Healing Status Research Articles

Method for evaluating healing state of self-healing ceramics using acoustic emission

Previous studies have evaluated the volume expansion rate of oxidation products and healing temperature and time. However, the bonding strength between the product and the matrix is yet to be appropriately evaluated. To develop a self-healing agent selection method for ceramics, this study proposed a method for examining the healing state and fracture behavior of self-healing ceramics through acoustic emissions (AE) generated during three-point bending tests. This study fabricated completely and incompletely healed SiC30 vol%/Al2O3 composite specimens by adjusting the healing time, and the crack length was assessed employing linear fracture mechanics, and effect of healing state on cumulative AE energy and AE frequency. The crack lengths were compared with those of the kinetic model of crack healing. The crack lengths of the 5-h healed specimens were estimated by linear fracture mechanics to be 12.5 μm for incomplete and 10.4 μm for complete healing, while that estimated by the kinetic model were 13.5 μm, indicating the usefulness of the kinetic model in the initial stages of crack healing. Furthermore, while the AE frequency at the initial stage of fracture was dominated by peaks below 100 kHz in damaged or incompletely healed specimen, there was a relatively high frequency peak of over 200 kHz in smooth and completely healed specimen, The average cumulative AE energies of smooth, damaged, 5 h-healed (incompletely), 5 h-healed (completely), and 24 h-healed specimens were 395, 0.89, 26.8, 189, and 318 V・μs, respectively. Thus, the AE energy that accumulated until rupture tended to increase as healing progressed, these findings suggest that the AE method can be used to determine healing conditions. These results will help establish a method for selecting self-healing agents according to the environment in which they are used.

Short term temporal outcomes after intramedullary fixation of lateral malleolus fractures

Ankle fractures are a common intra-articular trauma. The gold standard treatment for unstable ankle fractures has been Open Reduction Internal Fixation with plating and lag screw(s). Advocates for intramedullary nailing of the fibula note decreased wound complications and greater biomechanical strength. We hypothesized that time to union and time to weight bearing would be decreased with a fibular intramedullary nail compared to prior ankle ORIF literature. A retrospective cohort study was conducted of 65 consecutive ankle fracture patients treated with a fibular nail. The median follow-up time was 18.3 months (IQR: 55.4 – 97.6 days). All patients (100%) achieved clinical and radiographic union at a median of 9.6 (IQR: 54 – 78 days) and 10.8 weeks (IQR: 58 – 95 days), respectively. Post-operatively patients bore weight in walking boot and athletic shoe at a median 6.1 and 9.4 weeks, respectively. Fifteen patients suffered complications (23.1%). Patients with history of prior or active smoking were significantly correlated to longer time to union (p=0.016). Time to union also took 0.43 days longer for each additional year of age (t-value 2.13, p-value = 0.038). Nineteen out of 65 patients (29.2%) participated in the Olerud-Molander Ankle Scoring and the median functional outcome score was 71 (IQR: 56 – 93). While fibular nailing has advanced passive range of motion and weight bearing in our institution, time to weight bearing is clouded by surgeon comfort. Further study comparing fibular fracture healing and weight bearing status in regards to intramedullary and plate fixation in needed. Level of EvidenceIV

Heterogeneous Outcome Selection and Incomplete Prespecification of Outcomes in Systematic Reviews: A Case Study on Pressure Injury.

