraging the combined advantages of both paradigms. In our investigation, we introduced a hybrid model architecture, wherein a ResNet34 is utilized as the encoder, and a UNet is employed as the decoder. The combination of ResNet34's deep representation learning and UNet's efficient feature extraction yields notable benefits. The architectural design successfully integrated high-level and low-level features, enabling the generation of segmentation maps with high precision and accuracy. Following the implementation of our model to the actual data, we were able to determine the following values for the Intersection over Union (IOU), Dice score, and accuracy: 0.973, 0.986, and 0.9736, respectively. According to the achieved results, the proposed method is more precise and accurate than the current state-of-the-art.
Collapse
Affiliation(s)
- Maali Alabdulhafith
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Abduljabbar S. Ba Mahel
- School of Life Science, University of Electronic Science and Technology of China, Chengdu, China
| | - Nagwan Abdel Samee
- Department of Information Technology, College of Computer and Information Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Noha F. Mahmoud
- Rehabilitation Sciences Department, Health and Rehabilitation Sciences College, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Rawan Talaat
- Biotechnology and Genetics Department, Agriculture Engineering, Ain Shams University, Cairo, Egypt
| | | | - Tamer M. Nassef
- Computer and Software Engineering Department, Engineering College, Misr University for Science and Technology, 6th of October, Egypt
| |
Collapse
|
3
|
Tabja Bortesi JP, Ranisau J, Di S, McGillion M, Rosella L, Johnson A, Devereaux PJ, Petch J. Machine Learning Approaches for the Image-Based Identification of Surgical Wound Infections: Scoping Review. J Med Internet Res 2024; 26:e52880. [PMID: 38236623 PMCID: PMC10835585 DOI: 10.2196/52880] [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: 09/18/2023] [Revised: 11/09/2023] [Accepted: 12/12/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Surgical site infections (SSIs) occur frequently and impact patients and health care systems. Remote surveillance of surgical wounds is currently limited by the need for manual assessment by clinicians. Machine learning (ML)-based methods have recently been used to address various aspects of the postoperative wound healing process and may be used to improve the scalability and cost-effectiveness of remote surgical wound assessment. OBJECTIVE The objective of this review was to provide an overview of the ML methods that have been used to identify surgical wound infections from images. METHODS We conducted a scoping review of ML approaches for visual detection of SSIs following the JBI (Joanna Briggs Institute) methodology. Reports of participants in any postoperative context focusing on identification of surgical wound infections were included. Studies that did not address SSI identification, surgical wounds, or did not use image or video data were excluded. We searched MEDLINE, Embase, CINAHL, CENTRAL, Web of Science Core Collection, IEEE Xplore, Compendex, and arXiv for relevant studies in November 2022. The records retrieved were double screened for eligibility. A data extraction tool was used to chart the relevant data, which was described narratively and presented using tables. Employment of TRIPOD (Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis) guidelines was evaluated and PROBAST (Prediction Model Risk of Bias Assessment Tool) was used to assess risk of bias (RoB). RESULTS In total, 10 of the 715 unique records screened met the eligibility criteria. In these studies, the clinical contexts and surgical procedures were diverse. All papers developed diagnostic models, though none performed external validation. Both traditional ML and deep learning methods were used to identify SSIs from mostly color images, and the volume of images used ranged from under 50 to thousands. Further, 10 TRIPOD items were reported in at least 4 studies, though 15 items were reported in fewer than 4 studies. PROBAST assessment led to 9 studies being identified as having an overall high RoB, with 1 study having overall unclear RoB. CONCLUSIONS Research on the image-based identification of surgical wound infections using ML remains novel, and there is a need for standardized reporting. Limitations related to variability in image capture, model building, and data sources should be addressed in the future.
Collapse
Affiliation(s)
| | - Jonathan Ranisau
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Shuang Di
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Laura Rosella
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - P J Devereaux
- Population Health Research Institute, Hamilton, ON, Canada
| | - Jeremy Petch
- Centre for Data Science and Digital Health, Hamilton Health Sciences, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
- Division of Cardiology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
4
|
Teague J, Socia D, An G, Badylak S, Johnson S, Jiang P, Vodovotz Y, Cockrell RC. Artificial Intelligence Optical Biopsy for Evaluating the Functional State of Wounds. J Surg Res 2023; 291:683-690. [PMID: 37562230 DOI: 10.1016/j.jss.2023.07.017] [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: 03/02/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION The clinical characterization of the functional status of active wounds in terms of their driving cellular and molecular biology remains a considerable challenge that currently requires excision via a tissue biopsy. In this pilot study, we use convolutional Siamese neural network (SNN) architecture to predict the functional state of a wound using digital photographs of wounds in a canine model of volumetric muscle loss (VML). METHODS Digital images of VML injuries and tissue biopsies were obtained in a standardized fashion from an established canine model of VML. Gene expression profiles for each biopsy site were obtained using RNA sequencing. These profiles were converted to functional profiles by a manual review of validated gene ontology databases in which we determined a hierarchical representation of gene functions based on functional specificity. An SNN was trained to regress functional profile expression values, informed by an image segment showing the surface of a small tissue biopsy. RESULTS The SNN was able to predict the functional expression of a range of functions based with error ranging from ∼5% to ∼30%, with functions that are most closely associated with the early state of wound healing to be those best-predicted. CONCLUSIONS These initial results suggest promise for further research regarding this novel use of machine learning regression on medical images. The regression of functional profiles, as opposed to specific genes, both addresses the challenge of genetic redundancy and gives a deeper insight into the mechanistic configuration of a region of tissue in wounds.
