Open Wounds Research Articles

SWIRL: The First Australian Operational Radar-Based 3D Wind Analysis System

Abstract In this paper, the first Australian operational radar-based three-dimensional (3D) wind analysis system named Synthetic Wind Information from Radar and Lidar (SWIRL) is described and evaluated. SWIRL employs a variational minimization formulation to combine results from four individual wind retrieval techniques of varied complexity to derive 3D winds in single-Doppler and multi-Doppler radar regions: a variational version of the traditional velocity azimuth display (VVAD) and double VAD (DVAD) techniques, a single-Doppler wind retrieval technique using optical flow horizontal wind proxies, and a multi-Doppler 3D wind retrieval technique. The SWIRL 3D wind components are evaluated against wind profiler observations and radar simulations using a very high-resolution (50 m) numerical simulation of a supercell thunderstorm. We find that SWIRL can retrieve very accurate horizontal winds, especially below 2-km height in the multi-Doppler regions, with mean absolute errors on wind speed and direction < 2 m s−1 and 10° on average and <2.5 m s−1 and 15°–20° 90% of the time. These errors do not increase noticeably with wind speed, highlighting the suitability of these retrieved winds to be used for damaging and destructive wind detection and nowcasting. The single-Doppler retrieval using optical flow is also found to provide reasonably accurate winds at these heights. The accurate retrieval of convective-scale updrafts and downdrafts, even using multi-Doppler information, is still a major challenge, with mean absolute errors of vertical velocity of about 50% on average. This can be attributed to the limitations of the current radar technology used operationally, imposing slow antenna speeds. Significance Statement Damaging and destructive winds have the potential to inflict significant damage to properties and assets and, tragically, result in loss of life. Efficient direction of emergency services to affected areas is essential for a prompt return to normal conditions. Wind farm operators require precise information on anticipated wind shifts to reduce the risk of energy grid failures. Strong winds also contribute to compound weather events, such as water ingress through hail-damaged roofs or structural damage to buildings caused by hailstones. The purpose of this work was to equip Australia with the first operational wind monitoring system, based on operational radar observations, to serve all these critical applications (and more).

A suction blister model to characterize epidermal wound healing and evaluate the efficacy of the topical wound healing agent INM-755 in healthy volunteers.

Non-healing wounds represent a substantial medical burden with few effective treatments available. To address this challenge, we developed a novel epidermal wound healing model using suction blisters in healthy volunteers. This model allowed for the comprehensive assessment of wound healing dynamics and the evaluation of INM-755, a topical cream containing cannabinol, as a potential therapeutic agent. Two clinical studies were conducted: an observational study and an interventional study. In both studies, healthy volunteers underwent a suction blister procedure on their lower back, creating open epidermal wounds. Wound healing parameters were assessed using advanced imaging systems. Skin barrier function and perfusion were evaluated through trans epidermal water loss (TEWL) and dynamic optical coherence tomography (D-OCT), respectively. The observational study demonstrated the successful and reproducible induction of blisters and the removal of epidermal sheet, enabling quantifiable measurements of wound healing parameters over time. Re-epithelialization was observed, revealing recovery of skin barrier function and perfusion. In the interventional study, differences of treatments over time were quantified using the above-described techniques. Despite differences from disease-specific blistering, our developed model provides a valuable platform for studying wound healing mechanisms and assessing novel therapeutic interventions. The sensitivity to treatment effects demonstrated in our study underscores the potential utility of this model in early-phase clinical drug development programs targeting wound healing disorders.

Staged versus nonstaged elective hybrid iliofemoral revascularization – analysis of ten years of prospective data

Reports of large series of hybrid iliofemoral revascularization for chronic lower limb ischemia are scarce. The aims of this study were to evaluate outcomes for staged and non-staged procedures, and to evaluate risk factors for outcomes at 90 days. Patients were consecutively included between 2013 and 2023. Surgical site infection (SSI) was defined by the ASEPSIS criteria and major adverse limb events (MALE) as onset of acute or continuing or worsening chronic limb ischemia or major amputation. Factors associated with outcomes were tested in a multivariable logistic regression analysis and expressed in Odds ratios (OR) with 95% confidence intervals (CI). Patients undergoing non-staged procedures (n=124) had higher TASC (Trans-Atlantic Inter-Society Consensus) class representing anatomical occlusive complexity, more often through-and through femoral guidewire access, more endoprosthesis, more covered stents, longer procedure time with open groin wounds, and less contralateral femoral access, than those undergoing staged procedures (n=31). The median time interval between the staged procedures was one day, and iliac stenting was done first in 77%. The median in-hospital stay was non-significantly longer in staged procedure (8 versus 6 days, p=0.053). The overall SSI and MALE rates were 25.8% and 20.0%, respectively, without differences between groups. Diabetes mellitus (OR 3.7, 95% CI 1.2 - 7.2]) and presence of a foot ulcer (OR 3.7, 95% CI [1.5 - 9.4]) were independently associated with MALE at 90 days. Postoperative hyperglycemia was non-significantly associated with SSI (OR 2.1 [95% CI 1.0 - 4.5], p=0.066) in multivariable analysis. The risks of SSI and MALE after elective hybrid iliofemoral revascularization were high. There appears to be no benefit in performing staged as opposed to non-staged procedures. The extent of iliofemoral occlusive disease according to the TASC classification had little influence on outcomes whereas diabetes mellitus and presence of a foot ulcer had greater impact on MALE.