To understand how reviewers select and prespecify outcomes for systematic reviews (SRs), the authors report on the outcomes used in SRs of pressure injury (PI) intervention and treatment and evaluate their completeness of prespecification. The authors searched four electronic databases for SRs involving PI prevention and/or treatments. Inclusion criteria were SRs and meta-analyses evaluating interventions for preventing or treating PI. Studies without systematic search or risk-of-bias assessment, conference proceedings, and articles not in Chinese or English were excluded. Two reviewers extracted and categorized the outcomes in domains, assessing outcome prespecification using a five-element framework. Data items included study characteristics, target population, type of interventions, and outcome variables. This review included 95 SRs that reported a total of 432 instances of 24 different outcome domains. An average of four outcome domains were reported per SR. The most frequently reported domains were PI healing, PI occurrence, and PI status. Of the 62 SRs that prespecified primary outcomes, 40 (64.52%) reported more than one primary outcome. Only 24 of the 432 instances (5.56%) were completely specified. Among the 24 outcome domains, 12 (50.00%) were listed as primary outcomes at least once. Primary outcomes were more completely specified than nonprimary outcomes. Systematic reviews of PI prevention and/or treatment report diverse, incompletely prespecified outcomes, highlighting the need for a core outcome set to standardize key clinical outcomes.

Treatment of rotational tibial malunion after minimal invasive plate osteosynthesis (MIPO): Corrective osteotomy with original plate retention (PR-Osteotomy).

Residual axial and rotational deformities in tibial shaft fracture, after minimally invasive osteosynthesis (MIO) treatment, are widely described in literature. Nevertheless, there is still a lack of evidence about the malunion treatment strategies and results. The aim of our study is to present an innovative technique for tibial shaft malunion: a derotational proximal tibial osteotomy without removing the original plate (Plate-Retaining-Osteotomy: PR-Osteotomy). We present the results of two consecutive patients' treatment, affected by tibial shaft fracture malunion, as sequelae of MIO treatment. The two patients, male 60 years old and female 39 years old, underwent previous surgical treatment with an average of 9 months span time before surgical revision. The affected limb showed significant external torsional defect associated with gait impairment, pain and limping. The amount of rotational deformity and the bone healing condition is assessed through a methodical preoperative planning, including weight bearing lower limbs Xray and bilateral computed tomography (CT) scan of the lower limbs. The surgical technique involves a monoplanar tibial osteotomy, in a perpendicular fashion to the tibial axis, at a level that would allow at least 3 proximal screw-holes to become available for subsequent fixation. Proximal to the osteotomy line the screws are removed, while the distal ones, if stable after testing, are left in place. The amount of torsional correction, planned on CT, is reproduced intraoperatively with the assistance of graduated templates. A fibular osteotomy may be performed if required. After temporary stabilization, the correct functional reduction is checked with the aid of fluoroscopy and empirical rod measurement, using the contralateral limb alignment as a reference. Once the desired correction is achieved, absolute stability is applied to the osteotomy site. Postoperative rehabilitation protocol involves partial weight bearing for 6-8 weeks with progression to full weight bearing by 10-12 weeks. Both patients showed complete osteotomy healing at the 13th and 16th week respectively, with no complications and full recovery of normal gait and daily life activities. To our knowledge, this is the first description of such surgical technique. Less invasiveness, fast recovery time and cost reductions are the foremost proposed benefits. Further larger case series with longer follow up are needed to assess the advantages of the proposed treatment strategy.

Safety of silver dressings in infants; a systematic scoping review.

Silver-based dressings are used to reduce infection risk and optimise conditions for wound healing. They are widely used in the management of burns and other complex wounds. However, reports of elevated serum silver and concern over systemic toxicity, has meant that their use in young children has been questioned. The aim of the current study was to map the literature relating to use of silver-based dressings in children under 1 year of age. A systematic scoping review was conducted according to methodology described by the Joanna Briggs Institute. Sources were identified from major medical databases as well as the grey literature. Inclusion criteria were the use of silver-based dressing in children under 1 year of age. Outcomes of interest were complications or adverse events attributed to silver-based dressings and elevated serum silver levels. Five-hundred and ninety-nine sources were identified through the search strategy, with 110 included for review. Complications were described in 31 sources, with the most frequent being wound infection. No cases of argyria, kernitcterus or methemaglobinaemia were reported. Six sources documented elevated serum silver levels in infants but none reported adverse events related to this. On the basis of current evidence, we suggest reserving silver dressings in infants under one for wounds that are at high risk of infection. Wound area and duration of treatment should be considered when assessing risk of systemic absorption of silver.. Standardised data-collection and recording of complications and adverse events is recommended to better inform future clinical decision making.

