Assessment Of Healing Research Articles

Swine Model of Biofilm Infection and Invisible Wounds.

Biofilm infection is a major contributor to wound chronicity. The establishment of clinically relevant experimental wound biofilm infection requires the involvement of the host immune system. Iterative changes in the host and pathogen during the formation of such clinically relevant biofilm can only occur in vivo. The swine wound model is recognized for its advantages as a powerful pre-clinical model. There are several reported approaches for studying wound biofilms. In vitro and ex vivo systems are deficient in terms of the host immune response. Short-term in vivo studies involve acute responses and, thus, do not allow for biofilm maturation, as is known to occur clinically. The first long-term swine wound biofilm study was reported in 2014. The study recognized that biofilm-infected wounds may close as determined by planimetry, but the skin barrier function of the affected site may fail to be restored. Later, this observation was validated clinically. The concept of functional wound closure was thus born. Wounds closed but deficient in skin barrier function may be viewed as invisible wounds. In this work, we seek to report the methodological details necessary to reproduce the long-term swine model of biofilm-infected severe burn injury, which is clinically relevant and has translational value. This protocol provides detailed guidance on establishing an 8 week wound biofilm infection using P. aeruginosa (PA01). Eight full-thickness burn wounds were created symmetrically on the dorsum of domestic white pigs, which were inoculated with (PA01) at day 3 post-burn; subsequently, noninvasive assessments of the wound healing were conducted at different time points using laser speckle imaging (LSI), high-resolution ultrasound (HUSD), and transepidermal water loss (TEWL). The inoculated burn wounds were covered with a four-layer dressing. Biofilms, as established and confirmed structurally by SEM at day 7 post-inoculation, compromised the functional wound closure. Such an adverse outcome is subject to reversal in response to appropriate interventions.

Shape Memory Alloy Reinforced Self-Healing Metal Matrix Composites

This paper reviews the synthesis, characterization, healing assessment, and mechanics of NiTi and other shape memory alloy (SMA)-reinforced self-healing metal matrix composites (SHMMCs). Challenges to synthesizing and characterizing the SMA-reinforced SHMMCs and the strategies followed to overcome those challenges are discussed. To design the SMA-reinforced SHMMCs, it is necessary to understand their microstructural evolution during melting and solidification. This requires the knowledge of the thermodynamics of phase diagrams and nonequilibrium solidification, which are presented in this paper for a model self-healing composite system. Healing assessment provides information about the autonomous and multicycle healing capability of synthesized SHMMCs, which ultimately determines their success. Different techniques to assess the degree of healing of SHMMCs are discussed in this paper. Strategies are explored to find the optimum volume fraction of SMA wires needed to yield the matrix and prevent damage to the SMA wires for the most effective healing. Finally, major challenges, knowledge gaps, and future research directions, including the need for autonomous and multicycle healing capability in SMA-reinforced SHMMCs, are outlined.

Estimation of wound surface area: an evaluation of medical professionals' assessment in a plastic surgery unit.

The percentage of skin graft take following the resurfacing of burn injuries is routinely calculated in a subjective fashion, in order to make management decisions. Given the gravity of decisions made based on this clinical assessment of graft check, it is notable that limited research has been carried out on this subject. No standardised subjective assessment tools exist to measure surface area of graft take in a manner similar to that of Wallace's Rule of Nines or Lund and Browder. This study set out to examine the accuracy of visual assessments of graft take within the multidisciplinary team regularly making assessments of newly grafted burn wounds. A total of 15 digitally drawn images were used to assess 36 staff members' estimations of percentage of surface area. The results showed a wide variation in estimation in all staff types, including senior burns surgeons, who were found to underestimate surface area by as much as 30%. The British Burns Association has removed 'healing time' as an outcome measurement from its guidance, as it recognises how hard it is to make a standardised assessment of wound healing. This study demonstrates the difficulty in subjectively assessing surface area and makes some suggestions for further research and clinical applications of technology to aid assessment.

