Healing Rates In Patients Research Articles

Clinical Outcomes After Distal Bypass in Patients With Chronic Limb-Threatening Ischemia due to Connective Tissue Disease.

Chronic limb-threatening ischemia (CLTI) is mostly caused by arteriosclerosis, but is sometimes due to connective tissue disease. However, there is a limited knowledge of clinical outcomes of patients with CLTI with connective tissue disease. The objective of the study was to assess outcomes after distal bypass in these patients using global vascular guidelines. Data from distal bypasses performed for CLTI at a single center from 2014 to 2023 were evaluated retrospectively. Clinical outcomes after distal bypass were compared for patients with CLTI with arteriosclerosis (AS group) and those with connective tissue disease (CD group). The primary endpoints were limb salvage and wound healing. Of the 282 distal bypasses performed for 222 patients with CLTI, 22 were conducted for 21 patients with connective tissue disease (CD group). The connective tissue disease was progressive systemic scleroderma (n = 11 patients), pemphigoid diseases (n = 2), polyarteritis nodosa (n = 2), rheumatoid arthritis (n = 2), and others (n = 4). Compared with the AS group, the CD group included more females (P = .007) and had greater oral steroid use (P < .001) and a higher Global Limb Anatomical Staging System (GLASS) inframalleolar (IM) modifier P2 (P < .001). The mean follow-up period of the whole cohort was 27 ± 22 months with no significant difference between the groups (P = .25), and 22 limbs required major amputation during this period. The 2-year limb salvage rate was significantly lower in the CD group compared to the AS group (75% vs 94%, P = .020). Wound healing was achieved in 220 (78%) limbs, and the 12-month wound healing rate was significantly lower in the CD group (52% vs 86%, P = .006). The low 2-year limb salvage and 12-month wound healing rates in patients with CLTI with connective tissue disease indicate that distal bypass may be challenging in these patients.

The impact of statin therapy on the healing of diabetic foot ulcers: a case–control series

BackgroundDiabetic foot ulcers (DFU) are a costly complication of diabetes mellitus (DM), with significant implications for the patient and the healthcare professionals that treat them. The primary objective of this study was to evaluate if there were improved healing rates in patients with a DFU that were taking a statin medication compared to those patients with a DFU who were not taking a statin medication. Secondary outcomes assessed were correlations with wound healing or statin use on data obtained from retrospective chart review.MethodsA case–control series was performed to obtain appropriate demographic information, comorbid conditions, laboratory values, and physical examination findings. From the time of presentation with DFU, these patients were followed for 12 weeks to evaluate for healing. Healing was defined as full epithelialization of the DFU with no further drainage. Wound healing and statin use correlation testing was then done for collected variables and each cohort. Chi square and Pearson correlation were then performed to identify any significant correlations. All p-values were two-sided, and findings were considered statistically significant at p < 0.05.ResultsOur study identified 109 patients, 75 patients with a DFU on statin medication and 34 patients with a DFU not on statin medication. The statin cohort was more likely to be older, less than 5-year duration of diabetes, have more comorbidities, decreased low-density lipoprotein (LDL) cholesterol, and decreased total cholesterol (p < 0.05). Among those patients taking a statin medication, 48.0% (36/75) healed their DFU within 12 weeks. Among those patients not taking a statin medication, 44.1% (15/34) healed their DFU within 12 weeks. No correlation was noted between wound healing and statin use (p = 0.7). For wound healing, a negative correlation was noted for prior minor amputations (p < 0.05). For statin use, correlations were noted for age, duration of DM, LDL cholesterol level, total cholesterol level, HTN, CAD, and HLD (p < 0.05).ConclusionsStatin medication use did not influence DFU healing rates between cohorts. There was a correlation noted between wound healing and prior minor amputations and between statin use and age, duration of DM, LDL cholesterol, total cholesterol, HTN, CAD and HLD. Additionally, we observed no correlation between DFU healing rates and use of a statin medication.