Expression of Concern: The Effects of Zinc Supplementation on Wound Healing and Metabolic Status in Patients with Diabetic Foot Ulcer: A Randomized, Double-blind, Placebo-controlled Trial.

Expression of Concern: The Effects of Zinc Supplementation on Wound Healing and Metabolic Status in Patients with Diabetic Foot Ulcer: A Randomized, Double-blind, Placebo-controlled Trial.

Long non-coding TRPM2-AS regulates fracture healing by targeting miR-545-3p/Bmp2

ObjectiveDelayed fracture healing increases the suffering of patients. An in-depth investigation of the pathogenesis of delayed fracture healing may offer new direction for the prevention and treatment.MethodsThe study included 63 normal healing tibial fractures and 58 delayed healing tibial fractures patients. Long non-coding RNA (lncRNA)TRPM2-AS, microRNA-545-3p (miR-545-3p), bone morphogenetic protein 2 (Bmp2) mRNA and osteogenic differentiation markers, including runt-related transcription factor 2 (Runx2), osteocalcin (Ocn), and alkaline phosphatase (Alp) mRNA expression were determined by Real-time quantitative reverse transcription-polymerase chain reaction in serum and MC3T3-E1 cells. The prediction potential of TRPM2-AS in delayed healing fracture patients was verified by receiver operating characteristic curves. The binding relationship of TRPM2-AS/miR-545-3p/Bmp2 was evaluated by dual luciferase reporter gene assay. Cell proliferation and apoptosis were detected by CCK-8 and flow cytometry.ResultsTRPM2-AS was remarkably down-regulated in patients with delayed fracture healing and could better predict the fracture healing status. TRPM2-AS downregulation inhibited osteogenic markers mRNA expression, restrained proliferation, and promoted apoptosis of MC3T3-E1 cells (p < 0.05). In delayed fracture healing, miR-545-3p was dramatically up-regulated and was negatively regulated by TRPM2-AS. Reducing miR-545-3p eliminate the negative effect of TRPM2-AS down-regulation on osteoblast proliferation and differentiation (p < 0.05). miR-545-3p targets Bmp2, which plays a positive role in osteoblast differentiation (p < 0.05).ConclusionThis study found that TRPM2-AS has the potential to be a diagnostic marker for delayed fracture healing and revealed that the TRPM2-AS/miR-545-3p/Bmp2 axis affects fracture healing by regulating osteoblast.

Surgical advantage of modified labial salivary gland biopsy using chalazion forceps: a prospective randomized controlled study

Labial salivary gland biopsy (LSGB) is one of the specific diagnostic criteria for primary Sjögren's syndrome (pSS). In traditional LSGB, there is no lower lip fixation device, the field of view is unclear due to intraoperative bleeding, and the incision is large, which is unfavourable for healing. The use of auxiliary devices to improve the shortcomings of traditional LSGB technique would be meaningful. Therefore, this case–control study aimed to assess the value of modified LSGB using chalazion forceps as compared with traditional LSGB. After obtaining written informed consent from all participating parents and patients, we randomly assigned 217 eligible participants to undergo LSGB using chalazion forceps (n = 125) or traditional LSGB (n = 92). The outcome variables were surgical time, incision length, intraoperative bleeding, pain score at 24 h after surgery, incision healing status at 7 days after surgery, gland collection, and pathological results. The final diagnostic results of the two surgical methods were compared, and the match rates between the pathological results and the final clinical diagnoses were compared between the two groups. The data were analysed using parametric and nonparametric tests. Compared with the traditional group, the modified group had a smaller incision, shorter operative time, less blood loss, lower 24 h pain score, and better Grade A incision healing at 7 days after surgery (p < 0.01). There was no statistically significant difference between the patients in the two surgical-method groups in terms of the positive biopsy results and the final diagnosis based on expert opinions (p > 0.05). By multivariable regression analysis, only a focus score (FS) of ≥ 1 (p < 0.01), dry eye disease (p < 0.05) and anti-nuclear antibodies (ANA) titre ≥ 1:320 (p < 0.05) were correlated with the diagnosis of pSS. The positive biopsy results of patients in the different surgical-method groups had a biopsy accuracy of > 80.0% for the diagnosis of pSS. The positive biopsy results in the different surgical-method groups were consistent with the expert opinions and the 2016 ACR-EULAR primary SS classification criteria. The modified LSGB using an auxiliary chalazion forceps offers a good safety with a small incision, shorter operative time, less bleeding, reduced pain and a low incidence of postoperative complications.The match rate of LSGB pathological results of the proposed surgical procedure with the final diagnosis of pSS is high.