Wound-dependent leg amputations to combat infections in an ant society

Open wounds pose major infection and mortality risks in animals.1,2 To reduce these risks, many animal species apply antimicrobial compounds on their wounds.1,2,3,4 Ant societies use antimicrobial secretions from the metapleural gland to combat pathogens,5,6,7,8,9,10 but this gland has been lost over evolutionary time in several genera, including Camponotus.11 To understand how infected wounds are handled without the use of antimicrobial secretions from the metapleural gland, we conducted behavioral and microbiological experiments in Camponotus floridanus. When we experimentally injured a worker's leg at the femur, nestmates amputated the injured limb by biting the base (trochanter) of the leg until it was severed, thereby significantly increasing survival compared to ants that did not receive amputations. However, when the experimental injury was more distal (at the tibia), nestmates did not amputate the leg and instead directed more wound care to the injury site. Experimental amputations also failed to improve survival in ants with infected tibia injuries unless the leg was amputated immediately after pathogen exposure. Micro-CT scans revealed that the muscles likely responsible for leg hemolymph circulation are predominantly in the femur. Thus, it is likely that femur injuries, by attenuating hemolymph flow, provide sufficient time for workers to perform amputations before pathogen spread. Overall, this study provides the first example of the use of amputations to treat infected individuals in a non-human animal and demonstrates that ants can adapt their type of treatment depending on the location of wounds.

Potential and Limitations of Anomaly Detection via Tower-Radar Monitoring of Wind Turbine Blades in Regular Operation with Convolutional Networks

The authors have already presented a first analysis of a field study on radar- based structural health monitoring of rotor blades on two operational wind turbines. This analysis will now be extended with measurements from a third operational wind turbine used as a case study for structural monitoring of individual rotor blades over different time intervals and blade modifications. More precisely, a sensor box with a 35 GHz FMCW radar and a highspeed camera was positioned at 90m height on the turbine tower, collecting radar data for structural information and videos for automatic ground truth labelling. After two months of collecting data, each individual rotor blade of that turbine was differently modified and measured again. The radar-facing surface of one rotor blade was partially coated with a microwave absorber foil, while an equivalent foil was applied to the backside of the second rotor blade. The third rotor blade was intentionally left unchanged for the sake of comparability. This study investigates potential limitations like general dataset complexity in radar-based anomaly detection for operational wind turbines. Furthermore, the discriminative ability of a convolutional neural network for classifying moving rotor blades is discussed when encountering feature drift through changing environmental and operational conditions, i.e. metadata like nacelle orientation, rotor blade pitch and rotation speed.

Acute and subacute toxicity profiling of methanol extract of Combretum dolichopetalum leaf in albino rats

The leaf of Combretum dolichopetalum is widely used in ethnomedicine to treat cases of diarrhea, inflammation and open wound. This study was hence, undertaken to determine the acute and subacute toxicity profile of the plant in albino rat model. A total of 426 g of dried and pulverized leaves of the plant was extracted with 2.5 L of 80% methanol by cold maceration method. A modified up-and-down method was employed for the oral acute toxicity study, with the extract administered at a maximum dose of 4000 mg/kg. For the subacute toxicity study, 18 rats were assigned into 3 groups (n = 6). Group A (control) received distilled water (5 ml/kg), while groups B and C were given 200 and 400 mg/kg of the extract, respectively. All the treatments were delivered orally for 28 days, after which blood samples were collected for hematology and serum biochemistry. Some vital organs were harvested for histological examination. The result of the acute toxicity recorded neither death nor morbidity even at the highest dose of the extract. For the subacute study, 400 mg/kg of the extract caused significant (p < 0.05) increase in total cholesterol and low density lipoprotein cholesterol (LDL-C); and significant (p < 0.05) decrease in high density lipoprotein cholesterol (HDL-C) in the treated rats when compared with the control. The histology slides showed only a mild fatty infiltration of hepatocytes in the group treated with 400 mg/kg of the extract. The results indicate a high safety index of the Combretum dolichopetalum leaf, however prolonged administration of high doses may cause hyperlipidemia.

