Quality Of Healing Research Articles

Outcomes of dermal substitutes in burns and burn scar reconstruction: A systematic review and meta-analysis.

Dermal substitutes have been introduced in burn care to improve wound healing outcomes; however, their use remains limited in standard treatments. This systematic review and meta-analysis aimed to evaluate the outcomes of dermal substitutes in patients with burns and patients requiring burn scar reconstruction and subsequently contribute to optimising the integration of dermal substitutes into clinical practice and reducing the knowledge gap. A comprehensive search across various databases included human studies from peer-reviewed journals on dermal substitutes for deep dermal and full-thickness burns, and scar reconstruction across all ages. Data from comparative trials were extracted, focusing on patient and wound characteristics, treatment specifics, and outcomes related to wound healing and scar quality. Meta-analysis was performed on trials reporting similar post-burn measures, with statistical heterogeneity assessed. Outcomes were presented using mean differences or odds ratios with 95% confidence intervals. A total of 31 comparative trials were included. The overall quality of the studies was considered moderate. The meta-analysis indicated delayed re-epithelialization 4-7 days after treatment with a collagen-elastin matrix compared to split-thickness skin graft in acute burns (-7.30%, p = 0.02). Significant improvement in subjective scar quality was observed with acellular dermal matrix compared to split-thickness skin graft in acute burn wounds 6 months post-operative (-1.95, p <0.01). While acknowledging the initially delayed wound healing, incorporating dermal substitutes into the surgical treatment of burn patients holds promise for enhancing scar quality. However, future research must prioritise outcome measure uniformity, address variations in dermal substitute application, and standardise indications for consistent and effective practices.

Fish collagen sponge with human umbilical cord mesenchymal stem cells for diabetic wound repair in rats.

Stem cell therapy offers a novel approach to treating difbetic foot ulcers. Fish skin decellularized matrix, a type I collagen, provides a promising carrier for stem cells, creating a supportive microenvironment that enhances cell survival and therapeutic potential. This study aims to investigate the effects and mechanisms of human umbilical cord mesenchymal stem cells (HUCMSCs) loaded onto a fish collagen sponge for wound healing in diabetic rats. The study evaluates stem cell-loading efficiency with fish collagen sponge in vitro, assesses material distribution on diabetic rat wounds, and establishes a wound model. Rats are divided into the Self-healing group, Fish collagen sponge group, and Sponge loaded with HUCMSCs group. Therapeutic effects are evaluated through various analyses, including histopathology and reverse transcription polymerase chain reaction for collagen-related gene expression levels. Compared to the self-healing group, both the fish collagen group and the composite group show faster wound repair and improved healing outcomes. The composite group exhibits superior wound healing quality, with fish collagen contributing to enhanced tissue regeneration through collagen regulation at the wound site. Loading HUCMSCs onto a fish collagen sponge shows promise for treating diabetic wounds by addressing nutrient deficiency and cell supply issues, offering potential benefits for patients undergoing treatment.

Clinical outcomes of using operating microscope for alveolar ridge preservation: A randomized controlled trial.