Collapse
Affiliation(s)
- Joe Teague
- Department of Surgery, University of Vermont, Burlington, Vermont
| | - Damien Socia
- Department of Surgery, University of Vermont, Burlington, Vermont
| | - Gary An
- Department of Surgery, University of Vermont, Burlington, Vermont
| | - Stephen Badylak
- McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Scott Johnson
- McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peng Jiang
- Center for Gene Regulation in Health and Disease (GRHD), Cleveland State University, Cleveland, Ohio
| | - Yoram Vodovotz
- McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - R Chase Cockrell
- Department of Surgery, University of Vermont, Burlington, Vermont.
| |
Collapse
|
5
|
Monroy B, Sanchez K, Arguello P, Estupiñán J, Bacca J, Correa CV, Valencia L, Castillo JC, Mieles O, Arguello H, Castillo S, Rojas-Morales F. Automated chronic wounds medical assessment and tracking framework based on deep learning. Comput Biol Med 2023; 165:107335. [PMID: 37633087 DOI: 10.1016/j.compbiomed.2023.107335] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 07/09/2023] [Accepted: 08/07/2023] [Indexed: 08/28/2023]
Abstract
Chronic wounds are a latent health problem worldwide, due to high incidence of diseases such as diabetes and Hansen. Typically, wound evolution is tracked by medical staff through visual inspection, which becomes problematic for patients in rural areas with poor transportation and medical infrastructure. Alternatively, the design of software platforms for medical imaging applications has been increasingly prioritized. This work presents a framework for chronic wound tracking based on deep learning, which works on RGB images captured with smartphones, avoiding bulky and complicated acquisition setups. The framework integrates mainstream algorithms for medical image processing, including wound detection, segmentation, as well as quantitative analysis of area and perimeter. Additionally, a new chronic wounds dataset from leprosy patients is provided to the scientific community. Conducted experiments demonstrate the validity and accuracy of the proposed framework, with up to 84.5% in precision.
Collapse
Affiliation(s)
- Brayan Monroy
- Department of Systems Engineering and Informatics, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia.
| | - Karen Sanchez
- Department of Electrical Engineering, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Paula Arguello
- Department of Systems Engineering and Informatics, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Juan Estupiñán
- Department of Systems Engineering and Informatics, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Jorge Bacca
- Department of Systems Engineering and Informatics, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Claudia V Correa
- Department of Systems Engineering and Informatics, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Laura Valencia
- Department of Medicine, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Juan C Castillo
- Department of Medicine, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Olinto Mieles
- Sanatorio de Contratación ESE, Leprosy Control Program, Contratación, 683071, Colombia
| | - Henry Arguello
- Department of Systems Engineering and Informatics, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Sergio Castillo
- Department of Systems Engineering and Informatics, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| | - Fernando Rojas-Morales
- Department of Systems Engineering and Informatics, Universidad Industrial de Santander, Bucaramanga, 680002, Colombia
| |
Collapse
|
6
|
Dabas M, Schwartz D, Beeckman D, Gefen A. Application of Artificial Intelligence Methodologies to Chronic Wound Care and Management: A Scoping Review. Adv Wound Care (New Rochelle) 2023; 12:205-240. [PMID: 35438547 DOI: 10.1089/wound.2021.0144] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Significance: As the number of hard-to-heal wound cases rises with the aging of the population and the spread of chronic diseases, health care professionals struggle to provide safe and effective care to all their patients simultaneously. This study aimed at providing an in-depth overview of the relevant methodologies of artificial intelligence (AI) and their potential implementation to support these growing needs of wound care and management. Recent Advances: MEDLINE, Compendex, Scopus, Web of Science, and IEEE databases were all searched for new AI methods or novel uses of existing AI methods for the diagnosis or management of hard-to-heal wounds. We only included English peer-reviewed original articles, conference proceedings, published patent applications, or granted patents (not older than 2010) where the performance of the utilized AI algorithms was reported. Based on these criteria, a total of 75 studies were eligible for inclusion. These varied by the type of the utilized AI methodology, the wound type, the medical record/database configuration, and the research goal. Critical Issues: AI methodologies appear to have a strong positive impact and prospects in the wound care and management arena. Another important development that emerged from the findings is AI-based remote consultation systems utilizing smartphones and tablets for data collection and connectivity. Future Directions: The implementation of machine-learning algorithms in the diagnosis and managements of hard-to-heal wounds is a promising approach for improving the wound care delivered to hospitalized patients, while allowing health care professionals to manage their working time more efficiently.