Impact of Infrapopliteal Revascularisation Establishing In Line Flow to the Wound in Patients with Chronic Limb Threatening Ischaemia

This study aimed to determine the impact of infrapopliteal (IP) revascularisation establishing in line flow to the wound (IFW) on wound healing in chronic limb threatening ischaemia (CLTI), using a core laboratory assessment for wounds and in line flow. The Wound-directed Angiosome RevasculaRIzation apprOach to patients with cRitical limb iSchaemia (WARRIORS) multicentre observational study enrolled patients with CLTI with tissue loss undergoing IP revascularisation in Japan, with scheduled two year follow up. The primary outcome measure was complete wound healing, defined as achievement of complete epithelialisation of all wounds without major amputation. IP revascularisation establishing IFW was defined as revascularisation after which a tibiopedal artery that actually fed an injured pedal unit was patent. The incidence of wound healing was compared between the IFW and non-IFW groups using inverse probability of treatment weighting based on the propensity score. A total of 440 patients with CLTI (median age, 75 years; male, 64.1%; diabetes mellitus, 72.0%; dialysis, 57.7%) with tissue loss (Wound, Ischemia, and foot Infection stage 4, 66.4%) who underwent IP revascularisation (endovascular procedure, n = 304; bypass grafting, n = 136) between October 2017 and June 2020 were registered. During a median follow up of 23.6 months, 51.1% achieved wound healing. Successful IP revascularisation with IFW was achieved in 68.2%. After analysis, the IFW group had a higher incidence of wound healing than the non-IFW group (34.5 vs. 16.1 per 100 person years; p = .030). The association of IFW with wound healing was not statistically different between patients undergoing bypass grafting and those undergoing an endovascular procedure (p for interaction = .38). There was no statistically significant interaction effect between IFW and direct revascularisation for wound healing (p for interaction = .51). IP revascularisation establishing IFW was statistically significantly associated with a higher wound healing rate in patients with CLTI.

What Affects Healing Rates in Patients Treated for Medication-Related Osteonecrosis of the Jaw? The Role of Operative Therapy and Other Clinical Factors

BackgroundIn the therapy of medication-related osteonecrosis of the jaw (MRONJ), the healing rate, effectiveness of operative therapy, and factors associated with healing remain unclear. PurposeThis study aimed to estimate MRONJ therapy healing rates and identify associated prognostic factors. Study design, setting, sampleA 25-center prospective cohort study was conducted on 291 patients with MRONJ treated with a common therapeutic protocol during 2013–2016. Patients unable to continue examinations or treatment were excluded. Predictor variableThe primary predictor variable was MRONJ therapy grouped into two categories: operative and nonoperative. Secondarily, the prognostic factors categorized as demographic, medical, clinical, and perioperative were evaluated. Main outcome variablesThe primary outcome variable was treatment duration, defined as the time (in months) between the initiation of therapy and when the site was healed or the date of the final visit or loss to follow-up. CovariatesNot applicable. AnalysesDescriptive statistics and 3-year cumulative healing rates were calculated. The association between clinical factors and time to healing were analyzed using bivariate and multivariate analyses and propensity score analysis. P < .05 was considered significant. ResultsWe analyzed data from 291 subjects with 76 (26.1%) and 215 (73.9%) subjects in the operative and nonoperative therapy groups, respectively. The healing rates for operative and nonoperative therapies were 95.8% and 70.7%, respectively (hazard ratio [HR] = 1.6, 95% confidence interval [CI] = 1.1–2.2, P-value [P] < .01). The healing rates in patients for whom anti-resorptive agent (ARA) treatment was discontinued and continued were 87.2% and 37.4%, respectively (HR = 1.8, 95% CI = 1.1–3.0, P = .02). In a multiple regression analysis using ARA indication, the therapy method showed a significant association in the MRONJ malignancy group (HR = 2.75, 95% CI = 1.46–5.17, P < .01). Conclusions and RelevanceOperative therapy and ARA discontinuation were associated with better healing rates in MRONJ therapy. However, the choice of therapy for MRONJ should be based on a comprehensive consideration of the patient’s condition. ARA discontinuation should be considered an adjunctive measure because of the possibility of adverse events such as fragility fractures and skeletal related events.

Experience of humanistic nursing in hemodialysis nursing for patients with diabetic kidney disease.