The use of the operating microscope (OM) for extraction and alveolar ridge augmentation (ARP) is increasing due to enhanced magnification and illumination. The primary objective was to compare the wound healing and crestal bone quality after the use of OM and dental loupes (DL) for ARP. Forty non-molar teeth with periapical lesions in need of extraction and ARP from 33 patients were randomly assigned to 2 groups: DL (control) or OM (test). All procedures were performed by 1 surgeon and assessments done by masked examiners. ARP was performed with an allograft and a resorbable collagen membrane. The presence of granulomatous tissue remnants after debridement was recorded. Cone-beam computed tomography (CBCT) and ultrasound (US) scans were taken during the healing phase up to 16-week visits. Bone cores were retrieved from implant osteotomies for histologic analysis. Patient-reported outcome measurements (PROMs) were assessed. All patients completed all study visits except 1 who dropped out before the last visit. After socket debridement, the test group exhibited significantly fewer sites with tissue remnants (p=0.01) and a better healing score at 2-week (p=0.04) and 4-week (p=0.01) time points. There were no significant differences in 12-week crestal bone healing by histology (p=0.1), US (p=0.85), and CBCT healing (p=0.64) at 12weeks, as well as PROMs (p>0.1). Within the limitation of the study, the use of OM for ARP resulted in significantly fewer tissue remnants and favorable early visual wound healing. CBCT and US-derived-crestal bone quality did not show a difference between the 2 groups. Alveolar ridge preservation (ARP) by placing bone particulates in the extraction socket, covered by a wound dressing material, is commonly applied immediately after tooth extraction to reduce jawbone shrinkage in preparation for implant placement later. The jawbone healing varies, depending largely on the ability to remove the etiology, socket features, extent of surgical trauma, and wound stability. Healed jawbone with good quality is favorable for easiness of implant placement and could be related to maintenance of long-term implant health. The surgical microscope with high magnification (up to ∼25×) and co-axial illumination is ideal for assistance in the removal of granulomatous tissue that is believed to interfere with healing, performance of minimally invasive extraction, and stabilization of the wound with meticulous tissue management and fine sutures. This study compared the use of the surgical microscope to dental loupes for ARP in a randomized controlled design. The microscope-assisted ARP is associated with a significantly higher chance of removing granulomatous tissue, favorable early healing, and similar crestal bone quality. Removal of granulomatous tissue is significant for immediate implant placement. This study serves as a model for testing the benefits of the surgical microscope for encouraging early healing in more challenging intraoral surgical procedures.

A NOVEL WOUND DRESSING WITH SILKWORM COCOON SCAFFOLD TO FASTEN WOUND HEALING: AN IN VIVO STUDY USING RAT EXCISION WOUND MODEL

Objective: The study aimed to compare the effectiveness of silver-nano laden silkworm cocoon scaffold (SWCS), L-Ascorbic acid laden SWCS (AA-SWCS) over standard wet collagen sheet used for wound healing in rat incision wound model. Methods: A total of 24 Wistar rats (of either sex, pathogen free, 10–12 weeks old) were used in this study. SWCS was prepared and an excision wound model was carried out to study the wound healing capacity in four study groups. Dressings were made with silver nanoparticles SWCS (AgNP-SWCS), AA-SWCS and compared with wet collagen sheet regularly. Friedman’s test was used for analysis. Results: The results clearly indicate that both AgNP-SWCS and AA-SWCS significantly accelerate wound healing compared to the standard wet collagen sheet. The AgNP-SWCS outperformed the others in terms of wound contraction rate, histological quality of healing, and microbial load reduction. The AA-SWCS also showed enhanced healing properties, particularly in collagen synthesis and tissue organization. Conclusion: The study suggests that both AgNP-SWCS and AA-SWCS are highly effective alternatives to traditional collagen dressings for wound healing. These innovative scaffolds could represent a new frontier in wound care, providing enhanced healing rates, improved tissue quality, and reduced infection risks, ultimately leading to better patient outcomes.

Topical Application of Anti-Inflammatory Agents on Burn Wounds and Their Effect on Healing

Advancements in the treatment of burns have considerably improved overall survival rates, but they have also highlighted several long-term sequelae related to the injury. Hypertrophic scars can impair function, reduce quality of life, and require multiple procedures as well as physical therapy. The purpose of this study was to investigate the effects of topical application of anti-inflammatory drugs in the treatment of burns. Up to 15 deep-partial thickness burns were created on the dorsum of four anesthetized swine. Subsequently, the burn wounds were randomized to receive amiloride, celecoxib, dexamethasone or minocycline mixed in a hydrogel. Silver sulfadiazine cream and blank hydrogel acted as controls. The animals were followed for 90 days and the wounds were assessed on days 3, 7, 14, 28 and 90 post-burn. Assessments were performed using photographs (macroscopic healing, contraction), laser-speckle imaging (blood perfusion), 3D camera (scarring, pigmentation), and histology (inflammation, burn depth, epidermal maturation). Inflammation was present in all burn wound histology and it peaked on day 7 in all groups. Regardless of the treatment the burns progressed and were deeper on day 7 in comparison to day 3. The burns were 50 – 80% healed by day 14, but no significant differences were observed. No differences in epidermal thickness, rete ridges, contraction, hypopigmentation, and scar elevation were seen on day 90. Topical anti-inflammatories did not significantly decrease inflammation, mitigate burn wound progression in deep partial thickness burns in pigs. Also, no significant differences in wound healing or quality of healing were observed.

