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Zhu P, You T, Wang Y, Ma M, Ye S, Liu S. A Cysteine-Maleimide-Based Design for Hemostatic, Antibacterial, and Biodegradable Wound Dressing. Bioconjug Chem 2024; 35:203-213. [PMID: 38343092 DOI: 10.1021/acs.bioconjchem.3c00483] [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: 02/22/2024]
Abstract
The field of clinical surgery frequently encounters challenges related to atypical wound tissue healing, resulting in the development of persistent chronic wounds or aesthetically displeasing scar tissue. The use of wound dressings crafted from mussel adhesive proteins and hyaluronic acid has demonstrated the potential in mitigating these undesirable outcomes. However, the synergistic effects of these two biomaterials remain underexplored. In this study, we have engineered a versatile, degradable, and biocompatible dressing that comprises recombinant 3,4-dihydroxyphenylalanine (DOPA)-modified mussel adhesive proteins and maleimide-functionalized hyaluronic acid. We have successfully fabricated this biocompatible dressing and conducted comprehensive experimental assessments to confirm its hemostatic, antibacterial, and biocompatible characteristics. Importantly, this dressing exclusively incorporates biologically derived materials characterized by low toxicity and minimal immunogenicity, thus holding immense promise for clinical applications in the field of wound healing.
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Affiliation(s)
- Pei Zhu
- Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, P. R. China
| | - Tianjie You
- Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, P. R. China
| | - Ying Wang
- Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, P. R. China
| | - Mingxue Ma
- Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, P. R. China
| | - Sheng Ye
- Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, P. R. China
| | - Si Liu
- Tianjin Key Laboratory of Function and Application of Biological Macromolecular Structures, School of Life Sciences, Tianjin University, 92 Weijin Road, Nankai District, Tianjin 300072, P. R. China
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Lau CH, Yu KHO, Yip TF, Luk LY, Wai AKC, Sit TY, Wong JYH, Ho JWK. An artificial intelligence-enabled smartphone app for real-time pressure injury assessment. FRONTIERS IN MEDICAL TECHNOLOGY 2022; 4:905074. [PMID: 36212608 PMCID: PMC9541137 DOI: 10.3389/fmedt.2022.905074] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/01/2022] [Indexed: 11/29/2022] Open
Abstract
The management of chronic wounds in the elderly such as pressure injury (also known as bedsore or pressure ulcer) is increasingly important in an ageing population. Accurate classification of the stage of pressure injury is important for wound care planning. Nonetheless, the expertise required for staging is often not available in a residential care home setting. Artificial-intelligence (AI)-based computer vision techniques have opened up opportunities to harness the inbuilt camera in modern smartphones to support pressure injury staging by nursing home carers. In this paper, we summarise the recent development of smartphone or tablet-based applications for wound assessment. Furthermore, we present a new smartphone application (app) to perform real-time detection and staging classification of pressure injury wounds using a deep learning-based object detection system, YOLOv4. Based on our validation set of 144 photos, our app obtained an overall prediction accuracy of 63.2%. The per-class prediction specificity is generally high (85.1%–100%), but have variable sensitivity: 73.3% (stage 1 vs. others), 37% (stage 2 vs. others), 76.7 (stage 3 vs. others), 70% (stage 4 vs. others), and 55.6% (unstageable vs. others). Using another independent test set, 8 out of 10 images were predicted correctly by the YOLOv4 model. When deployed in a real-life setting with two different ambient brightness levels with three different Android phone models, the prediction accuracy of the 10 test images ranges from 80 to 90%, which highlight the importance of evaluation of mobile health (mHealth) application in a simulated real-life setting. This study details the development and evaluation process and demonstrates the feasibility of applying such a real-time staging app in wound care management.
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Affiliation(s)
- Chun Hon Lau
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Ken Hung-On Yu
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Tsz Fung Yip
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Luke Yik Fung Luk
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Abraham Ka Chung Wai
- Department of Emergency Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Tin-Yan Sit
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
| | - Janet Yuen-Ha Wong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- School of Nursing / Health Studies, Hong Kong Metropolitan University, Ho Man Tin, Hong Kong SAR, China
- Correspondence: Janet Yuen-Ha Wong Joshua Wing Kei Ho
| | - Joshua Wing Kei Ho
- Laboratory of Data Discovery for Health Limited (D24H), Hong Kong Science Park, Hong Kong SAR, China
- School of Biomedical Sciences, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR, China
- Correspondence: Janet Yuen-Ha Wong Joshua Wing Kei Ho
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Rani Raju N, Silina E, Stupin V, Manturova N, Chidambaram SB, Achar RR. Multifunctional and Smart Wound Dressings—A Review on Recent Research Advancements in Skin Regenerative Medicine. Pharmaceutics 2022; 14:pharmaceutics14081574. [PMID: 36015200 PMCID: PMC9414988 DOI: 10.3390/pharmaceutics14081574] [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: 06/19/2022] [Revised: 07/16/2022] [Accepted: 07/25/2022] [Indexed: 02/01/2023] Open
Abstract
The healing of wounds is a dynamic function that necessitates coordination among multiple cell types and an optimal extracellular milieu. Much of the research focused on finding new techniques to improve and manage dermal injuries, chronic injuries, burn injuries, and sepsis, which are frequent medical concerns. A new research strategy involves developing multifunctional dressings to aid innate healing and combat numerous issues that trouble incompletely healed injuries, such as extreme inflammation, ischemic damage, scarring, and wound infection. Natural origin-based compounds offer distinct characteristics, such as excellent biocompatibility, cost-effectiveness, and low toxicity. Researchers have developed biopolymer-based wound dressings with drugs, biomacromolecules, and cells that are cytocompatible, hemostatic, initiate skin rejuvenation and rapid healing, and possess anti-inflammatory and antimicrobial activity. The main goal would be to mimic characteristics of fetal tissue regeneration in the adult healing phase, including complete hair and glandular restoration without delay or scarring. Emerging treatments based on biomaterials, nanoparticles, and biomimetic proteases have the keys to improving wound care and will be a vital addition to the therapeutic toolkit for slow-healing wounds. This study focuses on recent discoveries of several dressings that have undergone extensive pre-clinical development or are now undergoing fundamental research.