Cinnamon Decoction for Healing Perineal Lacerations in Postpartum Mothers

Perineal laceration is one of the obstetrical complications that occurs during labour. As many as 2.7 million people in 2016 were found by mothers giving birth with perineal lacerations and it is estimated that by 2050 this will increase to 6.3 million. This study aims to determine the effectiveness of a decoction of cinnamon and binahong leaf tea in healing perineal lacerations in postpartum women at the Sunartik clinic. The research design used the pre-experimental design method with the pretest-posttest design. The population in this study were all spontaneous postpartum mothers who gave birth and experienced first and second degree perineal lacerations at the Pratama Sunartik Clinic, Sei Mencirim Village, as many as 15 people using purposive sampling techniques. Assessment of healing of perineal lacerations used the REEDA scale which was measured in 2 stages, namely the pretest was carried out before the intervention, and the posttest was carried out once a day after the last intervention was carried out or on the 8th day. The data analysis used was paired sample t test with a significance level of 95% (0.05). The results of the study obtained a sig value of 0.000 with a mean of 3.800 and CI (2.408-5.192). In conclusion, there is an effectiveness of cinnamon decoction which is shown in healing perineal lacerations. It is hoped that health workers, especially in primary facilities and clinics, will help and provide health education for postpartum women in an effort to heal perineal lacerations by empowering natural products.

Voluntary Medical Male Circumcision and Incident HIV Infection Among Men Who Have Sex With Men in China (The CoM Study): Protocol for a Randomized Controlled Trial.

Systematic reviews and meta-analyses based on observational studies have shown voluntary medical male circumcision (VMMC) may reduce HIV risk among men who have sex with men (MSM). There is a lack of randomized controlled trial (RCT) data assessing the efficacy of VMMC. The primary objective of this study was to assess the efficacy of VMMC for preventing HIV acquisition among MSM who primarily engage in insertive anal sex. A multicenter RCT will be conducted among MSM in 8 cities in China. Eligible participants are men aged 18-49 years who self-report ≥2 male sex partners in the past 6 months, predominantly practice insertive anal sex, and are willing to undergo circumcision. Interested men who satisfy inclusion criteria will be tested for HIV 1 month before enrollment and at enrollment, and only those who are HIV negative will be enrolled. At baseline, all enrolled participants will be asked to report sociodemographic characteristics and sexual behaviors; provide a blood sample for HIV, syphilis, and herpes simplex virus type 2 testing; and provide a penile swab for human papillomavirus testing. Participants will be randomly assigned to the intervention or control group. Those in the intervention group will receive VMMC and undergo a web-based weekly follow-up assessment of postsurgery healing for 6 consecutive weeks. All participants will be tested for HIV at 3-, 6-, 9-, and 12-month follow-ups. All participants will also be asked to report sexual behaviors and undergo repeat herpes simplex virus type 2 and human papillomavirus testing at 6- and 12-month follow-ups. The primary end point is HIV seroconversion. Secondary end points are the safety and satisfaction with VMMC and the changes in sexual behaviors after VMMC. The grouped censored data will be analyzed by intention-to-treat approach. Recruitment for the RCT began in August 2020 and continued through July 2022. Data collection is expected to be completed by July 2023, and full data analysis is going to be completed by September 2023. This study will be the first RCT to assess the efficacy of VMMC in preventing HIV infection among MSM. Results from this trial will provide preliminary evidence for the potential efficacy of VMMC to reduce incident HIV infection among MSM. Chinese Clinical Trial Registry ChiCTR2000039436; https://www.chictr.org.cn/showproj.html?proj=63369. DERR1-10.2196/47160.

KNOWLEDGE OF UNDERGRADUATE NURSING STUDENTS ABOUT GENERAL WOUND CARE: OBSERVATIONAL STUDY

Objective: To identify nursing students’ knowledge about general wound care. Methods: This is an observational-descriptive research conducted with final-year nursing undergraduate students from higher education institutions in the Cariri region, Ceara, Brazil. Data collection was developed through the sampling technique snowball or snowball sampling. The data were tabulated in Microsoft Excel Spreadsheet and later analyzed by simple descriptive statistics. Results: The sample included 211 nursing students, from the ninth (123) and tenth (88) semester, from public (50) and private (161) institutions. Among the students, 122 highlighted professors and scientific events as sources of searching for primary information about wounds, and that in their hospital internships they have skin assessment as part of the activities they perform (85.8%). About the knowledge, the data that showed the highest percentage are regarding aspects of wound assessment (98.6%), coverage (96.7%) and biological factors of healing (92.4%). The participants left to be desired in aspects of PU prevention (39.8%) and Braden scale, with 45% of correct answers. Conclusion: This study made it possible to identify the general knowledge about wounds of graduating nursing students.

Evaluation of a Rabbit Model of Vascular Stent Healing: Application of Optical Coherence Tomography.