Soluble allogenic telocollagen as a direct protein therapeutic: Results of serial injections in a rodent rotator cuff tear model

HypothesisDelivery of soluble allogeneic type I telocollagen (allo-telocollagen) will accelerate and improve the healing of damaged tendons. Our hypothesis draws from known mechanochemical properties of type I collagen that direct its incorporation into damaged connective tissue. We further suggest that allo-telocollagen will raise a minimal immunogenic reaction due to homology within species. MethodsSeventy-eight shoulders (39 Sprague-Dawley rats) had their supraspinatus tendon surgically detached from its footprint on the humerus and repaired (72 shoulders) or left uninjured (6 shoulders). The repaired tissue was treated with an injection of 100 μl of saline, 10 mg/ml allogeneic atelocollagen (allo-atelocollagen), or 10 mg/ml allo-telocollagen at 0-, 1-, and 2-weeks post-surgery. At 30- and 60-days post-surgery, the tendons were assessed by mechanical testing (failure load, failure stress, stiffness, and relaxation) and by semiquantitative histological scoring. ResultsAt 30-days post-surgery, the mechanical and histological outcomes were not statistically different. However, at day 60, allo-telocollagen improved the failure strength of the supraspinatus (29.9 ± 4.7 N) relative to saline (20.0 ± 3.5 N; P value <= 0.001) or allo-atelocollagen (23.2 ± 1.5 N; P value = 0.025) treated tendons, and it approached that of uninjured controls (36.9 ± 5.0 N; P value = 0.021). Allo-telocollagen improved the failure stress of the supraspinatus (34.1 ± 9.3 MPa) relative to the saline treated tendons (21.4 ± 6.0 MPa; P value = 0.031; 160% improvement) and was no different than uninjured controls (33.4 ± 9.9 MPa; P value = 0.999) or allo-atelocollagen (32.3 ± 7.4 MPa; P value = 0.977). The stiffness of uninjured controls was far greater than any of injured/treated tendons (>200% stiffer). Histological scoring showed that the allo-telocollagen treated tendons produced better collagen fiber arrangement (1.55 ± 0.17) than saline (2.50 ± 0.29; P value = 0.001) or allo-atelocollagen (2.23 ± 0.28; P value = 0.042) treated tendons and that it did not increase markers of immunogenesis (1.10 ± 0.42) relative to either saline (1.44 ± 0.20; P value = 0.369) or allo-atelocollagen (0.68 ± 0.41; P value = 0.1058). ConclusionsWhile all three treatments produced similar results at 30 days, by 60 days, soluble allo-telocollagen clearly separated from the other interventions, yielding better mechanical and histological outcomes in a torn/repaired rotator cuff rat model. Allo-telocollagen treated tendons also approached the failure strength and matched the failure stresses of uninjured control tendons. The data suggest a new use for allo-telocollagen as a deliverable direct protein mechanotherapeutic that can improve both healing quality and speed.

Clinical and histological study of cold physical plasma jet in treatment of full thickness skin wounds of normal and diabetic dogs.