The muscle pump activator device: From evidence to lived experiences.

A chronic wound is one that fails to progress through a normal timely sequence of repair, or in which the repair process fails to restore anatomic and functional integrity after 3 months. The most common chronic wounds include venous, ischaemic and mixed leg ulcers, diabetic foot ulcers and pressure injuries. Chronic wounds place immense physical and psychosocial burden on patients and exact heavy costs for healthcare systems, with many patients continuing to live with chronic wounds even after all management options have been exhausted. The muscle pump activator (MPA) device can be used to bridge this therapeutic gap. By stimulating the common peroneal nerve to activate venous muscle pump of the leg and foot, the MPA device increases blood flow to the lower leg and foot to improve conditions for healing. Currently, evidence in the literature exist to show that the MPA device improves wound outcomes over standard compression therapy, decreases edema and increases wound healing rates. In this review, we also present a series of chronic wound patients treated with the MPA device in multicentre clinics to demonstrate the ability of the MPA device to improve wound outcomes, reduce pain and edema and improve patient quality of life.

Clinical Study on the treatment of chronic infectious ulcers using Platelet-Rich technology combined with moist dressings.

To explore the clinical efficacy of platelet-rich technology combined with moist dressings in the treatment of chronic infectious ulcers. This was a retrospective study. The subjects of the study were 48 patients with chronic infectious ulcers in Sichuan Provincial Orthopedics Hospital from January 2019 to June 2022. Enrolled patients were randomly divided into four groups(n=12), and received different treatment methods respectively. Further analysis and comparison were performed on the changes in wound volume, wound healing status, wound bacterial culture results, and the incidence of adverse reactions among the four groups. Three months after debridement, the wound volume of all four groups of patients was significantly reduced compared with that before debridement, with a statistically significant difference in intra-Group-Comparison(P<0.05). The inter-Group-Comparison revealed a statistically significant difference in wound volume in Group-A, Group-B, and Group-C than that in Group-D(P<0.05). After treatment, the wound healing status of patients in groups A, B, and C was significantly better than that of patients in Group-D, with a statistically significant difference(P<0.05). During treatment, patients in all four groups had decreased count of would bacteria, and showed negative results of wound bacterial culture by the three-month follow-up. No serious adverse reactions were observed in the four groups during treatment, and all improved after management, with no statistically significant difference in the incidence of adverse reactions(P>0.05). Platelet-rich technology combined with moist dressings may effectively promote the repair of chronic infectious ulcer wounds, with good clinical safety.

Exosome-mediated Advancements in Plastic Surgery: Navigating Therapeutic Potential in Skin Rejuvenation and Wound Healing.