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Affiliation(s)
- Nithya Rani Raju
- Division of Biochemistry, School of Life Sciences, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India;
| | - Ekaterina Silina
- Institute of Biodesign and Modeling of Complex Systems, I.M. Sechenov First Moscow State Medical University (Sechenov University), Trubetskaya Street 8, 119991 Moscow, Russia;
| | - Victor Stupin
- Department of Hospital Surgery No 1, N.I. Pirogov Russian National Research Medical University (RNRMU), Ostrovityanova Street 1, 117997 Moscow, Russia;
| | - Natalia Manturova
- Department of Plastic and Reconstructive Surgery, Cosmetology and Cell Technologies, N.I. Pirogov Russian National Research Medical University, Ostrovityanova Street 1, 117997 Moscow, Russia;
| | - Saravana Babu Chidambaram
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India;
- Centre for Experimental Pharmacology and Toxicology (CPT), Central Animal Facility, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India
| | - Raghu Ram Achar
- Division of Biochemistry, School of Life Sciences, JSS Academy of Higher Education & Research, Mysuru 570015, Karnataka, India;
- Correspondence: ; Tel.: +91-9535413026
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Espaulella-Ferrer M, Espaulella-Panicot J, Noell-Boix R, Casals-Zorita M, Ferrer-Sola M, Puigoriol-Juvanteny E, Cullell-Dalmau M, Otero-Viñas M. Assessment of frailty in elderly patients attending a multidisciplinary wound care centre: a cohort study. BMC Geriatr 2021; 21:727. [PMID: 34922487 PMCID: PMC8684133 DOI: 10.1186/s12877-021-02676-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 11/25/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The incidence of frailty and non-healing wounds increases with patients' age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking. METHODS The aim of this study is to characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centres (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at 6 months or upon wound healing. Wounds were followed up every 2 weeks. To analyse the relationship between two variables was used the Chi-square test and Student's or the ANOVA model. The t-test for paired data was used to analyse the evolution of the frailty index during follow-up. RESULTS A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at 6 months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p = 0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p = 0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p = 0.637). Wound healing rate is statically significantly higher in non-frail patients (8.9% wound reduction/day, P25-P75 3.34-18.3%/day;AQ6 p = 0.044) in comparison with frail patients (3.26% wound reduction/day, P25-P75 0.8-8.8%/day). CONCLUSION Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.
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Affiliation(s)
- Mariona Espaulella-Ferrer
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain.,Hospital Universitari de la Santa Creu de Vic, 08500, Vic, Barcelona, Spain
| | - Joan Espaulella-Panicot
- Hospital Universitari de la Santa Creu de Vic, 08500, Vic, Barcelona, Spain.,Central Catalonia Chronicity Research Group (C3RG), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain
| | - Rosa Noell-Boix
- Hospital Universitari de la Santa Creu de Vic, 08500, Vic, Barcelona, Spain.,Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences (M3O), Faculty of Health Sciences and Welfare, Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVIC-UCC), C. Sagrada Família, 7, Barcelona, 08500, Vic, Spain
| | - Marta Casals-Zorita
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain.,Hospital Universitari de la Santa Creu de Vic, 08500, Vic, Barcelona, Spain
| | - Marta Ferrer-Sola
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain.,Hospital Universitari de la Santa Creu de Vic, 08500, Vic, Barcelona, Spain
| | - Emma Puigoriol-Juvanteny
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain.,Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain
| | - Marta Cullell-Dalmau
- Quantitative BioImaging (QuBI) Lab, University of Vic - Central University of Catalonia (UVIC-UCC), 08500, Vic, Barcelona, Spain.,Faculty of Sciences and Technology, University of Vic - Central University of Catalonia (UVIC-UCC), C. de la Laura, 13, 08500, Vic, Barcelona, Spain
| | - Marta Otero-Viñas
- Tissue Repair and Regeneration Laboratory (TR2Lab), Centre for Health and Social Care Research (CESS), University of Vic - Central University of Catalonia (UVIC-UCC), Fundació Hospital Universitari de la Santa Creu de Vic, and Hospital Universitari de Vic, 08500, Vic, Barcelona, Spain. .,Faculty of Sciences and Technology, University of Vic - Central University of Catalonia (UVIC-UCC), C. de la Laura, 13, 08500, Vic, Barcelona, Spain.
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Bankoti K, Rameshbabu AP, Datta S, Goswami P, Roy M, Das D, Ghosh SK, Das AK, Mitra A, Pal S, Maulik D, Su B, Ghosh P, Basu B, Dhara S. Dual Functionalized Injectable Hybrid Extracellular Matrix Hydrogel for Burn Wounds. Biomacromolecules 2020; 22:514-533. [PMID: 33289564 DOI: 10.1021/acs.biomac.0c01400] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Low strength and rapid biodegradability of acellular dermal matrix (ADM) restrict its wider clinical application as a rapid cell delivery platform in situ for management of burn wounds. Herein, the extracted ADM was modified by a dual cross-linking approach with ionic crosslinking using chitosan and covalent cross-linking using an iodine-modified 2,5-dihydro-2,5-dimethoxy-furan cross-linker, termed as CsADM-Cl. In addition, inherent growth factors and cytokines were found to be preserved in CsADM-Cl, irrespective of ionic/covalent crosslinking. CsADM-Cl demonstrated improvement in post crosslinking stiffness with a decreased biodegradation rate. This hybrid crosslinked hydrogel supported adhesion, proliferation, and migration of human foreskin-derived fibroblasts and keratinocytes. Also, the angiogenic potential of CsADM-Cl was manifested by chick chorioallantoic membrane assay. CsADM-Cl showed excellent antibacterial activity against Escherichia coli and Staphylococcus aureus. Moreover, CsADM-Cl treated full thickness burn wounds and demonstrated rapid healing marked with superior angiogenesis, well-defined dermal-epidermal junctions, mature basket weave collagen deposition, and development of more pronounced secondary appendages. Altogether, the bioactive CsADM-Cl hydrogel established significant clinical potential to support wound healing as an apt injectable antibacterial matrix to encounter unmet challenges concerning critical burn wounds.