Collapse
Affiliation(s)
- Mai Dabas
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Dafna Schwartz
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public Health, Ghent University, Ghent, Belgium.,Swedish Centre for Skin and Wound Research, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel.,The Herbert J. Berman Chair in Vascular Bioengineering, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
7
|
Rodrigues CF, Bezerra SMG, Calçada DB. COMPUTER SYSTEMS TO AID IN WOUND HEALING: SCOPE REVIEW. ESTIMA 2023. [DOI: 10.30886/estima.v21.1260_in] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Objective: To investigate studies that present computational systems to aid healing and systems which refer to the use of low-level laser.Method: Scope review that aimed to answer the question: Which computer systems help in wound healing? A subquestion was: Which of the computer systems refer to the use of low-level laser? Results: From the search, applying the eligibility criteria, 49 articles made up the final sample. The systems served multiple purposes in support of wound healing; the majority presented the health professional as a user of the system; medicine was the most mentioned professional area despite nursing being involved in the management of care for people with wounds. Innovation in care using the computer system was frequently reported, demonstrating the importance of this type of tool for clinical practice. There was a high frequency of the mobile platform, showing that this is a current trend. Conclusion:Computer systems have been used as tools to support patients and especially professionals in wound healing. Regarding the systems aimed at the low intensity laser, there was a shortage of computer systems for this purpose, with a study.
Collapse
|
8
|
Rodrigues CF, Bezerra SMG, Calçada DB. SISTEMAS COMPUTACIONAIS PARA AUXÍLIO NA CICATRIZAÇÃO DE FERIDAS: REVISÃO DE ESCOPO. ESTIMA 2023. [DOI: 10.30886/estima.v21.1260_pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Objetivo:Investigar estudos que apresentem sistemas computacionais de auxílio à cicatrização de feridas e quais sistemas se referem ao uso de laser de baixa intensidade. Método: Revisão de escopo que visou responder à questão de pesquisa: Quais sistemas computacionais auxiliam na cicatrização de feridas? Uma subquestão foi: quais sistemas computacionais se referem ao uso do laser de baixa intensidade? Resultados: A partir da busca, aplicando os critérios de elegibilidade, 49 artigos compuseram a amostra final. Os sistemas apresentaram várias finalidades de apoio à cicatrização de feridas, em que a maioria apresentou como usuário do sistema o profissional de saúde, sendo a medicina a área profissional mais mencionada, embora a enfermagem esteja envolvida com o manejo do cuidado às pessoas com feridas. Foi relatada com frequência a inovação na assistência a partir do uso do sistema computacional, o que demonstra a importância desse tipo de ferramenta para a prática clínica. Verificou-se com frequência o uso de plataforma mobile, como tendência da atualidade. Conclusão: Os sistemas computacionais têm sido utilizados como ferramentas para apoiar pacientes e principalmente profissionais na cicatrização de feridas. Quanto ao laser de baixa intensidade, houve escassez de sistemas computacionais com essa finalidade, com apenas um estudo.
Collapse
|
9
|
Irgang L, Barth H, Holmén M. Data-Driven Technologies as Enablers for Value Creation in the Prevention of Surgical Site Infections: a Systematic Review. JOURNAL OF HEALTHCARE INFORMATICS RESEARCH 2023; 7:1-41. [PMID: 36910913 PMCID: PMC9995622 DOI: 10.1007/s41666-023-00129-2] [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: 04/05/2022] [Revised: 01/16/2023] [Accepted: 02/03/2023] [Indexed: 03/02/2023]
Abstract
Despite the advances in modern medicine, the use of data-driven technologies (DDTs) to prevent surgical site infections (SSIs) remains a major challenge. Scholars recognise that data management is the next frontier in infection prevention, but many aspects related to the benefits and advantages of using DDTs to mitigate SSI risk factors remain unclear and underexplored in the literature. This study explores how DDTs enable value creation in the prevention of SSIs. This study follows a systematic literature review approach and the PRISMA statement to analyse peer-reviewed articles from seven databases. Fifty-nine articles were included in the review and were analysed through a descriptive and a thematic analysis. The findings suggest a growing interest in DDTs in SSI prevention in the last 5 years, and that machine learning and smartphone applications are widely used in SSI prevention. DDTs are mainly applied to prevent SSIs in clean and clean-contaminated surgeries and often used to manage patient-related data in the postoperative stage. DDTs enable the creation of nine categories of value that are classified in four dimensions: cost/sacrifice, functional/instrumental, experiential/hedonic, and symbolic/expressive. This study offers a unique and systematic overview of the value creation aspects enabled by DDT applications in SSI prevention and suggests that additional research is needed in four areas: value co-creation and product-service systems, DDTs in contaminated and dirty surgeries, data legitimation and explainability, and data-driven interventions. Supplementary Information The online version contains supplementary material available at 10.1007/s41666-023-00129-2.