Percutaneous coronary intervention (PCI) is a management strategy for symptomatic obstructive coronary artery disease (CAD). Despite advancements, in-stent restenosis (ISR) still imparts a 1-2% annual rate of repeat revascularization-a focus of ongoing translational research. Optical coherence tomography (OCT) provides high resolution virtual histology of stents. Our study evaluates the use of OCT for virtual histological assessment of stent healing in a rabbit aorta model, enabling complete assessment of intraluminal healing throughout the stent. ISR varies based on intra-stent location, stent length, and stent type in a rabbit model-important considerations for translational experimental design. Atherosclerosis leads to more prominent ISR proliferation independent of stent-related factors. Therabbit stent model mirrors clinical observations, while OCT-based virtualhistology demonstrates utility for pre-clinical stent assessment. Pre-clinical models should incorporate clinical and stent factors as feasible to maximize translation to clinical practice.

Antimicrobial efficacy of composite irrigation solution against dominant pathogens in seawater immersion wound and in vivo wound healing assessment.

Seawater immersion wound is inevitably accompanied by bacterial infection. Effective irrigation is critical for bacterial infection prevention and wound healing. In this study, the antimicrobial efficacy of a designed composite irrigation solution against several dominant pathogens in seawater immersion wounds was evaluated, and in vivo wound healing assessment was conducted in a rat model. According to the time-kill result, the composite irrigation solution exhibits excellent and rapid bactericidal effect against Vibrio alginolyticus and Vibrio parahaemolyticus within 30 s of treatment while eliminating Candida albicans, Pseudomonas aeruginosa, Escherichia coli, and the mixed microbes after 1 h, 2 h, 6 h, and 12 h of treatment, respectively. Significant bacterial count reduction of Staphylococcus aureus was observed after 5 h treatment. In addition to its skin non-irritating attribute, the in vivo wound healing results further demonstrated that the irrigation solution showed high repair efficiency in the skin defect model inoculated with the mixed microbes. The wound healing rate was significantly higher than that of the control and normal saline groups. It could also effectively reduce the number of viable bacteria on the wound surface. The histological staining indicated that the irrigation solution could reduce inflammatory cells and promote collagen fibers and angiogenesis, thereby promoting wound healing. We believed that the designed composite irrigation solution has great potential for application in the treatment of seawater immersion wounds.

Uloga CBCT-a u području dentalne implantologije

As radiology rapidly and continuously develops, dental radiological devices are becoming integral to dental practice. CBCT enables a precise three-dimensional image of the orofacial region. The wider use of CBCT devices is further encouraged by the flaws of two-dimensional radiological methods, especially concerning dental implantology. This paper aims to describe the advantages and disadvantages of using CBCT devices in planning and placing dental implants. It offers an insight into artifacts and radiation doses and their influence on the quality of the resulting image. The generation of multiplanar slices of the area of interest, the possibility of 3D reconstruction, the reduction of the magnification error, and the radiation dose are some of the important advantages of the CBCT device. A Limited FOV and volume of the screening, a low range of contrasts, measuring of bone density and shades of grayscale, as well as possible artifacts of movement are some of its disadvantages. Not only did the CBCT device find a purpose in the processes of planning and placement of dental implants, but also in postoperative assessments of healing and possible complications. CBCT balances the price and radiation dose and the quality of clinical information. It is used in oral surgery, orthodontics, periodontology, and endodontics. Due to its precision and quality, the CBCT device is the foundation of dental implantology.

Sonographic Findings of Abdominal Wall Endometriosis in Persistent Abdominal Wall Pain: A Case Report

Introduction/Background: Endometriosis is considered a chronic neuroinflammatory disease of debilitating pain, most often in the pelvic area. In rare cases, endometriosis can develop through iatrogenic implantation of endometrial cells/fragments into a scar area during the cesarean delivery. Case Description: A case of a 32-year-old female patient who underwent physical therapy for abdominal muscle pain with occasional irradiation of pain to the sacral region is presented. The pain developed soon after a cesarean delivery, which was performed 3 years ago. Outcomes: Palpation performed at the initial examination and after removal of the lesions showed a significant reduction in tone at the site of the lesions and a reduction in palpation pain. The objective primary tools and specific outcome measures used in this case were musculoskeletal sonography and a patient questionnaire (36-Item Short Form Health Survey [SF-36]). Abdominal wall lesions were found to be 34 × 13 × 40 mm and 30 × 15 × 22 mm in size and were surgically removed by a specialized surgeon with histological confirmation of endometriosis. The SF-36 scores considerably improved in all domains following removal of the lesions compared with the condition at the initial examination. Discussion: The presented case is an example of the musculoskeletal sonography evaluation following palpation of the abdominal wall in women after a cesarean delivery. The described sonographic examination performed by a physical therapist can be part of a comprehensive assessment of scar healing, diastasis, and the ability to activate the abdominal muscles during postpartum rehabilitation. Informed Consent: The patient signed informed consent, in which she agreed to the anonymous publication of her case. A supplemental video abstract available at: https://www.youtube.com/watch?v=Vd87WB8ZQd0&t=16s