Exosomes, tiny extracellular vesicles derived from various cells such as adipose-derived stem cells, bone marrow-derived mesenchymal stem cells, and human umbilical cord mesenchymal stem cells, exhibit considerable potential in wound healing due to their ability to facilitate cell communication and modulate inflammatory responses. These exosomes contribute positively to collagen synthesis and scar reduction, and have shown efficacy in documented clinical cases of wound improvement. Although research indicates their potential in reducing hypertrophic scars and suppressing keloid fibroblasts, further clinical investigations are warranted. In plastic surgery, exosome application postsurgery can enhance wound healing, particularly in cases prone to swelling or poor healing conditions. This study incorporates five case reports of individuals undergoing exosome treatment (EXOP; Sihler Inc., and Exodew; Hyundaimeditech, Inc.) for wound healing, providing practical insights into the application of this therapeutic approach. The five case reports presented in this study demonstrate the practical applications and efficacy of exosome therapy in promoting wound healing and reducing scarring. Exosomes emerge as a promising avenue within the field of plastic surgery, showcasing their potential to enhance wound healing, reduce scarring, and improve overall outcomes in clinical settings. The findings from this study underscore the importance of further exploration into the therapeutic benefits of exosomes in wound management, paving the way for their widespread adoption in clinical practice.

Hypoxia-inducible factor-1α/vascular endothelial growth factor signaling pathway-based ulcer-healing mechanism of Astragalus Aqueous extract in diabetic foot rats.

The main objective of this work was to investigate the mechanism of Astragalus aqueous extract ulcer healing in diabetic foot model rats through the hypoxia-inducible factor 1-alpha (HIF-1ɑ)/vascular endothelial growth factor (VEGF) signalling pathway. Fifty specific-pathogen-free male Sprague Dawley rats were divided into blank (A), model control (B), Astragalus extract (C) and mupirocin (D) treatment groups. Group A received a regular diet, whereas the other groups received a high-fat/high-sugar diet and intraperitoneal streptozotocin injections to induce diabetes. Diabetic foot ulcers were created via skin excision. Subsequently, ulcers were debrided daily. Groups B, C and D received wet saline gauze, wet gauze with Astragalus extract and gauze with mupirocin, respectively, on the affected area. Group A received no treatment. After 14days, the rats were assessed for ulcer healing and general condition. Immunohistochemistry was used to detect HIF-1ɑ and VEGF levels in the dorsalis pedis artery, and ELISA was used to determine serum IL-6 and CRP levels. The results revealed that Groups C and D had significantly faster ulcer healing compared with Group B (p < 0.01), and ulcer healing was faster in Group C than in Group D (p < 0.01). Group C exhibited notably higher HIF-1ɑ and VEGF protein expression levels compared with Groups B and D (p < 0.01). IL-6 and CRP expression levels in Groups C and D were significantly lower than those in Group B (p < 0.01). In summary, Astragalus aqueous extract effectively treats diabetic foot ulcers by up-regulating HIF-1ɑ and VEGF expression, activating the HIF-1ɑ/VEGF pathway, improving local tissue ischaemia and hypoxia, promoting collateral circulation and enhancing dorsalis pedis artery formation, thereby accelerating ulcer repair in diabetic rats.

Evaluation of the Healing Status of Lateral Ankle Ligaments 6 Weeks After an Acute Ankle Sprain

We aimed to investigate whether there is clinical and MRI evidence of healing of lateral ligaments 6 weeks after acute lateral ankle sprain (LAS). We prospectively enrolled 18 participants (age 32.7 ± 7.5 years) who sustained an acute LAS and underwent conservative treatment. An ankle MRI was acquired up to 48 hours and 6 weeks following the LAS. A partial tear of the anterior talofibular ligament (ATFL) was observed in 10/18 and a complete tear in 8/18 of the patients. The calcaneofibular ligament (CFL) was partially torn in 11/18 and completely torn in 1/18 of the patients. The healing status, intensity, and thickness of the ligaments, Anterior Drawer Test (ADT), and FAOS scale were assessed. A control group (CG) was composed by 17 participants (age 40 ± 13.9 years). Six weeks after the LAS, 89% of the participants presented MRI evidence of ATFL healing. The repaired ATFL was thicker in comparison with the CG (p < .001). The cut-off of 2.5 mm for ATFL thickness in the 6th week maximized sensitivity (62.5%) and specificity (100%). CFL and PTFL presented 94% and 100% of healing signs, respectively. In the 6th week, 11/18 (61%) participants showed mild residual instability and a mean FAOS of 80 ± 11. The MRI revealed signs of the repair process in 89% of ATFL and 94% of CFL tears, 6 weeks after a moderate or severe LAS. The MRI findings were concomitant with enhancements in mechanical ankle stability and function.