To study the effect of physical plasma jet in treating open wounds in diabetic and non-diabetic dogs. The experimental study was conducted at the College of Veterinary Medicine, University of Baghdad, Iraq, from 20 January, 2020 to 1st May 2020, according to (no. 1364/ P.G), and comprised adult male diabetic and nondiabetic dogs. They were divided into non-diabetic group N and diabetic group D. Each group was further divided into treatment subgroup T and control subgroup C. Each dog was subjected to 4 wounds 3×3cm in size. Homemade helium non-equilibrium atmospheric pressure plasma jet therapy was used for healing purposes. Clinical parameters were evaluated by observation, while histological images were scored based on the semi-quantitative evaluation of histological sections on days 3-, 7- and 21-days post-wound. Data was analysed using SPSS Version 26 with One-way ANOVA for statistical analysis between groups and sub-groups. Of the 24 dogs, 12(50%) were in each of the two groups, which were further divided into subgroups having 6(50%) dogs each. The therapy accelerated the process of wound healing in the NT and DT subgroups compared to NC and DC. Clinical observations revealed early and complete closure of plasma-treated wounds in NT and DT subgroups started at day 30 post-wounding, while in the NC subgroup it started at day 35, and in the DC subgroup, wounds failed to close even after 35 days post-wounding. Histological analysis suggested that a plasma jet supported epithelisation, angiogenesis, formation of new hair follicles and collagen fibres, while it also controlled inflammation. In addition, in NT and DT subgroups, it increased the proliferation of fibroblasts and deposition of collagen, and there is a very, highly significant difference between groups (P<0.001), and a significant difference between days (P<0.05). Home-made helium non-equilibrium atmospheric pressure plasma jet therapy improved the quality and pace of wound healing.

Enhancing early-stage healing responses through the modified "Poncho" technique in customized titanium mesh-mediated bone regeneration: A soft tissue management approach-case series.

Soft tissue management is critical in bone augmentation surgery to prevent wound dehiscence. Several strategies for passive tissue primary closure have been explored. This article introduces a flap design known as the modified "Poncho" technique (MPT), integrated with customized titanium mesh-mediated bone regeneration, and investigates the healing quality during the initial stages of an incision. The cohort consisted of 5 patients undergoing customized bone regeneration procedures, concerned primarily with the successful integration and healing of the augmented bone site without complications such as wound dehiscence or infection. All patients were diagnosed with insufficient bone volume requiring augmentation to support future dental implants, necessitating the use of customized titanium mesh for guided bone regeneration. The MPT was detailed and applied during the customized bone regeneration procedures. Postoperative evaluations included recording complications and using Landry's healing index at intervals of 3, 7, 14, and 30 days post-surgery to assess the technique's performance in early wound closure. The study found that 95.7% of surgery sites experienced uneventful soft tissue healing within the observation period. Only 1 of 23 sites exhibited partial wound dehiscence at postsurgical days 14 and 30, accompanied by mild inflammation. The Landry's healing index increased from 3 ± 0.47 to a final value of 4.69 ± 1.06, indicating substantial improvement in healing over time. The MPT shows promise as an innovative approach for promoting passive and predictable primary wound closure beneath a digitally customized titanium mesh for bone regeneration, demonstrating a high rate of successful healing and minimal complications during the early postoperative phase.

Benefits of In Situ Foamed and Printed Porous Scaffolds in Wound Healing.

Macroporous hydrogels have shown significant promise in biomedical applications, particularly regenerative medicine, due to their enhanced nutrient and waste permeability, improved cell permissibility, and minimal immunogenicity. However, traditional methods of generating porous hydrogels require secondary post-processing steps or harmful reagents making simultaneous fabrication with bioactive factors and cells impossible. Therefore, a handheld printer is engineered for facile and continuous generation and deposition of hydrogel foams directly within the skin defect to form defect-specific macroporous scaffolds. Within the handheld system, a temperature-controlled microfluidic homogenizer is coupled with miniaturized liquid and air pumps to mix sterile air with gelatin methacryloyl (GelMA) at the desired ratio. An integrated photocrosslinking unit is then utilized to crosslink the printed foam in situ to form scaffolds with controlled porosity. The system is optimized to form reliable and uniform GelMA foams. The resulting foam scaffolds demonstrate mechanical properties with excellent flexibility making them suitable for wound healing applications. The results of in vitro cell culture on the scaffolds demonstrate significantly increased cellular activity compared to the solid hydrogel. The in vivo printed foam scaffolds enhanced the rate and quality of wound healing in mice with full-thickness wound without the use of biological materials.