Collapse
Affiliation(s)
- Luís Irgang
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
| | - Henrik Barth
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
| | - Magnus Holmén
- School of Business, Innovation and Sustainability - Department of Engineering and Innovation, Halmstad University, Halmstad, Sweden
| |
Collapse
|
10
|
Liu Z, Agu E, Pedersen P, Lindsay C, Tulu B, Strong D. Chronic Wound Image Augmentation and Assessment Using Semi-Supervised Progressive Multi-Granularity EfficientNet. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 5:404-420. [PMID: 38899014 PMCID: PMC11186650 DOI: 10.1109/ojemb.2023.3248307] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/06/2023] [Accepted: 02/20/2023] [Indexed: 06/21/2024] Open
Abstract
Goal: Augment a small, imbalanced, wound dataset by using semi-supervised learning with a secondary dataset. Then utilize the augmented wound dataset for deep learning-based wound assessment. Methods: The clinically-validated Photographic Wound Assessment Tool (PWAT) scores eight wound attributes: Size, Depth, Necrotic Tissue Type, Necrotic Tissue Amount, Granulation Tissue type, Granulation Tissue Amount, Edges, Periulcer Skin Viability to comprehensively assess chronic wound images. A small corpus of 1639 wound images labeled with ground truth PWAT scores was used as reference. A Semi-Supervised learning and Progressive Multi-Granularity training mechanism were used to leverage a secondary corpus of 9870 unlabeled wound images. Wound scoring utilized the EfficientNet Convolutional Neural Network on the augmented wound corpus. Results: Our proposed Semi-Supervised PMG EfficientNet (SS-PMG-EfficientNet) approach estimated all 8 PWAT sub-scores with classification accuracies and F1 scores of about 90% on average, and outperformed a comprehensive list of baseline models and had a 7% improvement over the prior state-of-the-art (without data augmentation). We also demonstrate that synthetic wound image generation using Generative Adversarial Networks (GANs) did not improve wound assessment. Conclusions: Semi-supervised learning on unlabeled wound images in a secondary dataset achieved impressive performance for deep learning-based wound grading.
Collapse
Affiliation(s)
- Ziyang Liu
- Computer Science DepartmentWorcester Polytechnic InstituteWorcesterMA01609USA
| | - Emmanuel Agu
- Computer Science DepartmentWorcester Polytechnic InstituteWorcesterMA01609USA
| | - Peder Pedersen
- Electrical and Computer Engineering DepartmentWorcester Polytechnic InstituteWorcesterMA01609USA
| | - Clifford Lindsay
- Department of RadiologyUniversity of Massachusetts Medical SchoolWorcesterMA01609USA
| | - Bengisu Tulu
- Foisie Business SchoolWorcester Polytechnic InstituteWorcesterMA01609USA
| | - Diane Strong
- Foisie Business SchoolWorcester Polytechnic InstituteWorcesterMA01609USA
| |
Collapse
|
11
|
Fluorescence - modern method of the diagnosis of chronic wounds on the example of venous leg ulcer. Postepy Dermatol Alergol 2023; 40:66-71. [PMID: 36909920 PMCID: PMC9993220 DOI: 10.5114/ada.2022.119419] [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: 03/25/2022] [Accepted: 07/13/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Fluorescence imaging has become a method for bacterial visualisation in chronic wounds for the last few years. MolecuLight i:X (MolecuLight, Inc, ON, Canada) is a handheld device, which enables quick diagnostics to determine both the type and location of pathogens present in the wound and on the skin. By means of fluorescent light illumination the tissues populated by pathogenic bacteria emit red or cyan fluorescent signatures, depending on the type of the pathogen: red fluorescence signal is emitted by Staphylococcus and Escherichia coli among others, while Pseudomonas aeruginosa produce cyan fluorescence. The fluorescence image also presents the spatial pattern of bacterial load, which creates bacterial mapping of the wound and may be used by a clinician for targeted sampling or debridement, among others. Aim This study presents the method of microbiological fluorescent imaging and two case studies of patients with venous leg ulcers. Material and methods In both cases, the sample for microbiological testing was obtained by means of a swab stick. Results The results obtained from fluorescent imaging showed moderate-to-heavy bacterial load, which corresponded with the results from microbiology laboratory. Thanks to quick diagnostics with the use of MolecuLight i:X device, instant implementation of targeted topical actions such as wound hygiene, skin disinfection, appropriate dressing choice and curative treatment among others was possible. Conclusions Our observations are consistent with the reports from other facilities.