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Affiliation(s)
- Kamakshi Bankoti
- Biomaterials and Tissue Engineering Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Arun Prabhu Rameshbabu
- Biomaterials and Tissue Engineering Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Sayanti Datta
- Biomaterials and Tissue Engineering Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Piyali Goswami
- Department of Biotechnology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Madhurima Roy
- Department of Biotechnology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Dipankar Das
- Polymer Chemistry Laboratory, Department of Applied Chemistry, Indian Institute of Technology (Indian School of Mines), Dhanbad 826004, India
| | - Sudip Kumar Ghosh
- Department of Biotechnology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Amit Kumar Das
- Department of Biotechnology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Analava Mitra
- Natural Products Research Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
| | - Sagar Pal
- Polymer Chemistry Laboratory, Department of Applied Chemistry, Indian Institute of Technology (Indian School of Mines), Dhanbad 826004, India
| | - Dhrubajyoti Maulik
- Department of Surgery, Bankura Sammilani Medical College, Bankura 722102, India
| | - Bo Su
- Bristol Dental School, University of Bristol, Bristol BS1 2LY, U.K
| | - Paulomi Ghosh
- Structural Biology and Bioinformatics, CSIR-Indian Institute of Chemical Biology (CSIR-IICB), 4, Raja S C Mullick Road, Kolkata 700032, India
| | - Bikramajit Basu
- Materials Research Center, Indian Institute of Science, Bangalore 560012, India
| | - Santanu Dhara
- Biomaterials and Tissue Engineering Laboratory, School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur 721302, India
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7
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Khémiri I, Essghaier B, Sadfi-Zouaoui N, Bitri L. Antioxidant and Antimicrobial Potentials of Seed Oil from Carthamus tinctorius L. in the Management of Skin Injuries. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2020; 2020:4103418. [PMID: 33204394 PMCID: PMC7661123 DOI: 10.1155/2020/4103418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 10/20/2020] [Indexed: 12/13/2022]
Abstract
Infection of skin injuries by pathogenic microbial strains is generally associated if not treated with a lasting wound bed oxidative stress status, a delay in healing process, and even wound chronicity with several human health complications. The aim of the current study was to explore the antioxidant and antimicrobial potentialities of safflower (Carthamus tinctorius L.) extracted oil from seeds by cold pressing which would be beneficial in the management of skin wounds. Antioxidant capacity of the oil was evaluated (scavenging ability against 1,1-diphenyl-2-picrylhydrazyl radical (DPPH) and 2,2'-azino-bis 3-ethylbenzothiazoline-6-sulfonic acid (ABTS), and ferric reducing antioxidant power (FRAP)). Total phenolic, total flavonoid, total carotenoid, and total chlorophyll contents were determined. Antimicrobial activities of safflower oil were tested against 10 skin pathogenic microorganisms: 4 bacterial strains (Escherichia coli, Enterobacter cloacae, Staphylococcus aureus, and Streptococcus agalactiae), 3 yeast species strains (Candida albicans, Candida parapsilosis, and Candida sake), and 3 fungi species (Aspergillus niger, Penicillium digitatum, and Fusarium oxysporum). A notable antioxidant capacity was demonstrated for the tested oil that exhibited moreover high antibacterial effects by both bacteriostatic and bactericidal pathways including lysozyme activity. An antifungal effect was further observed on the spore's germination. Safflower oil could be considered as a good natural alternative remedy in the management of skin wounds and their possible microbial infections.
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Affiliation(s)
- Ikram Khémiri
- Unité de Physiologie des Systèmes de Régulations et des Adaptations, Faculté des Sciences de Tunis, Université de Tunis El Manar, Campus Universitaire, 2092 Tunis, Tunisia
| | - Badiaa Essghaier
- Laboratoire de Mycologie, Pathologies et Biomarqueurs, Faculté des Sciences de Tunis, Université de Tunis El Manar, Campus Universitaire, 2092 Tunis, Tunisia
| | - Najla Sadfi-Zouaoui
- Laboratoire de Mycologie, Pathologies et Biomarqueurs, Faculté des Sciences de Tunis, Université de Tunis El Manar, Campus Universitaire, 2092 Tunis, Tunisia
| | - Lotfi Bitri
- Unité de Physiologie des Systèmes de Régulations et des Adaptations, Faculté des Sciences de Tunis, Université de Tunis El Manar, Campus Universitaire, 2092 Tunis, Tunisia
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8
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Al-Gharibi KA, Sharstha S, Al-Faras MA. Cost-Effectiveness of Wound Care: A concept analysis. Sultan Qaboos Univ Med J 2019; 18:e433-e439. [PMID: 30988960 DOI: 10.18295/squmj.2018.18.04.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 07/09/2018] [Accepted: 08/02/2018] [Indexed: 11/16/2022] Open
Abstract
This review aimed to analyse the concept of cost-effectiveness within the context of chronic wound care using Walker and Avant's approach. The Cumulative Index to Nursing and Allied Health Literature® (EBSCO Information Services, Ipswich, Massachusetts, USA), MEDLINE® (National Library of Medicine, Bethesda, Maryland, USA) and Nursing & Allied Health® (ProQuest LLC, Ann Arbor, Michigan, USA) databases were searched using a combination of keywords. A total of 18 peer-reviewed articles were identified. In wound care, defining attributes for the concept of cost-effectiveness encompassed treatments which were both effective and economical. Four antecedents were identified, including the type of wound, care setting, type of dressing and patient-related characteristics. The consequences of cost-effective wound care were patient prognosis, quality of life, the economic burden on the patient and healthcare system and cost-savings. These findings will hopefully help to standardise cost-effectiveness terminology among nursing professionals in various healthcare settings.