Calcium Peroxide-Based Hydrogels Enable Biphasic Release of Hydrogen Peroxide for Infected Wound Healing.

Wound infection is a major factor affecting the speed and quality of wound healing. While hydrogen peroxide (H2O2) is recognized for its antibacterial capacity and facilitation of wound healing, its administration requires careful dosage differentiation. Inappropriately matched dosages can protract the healing of infected wounds. Herein, a calcium peroxide-based hydrogel (CPO-Alg hydrogel) is fabricated to enable a biphasic tapered release of H2O2, ensuring robust initial antimicrobial activity followed by sustained promotion of cellular proliferation of wound healing. The design of the hydrogel allowed for the calcium peroxide nanoparticles (CPO NPs) being in two spatial niches within the gel framework. When applied to infectious wounds, CPO NPs with weak constraints are promptly released out of the gel, penetrating into infected regions to serve as antibacterial agents that eliminate bacteria and biofilms at high concentrations. Conversely, the entrapped CPO NPs structurally integrated into the gel remain confined, thus gradually degrading and allowing a mild release of H2O2 through hydrolysis in a moist environment that contributes to the cell growth in the later stage. The CPO-Alg hydrogel represents an innovative and practical solution for the antimicrobial protection of chronic wounds, offering promising prospects for advancing wound healing.

NIR-driven intense UV upconversion films for non-contact high-efficiency prevention of bacterial infections

Bacterial infections on wounds imposes a significant limitation to the wound healing. Although the conventional drug antibacterial dressing is employed for hindering bacterial infection, the inevitable microbial resistance and secondary damage severely limit the quality and speed of wound healing. Herein, the NIR-driven intense UV upconversion (UC) BaLu2F8:80%Yb3+/0.5%Tm3+ microcrystals are, for the first time, designed and fabricated into solid sterilization film to protect the wounds from infections. Equipped with excessive Yb3+ sensitizers, the emission of Yb3+/Tm3+ co-doped monoclinic BaLu2F8 matrix achieve a 175-fold enhancement at the UV band. The UV UC microcrystals was further fabricated into a NIR-to-UV sterilization film with a diameter of 1.5 cm and a thickness of 150 μm using solution casting method, which can efficiently destroy 97 % of E. coli with a NIR irradiation of 5 minutes. Due to the outstanding penetrability of NIR irradiation, the sterilization film under 4 layers gauze dressing can be activated to produce UV photons. The in-vivo mouse tests demonstrate the well-designed NIR-to-UV sterilization film can speed up the wound healing by high-efficient inhibiting E. coli infection under the irradiation of 980 nm NIR laser. The non-contact NIR-driven UV sterilization film require no more drugs and dressing exchange, thus entirely eliminating the effect of microbial resistance and secondary damage from conventional drug dressing. Our work provides a new alternative for constructing highly-efficiency sterilization dressing through the utilization of NIR-to-UV optical conversion materials.

MCC950 promotes diabetic wound healing through modulating macrophage polarization in an MDSC-dependent manner

Diabetic foot ulcers (DFUs) are serious skin injuries whereby the wound healing process is frequently stalled in the inflammatory phase. Currently, there is a lack of effective therapeutic strategies. MCC950, a highly selective nod-like receptor family pyrin domain containing 3 (NLRP3) inhibitor, has been reported to show strong anti-inflammation effects in many diseases. In this study, we unveiled the role of MCC950 in DFU mice model and its underlying molecular mechanisms. MCC950 could significantly accelerate diabetic wound healing, as shown by shortened healing time and better healing quality. Moreover, increased M2 phenotype macrophages and decreased pro-inflammatory genes were observed in MCC950-treated DFU mice. Additionally, myeloid-derived suppressor cells (MDSCs) were significantly increased in blood, spleen and wound tissues at different time courses. Specifically, MCC950 could recruit more MDSCs in an early phase in DFU mice, exerting an anti-inflammation effect. We identified the cell crosstalk between macrophages and MDSCs with MCC950 treatment process. Depleting MDSCs in vivo could eliminate the therapeutic effect of MCC950 on diabetic wound healing through inhibiting M2 macrophage polarization. Besides, MDSCs isolated from the wounds of MCC950 or saline treated mice were cocultured with bone marrow derived macrophage (BMDM) in a transwell system. Results confirmed that MDSCs sorted from MCC950 treated mice caused a significant increased percentage of M2 macrophages. Collectively, our findings suggest that the administration of MCC950 has the potential to accelerate diabetic wound healing by promoting M2 macrophage polarization in an MDSC-dependent manner. This study provides valuable insights into the utilization of pharmacological agents for DFU treatment.