Diabetic kidney disease (DKD) is a prevalent complication of diabetes that often requires hemodialysis for treatment. In the field of nursing, there is a growing recognition of the importance of humanistic care, which focuses on the holistic needs of patients, including their emotional, psychological, and social well-being. However, the application of humanistic nursing in the context of hemodialysis for DKD patients remains relatively unexplored. To explore the experience of humanistic nursing in hemodialysis nursing for DKD patients. Ninety-six DKD patients treated with hemodialysis from March 2020 to June 2022 were included in the study and divided into the control cluster (48 cases) and the study cluster (48 cases) according to different nursing methods; the control cluster was given routine nursing and the study cluster was given humanized nursing. The variances of negative emotion mark, blood glucose, renal function, the incidence of complications, life mark and nursing satisfaction before and after nur-sing were contrasted between the two clusters. No significant difference in negative emotion markers between the two clusters were observed before nursing (P > 0.05), and the negative emotion markers of the two clusters decreased after nursing. The Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale markers were lower in the study cluster than the control cluster. The healing rate of patients in the study cluster was significantly higher than the control cluster (97.92% vs 85.42%, P < 0.05). Blood glucose parameters were not significantly different between the groups prior to nursing (P > 0.05). However, after nursing, blood urea nitrogen and serum creatinine (SCr) levels in the study cluster were lower than those in the control cluster (P < 0.05). The incidence rate of complications was significantly lower in the study group compared to the control cluster (6.25% vs 20.83%, P < 0.05). There was no significant difference in the life markers between the two clusters before nursing. While the life markers increased after nursing for both groups, the 36-item health scale markers in the study cluster were higher than those within the control cluster (P < 0.05). Finally, the nursing satisfaction rate was 93.75% in the study cluster, compared to 75% in the control cluster (P < 0.05). In hemodialysis for DKD patients, the implementation of humanistic nursing achieved ideal results, effectively reducing patients' psychological negative emotion markers so that they can actively cooperate with the diagnosis and nursing, facilitate the control of blood glucose and the maintenance of residual renal function, reduce the occurrence of complications, and finally enhance the life quality and nursing satisfaction of patients. It is worthy of being widely popularized and applied.

Vonoprazan is superior to lansoprazole for healing of severe but not mild erosive esophagitis: A systematic review with meta-analysis of randomized controlled trials.

Healing rates of severe erosive esophagitis (EE; Los Angeles [LA] Grade C/D) in patients treated with a proton pump inhibitor (PPI) is suboptimal (~60-70%). Vonoprazan, a potassium-competitive acid blocker, is suggested to have better healing rates in patients with severe EE. This meta-analysis compares the efficacy and safety of vonoprazan 20mg versus lansoprazole 30mg daily in healing EE, specifically in those with LA Grade C/D. We searched MEDLINE, Embase, and CENTRAL on May 24, 2023. Studies that randomized EE patients to vonoprazan 20mg daily or lansoprazole 30mg daily and compared healing rates were included. The risk of bias was assessed using Cochrane's Risk of Bias 2 tool. The fixed-effect model was used to obtain the pooled efficacy and safety outcomes. Subgroup analysis was done to compare healing rates in mild (LA Grade A/B) versus severe EE and based on study location. Four randomized controlled trials (RCTs) with low risks of bias comprising 2208 participants were included. Vonoprazan 20mg was superior to lansoprazole 30mg daily in healing severe EE at all weeks (Week 2 RR 1.294 [95% CI 1.169-1.433], Week 4 1.160 [1.059-1.270], and Week 8 1.175 [95% CI 1.107-1.247]), but was similar for mild EE at all weeks (P-interaction<0.01). Vonoprazan 20mg was more efficacious than lansoprazole 30mg at Week 8 in Western versus Asian studies (P-interaction<0.01). Any, serious, and drug-related treatment-emergent adverse events were comparable between groups. Vonoprazan 20mg is superior to lansoprazole 30mg for healing severe EE but not mild EE. Vonoprazan 20mg daily has a similar safety profile to lansoprazole 30mg daily.

Evaluating the cost-effectiveness of diabetic foot ulcer management by wound care specialists in Indonesia.

Diabetic foot ulcers affect quality of life and economically burden patients and the Indonesian healthcare system. The comparative cost-effectiveness of wound care specialists in private practices (e.g., wound clinics) and wound care nurses in national hospitals remains unknown. Thus, we used a decision tree to compare the cost and healing rates for patients after 12 weeks of wound care. Uncertainty was addressed using one-way and probabilistic sensitivity analyses. Among 89 participants (42 in the national hospital and 47 in the private practice), no significant differences were observed between the two groups in terms of sex, age, education level, smoking status, duration of diabetes, Wagner wound classification, glycated haemoglobin levels, neuropathy status, ankle-brachial index, baseline characteristics, quality of life, DMIST (depth, maceration, inflammation/infection, size, tissue type of the wound bed, type of wound edge, and tunnelling/undermining) score and wound location (p > 0.05). However, significant differences were observed for days from first visit/assessment until complete healing, mean quality of life (p ≤ 0.001) and wound size (p = 0.047). Wound care specialists in private practices had a significantly lower cost of 2,804,423.3 Indonesian rupiah compared to 6,483,493.4 Indonesian rupiah for wound care nurses in national hospitals. The incremental cost-effectiveness ratio was -165,723.9. Therefore, wound care specialists in private practices are more cost-effective for managing diabetic foot ulcers. Probability sensitivity analysis confirmed that 80%-90% of the scenarios were cost-effective. These findings may inform healthcare resource allocation in Indonesia. Additionally, evidence-based cost-effectiveness measures were strengthened in private practices and national hospitals.