Collapse
|
12
|
Liu Z, John J, Agu E. Diabetic Foot Ulcer Ischemia and Infection Classification Using EfficientNet Deep Learning Models. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2022; 3:189-201. [PMID: 36660100 PMCID: PMC9842228 DOI: 10.1109/ojemb.2022.3219725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 07/05/2022] [Accepted: 10/23/2022] [Indexed: 11/23/2022] Open
Abstract
Motivation: Infection (bacteria in the wound) and ischemia (insufficient blood supply) in Diabetic Foot Ulcers (DFUs) increase the risk of limb amputation. Goal: To develop an image-based DFU infection and ischemia detection system that uses deep learning. Methods: The DFU dataset was augmented using geometric and color image operations, after which binary infection and ischemia classification was done using the EfficientNet deep learning model and a comprehensive set of baselines. Results: The EfficientNets model achieved 99% accuracy in ischemia classification and 98% in infection classification, outperforming ResNet and Inception (87% accuracy) and Ensemble CNN, the prior state of the art (Classification accuracy of 90% for ischemia 73% for infection). EfficientNets also classified test images in a fraction (10% to 50%) of the time taken by baseline models. Conclusions: This work demonstrates that EfficientNets is a viable deep learning model for infection and ischemia classification.
Collapse
Affiliation(s)
- Ziyang Liu
- Computer Science DepartmentWorcester Polytechnic InstituteWorcesterMA 01609USA
| | - Josvin John
- Computer Science DepartmentWorcester Polytechnic InstituteWorcesterMA 01609USA
| | - Emmanuel Agu
- Computer Science DepartmentWorcester Polytechnic InstituteWorcesterMA 01609USA
| |
Collapse
|
13
|
Guo J, Wang T, Yan Z, Ji D, Li J, Pan H. Preparation and evaluation of dual drug-loaded nanofiber membranes based on coaxial electrostatic spinning technology. Int J Pharm 2022; 629:122410. [DOI: 10.1016/j.ijpharm.2022.122410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 11/02/2022] [Accepted: 11/12/2022] [Indexed: 11/18/2022]
|
14
|
Li D, Mathews C, Zamarripa C, Zhang F, Xiao Q. Wound tissue segmentation by computerised image analysis of clinical pressure injury photographs: a pilot study. J Wound Care 2022; 31:710-719. [PMID: 36001699 DOI: 10.12968/jowc.2022.31.8.710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Wound tissues can provide ample information about the wound development and healing process. However, the manual identification and measurement of wound tissue types is time-consuming and challenging due to the complexities of pressure injuries (PI). This study aims to develop an image analysis algorithm to automatically identify and differentiate wound tissue types from PI wound beds. METHOD This was a cross-sectional algorithm development study. PI photographs were obtained from a western Pennsylvania hospital. We used our previously developed wound bed segmentation tool to identify PI wound beds. We then used the k-means clustering method to classify the subzones on the wound beds. Finally, the support vector machine classifier was used to identify the classified subzones to certain types of wound tissue. RESULTS An image analysis algorithm was developed, using 64 selected PI photographs, to automatically identify different wound tissues for PIs. CONCLUSION Validation of the wound tissue identification of the PIs by image analysis algorithm demonstrated that our image analysis algorithm is a reliable and objective approach to monitoring wound healing progress through clinical PI photographs, and offers new insight into PI evaluation and documentation. DECLARATION OF INTEREST The authors have no conflicts of interest to declare.
Collapse
Affiliation(s)
- Dan Li
- Department of Health and Community Systems, University of Pittsburgh School of Nursing, US
| | - Carol Mathews
- University of Pittsburgh Medical Center Presbyterian Shadyside, US
| | | | - Fei Zhang
- Department of Nurse Anesthesia, University of Pittsburgh School of Nursing, US
| | - Qian Xiao
- School of Nursing, Capital Medical University, Beijing, China
| |
Collapse
|
15
|
Balch JA, Efron PA, Bihorac A, Loftus TJ. Gamification for Machine Learning in Surgical Patient Engagement. Front Surg 2022; 9:896351. [PMID: 35656082 PMCID: PMC9152738 DOI: 10.3389/fsurg.2022.896351] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
Patients and their surgeons face a complex and evolving set of choices in the process of shared decision making. The plan of care must be tailored to individual patient risk factors and values, though objective estimates of risk can be elusive, and these risk factors are often modifiable and can alter the plan of care. Machine learning can perform real-time predictions of outcomes, though these technologies are limited by usability and interpretability. Gamification, or the use of game elements in non-game contexts, may be able to incorporate machine learning technology to help patients optimize their pre-operative risks, reduce in-hospital complications, and hasten recovery. This article proposes a theoretical mobile application to help guide decision making and provide evidence-based, tangible goals for patients and surgeons with the goal of achieving the best possible operative outcome that aligns with patient values.