Fusion protein of FGF21 and elastin-like peptide improves wound healing in diabetic mice via inflammation modulation, collagen synthesis, and vascular network formation

Chronic-healing skin wounds are a common complication in diabetic individuals. To alleviate patient suffering, there is a pressing demand for more effective strategies to expedite the repair of diabetic wounds. Fibroblast growth factor 21(FGF21) has been proven to accelerate wound healing, but its stability and ability to assist in the healing of diabetic ulcers have not met expectations. Therefore, we have fused FGF21 with an elastin-like peptide (ELP) to create a recombinant fusion protein (abbreviated as “ELF”) to increase the bioactivity and stability in vitro or in vivo. Our results demonstrated that ELF significantly improved the efficiency of FGF21 purification due to the inverse temperature responsive phase transition property of ELP. Meanwhile, the fusion strategy did not impair the structure of FGF21 or diminish its activity, as demonstrated by the highly similar secondary structure of ELF and FGF21, and their considerable inhibitory activity in the glucose consumption experiment of Huh-7 cells. An in vitro migration assay revealed that ELF promoted healing more effectively than either free FGF21 or ELP. Further in vivo study revealed the ability of ELF to improve skin wound healing quality, manifested by lower levels of inflammatory factors, more collagen formation and deposition, and the formation of robust vascular networks, though there was no significant difference in healing rate among the ELF, FGF21, and ELP groups. In conclusion, our study indicated that FGF21 and ELP fusion molecules could be developed as more efficient and cost-effective therapeutic strategies for diabetic wound healing.

Suppression the glucose-induced ferroptosis in endothelial cells by 4OI-loading exosomes hydrogel for the treatment of diabetic foot ulcer

The prevalence of diabetic foot ulcer in individuals with diabetes is approximately 15%, and it is frequently accompanied by vascular dysfunction and infection. The management challenges make it the primary cause for amputation; however, the underlying mechanisms remain poorly understood, thereby impeding the advancement of novel wound dressings and medication. Herein, single-cell sequencing analysis revealed that ferroptosis induced by high glucose levels in vascular endothelial cells (VECs) represents a significant molecular pathological feature in diabetic foot ulcer (DFU) tissue. Furthermore, 4-Octyl itaconate (4OI) exhibited a pronounced protective effect against VECs injury induced by high glucose (HG), and its underlying molecular mechanisms involve the mitigation of HG-induced reactive oxygen species (ROS) injury and ferroptosis in VECs through the regulation Keap1/Nrf2/GPX4. For enhanced application, incubation at 37℃ was used to load 4OI into exosomes, which were subsequently encapsulated within an Alg-DA/GelMA-based hydrogel matrix. Remarkably, the utilization of 4OI-Exo-Gel not only expedited wound healing but also significantly improved the overall quality of healing in DFU. In conclusion, these findings not only demonstrate, for the first time, the remarkable ability of 4OI to enhance diabetic wound healing by mitigating VECs ferroptosis induced by HG, but also provide evidence for the potential clinical translation of a 4OI-loaded exosomes hydrogel in diabetic wound therapy.

Contributions of T Cell Signaling for Wound Healing.