Multilayered hydrogel scaffold construct with native tissue matched elastic modulus: A regenerative microenvironment for urethral scar-free healing

The unsuitable deformation stimulus, harsh urine environment, and lack of a regenerative microenvironment (RME) prevent scaffold-based urethral repair and ultimately lead to irreversible urethral scarring. The researchers clarify the optimal elastic modulus of the urethral scaffolds for urethral repair and design a multilayered PVA hydrogel scaffold for urethral scar-free healing. The inner layer of the scaffold has self-healing properties, which ensures that the wound effectively resists harsh urine erosion, even when subjected to sutures. In addition, the scaffold's outer layer has an extracellular matrix-like structure that synergizes with adipose-derived stem cells to create a favorable RME. In vivo experiments confirm successful urethral scar-free healing using the PVA multilayered hydrogel scaffold. Further mechanistic study shows that the PVA multilayer hydrogel effectively resists the urine-induced inflammatory response and accelerates the transition of urethral wound healing to the proliferative phase by regulating macrophage polarization, thus providing favorable conditions for urethral scar-free healing. This study provides mechanical criteria for the fabrication of urethral tissue-engineered scaffolds, as well as important insights into their design.

Study on self-healing performance of microcracks in SBS/waste rubber powder composite-modified asphalt based on molecular dynamics simulation

The internal microcracks in asphalt materials can heal spontaneously under suitable conditions, and understanding the characteristics of the self-healing behavior of asphalt materials is crucial for evaluating the fatigue life of asphalt pavements. In this paper, a molecular model of modified asphalt microcracks was created by introducing modifier molecules into the virgin asphalt model, and the self-healing process of the asphalt microcrack model under different healing conditions was investigated, which revealed the effects of modifier materials and healing temperatures on the healing performance of asphalt. The results show that the effect of healing temperature on asphalt healing performance is more significant than the modifier material, the relative concentration of molecules at the microcrack healing and the healing temperature is positively correlated; asphalt material healing free volume fraction with the increase in healing temperature gradually increases, the incorporation of modifiers can reduce the free volume fraction growth caused by high-temperature healing, improve the healing stability of modified asphalt. The asphalt ductility specimen crack healing test shows that when the healing temperature exceeds 45 ℃, there is a decreased increase in self-healing rate; taking into account the high-temperature healing is easy to make the asphalt material produce permanent deformation, this paper determines the optimal healing temperature in the vicinity of 48 ℃. The research results have certain reference and application values for asphalt pavement damage repair.

Patients with venous leg ulcers can be managed safely in the community ----results of an observational comparison study in Singapore

AimTo examine the healing outcomes of patients with venous leg ulcers requiring compression bandaging in community care versus tertiary care. MethodThis was an analytical observational cohort study. Venous leg ulcer (VLU) patients who required compression bandaging were recruited from an outpatient vascular clinic between May 2021 and August 2022. Eligible patients received two—or four-layer compression bandaging and followed up with the community care or tertiary care centre nurses. The primary outcome was the difference in the total surface area of the VLU after 12 weeks, and the secondary outcome was the patient's quality of life, as measured by the Cardiff Wound Impact Schedule (CWIS). ResultsForty-seven VLU patients were recruited; 27 received compression bandaging in the community care and 20 by the tertiary care centre. Mean age 70 years old (SD 11.04). The two most prevalent comorbidities were hypertension (51.06 %) and diabetes mellitus (38.29 %). Among those who completed follow-up (12 weeks), the median difference of the total surface area of the VLU between community-based care (p = 0.02) versus tertiary-based care (0.003) was significant. However, there was no difference in the healing status between community and tertiary-based care (p = 0.68). There was no difference in the quality of life of patients between groups. ConclusionThis first tropical study comparing VLU healing outcomes between community and tertiary care found no significant difference in healing with compression bandaging by nurses in either setting. However, the small sample size and high dropout rate limit the generalizability of the findings, necessitating a larger-scale study with longer follow-up. Despite these limitations, the study is a crucial step toward improving wound care services in Singapore, and highlights the need for further research to guide future community wound care implementation.