Collapse
Affiliation(s)
- Jeremy A. Balch
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
| | - Philip A. Efron
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
| | - Azra Bihorac
- Department of Medicine, University of Florida Health, Gainesville, FL, United States
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, United States
| | - Tyler J. Loftus
- Department of Surgery, University of Florida Health, Gainesville, FL, United States
- Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL, United States
- Correspondence: Tyler J. Loftus
| |
Collapse
|
16
|
Gholian S, Pishgahi A, Shakouri SK, Eslamian F, Yousefi M, Kheiraddin BP, Dareshiri S, Yarani R, Dolatkhah N. Use of autologous conditioned serum dressings in hard-to-heal wounds: a randomised prospective clinical trial. J Wound Care 2022; 31:68-77. [PMID: 35077207 DOI: 10.12968/jowc.2022.31.1.68] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE In this study, we aimed to assess both the efficacy and tolerability of autologous conditioned serum (ACS) as an innovative wound dressing in the local management of hard-to-heal wounds. METHOD In this single-blinded randomised controlled trial, patients with hard-to-heal wounds were randomly assigned to receive either ACS treatment or normal saline (NS) dressings. The treatment was applied once a week for three weeks with a final assessment at three weeks from the first ACS application. RESULTS A total of 30 patients took part in the study. Analysis of wound assessment data demonstrated statistically significant differences for wound surface area and Pressure Ulcer Scale for Healing scores (area score, exudate and tissue) from baseline to the end of the study in patients who received the ACS dressing, but not in patients who received the normal saline dressing. There were statistically significant differences in changes in: the wound surface area at week three (-6.4±2.69cm2 versus +0.4±2.52cm2); area score at week three (-2.2±1.08 versus +0.2±0.86); exudate at week two (-1.2±0.70 versus +0.0±0.45) and at week 3 (-1.3±0.72 versus -0.1±0.63); tissue at week two (-1.1±0.35 versus +0.0±0.53) and at week three (-1.8±0.65 versus -0.1±0.63); and the PUSH total score at week one (-1.6±0.98 versus +0.4±1.22), week two (-3.2±0.86 versus +0.4±0.98) and week three (-5.3±1.17 versus -0.0±1.33) between the ACS and NS groups, respectively. CONCLUSION This trial revealed a significant decrease in wound surface area as well as a considerable improvement in wound healing in the ACS dressing group.
Collapse
Affiliation(s)
- Shakiba Gholian
- Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alireza Pishgahi
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Kazem Shakouri
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Eslamian
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Yousefi
- Department of Immunology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Shahla Dareshiri
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Yarani
- Interventional Regenerative Medicine and Imaging Laboratory, Department of Radiology, Stanford University School of Medicine, US.,Translational Type 1 Diabetes Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Neda Dolatkhah
- Physical Medicine and Rehabilitation Research Center, Aging Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| |
Collapse
|
17
|
Schollemann F, Kunczik J, Dohmeier H, Pereira CB, Follmann A, Czaplik M. Infection Probability Index: Implementation of an Automated Chronic Wound Infection Marker. J Clin Med 2021; 11:jcm11010169. [PMID: 35011910 PMCID: PMC8745914 DOI: 10.3390/jcm11010169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/20/2021] [Accepted: 12/21/2021] [Indexed: 01/09/2023] Open
Abstract
The number of people suffering from chronic wounds is increasing due to demographic changes and the global epidemics of obesity and diabetes. Innovative imaging techniques within the field of chronic wound diagnostics are required to improve wound care by predicting and detecting wound infections to accelerate the application of treatments. For this reason, the infection probability index (IPI) is introduced as a novel infection marker based on thermal wound imaging. To improve usability, the IPI was implemented to automate scoring. Visual and thermal image pairs of 60 wounds were acquired to test the implemented algorithms on clinical data. The proposed process consists of (1) determining various parameters of the IPI based on medical hypotheses, (2) acquiring data, (3) extracting camera distortions using camera calibration, and (4) preprocessing and (5) automating segmentation of the wound to calculate (6) the IPI. Wound segmentation is reviewed by user input, whereas the segmented area can be refined manually. Furthermore, in addition to proof of concept, IPIs’ correlation with C-reactive protein (CRP) levels as a clinical infection marker was evaluated. Based on average CRP levels, the patients were clustered into two groups, on the basis of the separation value of an averaged CRP level of 100. We calculated the IPIs of the 60 wound images based on automated wound segmentation. Average runtime was less than a minute. In the group with lower average CRP, a correlation between IPI and CRP was evident.