Assessment of Healing after Diode Laser Gingivectomy Prior to Prosthetic Procedures

The current pilot study investigates the effects following removal of excessive gingival tissue, which is often necessary in fixed prosthodontic cases. The aim of the study is to assess gingival healing after diode laser gingivectomy prior to prosthetic procedures. Materials and methods: The healing process of the gingiva after the diode laser gingivectomy of 41 teeth was assessed. The following parameters were examined: recovery time of the gingiva, possibility to take the impression at the same visit, duration of the manipulation, bleeding during the procedure, tissue adherence to the instrument, postoperative hemorrhage on probing, postoperative pain, and wound healing in regard to tissue color, tissue contour, and appearance of the wound. Results: At the 24th hour, all gingival wounds were covered with fibrinous plaque and an erythematous halo. At the 72nd hour, in two cases (4.9%), this wound’s characteristic had already passed through to the next healing stage—granulated surface and normal pale pink color. A granulated surface in the 1st week was reported in 10 (24.4%) cases, and in all of the other 31 (75.6%) cases, complete healing was reported. In the second week, all wound surfaces had a normal pale pink color. Bleeding was self-limiting in most of the cases and negligible from a clinical point of view. The postoperative pain levels were low or nonexistent. There was lack of postoperative hemorrhage on probing after the first week in all examined cases. Tissue recovery in terms of tissue contour, color, and appearance of the wound was asymptomatic. Conclusion: within the limitations of this pilot study, the outcomes of the wound healing after laser gingivectomy aided the clinicians to perform the prosthetic procedures in the same visit.

Effectiveness of Betadine Versus Neem Extract Sitzbath on Episiotomy Wound Healing Among Post-Natal Mothers

Post-partum period lasts from delivery to six weeks afterward, it is also known as fourth trimester. The post-natal mothers experience various physiological and psychological changes when she makes the transition from the pregnant woman to a mother. Episiotomy wound can cause a considerable discomfort and pain the perineum is extremely tender area and the muscles of perineum are involved in many activities. e.g sitting, walking, controlling urination and defecation. This discomfort interferes with the rest and sleep. Sitzbath is one of the oldest, cheapestand safest treatments for curing many common ailments. The technique exploits the reaction of the body to hot stimulus. Povidine - Iodine is an antiseptic solution that is usually used in Iran for episiotomy wound healing. Neem extracts is a powerful insects repellent, anti- bacterial, anti- fungal, anti- viral, anti- inflammatory, anti- diabetic and also strengthens the body’s over all immune responses. Materials and Methods: Quasi-Experimental design, two groups pre-test, post-test only design was used to assess the effectiveness of Neem extract and Betadine sitz bath on episiotomy wound healing among post-natal mothers. The study conducted on 60 samples. Data was collected using structured interview schedule and REEDA scale assessment of episiotomy wound healing. Results: The findings shows that the mean wound healing score in experimental group I in before betadine sitzbath is 9.3 (SD±1.104) and after Betadine sitzhbath is 0.56 (SD±0.670) respectively. The paired t- test value is 38.870which is significant at P<0.05 level. And the mean wound healing score in experimental group II, before Neem extract sitzbath is 9.2 (SD±0.959) and after Neem extract sitzhbath is 0.23 (SD±0.424) respectively. The paired t-test value is 53.926which is significant at P<0.05 level.The mean post-test wound healing score in group I is about 0.56 (SD±0.670) and group II is about 0.23 (SD±0.424) respectively. The independent t-test value 2.537 which is significant at p<0.05. The results shows that there is a significant difference between the mean post test score of betadine sitzbath and mean post test score of neem extract sitzbath on episiotomy wound healing among postnatal mothers. Therefore it is clearly proved by this study that Neem Extract Sitzbath is effective more than betadine sitz bath on episiotomy wound healing. Conclusion: After the detailed analysis of the study findings showed that neem extract sitzbath is more effective in episiotomy wound healing than Betadine among postnatal mothers. Regarding the association the findings revealed that there was no significant association between the level of wound healing and their selected demographic variables in experimental group-I and experimental group-II..