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Affiliation(s)
| | - Sajana Sharstha
- College of Nursing & Health Professions, Valparaiso University, Valparaiso, Indiana, USA
| | - Maria A Al-Faras
- College of Nursing & Health Professions, Valparaiso University, Valparaiso, Indiana, USA
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9
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Olivieri B, Yates TE, Vianna S, Adenikinju O, Beasley RE, Houseworth J. On the Cutting Edge: Wound Care for the Endovascular Specialist. Semin Intervent Radiol 2018; 35:406-426. [PMID: 30728657 PMCID: PMC6363558 DOI: 10.1055/s-0038-1676342] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Clinical outcomes in patients with critical limb ischemia (CLI) depend not only on endovascular restoration of macrovascular blood flow but also on aggressive periprocedural wound care. Education about this area of CLI therapy is essential not only to maximize the benefits of endovascular therapy but also to facilitate participation in the multidisciplinary care crucial to attaining limb salvage. In this article, we review the advances in wound care products and therapies that have granted the wound care specialist the ability to heal previously nonhealing wounds. We provide a primer on the basic science behind wound healing and the pathogenesis of ischemic wounds, familiarize the reader with methods of tissue viability assessment, and provide an overview of wound debridement techniques, dressings, hyperbaric therapy, and tissue offloading devices. Lastly, we explore emerging technology on the horizons of wound care.
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Affiliation(s)
- Brandon Olivieri
- Department of Interventional Radiology, Mount Sinai Medical Center, Miami, Florida
| | - Timothy E. Yates
- Department of Interventional Radiology, Mount Sinai Medical Center, Miami, Florida
| | - Sofia Vianna
- Department of Interventional Radiology, Mount Sinai Medical Center, Miami, Florida
| | | | - Robert E. Beasley
- Department of Interventional Radiology, Mount Sinai Medical Center, Miami, Florida
| | - Jon Houseworth
- School of Podiatric Medicine, Barry University, Miami, Florida
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10
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Venault A, Liou CS, Yeh LC, Jhong JF, Huang J, Chang Y. Turning Expanded Poly(tetrafluoroethylene) Membranes into Potential Skin Wound Dressings by Grafting a Bioinert Epoxylated PEGMA Copolymer. ACS Biomater Sci Eng 2017; 3:3338-3350. [DOI: 10.1021/acsbiomaterials.7b00732] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Antoine Venault
- Department of Chemical Engineering and R&D Center for Membrane Technology, Chung Yuan Christian University, 200 Chung Pei Road, Chung-Li City 32023, Taiwan
| | - Cheng-Sian Liou
- Department of Chemical Engineering and R&D Center for Membrane Technology, Chung Yuan Christian University, 200 Chung Pei Road, Chung-Li City 32023, Taiwan
| | - Lu-Chen Yeh
- Department of Chemical Engineering and R&D Center for Membrane Technology, Chung Yuan Christian University, 200 Chung Pei Road, Chung-Li City 32023, Taiwan
| | - Jheng-Fong Jhong
- Department of Chemical Engineering and R&D Center for Membrane Technology, Chung Yuan Christian University, 200 Chung Pei Road, Chung-Li City 32023, Taiwan
| | - James Huang
- Yeu Ming Tai Chemical Industrial Co. Ltd, Taichung 407, Taiwan
| | - Yung Chang
- Department of Chemical Engineering and R&D Center for Membrane Technology, Chung Yuan Christian University, 200 Chung Pei Road, Chung-Li City 32023, Taiwan
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11
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Chen YC, Yang H. Octopus-Inspired Assembly of Nanosucker Arrays for Dry/Wet Adhesion. ACS NANO 2017; 11:5332-5338. [PMID: 28448714 DOI: 10.1021/acsnano.7b00809] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The octopus is capable of adhering to slippery, rough, and irregular surfaces in the marine intertidal zone because of its periodic infundibulum-shaped suckers on the arms. Here, we present a scalable self-assembly technology for fabricating adhesion materials that mimic octopus sucker functionality. By utilizing spin-coated two-dimensional colloidal crystals as templates, non-close-packed nanosucker arrays are patterned on silicone substrates. The resulting nanosuckers can be deformed to exhibit great adhesive capacities on both microrough and flat surfaces in dry and wet environments. This indicates a probable biomimetic solution to the challenge of wound care.