The Effect of Clinical Frailty on Wound Healing in Patients With Chronic Limb-Threatening Ischemia.

Clinical frailty increases the risk of adverse outcomes in older people. Patients with Chronic limb-threatening ischemia (CLTI) also had several clinical frailties. The aim of this study was to investigate the correlation between clinical frailty scales (CFS) at discharge and wound healing rate in patients with tissue loss. A total of 510 limbs in 431 CLTI patients who were undergone endovascular treatment (EVT) from January 2013 to November 2018 were enrolled in this study. Patients were categorized into 4-groups based on the CFS stages: CFS 1 to 4 (well), CFS 5 (mild), CFS 6 (moderate) and CFS ≥7 (severe). And the change in patient's activities during hospitalize was classified into 3 groups based on CFS; improve, stable, worse. Primary endpoint was correlation between CFS at discharge and wound healing rate. Secondary endpoint was relationship between the changes in patient's activities and wound healing rate. A total of 365 limbs were obtained complete wound healing during this study period. Patient distribution into the 4 CFS groups was as follows: 13.3% (well), 21.8% (mild), 25.3% (moderate) and 39.6% (severe). Wound healing rate in severe CFS group was significantly lower than that in other CFS groups (p<0.0001). Wound healing rate in the patients who achieved improvement of activity was significantly higher than that in the other groups (p=0.008). CFS might be useful for risk stratification in patients with tissue loss. And improvement of activity during hospitalization might lead to increase the wound healing rate. Although the association between clinical frailty and prognosis outcome of Chronic limb-threatening ischemia (CLTI) has been reported, the effect of clinical frailty on wound healing remains unclear. Clinical frailty scale is independently associated with wound healing and might be useful for risk stratification in patients with tissue loss. Improvement of activity during hospitalization might lead to increase the wound healing rate.

Correlated Naïve Bayes Algorithm to Determine Healing Rate of Hepatitis Patients

The Correlated Naïve Bayes Algorithm is a statistical learning method that has shown promise in predicting the healing rate of hepatitis patients. Hepatitis is a liver disease that can be chronic or acute and affects millions of people worldwide. The healing rate of patients with hepatitis can vary widely depending on various factors such as age, gender, and medical history. The Correlated Naïve Bayes Algorithm takes into account the correlations between the different attributes of patients and their healing rates, unlike the traditional Naïve Bayes Algorithm. This approach has been shown to improve the accuracy of predictions significantly. In this study, the Correlated Naïve Bayes Algorithm was applied to a dataset of hepatitis patients. The dataset contained information about patients' age, gender, medical history, and other attributes that might affect their healing rates. The algorithm was trained on this dataset to predict the healing rate of new patients. The results showed that the Correlated Naïve Bayes Algorithm achieved higher accuracy in predicting the healing rate of hepatitis patients compared to the traditional Naïve Bayes Algorithm. This suggests that the Correlated Naïve Bayes Algorithm could be a useful tool for healthcare professionals in predicting the healing rate of hepatitis patients, and ultimately improving their treatment and care. Furthermore, the study also investigated the importance of different attributes in predicting the healing rate of hepatitis patients. The results showed that age and medical history were the most important factors, followed by gender and other attributes. The findings of this study have significant implications for the medical community, as accurate prediction of healing rates can inform treatment decisions and improve patient outcomes. The Correlated Naïve Bayes Algorithm provides a powerful tool for healthcare professionals in predicting the healing rate of hepatitis patients, and could be extended to other medical conditions. However, it is important to note that the Correlated Naïve Bayes Algorithm has limitations, such as the assumption of independence between attributes. Therefore, future research should investigate alternative methods that can overcome these limitations and improve the accuracy of predictions further.

Correlation analysis and prognostic value of miR-29a-3p expression and CYP2C19 genotypes in exfoliated cells from tongue coating of patients with gastroesophageal reflux disease.