A CBCT Healing Assessment of Nonsurgical Endodontic Management of Two Trauma-induced Large Periapical Lesions

A CBCT Healing Assessment of Nonsurgical Endodontic Management of Two Trauma-induced Large Periapical Lesions

Clinical Investigation of a Rapid Non-invasive Multispectral Imaging Device Utilizing an Artificial Intelligence Algorithm for Improved Burn Assessment.

Currently, the incorrect judgment of burn depth remains common even among experienced surgeons. Contributing to this problem are change in burn appearance throughout the first week requiring periodic evaluation until a confident diagnosis can be made. To overcome these issues, we investigated the feasibility of an artificial intelligence algorithm trained with multispectral images of burn injuries to predict burn depth rapidly and accurately, including burns of indeterminate depth. In a feasibility study, 406 multispectral images of burns were collected within 72 hours of injury and then serially for up to 7 days. Simultaneously, the subject's clinician indicated whether the burn was of indeterminate depth. The final depth of burned regions within images were agreed upon by a panel of burn practitioners using biopsies and 21-day healing assessments as reference standards. We compared three convolutional neural network architectures and an ensemble in their capability to automatically highlight areas of nonhealing burn regions within images. The top algorithm was the ensemble with 81% sensitivity, 100% specificity, and 97% positive predictive value (PPV). Its sensitivity and PPV were found to increase in a sigmoid shape during the first week postburn, with the inflection point at day 2.5. Additionally, when burns were labeled as indeterminate, the algorithm's sensitivity, specificity, PPV, and negative predictive value were: 70%, 100%, 97%, and 100%. These results suggest multispectral imaging combined with artificial intelligence is feasible for detecting nonhealing burn tissue and could play an important role in aiding the earlier diagnosis of indeterminate burns.

IS MESENCHYMAL STROMAL CELL-BASED CELLULAR THERAPY BENEFICIAL IN THE MANAGEMENT OF ROTATOR CUFF TEARS? A META-ANALYSIS OF COMPARATIVE CLINICAL STUDIES

To analyse the efficacy and safety of cellular therapy utilizing Mesenchymal Stromal Cells (MSCs) in the management of rotator cuff(RC) tears from clinical studies available in the literature.We conducted independent and duplicate electronic database searches including PubMed, Embase, Web of Science, and Cochrane Library on August 2021 for studies analyzing the efficacy and safety of cellular therapy (CT) utilizing MSCs in the management of RC tears. VAS for pain, ASES Score, DASH Score, Constant Score, radiological assessment of healing and complications and adverse events were the outcomes analyzed. Analysis was performed in R-platform using OpenMeta [Analyst] software.RESULTS:6 studies involving 238 patients were included for analysis. We noted a significant reduction in VAS score for pain at 3 months (WMD=-2.234,p<0.001) and 6 months (WMD=-3.078,p<0.001) with the use of CT. Concerning functional outcomes, utilization of CT produced a significant short-term improvement in the ASES score (WMD=17.090,p<0.001) and significant benefit in functional scores such as Constant score (WMD=0.833,p=0.760) at long-term. Moreover, we also observed a significantly improved radiological tendon healing during the long-term follow-up (OR=3.252,p=0.059). We also noted a significant reduction in the retear rate upon utilization of CT in RC tears both at short- (OR=0.079,p=0.032) and long-term (OR=0.434,p=0.027). We did not observe any significant increase in the adverse events as compared with the control group (OR=0.876,p=0.869).Utilization of CT in RC tear is safe and it significantly reduced pain severity, improved functional outcome, enhanced radiological tendon healing, and mitigated retear rates at short- and long-term follow-up.

Utilization of Treat-to-Target Monitoring Colonoscopy After Treatment Initiation in the US-Based Study of a Prospective Adult Research Cohort With Inflammatory Bowel Disease.