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Affiliation(s)
- Ying-Chu Chen
- Department of Chemical Engineering, National Chung Hsing University , No. 145, Xingda Road, Taichung 40227, Taiwan
| | - Hongta Yang
- Department of Chemical Engineering, National Chung Hsing University , No. 145, Xingda Road, Taichung 40227, Taiwan
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12
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McMahon S, Kennedy R, Duffy P, Vasquez JM, Wall JG, Tai H, Wang W. Poly(ethylene glycol)-Based Hyperbranched Polymer from RAFT and Its Application as a Silver-Sulfadiazine-Loaded Antibacterial Hydrogel in Wound Care. ACS APPLIED MATERIALS & INTERFACES 2016; 8:26648-26656. [PMID: 27636330 DOI: 10.1021/acsami.6b11371] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
A multifunctional branched copolymer was synthesized by Reversible Addition-Fragmentation Chain Transfer polymerization (RAFT) of poly(ethylene glycol) diacrylate (PEGDA Mn = 575) and poly(ethylene glycol) methyl methacrylate (PEGMEMA Mn = 500) at a feed molar ratio of 50:50. Proton nuclear magnetic resonance spectroscopy (1H NMR) confirmed a hyperbranched molecular structure and a high degree of vinyl functionality. An in situ cross-linkable hydrogel system was generated via a "click" thiol-ene-type Michael addition reaction of vinyl functional groups from this PEGDA/PEGMEMA copolymer system in combination with thiol-modified hyaluronic acid. Furthermore, encapsulation of antimicrobial silver sulfadiazine (SSD) into the copolymer system was conducted to create an advanced antimicrobial wound care dressing. This hydrogel demonstrated a sustained antibacterial activity against the bacterial strains Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli in comparison to the direct topical application of SSD. In addition, in vitro toxicology evaluations demonstrated that this hydrogel-with low concentrations of encapsulated SSD-supported the survival of embedded human adipose derived stem cells (hADSCs) and inhibited growth of the aforementioned pathogens. Here we demonstrate that this hydrogel encapsulated with a low concentration (1.0% w/v) of SSD can be utilized as a carrier system for stem cells with the ability to inhibit growth of pathogens and without adverse effects on hADSCs.
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Affiliation(s)
- Sean McMahon
- Charles Institute of Dermatology, School of Medicine and Medical Sciences, University College Dublin , Belfield, Dublin Dublin 4, Ireland
| | - Robert Kennedy
- Charles Institute of Dermatology, School of Medicine and Medical Sciences, University College Dublin , Belfield, Dublin Dublin 4, Ireland
| | - Patrick Duffy
- Charles Institute of Dermatology, School of Medicine and Medical Sciences, University College Dublin , Belfield, Dublin Dublin 4, Ireland
| | - Jeddah Marie Vasquez
- Charles Institute of Dermatology, School of Medicine and Medical Sciences, University College Dublin , Belfield, Dublin Dublin 4, Ireland
| | - J Gerard Wall
- Microbiology and Centre for Research in Medical Devices (CÚRAM), National University of Ireland , Galway SW4, Ireland
| | - Hongyun Tai
- School of Chemistry, Bangor University , Bangor LL57 2UW, United Kingdom
| | - Wenxin Wang
- Charles Institute of Dermatology, School of Medicine and Medical Sciences, University College Dublin , Belfield, Dublin Dublin 4, Ireland
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Farooqui MF, Shamim A. Low Cost Inkjet Printed Smart Bandage for Wireless Monitoring of Chronic Wounds. Sci Rep 2016; 6:28949. [PMID: 27353200 PMCID: PMC4926082 DOI: 10.1038/srep28949] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 06/07/2016] [Indexed: 11/26/2022] Open
Abstract
Chronic wounds affect millions of patients around the world and their treatment is challenging as the early signs indicating their development are subtle. In addition, a type of chronic wound, known as pressure ulcer, develops in patients with limited mobility. Infection and frequent bleeding are indicators of chronic wound development. In this article, we present an unprecedented low cost continuous wireless monitoring system, realized through inkjet printing on a standard bandage, which can send early warnings for the parameters like irregular bleeding, variations in pH levels and external pressure at wound site. In addition to the early warnings, this smart bandage concept can provide long term wound progression data to the health care providers. The smart bandage comprises a disposable part which has the inkjet printed sensors and a reusable part constituting the wireless electronics. This work is an important step towards futuristic wearable sensors for remote health care applications.
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Affiliation(s)
- Muhammad Fahad Farooqui
- Electrical Engineering Program, 4700 King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
| | - Atif Shamim
- Electrical Engineering Program, 4700 King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia
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14
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Lee SM, Park IK, Kim YS, Kim HJ, Moon H, Mueller S, Jeong YI. Physical, morphological, and wound healing properties of a polyurethane foam-film dressing. Biomater Res 2016; 20:15. [PMID: 27274861 PMCID: PMC4893288 DOI: 10.1186/s40824-016-0063-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/31/2016] [Indexed: 11/19/2022] Open
Abstract
Background We investigated the physicochemical properties of Medifoam® N and its wound healing performance compared to other commercially available polyurethane (PU) foam dressing in vitro and in vivo to gain insight in their clinical performance. Methods Wound contact layer and cross-section of eleven polyurethane foam dressings were assessed with field-emission scanning electron microscope. Thickness, density, tensile strength, elongation, moisture-vapor transmission rate (MVTR), retention and absorptivity were measured to compare physical properties. Phosphate-buffered saline (PBS) solution absorption patterns were compared. An animal model for wound-healing was applied to validate in vitro findings. Results Among eleven tested foam dressings, Medifoam® N has the smallest pore and cell sizes with excellent uniformity, i.e. it has 25 ~ 75 μm on the wound contact layer and 100 ~ 350 μm in the cross-section while other dressings have a larger pose size with larger variability. Compared to other PU foams, Medifoam® N also has moderate thickness, density, tensile strength, elongation and MVTR. Furthermore, it has excellent fluid absorption and retention capacity. These intrinsic properties of Medifoam® N contributed to improve fluid absorption patterns, i.e. other dressing material flawed out PBS solution on the dressings while Medifoam® N retained all the tested solutions. In animal wound-healing study, Medifoam® N treated animals showed excellent angiogenesis and collagen deposition even though epithelial recovery rate was not significantly different to other dressings. Conclusions Medifoam® N has optimized physical properties and thus improved fluid absorption/retention capacity. Compared to other dressings, Medifoam® N showed excellent fluid absorption patterns and these characteristics contributed to improved wound healing and excellent angiogenic potential. We found that Medifoam® N showed the best results among the employed dressing samples. Electronic supplementary material The online version of this article (doi:10.1186/s40824-016-0063-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | - Young-Il Jeong
- Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan, 602-739 Republic of Korea
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Percival SL, McCarty SM. Silver and Alginates: Role in Wound Healing and Biofilm Control. Adv Wound Care (New Rochelle) 2015; 4:407-414. [PMID: 26155383 PMCID: PMC4486446 DOI: 10.1089/wound.2014.0541] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 06/15/2014] [Indexed: 01/08/2023] Open
Abstract
Significance: Chronic wounds are known to be a significant issue globally. Of concern in wounds are the numbers and types of residing microorganisms and the ability of the host's immune system to control their proliferation. Wound healing is impeded by colonizing microorganisms growing within the biofilm phenotypic state. In this state microorganisms are recalcitrant to routinely impeded by used antimicrobial interventions. Recent advances: Silver has been reported to demonstrate efficacy on planktonic microorganisms both within the in vitro and in vivo environments. However, when silver is incorporated into a wound dressing, its antimicrobial efficacy on biofilms within the in vivo environment remains contentious. Critical Issues: Unequivocal evidence of the efficacy of silver, and wound dressings containing silver, on biofilms in clinical situations is lacking. This is principally due to the deficiency of definite biofilm definitions, markers, and evidence in the chronic wound environment. Future Direction: Research studies demonstrating antimicrobial efficacy on in vitro biofilms can be used to generate data and information appropriate for extrapolation and applicability to the in vivo environment. It is very important that inventors of antimicrobial wound dressings ensure efficacy against both planktonic and sessile microorganisms, within the in vitro and in vivo environments.