Gastroesophageal reflux disease (GERD) is a highly prevalent and troublesome disease. Several differentially expressed microRNAs (miRNAs) have been found in GERD. This study was to analyze the correlation of miR-29a-3p expression and CYP2C19 genotypes in exfoliated cells from tongue coating of GERD patients and its prognostic value. Tongue coating specimens were collected from 130 GERD patients and 70 healthy volunteers and their clinical baseline information was recorded. miR-29a-3p expression in exfoliated cells from tongue coating was determined via RT-qPCR, and its diagnostic efficiency on GERD was evaluated via receiver operating characteristic curve. CYP2C19 genotypes and their correlation with miR-29a-3p were analyzed via polymerase chain reaction restriction fragment length polymorphism technique. The adverse events of patients were documented via 12-month follow-up. The impact of miR-29a-3p expression on the healing rate of patients was analyzed via Kaplan-Meier method. Qualification of miR-29a-3p as an independent prognostic factor of GERD patients was analyzed via multivariate Cox regression analysis. miR-29a-3p was highly-expressed in exfoliated cells from tongue coating of GERD patients. miR-29a-3p expression had high specificity and sensitivity in diagnosing GERD. CYP2C19 genotypes in GERD patients comprised rapid metabolizers, intermedia metabolizers, and poor metabolizers. miR-29a-3p expression showed a correlation with CYP2C19 genotypes. Higher miR-29a-3p expression predicted higher cumulative incidences of adverse outcomes. Highly-expressed miR-29a-3p was an independent prognostic factor for adverse outcomes of GERD patients. High expression of miR-29a-3p aided the diagnosis and predicted poor prognosis of GERD patients.

Intraoperative Channeling in Arthroscopic Rotator Cuff Repair: A Multicenter Randomized Controlled Trial

Background: Despite recent advances in arthroscopic rotator cuff repair, the retear rate remains high. New methods to optimize healing rates must be sought. Bone channeling may create a quicker and more vigorous healing response by attracting autologous mesenchymal stem cells, cytokines, and growth factors to the repair site. Hypothesis: Arthroscopic rotator cuff repair with bone channeling would result in a higher healing rate compared with arthroscopic rotator cuff repair without adjuvant channeling. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: Our primary objective was to compare healing rates in patients undergoing arthroscopic rotator cuff repair for degenerative tears, with and without bone channeling. Secondary objectives included comparisons of the Western Ontario Rotator Cuff Index (WORC) score, American Shoulder and Elbow Surgeons (ASES) score, Constant score, Constant strength subscore, and visual analog scale (VAS) for pain score between groups. Patients undergoing arthroscopic rotator cuff repair were recruited at 3 sites and were randomized to receive either bone channeling augmentation or standard repair. Healing was determined via ultrasound at 24 months postoperatively. WORC, ASES, and Constant scores were compared between groups at baseline and at 3, 6, 12, and 24 months postoperatively. Results: A total of 168 patients were enrolled between 2013 and 2018. Intention-to-treat analysis revealed no statistical differences in healing rates between the 2 interventions at 24 months postoperatively. Statistically significant improvements occurred in both groups from preoperatively to all time points for the WORC, the ASES score, the Constant score or Constant strength subscore, and the VAS for pain (P < .0001). No differences were observed between the bone channeling and control groups in WORC, ASES, Constant, and VAS pain scores at any time point. Conclusion: This trial did not demonstrate the superiority of intraoperative bone channeling in rotator cuff repair over standard rotator cuff repair at 24 months postoperatively. Healing rates, patient-reported function, and quality-of-life outcomes were similar between groups. Registration: NCT01877772 (ClinicalTrials.gov identifier).

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Anal Fissures.