Relationship between gene expression associated with cellular senescence in cells from discarded wound dressings and wound healing: A retrospective cohort study

AimSenescent cells, inducing a senescence-associated secretory phenotype (SASP), lead to chronic inflammation in hard-to-heal wound tissue. However, eliminating senescent cells may impede normal wound healing due to their important role in the wound healing mechanism. Accordingly, we focused on wound exudates in hard-to-heal wounds, which contain many inflammation biomarkers consistent with SASP. Therefore, we hypothesized that senescent cells might be present in the exudates and induce chronic inflammation. This study investigated the relationship between gene expression associated with cellular senescence in exudates from pressure injuries and wound healing status. MethodsThis retrospective cohort study involved patients treated by a pressure injury team. We collected viable cells from wound dressings and analyzed gene expression. Pearson's correlation coefficient was calculated between cellular senescence and SASP expression. The relationship between the gene expression of cellular senescence and the wound area reduction rate by the following week was examined using a mixed-effects model. ResultsCDKN1A—related to cellular senescence—was expressed in 96.3 % of 54 samples, and CDKN1A expression and SASPs positively correlated (PLAU: r = 0.68 and TNF: r = 0.34). Low CDKN1A expression was statistically associated with a large wound area reduction rate (β = 0.83, p < 0.01). ConclusionsGene expression of both cellular senescence and SASP factor in wound dressings suggests the presence of cellular senescence. Senescent cells in wound dressings could be associated with delayed wound healing in the following week.

Influence of neoadjuvant chemoradiotherapy on peritoneal wound healing after abdominoperineal resection

Objective: To study the influence of neoadjuvant chemoradiotherapy on peritoneal wound recovery after abdominoperineal resection (APR). Methods: This was a retrospective cohort study of data of 219 patients who had been pathologically diagnosed with low rectal cancer and undergone APR in the Union Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2018 and December 2021. Of these patients, 158 had undergone surgery without any pre-surgical treatment (surgery group), 35 had undergone surgery after neoadjuvant chemotherapy (neoadjuvant chemotherapy group), and 26 had undergone surgery after neoadjuvant chemoradiotherapy (neoadjuvant chemoradiotherapy group). The primary outcome was perineal wound complications occurring within 30 days. The status of wound healing was classified into the following three levels: Level A: abnormal wound seepage that improved after wound discharge; Level B: wound infection and dehiscence; and Level C: Level B plus fever. The patients' general condition, tumor status, perianal wound healing level, and intra- and post-operative recovery were recorded. Results: None of the study patients had any complications during surgery. The duration of surgery was 240.0 (180.0-300.0) minutes, 240.0 (225.0-270.0) minutes and 270.0 (240.0-356.2) minutes in the surgery, neoadjuvant chemotherapy, and neoadjuvant chemoradiotherapy groups, respectively (H=6.508, P=0.039). The rates of perineal wound complications were 34.6% (9/26) and (22.9%, 8/35)in the neoadjuvant chemoradiotherapy group and the neoadjuvant chemotherapy group, being significantly higher than that in the surgery group (10.1%, 16/158). After adjusting for patient age and sex using a logistic regression model, the risk of complications was still higher in the neoadjuvant chemoradiotherapy than in the surgery group (OR=4.6, 95%CI: 1.7-12.7; OR=2.6, 95%CI: 1.0-6.8), these differences being statistically significant (both P<0.05). The duration of hospital stay was 9.5 (7.0-12.0) days, 10.0 (8.0-17.0) days and 11.5 (9.0-19.5) days for patients in the surgery, neoadjuvant chemotherapy, and neoadjuvant chemoradiotherapy groups, respectively (H=0.569, P=0.752). However, after adjusting for patient age and sex by using a generalized linear model, hospital stay was longer in the neoadjuvant chemoradiotherapy than in the surgery group (β [95% CI]: 4.4 [0.5-8.4], P=0.028). After surgery, 155 of 219 patients required further adjuvant chemotherapy. A higher proportion of patients with than without wound complications did not attend for follow-up (32.2% [10/31] vs. 16.1% [20/124]); this difference is statistically significant (χ2=4.133, P=0.023). Conclusions: In patients with low rectal cancer, neoadjuvant radiotherapy may be associated with an increased risk of perineal wound infection and non-healing.