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Affiliation(s)
- Steven L. Percival
- Surface Science Research Centre, University of Liverpool, Liverpool, United Kingdom
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
- Scapa Healthcare, Manchester, United Kingdom
| | - Sara M. McCarty
- Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, United Kingdom
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Ou L, Shi Y, Dong W, Liu C, Schmidt TJ, Nagarkatti P, Nagarkatti M, Fan D, Ai W. Kruppel-like factor KLF4 facilitates cutaneous wound healing by promoting fibrocyte generation from myeloid-derived suppressor cells. J Invest Dermatol 2015; 135:1425-1434. [PMID: 25581502 PMCID: PMC4402119 DOI: 10.1038/jid.2015.3] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 12/05/2014] [Accepted: 12/15/2014] [Indexed: 12/17/2022]
Abstract
Pressure ulcers (PUs) are serious skin injuries whereby the wound healing process is frequently stalled in the inflammatory phase. Myeloid-derived suppressor cells (MDSCs) accumulate as a result of inflammation and promote cutaneous wound healing by mechanisms not fully understood. Recently, MDSCs have been shown to differentiate into fibrocytes which serve as emerging effector cells that enhance cell proliferation in wound healing. We postulate that in wound healing, MDSCs not only execute their immunosuppressive function to regulate inflammation, but also stimulate cell proliferation once they differentiate into fibrocytes. In the current study, using full thickness and pressure ulcer mouse models, we found that KLF4 deficiency resulted in decreased accumulation of MDSCs and fibrocytes and wound healing was significantly delayed. Conversely, KLF4 activation by the plant-derived product, Mexicanin I, increased the numbers of MDSCs and fibrocytes and accelerated wound healing. Collectively, our study revealed a previously unreported function of MDSCs in cutaneous wound healing and identified Mexicanin I as a potential agent to accelerate PU wound healing.
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Affiliation(s)
- Lingling Ou
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, USA.,Department of Biopharmaceuticals, School of Biotechnology, Southern Medical University, Guangzhou, China
| | - Ying Shi
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, USA.,Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wenqi Dong
- Department of Biopharmaceuticals, School of Biotechnology, Southern Medical University, Guangzhou, China
| | - Chunming Liu
- Department of Molecular and Cellular Biochemistry, University of Kentucky, Lexington, KY, USA
| | - Thomas J Schmidt
- Institute of Pharmaceutical Biology and Phytochemistry (IPBP), PharmaCampus, Westfälische-Wilhelms-Universität, Münster, Germany
| | - Prakash Nagarkatti
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Mitzi Nagarkatti
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Daping Fan
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Walden Ai
- Department of Pathology, Microbiology and Immunology, University of South Carolina School of Medicine, Columbia, SC, USA
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17
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Ruedrich ED, Henzel MK, Hausman BS, Bogie KM. Reference gene identification for reverse transcription-quantitative polymerase chain reaction analysis in an ischemic wound-healing model. J Biomol Tech 2014; 24:181-6. [PMID: 24294111 DOI: 10.7171/jbt.13-2404-003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Reference genes are often used in RT-quantitative PCR (qPCR) analysis to normalize gene expression levels to a gene that is expressed stably across study groups. They ultimately serve as a control in RT-qPCR analysis, producing more accurate interpretation of results. Whereas many reference genes have been used in various wound-healing studies, the most stable reference gene for ischemic wound-healing analysis has yet to be identified. The goal of this study was to determine systematically the most stable reference gene for studying gene expression in a rat ischemic wound-healing model using RT-qPCR. Twelve commonly used reference genes were analyzed using RT-qPCR and geNorm data analysis to determine stability across normal and ischemic skin tissue. It was ultimately determined that Ubiquitin C (UBC) and β-2 Microglobulin (B2M) are the most stably conserved reference genes across normal and ischemic skin tissue. UBC and B2M represent reliable reference genes for RT-qPCR studies in the rat ischemic wound model and are unaffected by sustained tissue ischemia. The geometric mean of these two stable genes provides an accurate normalization factor. These results provide insight on dependence of reference-gene stability on experimental parameters and the importance of such reference-gene investigations.