Endoscopic healing has been associated with improved long-term clinical outcomes in inflammatory bowel disease (IBD) and is a recommended target for treatment. Evidence is limited regarding real-world uptake and patterns of treat-to-target monitoring to assess endoscopic healing after treatment initiation. We aimed to estimate the proportion of patients in the Study of a Prospective Adult Research Cohort with IBD (SPARC IBD) who received colonoscopy in the 3-15 months after starting a new IBD treatment. We identified SPARC IBD patients who initiated a new biologic (infliximab, adalimumab, certolizumab pegol, golimumab, vedolizumab, and ustekinumab) or tofacitinib. We estimated the proportion of patients who received colonoscopies in the 3-15 months after IBD treatment initiation and described use by patient subgroups. Among 1,708 eligible initiations from 2017 to 2022, the most common medications were ustekinumab (32%), infliximab (22%), vedolizumab (20%), and adalimumab (16%). The median patient age was 38 years, with 66% Crohn's disease; 55% were female, and 12% were non-White. In the 3-15 months after medication initiation, 49.3% (95% confidence interval 46.2%-52.5%) of initiations were followed by a colonoscopy. Colonoscopy use was similar between ulcerative colitis and Crohn's disease, but was higher among male patients, those older than 40 years, and those who received colonoscopy within 3 months of initiation. Colonoscopy use varied between study sites, from 26.6% (15.0%-38.3%) to 63.2% (54.5%-72.0%). Approximately half of SPARC IBD patients received colonoscopy in the 3-15 months after initiation to a new IBD treatment, suggesting a low uptake of treat-to-target colonoscopy for the assessment of mucosal healing in real-world clinical practice. The variation in colonoscopy use between study sites suggests a lack of consensus and a need for more robust evidence around whether or not the practice of routine monitoring colonoscopy is associated with improved patient outcomes.

Mucosal healing assessment in Crohn’s disease with normalized iodine concentration from dual-energy CT enterography: comparison with endoscopy

ObjectivesMucosal healing (MH) is an important goal in the treatment of patients with Crohn’s disease (CD). Noninvasive assessment of MH with normalized iodine concentration (NIC) is unknown.MethodsIn this retrospective study, 94 patients with diagnosed CD underwent endoscopy and dual-energy CT enterography (DECTE) at the post-infliximab treatment review. Two radiologists reviewed DECTE images by consensus for assessing diseased bowel segments of the colon or terminal ileum, and the NIC was measured. Patients were divided into transmural healing (TH), MH and non-MH groups. The diagnostic performance of the MH and non-MH groups with clinical factors and NIC was assessed utilizing receiver operating characteristic (ROC) curve analysis.ResultsOf the 94 patients included in our study, 8 patients achieved TH, 34 patients achieved MH, and 52 patients did not achieve MH at the post-IFX treatment review. The area under the ROC curve (AUC), sensitivity, specificity, and accuracy values were 0.929 (95% confidence interval [CI] 0.883–0.967), 0.853, 0.827, and 0.837, respectively, for differentiating MHs from non-MHs, and the optimal NIC threshold was 0.448. The AUC of the combined model for distinguishing MHs from non-MHs in CD patients, which was based on the NIC and calprotectin, was 0.964 (95% CI 0.935–0.987).ConclusionsThe normalized iodine concentration measurement in DECTE has good performance in assessment MH in patients with CD. Iodine concentration from DECTE can be used as a radiologic marker for MH.

ULTRASOUND ASSESSMENT OF HUMERAL SHAFT FRACTURE HEALING: A PROOF OF CONCEPT STUDY

The primary aim was to assess the reliability of ultrasound in the assessment of humeral shaft fracture healing. The secondary aim was to estimate the accuracy of ultrasound assessment in predicting humeral shaft nonunion.Twelve patients (mean age 54yrs [20–81], 58% [n=7/12] female) with a non-operatively managed humeral diaphyseal fracture were prospectively recruited and underwent ultrasound scanning at six and 12wks post-injury. Scans were reviewed by seven blinded observers to evaluate the presence of sonographic callus. Intra- and inter-observer reliability were determined using the weighted kappa and intraclass correlation coefficient (ICC). Accuracy of ultrasound assessment in nonunion prediction was estimated by comparing scans for patients that united (n=10/12) with those that developed a nonunion (n=2/12).At both six and 12wks, sonographic callus was present in 11 patients (10 united, one developed a nonunion) and sonographic bridging callus (SBC) was present in seven patients (all united). Ultrasound assessment demonstrated substantial intra- (6wk kappa 0.75, 95% CI 0.47-1.03; 12wk kappa 0.75, 95% CI 0.46-1.04) and inter-observer reliability (6wk ICC 0.60, 95% CI 0.38-0.83; 12wk ICC 0.76, 95% CI 0.58-0.91). Absence of sonographic callus demonstrated a sensitivity of 50%, specificity 100%, positive predictive value (PPV) 100% and negative predictive value (NPV) 91% in nonunion prediction (accuracy 92%). Absence of SBC demonstrated a sensitivity of 100%, specificity 70%, PPV 40% and NPV 100% (accuracy 75%). Of three patients at risk of nonunion based on reduced radiographic callus formation (Radiographic Union Score for HUmeral fractures <8), one had SBC on 6wk ultrasound (and united) and the other two had non-bridging or absent sonographic callus (both developed a nonunion).Ultrasound assessment of humeral shaft fracture healing was reliable and predictive of nonunion, and may be a useful tool in defining the risk of nonunion among patients with reduced radiographic callus formation.