Revolutionizing Wound Healing: The Rise of Electrospinning Nanofibers for Bioactive Dressings

A noticeable focus in recent years has been on creating bioactive dressings that are tailored to meet the requirements of wounds that are both acute and chronic. Because of these exceptional properties, electrospinning nanofibers stand out as a potential choice among the creative solutions being investigated. Among these are very high porosity and superior permeability to water and air, both of which are essential for promoting wound healing conditions. Moreover, these nanofibers’ ability to ward against foreign infections makes them an attractive option for improving wound care protocols. It is particularly notable because they closely mimic the extracellular matrix since this property can greatly enhance the efficacy of skin regeneration and wound healing processes. The present study aimed to explore the use of electrospinning nanofibers for bioactive dressings and wound healing. Extensive literature search was performed and relevant articles were collected from various databases like Google scholar, Taylor and Francis, Science direct, Springer, Embase, and Willey. Electrospinning nanofiber applications for the bioactive healing of wounds. The investigation begins with a comprehensive review of the wound healing procedure and the several electrospinning techniques used here. The many natural and synthetic polymers that are used to make electrospinning wound dressings are discussed in more detail. Prominent natural polymers, including hyaluronic acid, collagen, gelatin, silk fibroin, chitosan, and sodium alginate, are emphasized due to their special qualities and possible advantages in wound treatment. Furthermore, the paper explores the wide application of artificial polymers such as polyvinyl alcohol, polyvinyl chloride, polyethylene lactone, polylactide, and polyurethane, providing insight into their roles in the advancement of sophisticated wound dressings. In conclusion, the development of electrospinning technology offers promising prospects for creating improved wound care products and dressings that have the potential to completely transform the wound management industry.

Wound Tissue Segmentation and Classification Using U-Net and Random Forest

Analysing wound tissue is a crucial research field for assessing the progression of wound healing. Wounds exhibit certain attributes concerning colour and texture, although these features can vary among different wound images. Research in this field serves multiple purposes, including confirming the presence of chronic wounds, identifying infected wounds, determining the origin of the wound and addressing other factors that classify and characterise various types of wounds. Wounds pose a substantial health concern. Currently, clinicians and nurses mainly evaluate the healing status of wounds based on visual examination. This paper presents an outline of digital image processing and traditional machine learning methods for the tissue analysis of chronic wound images. Here, we propose a novel wound tissue analysis system that consists of wound image pre-processing, wound area segmentation and wound analysis by tissue segmentation. The wound area is extracted using a simple U-Net segmentation model. Granulation, slough and necrotic tissues are the three primary forms of wound tissues. The [Formula: see text]-means clustering technique is employed to assign labels to tissues. Within the wound boundary, the tissue classification is performed by applying the Random Forest classification algorithm. Both segmentation (U-Net) and classification (Random Forest) models are trained, and the segmentation gives 99% accuracy, and the classification model gives 99.21% accuracy.