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18
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Carter MJ. Economic evaluations of guideline-based or strategic interventions for the prevention or treatment of chronic wounds. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2014; 12:373-389. [PMID: 24615160 PMCID: PMC4110411 DOI: 10.1007/s40258-014-0094-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Costs of chronic wound care are significant, but systematic reviews of cost-effectiveness studies regarding guideline-based or strategic interventions are scarce. OBJECTIVES Our objectives were to assess/compare the cost effectiveness of new interventions/systems designed to improve the prevention/treatment of chronic wounds in adult populations against current care and provide decision makers with information on which to base future interventions for chronic wound management. DATA SOURCES Data sources included PubMed, Scopus, HTA, and NHS EED. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS We included comparative health economic evaluations of interventions published in English designed to prevent or treat adult chronic wounds that were guideline-based or strategic in nature and from which an incremental cost-effectiveness ratio or incremental net health benefit was reported or could be calculated. STUDY APPRAISAL AND SYNTHESIS METHODS Study and model characteristics and outcomes were extracted into pre-designed tables. Quality assessment of studies was based on literature-reported methods. Studies were assigned strength of evidence ratings and recommendation level for decision makers. RESULTS A total of 16 health economic evaluations were included, of which ten were trial based and six were wholly model based. Only three studies had high, and five studies moderate, strength of evidence and were recommended for decision makers. All studies had some shortcomings regarding time horizon, costs, effectiveness units, and methodological reporting. Two studies had major flaws. LIMITATIONS Limitations include missed studies published in non-English languages or not cited in searched databases; judgment bias in assessing studies. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS Few well conducted cost-effectiveness studies exist to guide decision makers regarding guideline-based or strategic interventions for chronic wounds.
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Affiliation(s)
- Marissa J Carter
- Strategic Solutions, Inc., 1143 Salsbury Ave, Cody, WY, 82414, USA,
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McCallon SK, Weir D, Lantis JC. Optimizing Wound Bed Preparation With Collagenase Enzymatic Debridement. J Am Coll Clin Wound Spec 2014; 6:14-23. [PMID: 26442207 PMCID: PMC4566869 DOI: 10.1016/j.jccw.2015.08.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Difficult-to-heal and chronic wounds affect tens of millions of people worldwide. In the U.S. alone, the direct cost for their treatment exceeds $25 billion. Yet despite advances in wound research and treatment that have markedly improved patient care, wound healing is often delayed for weeks or months. For venous and diabetic ulcers, complete wound closure is achieved in as few as 25%-50% of chronic or hard-to-heal wounds. Wound bed preparation and the consistent application of appropriate and effective debridement techniques are recommended for the optimized treatment of chronic wounds. The TIME paradigm (Tissue, Inflammation/infection, Moisture balance and Edge of wound) provides a model to remove barriers to healing and optimize the healing process. While we often think of debridement as an episodic event that occurs in specific care giver/patient interface. There is the possibility of a maintenance debridement in which the chronic application of a medication can assist in both the macroscopic and microscopic debridement of a wound. We review the various debridement therapies available to clinicians in the United States, and explore the characteristics and capabilities of clostridial collagenase ointment (CCO), a type of enzymatic debridement, that potentially allows for epithelialization while debriding. It appears that in the case of CCO it may exert this influences by removal of the necrotic plug while promoting granulation and sustaining epithelialization. It is also easily combined with other methods of debridement, is selective to necrotic tissue, and has been safely used in various populations. We review the body of evidence has indicated that this concept of maintenance debridement, especially when combined episodic debridement may add a cost an efficacious, safe and cost-effective choice for debridement of cutaneous ulcers and burn wounds and it will likely play an expanding role in all phases of wound bed preparation.
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Affiliation(s)
- Stanley K. McCallon
- Department of Physical Therapy, Louisiana State University Health Sciences Center, School of Allied Health Professions, Shreveport, LA, USA
| | - Dorothy Weir
- Osceola Regional Medical Center, Kissimmee, FL, USA
| | - John C. Lantis
- Division Vascular/Endovascular Surgery, Division of Clinical Surgical Research, Mt Sinai St. Luke's and Roosevelt Hospital Center, New York, NY, USA
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20
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Next science wound gel technology, a novel agent that inhibits biofilm development by gram-positive and gram-negative wound pathogens. Antimicrob Agents Chemother 2014; 58:3060-72. [PMID: 24637684 DOI: 10.1128/aac.00108-14] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Loss of the skin barrier facilitates the colonization of underlying tissues with various bacteria, where they form biofilms that protect them from antibiotics and host responses. Such wounds then become chronically infected. Topical antimicrobials are a major component of chronic wound therapy, yet currently available topical antimicrobials vary in their effectiveness on biofilm-forming pathogens. In this study, we evaluated the efficacy of Next Science wound gel technology (NxtSc), a novel topical agent designed to kill planktonic bacteria, penetrate biofilms, and kill the bacteria within. In vitro quantitative analysis, using strains isolated from wounds, showed that NxtSc inhibited biofilm development by Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae by inhibiting bacterial growth. The gel formulation NxtSc-G5, when applied to biofilms preformed by these pathogens, reduced the numbers of bacteria present by 7 to 8 log10 CFU/disc or CFU/g. In vivo, NxtSc-G5 prevented biofilm formation for 72 h when applied at the time of wounding and infection and eliminated biofilm infection when applied 24 h after wounding and infection. Storage of NxtSc-G5 at room temperature for 9 months did not diminish its efficacy. These results establish that NxtSc is efficacious in vitro and in vivo in preventing infection and biofilm development by different wound pathogens when applied immediately and in eliminating biofilm infection already established by these pathogens. This novel antimicrobial agent, which is nontoxic and has a usefully long shelf life, shows promise as an effective agent for the prevention and treatment of biofilm-related infections.