Maxillary and Mandibular Healing after Facial Allotransplantation

PURPOSE: Facial transplantation has emerged as a viable option in treating devastating facial injuries. Despite the high healing rate of Le Fort I-II-III and bilateral sagittal split osteotomies (BSSO) in non-transplant patients (with reported non-union rates of 1.6% and 2.6%, respectively),[1,2] previous studies have reported nonunion between the allograft and the recipient’s bone at the area of maxillary and mandibular osteotomies. [3,4] This suboptimal bone healing remains unexplained and is still yet to be investigated. In this study, we present three patients that received facial transplantation at our institution with a focus on the healing of the mandibular and maxillary osteotomies after osteocutaneous face transplantation. METHOD: A retrospective chart review was conducted of facial allotransplantation patients at the Cleveland Clinic from December 2008 to inception. Demographics such as age, date of birth, and sex were recorded. Additional variables included procedures, revisions, reoperations, medications, and bone stability and healing. Computed tomography (CT) images assessed alignment of skeletal components, bony union quality, and stability of fixation. RESULTS: Three patients receiving facial allotransplantation at our institution were included in our study: two had Le Fort III segment transplantation, and one had transplantation of both a Le Fort III segment and mandibular BSSO. The Le Fort III segment in all three patients exhibited mobility and fibrous union at the Le Fort III osteotomy on CT. In contrast, the BSSO healed uneventfully after transplantation and revision surgery, with bony union confirmed by both CT and histology of the fixation area between the donor and recipient mandible bilaterally. No patients with midfacial fibrous union required revision of the nonunion as they were clinically asymptomatic. CONCLUSION: Le Fort osteotomies demonstrated inferior healing in patients undergoing facial transplantation compared to Le Fort osteotomies in patients treated for malocclusion. Interestingly, the mandible healed uneventfully after facial transplantation, likely due to the amount of rich cancellous bone in the mandible. This similarly reflects bone healing rates in patients undergoing mandibular surgery for correction of malocclusion or hand transplantation at the level of the humerus, radius, and ulna. Nonunion of the midface does not require revision unless the patient is clinically symptomatic. REFERENCES: 1. Imholz B, Richter M, Dojcinovic I, and Hugentobler M, Non-union of the maxilla: a rare complication after Le Fort I osteotomy. Revue de stomatologie et de chirurgie maxillo-faciale. 2010; 111(5-6): p. 270-275. 2. Chin M and Toth BA, Le Fort III advancement with gradual distraction using internal devices. Plast Reconstr Surg. 1997; 100(4): p. 819-30; discussion 831-2. 3. Lantieri L, Grimbert P, Ortonne N, et al., Face transplant: long-term follow-up and results of a prospective open study. Lancet. 2016; 388(10052): p. 1398-1407. 4. Goutard M, Lellouch AG, Dussol B, and Lantieri LA, Facial Trauma 8 years after a Face Transplantation. Plast Reconstr Surg Glob Open. 2021; 9(5): p. e3575.

Frequency of Post-Operative Fecal Incontinence and Healing Rate in Patients with Open and Closed Lateral Internal Anal Sphincterotomy

OBJECTIVES This study aims to compare the frequency of fecal incontinence and healing rate in patients treated with Open Internal Anal Sphincterotomy (OIAS) and Closed Lateral Internal Anal Sphincterotomy (CLIAS). METHODOLOGY This randomized control trial was carried out in the Department of Surgery Hayatabad Medical Complex, Peshawar Pakistan from Feb 2019 to Feb 2020. Eighty-four patients were assigned to the open method in Group B while eighty-four patients were allocated to the closed method in Group A (using blade 11) through the randomized control trial method. Fecal incontinence and healing rate were observed on the 7 th postoperative day. SPSS 23.0 software was used to analyse the data. RESULTS In group A out of a total of 84 patients, 96% of patients were in category A, 4% of patients were in category B, and no patients were in categories C and D. In group B out of 84 patients, 96% of patients were in category A while 4% patients were in category B and no patients were in category C and D. The total faecal incontinence in Group B (open method) was 21% while total fecal incontinence in Group A (closed method) was only 4% that is a clear dierence between the two groups. In group A (closed method) out of 84 patients, 2 patients (2.38 %) showed delayed healing while 82 patients (97.61 %) showed normal healing. In group B (open method) 7.4% of patients showed delayed healing with a signicance p level of 0.04 while 92.85 showed normal healing. CONCLUSION Fecal incontinence was less in closed Lateral Anal Sphincterotomy due to the use of blade 11 while it was higher in open internal anal sphincterotomy. Similarly, the healing rate was signicantly higher in the closed method while delayed healing was seen in the open method.

Topical Biological Agents as Adjuncts to Improve Wound Healing in Chronic Diabetic Wounds: A Systematic Review of Clinical Evidence and Future Directions.