Collapse
|
18
|
Schumaker G, Becker A, An G, Badylak S, Johnson S, Jiang P, Vodovotz Y, Cockrell RC. Optical Biopsy Using a Neural Network to Predict Gene Expression From Photos of Wounds. J Surg Res 2021; 270:547-554. [PMID: 34826690 DOI: 10.1016/j.jss.2021.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 09/16/2021] [Accepted: 10/09/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND The clinical characterization of the biological status of complex wounds remains a considerable challenge. Digital photography provides a non-invasive means of obtaining wound information and is currently employed to assess wounds qualitatively. Advances in machine learning (ML) image processing provide a means of identifying "hidden" features in pictures. This pilot study trains a convolutional neural network (CNN) to predict gene expression based on digital photographs of wounds in a canine model of volumetric muscle loss (VML). MATERIALS AND METHODS Images of volumetric muscle loss injuries and tissue biopsies were obtained in a canine model of VML. A CNN was trained to regress gene expression values as a function of the extracted image segment (color and spatial distribution). Performance of the CNN was assessed in a held-back test set of images using Mean Absolute Percentage Error (MAPE). RESULTS The CNN was able to predict the gene expression of certain genes based on digital images, with a MAPE ranging from ∼10% to ∼30%, indicating the presence and identification of distinct, and identifiable patterns in gene expression throughout the wound. CONCLUSIONS These initial results suggest promise for further research regarding this novel use of ML regression on medical images. Specifically, the use of CNNs to determine the mechanistic biological state of a VML wound could aid both the design of future mechanistic interventions and the design of trials to test those therapies. Future work will expand the CNN training and/or test set, with potential expansion to predicting functional gene modules.
Collapse
Affiliation(s)
- Grant Schumaker
- Department of Surgery, University of Vermont, Burlington, Vermont
| | - Andrew Becker
- Department of Surgery, University of Vermont, Burlington, Vermont
| | - Gary An
- Department of Surgery, University of Vermont, Burlington, Vermont
| | - Stephen Badylak
- McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Scott Johnson
- McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Peng Jiang
- Center for Gene Regulation in Health and Disease (GRHD)Department of Biological, Geological and Environmental Sciences (BGES) Cleveland State University, Cleveland, OH
| | - Yoram Vodovotz
- McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Surgery, University of Pittsburgh, W944 Biomedical Sciences Tower, Pittsburgh, Pennsylvania
| | - R Chase Cockrell
- Department of Surgery, University of Vermont, Burlington, Vermont.
| |
Collapse
|
19
|
Liu Z, Agu E, Pedersen P, Lindsay C, Tulu B, Strong D. Comprehensive Assessment of Fine-Grained Wound Images Using a Patch-Based CNN With Context-Preserving Attention. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2021; 2:224-234. [PMID: 34532712 PMCID: PMC8442961 DOI: 10.1109/ojemb.2021.3092207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Goal: Chronic wounds affect 6.5 million Americans. Wound assessment via algorithmic analysis of smartphone images has emerged as a viable option for remote assessment. Methods: We comprehensively score wounds based on the clinically-validated Photographic Wound Assessment Tool (PWAT), which comprehensively assesses clinically important ranges of eight wound attributes: Size, Depth, Necrotic Tissue Type, Necrotic Tissue Amount, Granulation Tissue type, Granulation Tissue Amount, Edges, Periulcer Skin Viability. We proposed a DenseNet Convolutional Neural Network (CNN) framework with patch-based context-preserving attention to assess the 8 PWAT attributes of four wound types: diabetic ulcers, pressure ulcers, vascular ulcers and surgical wounds. Results: In an evaluation on our dataset of 1639 wound images, our model estimated all 8 PWAT sub-scores with classification accuracies and F1 scores of over 80%. Conclusions: Our work is the first intelligent system that autonomously grades wounds comprehensively based on criteria in the PWAT rubric, alleviating the significant burden that manual wound grading imposes on wound care nurses.