Comparison of radiographic scoring systems for assessment of bone healing after tibial plateau leveling osteotomy in dogs.

Accurate radiographic assessment of bone healing is vital in determining both clinical treatment and for assessing interventions aimed at the promotion of bone healing. Several scoring systems have been used to evaluate osteotomy changes following tibial plateau leveling osteotomy (TPLO). The goal of this study was to compare the ability of five radiographic scoring systems to identify changes in bone healing following TPLO over time (Aim I), and to evaluate the influence of limb positioning on TPLO osteotomy scoring (Aim II). Phase I-A randomized, blinded, prospective study was conducted using similarly positioned postoperative TPLO radiographs from seven dogs taken immediately postoperatively, 6-weeks, and 8-weeks postoperatively. Ten reviewers assessed the radiographs, and five different scoring systems were tested for each set including three previously published ones, a Visual Analog Score (VAS), and a subjective 11-point scale. For each system, responses for 6-week postoperative were compared to 8-week postoperative. Scores were judged as correct (=showing an increase in score), incorrect (=decrease in score), or unchanged (=same score). Phase II-An international group of 39 reviewers was asked to score radiographs from three dogs, taken in different positions, using the VAS grading system. Scores were averaged and comparisons were made for each set. Phase I-The VAS system identified the greatest number of sets correctly (76%), with the least unchanged scores (15%), and 9% incorrect scores. Phase II-All three patients had an increase in the average difference between VAS-scores for differently positioned radiographs compared to similarly positioned radiographs. The magnitude of change between different positions far exceeded the magnitude of comparison of the similarly positioned radiographs from the 6- and 8-week time point. The VAS system appears to be the most appropriate of the tested systems to identify small changes in bone healing. In addition, the positioning of postoperative TPLO radiographs makes a substantial difference in the healing score that is assigned. Care must be undertaken when performing postoperative radiographs in both the clinical and research setting to ensure accurate assessment of bone healing.

Electrospun bio-nano hybrid scaffold from collagen,Nigella sativa, and chitosan for skin tissue engineering application

The new sophisticated tissue engineering focused on producing nanocomposite with different morphologies for rapid tissue regeneration. In this case, utilizing nanotechnology with the incorporation of bio-based materials have achieved the interest of researchers. This research aims at developing hybrid bio-nano scaffold with collagen (Col), Nigella sativa ( Ns), and chitosan (Cs) by a bi-layered green electrospinning on polyvinyl chloride (PVA) layer in a different ratio for tissue regeneration. Field emission electron microscopy (FE-SEM), fourier transform infrared spectroscopy (FTIR), moisture management properties, tensile properties, antibacterial activity, and wound healing assessment of the fabricated hybrid bio-nano scaffolds were employed to investigate the different properties of hybrid bio-nano scaffolds. The results exhibit that the sample with Col (50%) and Ns (25%), Cs (25%) has good fiber formation with a mean diameter of 381 ± 22 nm. This bio-nano scaffold has a porosity of 78 ± 6.9% and a fast absorbing-slow drying nature for providing a moist environment. The antibacterial zones of inhibition (ZOI) against Staphylococcus aureus and Escherichia coli were 10 ± 1.3 and 8 ± 0.9 mm respectively, and appeared to be adequate to inhibit bacterial action. The wound healing assessment states that 84 ± 3.8% of wound closure occurs in just 10 days, which is quicker (1.5 times) than the duration of a commercial bandage. All of the findings suggest that the bio-nano scaffold could be useful for skin tissue engineering.