Diabetes is a leading chronic illness in the modern world and 19-34% develop chronic diabetic foot ulcers (DFUs) in their lifetime, often necessitating amputation. The reduction in tissue growth factors and resulting imbalance between proteolytic enzymes and their inhibitors, along with systemic factors impairing healing appear particularly important in chronic wounds. Growth factors applied topically have thus been suggested to be a non-invasive, safe, and cost-effective adjunct to improve wound healing and prevent complications.Comprehensive database searches of MEDLINE via PubMed, EMBASE, Cochrane, and ClinicalTrials.gov were performed to identify clinical evidence and ongoing trials. The risk of bias analysis included randomized controlled trials (RCTs) was performed using the Cochrane Risk of Bias 2.0 tool. We included randomized controlled trials that compared the use of a topical biologic growth factor-containing regimen to any other regimen. Primary outcomes of interest were time to wound closure, healing rate, and time. Secondary outcomes included the incidence of adverse events such as infection.A total of 41 trials from 1992-2020 were included in this review, with a total recorded 3,112 patients. Platelet-derived growth factors (PDGF) in the form of becaplermin gel are likely to reduce the time of closure, increase the incidence of wound closure, and complete wound healing. Human umbilical cord-related treatments, dehydrated human amnion and chorion allograft (dHACA), and hypothermically stored amniotic membrane (HSAM), consistently increased the rates and incidence of complete ulcer healing while reducing ulcer size and time to complete ulcer healing. Fibroblast growth factor-1 (FGF1) showed only a slight benefit in multiple studies regarding increasing complete ulcer healing rates and incidence while reducing ulcer size and time to complete ulcer healing, with a few studies showing no statistical difference from placebo. Platelet-rich fibrin (PRF) is consistent in reducing the time to complete ulcer healing and increasing wound healing rate but may not reduce ulcer size or increase the incidence of complete ulcer healing.Targeting the wound healing pathway via the extrinsic administration of growth factors is a promising option to augment wound healing in diabetic patients. Growth factors have also shown promise in specific subgroups of patients who are at risk of significantly impaired wound healing such as those with a history of secondary infection and vasculopathy. As diabetes impairs multiple stages of wound healing, combining growth factors in diabetic wound care may prove to be an area of interest. Evidence from this systematic literature review suggests that topical adjuncts probably reduce time to wound closure, reduce healing time, and increase the healing rate in patients with chronic DFUs.

Rehabilitation Treatment and Monitoring of Ankle Achilles Tendon Ligament Injury in Athletes Repaired by Nanomaterials

During sports, athletes’ incorrect technical movements and direct physical confrontation can easily cause ankle injuries. Joint ligament injury is a common injury in sports. A ligament injury is an injury to the ligaments in a part of the body caused by varying degrees of injury. Clinical manifestations include localized swelling, pressure pain or joint instability, and pain that increases when pulled in the direction of violence. In order to further investigate the rehabilitation methods of nanomaterials for repairing the ankle Achilles tendon ligament injury in athletes, nanomaterials are materials in which at least one dimension in three‐dimensional space is at the nanometer size (1‐100 nm) or consists of them as the basic unit, which is approximately equivalent to the scale of 10 to 1000 atoms closely aligned together. In this paper, we found that the healing rate of patients was over 90% by the dynamic balance system combined with surface electromyography, surgical treatment, and extracorporeal shock wave. It can be seen that the dynamic balance system combined with surface electromyography (SEMG), surgical treatment, rehabilitation therapy of Taijiquan exercise, and extracorporeal shock wave therapy have significant effects on the rehabilitation of athletes’ ankle and Achilles tendon ligament injuries and can effectively alleviate and resolve athletes’ ankle Achilles tendon ligament injury.

Nursing Effect of Zinc Oxide Nanoantibacterial Materials after Adrenalectomy

Laparoscopic adrenalectomy (RLA) is widely used for adrenal tumors, cancer, cortical hyperplasia, etc. Therefore, how to care for patients after surgery is a necessary means to speed up the rapid healing of surgical wounds and reduce the incidence of related complications. To solve the problem in traditional wound treatment, antibacterial dressings are used, and most of the auxiliary materials need to be replaced frequently, or there is serious adhesion to the wound, which causes secondary wound infection. The methods used to study in this work report a new long‐acting antibacterial and breathable wound dressing based on nanoscale zinc oxide nanoparticles (ZnO NPs) in the care of adrenalectomy; the clinical effects of ZnO NP‐based antibacterial dressings were systematically evaluated in terms of patients’ wound healing rate (%), infection rate (%), healing time (d), and the number of dressing changes. The results revealed that the wound healing rate of patients with ZnO NP‐based antibacterial dressing was as high as 16.67% and the incidence of adverse reactions was only 26.19%, which was 40.48% lower than traditional dressings. Such promising antibacterial dressings are expected to be greatly used in the medical field in the future.

The effect of non-steroidal anti-inflammatory medications on spinal fracture healing: a systematic review.