Collapse
Affiliation(s)
- Ziyang Liu
- Computer Science Department, Worcester Polytechnic Institute, Worcester, MA 01609 USA
| | - Emmanuel Agu
- Computer Science Department, Worcester Polytechnic Institute, Worcester, MA 01609 USA
| | - Peder Pedersen
- Electrical and Computer Engineering Department, Worcester Polytechnic Institute, Worcester, MA 01609 USA
| | - Clifford Lindsay
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA 01655 USA
| | - Bengisu Tulu
- Foisie Business School, Worcester Polytechnic Institute, Worcester, MA 01609 USA
| | - Diane Strong
- Foisie Business School, Worcester Polytechnic Institute, Worcester, MA 01609 USA
| |
Collapse
|
20
|
Interplay between ESKAPE Pathogens and Immunity in Skin Infections: An Overview of the Major Determinants of Virulence and Antibiotic Resistance. Pathogens 2021; 10:pathogens10020148. [PMID: 33540588 PMCID: PMC7912840 DOI: 10.3390/pathogens10020148] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 12/16/2022] Open
Abstract
The skin is the largest organ in the human body, acting as a physical and immunological barrier against pathogenic microorganisms. The cutaneous lesions constitute a gateway for microbial contamination that can lead to chronic wounds and other invasive infections. Chronic wounds are considered as serious public health problems due the related social, psychological and economic consequences. The group of bacteria known as ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter sp.) are among the most prevalent bacteria in cutaneous infections. These pathogens have a high level of incidence in hospital environments and several strains present phenotypes of multidrug resistance. In this review, we discuss some important aspects of skin immunology and the involvement of ESKAPE in wound infections. First, we introduce some fundamental aspects of skin physiology and immunology related to cutaneous infections. Following this, the major virulence factors involved in colonization and tissue damage are highlighted, as well as the most frequently detected antimicrobial resistance genes. ESKAPE pathogens express several virulence determinants that overcome the skin's physical and immunological barriers, enabling them to cause severe wound infections. The high ability these bacteria to acquire resistance is alarming, particularly in the hospital settings where immunocompromised individuals are exposed to these pathogens. Knowledge about the virulence and resistance markers of these species is important in order to develop new strategies to detect and treat their associated infections.
Collapse
|
21
|
Buch PJ, Chai Y, Goluch ED. Bacterial chatter in chronic wound infections. Wound Repair Regen 2020; 29:106-116. [PMID: 33047459 DOI: 10.1111/wrr.12867] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 08/07/2020] [Accepted: 10/06/2020] [Indexed: 11/29/2022]
Abstract
One of the hallmark characteristics of chronic diabetic wounds is the presence of biofilm-forming bacteria. Bacteria encapsulated in a biofilm may coexist as a polymicrobial community and communicate with each other through a phenomenon termed quorum sensing (QS). Here, we describe the QS circuits of bacterial species commonly found in chronic diabetic wounds. QS relies on diffusion of signaling molecules and the local concentration changes of these molecules that bacteria experience in wounds. These biochemical signaling pathways play a role not only in biofilm formation and virulence but also in wound healing. They are, therefore, key to understanding the distinctive nature of these infections. While several in vivo and in vitro models exist to study QS in wounds, there has been limited progress in understanding the interplay between QS molecules and host factors that contribute to wound healing. Lastly, we examine the potential of targeting QS for both diagnosis and therapeutic intervention purposes.
Collapse
Affiliation(s)
- Pranali J Buch
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts, USA
| | - Yunrong Chai
- Department of Biology, Northeastern University, Boston, Massachusetts, USA
| | - Edgar D Goluch
- Department of Chemical Engineering, Northeastern University, Boston, Massachusetts, USA.,Department of Biology, Northeastern University, Boston, Massachusetts, USA
| |
Collapse
|
22
|
Jeckson TA, Neo YP, Sisinthy SP, Gorain B. Delivery of Therapeutics from Layer-by-Layer Electrospun Nanofiber Matrix for Wound Healing: An Update. J Pharm Sci 2020; 110:635-653. [PMID: 33039441 DOI: 10.1016/j.xphs.2020.10.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/28/2020] [Accepted: 10/01/2020] [Indexed: 02/09/2023]
Abstract
Increasing incidences of chronic wounds urge the development of effective therapeutic wound treatment. As the conventional wound dressings are found not to comply with all the requirements of an ideal wound dressing, the development of alternative and effective dressings is demanded. Over the past few years, electrospun nanofiber has been recognized as a better system for wound dressing and hence has been studied extensively. Most of the electrospun nanofiber dressings were fabricated as single-layer structure mats. However, this design is less favorable for the effective healing of wounds mainly due to its burst release effect. To address this problem and to simulate the organized skin layer's structure and function, a multilayer structure of wound dressing had been proposed. This design enables a sustained release of the therapeutic agent(s), and more resembles the natural skin extracellular matrix. Multilayer structure is also referred to layer-by-layer (LbL), which has been established as an innovative method of drug incorporation and delivery, combines a high surface area of electrospun nanofibers with the multilayer structure mat. This review focuses on LbL multilayer electrospun nanofiber as a superior strategy in designing an optimal wound dressing.
Collapse
Affiliation(s)
- Tracey Anastacia Jeckson
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Yun Ping Neo
- School of Biosciences, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia
| | - Sreenivas Patro Sisinthy
- Faculty of Pharmacy and Health Sciences, Royal College of Medicine Perak, University Kuala Lumpur (RCMP Uni-KL), Ipoh, Perak, Malaysia.
| | - Bapi Gorain
- School of Pharmacy, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia; Centre for Drug Delivery and Molecular Pharmacology, Faculty of Health and Medical Sciences, Taylor's University, Subang Jaya, Selangor, Malaysia.
| |
Collapse
|