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21
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Whitcomb E, Monroe N, Hope-Higman J, Campbell P. Demonstration of a microcurrent-generating wound care device for wound healing within a rehabilitation center patient population. J Am Coll Clin Wound Spec 2013; 4:32-9. [PMID: 24527381 DOI: 10.1016/j.jccw.2013.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/03/2013] [Accepted: 07/05/2013] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Wound care in a rehabilitation environment is a costly and difficult problem. The goal of this retrospective study is to evaluate differences in wound closure outcomes in acute and chronic wounds when treated with a microcurrent-generating wound care device as compared to standard wound care methods. METHODS Data files of 38 patients who received either standard wound treatment (SOC; n = 20), or were treated with a microcurrent-generating wound device (MCD, n = 18), were retrospectively reviewed. Wounds were assessed until deemed clinically to have closed or healed with up to 100% epithelialization. All patients (18-99 years) with single wounds were included. The number of days to wound closure and the rate of wound volume reduction were compared across groups. Persistent reduction of wound size improvement was also examined. RESULTS The wounds in the SOC group closed on average at 36.25 days (SD = 28.89), while the MCD group closed significantly faster in 19.78 days (SD = 14.45), p = 0.036. The rate of volume reduction per day was -3.83% for SOC vs. -9.82% volume reduction per day (p = 0.013) for the MCD group. The SOC group had 50% of its wounds close monotonically vs. 83.3% in the MCD group (p = 0.018). CONCLUSION This two-center retrospective study demonstrated a 45.4% faster, and more robust healing of wounds with the use of the MCD, when compared to SOC in a rehabilitation center environment. This translates into improved patient care, and potentially significant cost savings. Economic benefits for the use of MCD compared to other wound care methods are planned for future research.
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Affiliation(s)
- Emily Whitcomb
- Bethany Health and Rehab Center, Nashville, TN, USA ; Trevecca Health and Rehab Center, Nashville, TN, USA
| | - Nina Monroe
- Bethany Health and Rehab Center, Nashville, TN, USA
| | | | - Penny Campbell
- Bethany Health and Rehab Center, Nashville, TN, USA ; Trevecca Health and Rehab Center, Nashville, TN, USA ; Vomaris Wound Care, Inc., Chandler, AZ, USA
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Regulation of connexin43 gap junction protein triggers vascular recovery and healing in human ocular persistent epithelial defect wounds. J Membr Biol 2012; 245:381-8. [PMID: 22797940 DOI: 10.1007/s00232-012-9460-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
Abstract
Transiently blocking the expression of the gap junction protein connexin43 using antisense oligodeoxynucleotides or blocking hemichannels with connexin mimetic peptides has been shown to significantly improve outcomes in a range of acute wound models. Less is known about their likely effects in nonhealing wounds. In the eye, prolonged inflammation and lack of epithelial recovery in nonhealing corneal epithelial wounds may lead to corneal opacity, blindness or enucleation. We report here the first human applications of antisense oligodeoxynucleotides that transiently block translation of connexin43 in a prospective study of five eyes with severe ocular surface burns (persistent epithelial defects), which were unresponsive to established therapy for 7 days to 8 weeks prior to treatment. Connexin43-specific antisense oligodeoxynucleotide was delivered in cold, thermoreversible Poloxamer407 gel under either an amniotic membrane graft or a bandage contact lens. The connexin43-specific antisense application reduced inflammation within 1-2 days, and in all five eyes complete and stable corneal reepithelialization was obtained. Recovery of the vascular bed and limbal reperfusion appeared to precede corneal epithelial recovery. We conclude that connexin modulation provides a number of benefits for nonhealing ocular burn wounds, one of which is to promote vascular recovery.
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Hooper SJ, Percival SL, Hill KE, Thomas DW, Hayes AJ, Williams DW. The visualisation and speed of kill of wound isolates on a silver alginate dressing. Int Wound J 2012; 9:633-42. [PMID: 22405034 DOI: 10.1111/j.1742-481x.2012.00927.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In chronic wound management, alginate dressings are used to absorb exudate and reduce the microbial burden. Silver alginate offers the added benefit of an additional antimicrobial pressure on contaminating microorganisms. This present study compares the antimicrobial activity of a RESTORE silver alginate dressing with a silver-free control dressing using a combination of in vitro culture and imaging techniques. The wound pathogens examined included Candida albicans, Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, β-haemolytic Streptococcus, and strictly anaerobic bacteria. The antimicrobial efficacy of the dressings was assessed using log(10) reduction and 13-day corrected zone of inhibition (CZOI) time-course assays. Confocal laser scanning microscopy (CLSM) was used to visualise the relative proportions of live/dead microorganisms sequestered into the dressings over 24 hours and estimate the comparative speed of kill. The RESTORE silver alginate dressing showed significantly greater log(10) reductions and CZOIs for all microorganisms compared with the control, indicating the antimicrobial effect of ionic silver. Antimicrobial activity was evident against all test organisms for up to 5 days and, in some cases, up to 12 days following an on-going microbial challenge. Imaging bacteria sequestered in the silver-free dressing showed that each microbial species aggregated in the dressing and remained viable for more than 20 hours. Growth was not observed inside of the dressing, indicating a possible microbiostatic effect of the alginate fibres. In comparison, organisms in the RESTORE silver alginate dressing were seen to lose viability at a considerably greater rate. After 16 hours of contact with the RESTORE silver alginate dressing, >90% of cells of all bacteria and yeast were no longer viable. In conclusion, collectively, the data highlights the rapid speed of kill and antimicrobial suitability of this RESTORE silver alginate dressing on wound isolates and highlights its overwhelming ability to manage a microbial wound bioburden in the management of infected wounds.
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Affiliation(s)
- Samuel J Hooper
- Tissue Engineering and Reparative Dentistry, Cardiff University, UK
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