The effect of non-steroidal anti-inflammatory medications (NSAIDs) on fracture healing is a topic of debate. The purpose of this study was to systematically review the effect of NSAID medications on spinal fracture healing rates. We searched the Cochrane Library, PubMed, Medline Ovid, and SCOPUS databases from inception until April 2021, and additionally searched the NIH Clinical Trials Database. Eligible studies included those which reported on spinal fracture healing rates in patients taking NSAIDs. Two reviewers independently assessed all potential studies for eligibility and extracted data. Risk of bias was assessed with validated tools by two reviewers. The primary outcome of interest was healing rates of spinal fractures in patients taking NSAIDs. Secondary outcomes of interest included healing rates stratified by NSAID selectivity. A total of 1,715 studies were initially screened. After inclusion criteria were applied, three studies (214 patients) were included which discussed spinal fracture healing rates in patients taking NSAIDs. These studies showed acceptable reliability for inclusion. The 3 studies reported heterogeneous results, with one study reporting a 96% healing rate, and another study reporting over 90% non-union rate. The types of fracture, NSAID type, and dosage/duration of NSAID use varied widely amongst studies. This systematic review identified a significant paucity in the literature on the effect of NSAID medications on spinal fracture healing rates. Given the limited number of studies, as well as the heterogeneous results and methods from these studies, no consensus statement can be made on the safety profile of NSAIDs in the context of spinal fractures. Further studies are needed to better address this question.

Second-Look Arthroscopic Evaluation of Healing Rates After Arthroscopic Repair of Meniscal Tears: A Systematic Review and Meta-analysis.

Background:Evaluation of meniscal healing status after repair is important, as it allows the surgeon to inform patients whether they can increase their activities or return to sports.Purpose:To identify the healing rates after arthroscopic repair of meniscal tears via second-look arthroscopic evaluation.Study Design:Systematic review; Level of evidence, 4.Methods:Searches of PubMed, Embase, Scopus, and the Cochrane databases were conducted to identify relevant studies published before June 1, 2020. Studies were eligible for this meta-analysis if they provided data regarding healing status of the meniscus at second-look arthroscopy. Random-effects meta-analyses were generated to provide pooled meniscal healing estimates. We further performed subgroup analysis to investigate the healing rates of the meniscus under different situations.Results:A total of 41 studies with 1908 individuals were included in the study. The pooled analysis showed the complete healing rate was 74% (95% confidence interval [CI], 67%-80%), the partial healing rate was 10% (95% CI, 6%-16%), and the failure rate was 12% (95% CI, 10%-15%) for arthroscopic repair of meniscal tears via second-look arthroscopic evaluation. Sensitivity analysis demonstrated that no individual study affected the overall healing rate by >1%. Subgroup analysis found higher meniscal healing rates in patients with the following characteristics: age <40 years, male, body mass index <26, red-red tear location, tear in posterior horn, vertical tear, outside-in technique, repair concomitant with anterior cruciate ligament reconstruction, weight-restricted rehabilitation, and time interval from meniscal repair to second-look arthroscopy >12 months.Conclusion:In this systematic review, the complete healing rate was 74%, the partial healing rate was 10%, and the failure rate was 12% for arthroscopic repair of meniscal tears via second-look arthroscopic evaluation.

Development of a Prognostic Model for Stump Healing in Major Lower Limb Amputation among the Diabetic Population

Background: This study aimed to explore the effect of haematological markers as well as patient characteristics on stump healing in patients who underwent a lower limb amputation procedure. In addition, a practical model regarding factors that affected stump healing was developed. Methods: Patients who underwent a major lower limb amputation (above knee and below knee) at the Royal Infirmary of Edinburgh from the period of 2007 to 2010 were included in this study. A prognostic model utilizing backward stepwise logistical regression was developed to measure the probability of lower limb stump healing. The relationship between the dependent and independent variables was identified using univariate and multivariate logistic regression. Results: Three variables, namely serum sodium, serum creatinine and serum high density lipid cholesterol were identified which influenced stump healing. Patients with normal serum sodium were 75% more likely to have lower limb stump healing compared to that of patients with abnormal serum sodium (odds ratio [OR] 1.756; 95% confidence interval [CI] 1.048–2.942). Patients with normal serum creatinine were 66% more likely to have their stump healed (OR 1.664; 95% CI 0.94 to 2.946). The healing rate of patients with a normal level of serum high density lipid cholesterol was 75%, in contrast to patients with an aberrant level of serum high density lipids cholesterol (OR 1.753; 95% CI 1.061 to 2.895). The effectiveness of the retrospective stump-healing model was demonstrated by the area under the ROC curve (0.612), which was supported by the Hosmer and Lemeshow goodness-of-fit test (p = 0.879). Conclusions: Serum sodium, serum high density lipid cholesterol and serum creatinine have a strong correlation with lower limb stump healing. However, serum sodium and serum high density lipid cholesterol secondary to multiple co-morbidities in this cohort group could be altered secondary to disease pathology itself.