It has long been known that T cells participate in wound healing, however, it is still enigmatic about the landscape of the signaling derived from T cells in the process of wound healing. With the advantages of scRNA-seq, in combination of immunofluorescent imaging, we identified activated T cells, cytotoxic T cells (CTLs), exhausting T cells and Tregs existing in inflammation phase of wound healing. Further analysis revealed each T cell population possess distinguished signals contributed to wound healing, some are critical for improving the wound healing quality. Besides, this study discovered and validated the exhistance of exhausting T cells among the T cells accumulated in skin duing wound healing, and the molecular mechanism(s) and contribution of exhausting T cells to wound healing deserves extensive studies in the future.

Far Cortical Locking Versus Standard Constructs for Locked Plate Fixation in the Treatment of Acute, Displaced Fractures of the Distal Femur

Background: Fixation of distal femoral fractures remains a challenge, and nonunions are common with standard constructs. Far cortical locking (FCL) constructs have been purported to lead to improved fracture-healing as compared with that achieved with traditional locking bridge plates. We sought to test this hypothesis in a comparative effectiveness clinical trial. Methods: This randomized trial was performed across 16 centers and included adult patients with an AO/OTA type 33A or 33C distal femoral fracture that was suitable for bridging fixation. We excluded patients with periprosthetic fractures. Participants were randomly assigned to either FCL fixation or standard locking plate fixation. The primary outcome was a hierarchical composite of radiographic and clinical fracture-healing at 3 months after fixation. We estimated between-group differences with use of the win ratio approach. Secondary outcomes included radiographic healing, clinical fracture-healing, complications, reoperations, and health-related quality of life (Short Form-36 Health Survey Version 2 [SF-36] Physical Component Summary and Mental Component Summary scores) at 3, 6, and 12 months after fixation. Results: We randomly assigned 193 patients to treatment with either FCL screws (96 patients) or standard screws (97 patients). The study population had a mean age of 63.4 years, consisted predominantly of women (68%), and was well-balanced between AO/OTA 33A and 33C fractures. Based on 4,355 pairwise comparisons, the calculated win ratio was 1.18 (95% confidence interval [CI], 0.77 to 1.79; p = 0.45), indicating that patients assigned to FCL screws had better outcomes in 51% of the comparisons. Radiographic healing did not differ significantly between the groups (odds ratio, 1.36; 95% CI, 0.69 to 2.72; p = 0.38), nor did Function IndeX for Trauma (FIX-IT) scores (p = 0.41). There were no significant differences between the groups in terms of SF-36 Physical Component Summary scores at 3 months or in the change in scores at 12 months after fixation. Conclusions: In this multicenter randomized trial of adult patients with an AO/OTA type 33A or 33C distal femoral fracture, similar clinical and radiographic healing outcomes were observed in the FCL and standard fixation groups. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Effects of diabetes-related foot ulcer depth on healing days, cost, and quality of life: A prospective observational study.

The relationship between the depth of the diabetes-related foot ulcers, and the healing days, cost, and QOL was examined.Depth 4 and 5 ulcers, namely beyond the tendons, exhibited significantly longer healing days and higher costs than Depth 2 and 3 ulcers. As for QOL, there were no significant differences in utility values between the depth categories.Results on healing time and cost reiterate the importance of early consultation, especially before the depth becomes deeper than the tendon.

Structure, ingredient, and function-based biomimetic scaffolds for accelerated healing of tendon-bone interface

BackgroundTendon-bone interface (TBI) repair is slow and challenging owing to its hierarchical structure, gradient composition, and complex function. In this work, enlightened by the natural characteristics of TBI microstructure and the demands of TBI regeneration, a structure, composition, and function-based scaffold was fabricated. Methods: The biomimetic scaffold was designed based on the “tissue-inducing biomaterials” theory: (1) a porous scaffold was created with poly-lactic-co-glycolic-acid, nano-hydroxyapatite and loaded with BMP2-gelatinmp to simulate the bone (BP); (2) a hydrogel was produced from sodium alginate, type I collagen, and loaded with TGF-β3 to simulate the cartilage (CP); (3) the L-poly-lactic-acid fibers were oriented to simulate the tendon (TP). The morphology of tri-layered constructs, gelation kinetics, degradation rate, release kinetics and mechanical strength of the scaffold were characterized. Then, bone marrow mesenchymal stem cells (MSCs) and tenocytes (TT-D6) were cultured on the scaffold to evaluate its gradient differentiation inductivity. A rat Achilles tendon defect model was established, and BMSCs seeded on scaffolds were implanted into the lesionsite. The tendon-bone lesionsite of calcaneus at 4w and 8w post-operation were obtained for gross observation, radiological evaluation, biomechanical and histological assessment. ResultsThe hierarchical microstructures not only endowed the scaffold with gradual composition and mechanical properties for matching the regional biophysical characteristics of TBI but also exhibited gradient differentiation inductivity through providing regional microenvironment for cells. Moreover, the scaffold seeded with cells could effectively accelerate healing in rat Achilles tendon defects, attributable to its enhanced differentiation performance. ConclusionThe hierarchical scaffolds simulating the structural, compositional, and cellular heterogeneity of natural TBI tissue performed therapeutic effects on promoting regeneration of TBI and enhancing the healing quality of Achilles tendon. The translational potential of this articleThe novel scaffold showed the great efficacy on tendon to bone healing by offering a structural and compositional microenvironment. The results meant that the hierarchical scaffold with BMSCs may have a great potential for clinical application.

Treatment of active ulcerative colitis with Yinmei Kuijie decoction combined with 5-aminosalicylic acid: A non-randomized multicenter prospective observational protocol based on real-world conditions

ObjectiveTo determine the efficacy and safety of the Yinmei Kuijie decoction combined with 5-aminosalicylic acid (5-ASA) in treating mildly to moderately active ulcerative colitis (UC) under real-world conditions. MethodsThis multicenter, prospective, non-randomized, observational study will be conducted in real-world settings. A total of 204 eligible patients will be consecutively enrolled in the study. Patients in the combination treatment group will receive Yinmei Kuijie decoction in combination with 5-ASA, whereas those in the control group will be treated with 5-ASA alone. The primary endpoint will be a clinical response at week 12, defined as a ≥3 point and ≥30% reduction from baseline in the Mayo total score with ≥1 reduction in rectal bleeding or rectal bleeding score = 0 or 1. Secondary efficacy endpoints at week 12 will include health-related quality of life, mucosal healing, and inflammation indicators. ConclusionThe results of this study may provide evidence of the efficacy and safety of Yinmei Kuijie decoction combined with 5-ASA in treating patients with mildly to moderately active UC under real-world principles. The results will provide a basis for further confirmatory studies on the efficacy of Yinmei Kuijie decoction.

Development and characterization of contraction-suppressed full-thickness skin wound model in rabbits

The wound healing process in rodents (rats and mice) and lagomorphs (rabbits) predominantly relies on wound contraction rather than re-epithelialization and granulation tissue formation. As a result, existing laboratory animal models for wound healing often fail to mimic human wound healing mechanisms accurately. This study introduces a standardized rabbit model with superior translational potential for skin wound healing research. Two full-thickness dermal wounds were created on the posterior dorsal surface of each rabbit using a standard 2 ×2 cm² template. One of these wounds was randomly selected to be treated as a contraction-suppressed wound by applying a transparent adhesive elastic bandage. At the same time, the other was retained as a standard full-thickness wound. Wound contraction was measured on 7, 14, 21, 28, and 35 days. Histomorphological evaluation was done on day 35 to evaluate the quality of wound healing. The findings indicate that transparent adhesive elastic bandage prolonged the wound healing time and suppressed wound contraction in rabbits. In addition, the healed contraction-suppressed full-thickness wounds had denser and thicker collagen fibers than the healed standard full-thickness wounds, indicating better collagen fiber deposition. Our model achieved a 100 % success rate in maintaining the transparent adhesive elastic bandage in the rabbits. Therefore, we have developed a simple, non-invasive, cost-effective method for preventing wound contraction. Further studies are required to establish the utility of this model for studying wound healing mechanisms and evaluating therapeutic interventions.