Modified Radiological Union Score of Tibia (RUST) Scores in Diaphyseal Fractures Treated by the Ilizarov Frame: A Retrospective Analysis Evaluating Reliability.

Introduction The number of cases of tibia diaphyseal fractures treated by Ilizarov fixation is increasing. Fractures with infective etiology and altered bone biology due to the requirement of revision surgery or open wounds, which are often treated by the Ilizarov method, have challenges in ascertaining radiological signs of union. In this study, we aim to demonstrate the application of the modified Radiological Union Score of Tibia (m-RUST) scores in the assessment of fracture union in patients operated by the Ilizarov method. The secondary aim is to assess the interobserver and intraobserver variability of the m-RUST score validated by orthopaedicians and radiologists. Methodology A total of 119 patients who were treated with an Ilizarov fixator from February 2017 to December 2023 were included in the study. Four observers (two orthopaedicians and two radiologists) independently applied the m-RUST score for the included patients. Clinical data were not disclosed to the observers who worked independently of each other. Intraclass correlation coefficients (ICC) with 95% confidence intervals (CI) were used to measure the reliability of the m-RUST score. Interobserver reliability was measured by examining the scores of four observers from the second assessment, and intra-observer variability was assessed by a repeat evaluation after two weeks following the first assessment. Results The m-RUST score of the 119 X-rays analysed ranged from 8 to 16. The mean score in the first assessment was 11.36±3.51, and in the second assessment was 11.42±3.39. The reliability between all the observers was "substantial agreement" (ICC: 0.74, 95% CI). The ICC among the orthopaedicians was 0.77 and that among the radiologists was 0.72. Conclusion The m-RUST score has potential in other long bone fractures such as femur or humerus. Assessment of the m-RUST score in the healing of infective sequel and bone grafting conditions has been found effective. The m-RUST score is a dependable score in evaluating union in tibia fractures treated by the Ilizarov frame.

A MULTIDISCIPLINARY APPROACH TO PERFORMING ENDOVASCULAR OPERATIONS AND ECONOMICAL FOOT AMPUTAIONS AGAINST THE BACKGROUND OF CHRONIC THREATENING ISCHEMIA OF THE LOWER EXTREMITIES (CLTI)

The aim of the work: to determine the effectiveness of a multidisciplinary approach to the treatment of chronic threatening ischemia of the lower extremities associated with necrotic changes in the area of the foot. Мaterials and Methods. The results of the use of endovascular operations in 39 patients with CLTI IV class were analyzed according to the Fontaine classification (category 6 according to the Rutherford classification), with open wounds after amputation of a part of the foot due to dry gangrene and PRP and PRF therapy using the PRGF®-ENDORET® technology, according to the examination and conclusions of the multidisciplinary team. The control group consisted of 41 patients with a similar pathology and stage of the necrotic process, in the treatment of which no relevant specialists were involved, and the treatment of open wounds after amputation of a part of the foot due to dry gangrene was carried out according to traditional methods. The average age of the patients was 56.7±9.3 years, all men. A multidisciplinary team consisting of vascular surgeons, ultrasound specialists and angioradiologists, an interventional physician, an orthopedic surgeon, and functional diagnosticians was created for the specific treatment tactics of the above-mentioned patients. In order to determine the indications for performing small amputations on the foot, we performed a comprehensive assessment of the limb's blood supply after endovascular operations and the use of platelet-rich plasma. Results and Discussion.The use of endovascular operations in combination with PRP and PRF has a positive effect on the blood supply in the ischemic limb. This is evidenced by: improvement of indicators of microcirculation, speed of blood flow, increase of local skin temperature on the foot, indicators of the Ankle Brachial Index. As our studies have shown, the activity of the tyrosine kinase system, as well as the peculiarities of the cytokine relationship, which is a reflection of the processes of alteration and proliferation in the wound, can be an objective criterion for skin autotransplantation on the wound surface. After consultation with an orthopedist, we performed amputation of the foot: according to Garangeau – in 10 patients, according to Chopar – in 51 cases, according to Lisfranc or Lisfranc-Haye in 19 patients. Due to the lack of skin flaps, the wounds were treated by an open method followed by autodermoplasty, except for 39 patients (after endovascular surgery and PRP therapy), who were stimulated on the 5-6th day after foot amputation with the help of a plasma membrane (PRGF supernatant) ®-Endoret®), enriched with a growth factor, which covered the entire area of the wound surface.

Assessment of Vacuum-Assisted Closure (VAC) Therapy in Orthopaedic Infections.

Introduction Chronic and infected orthopaedic wounds may result in profound morbidity, amputation, sepsis andeven death. It may need prolonged hospitalization and multiple surgical procedures for treatment. Vacuum-assisted dressing (VAD) is a comparatively newer modality for treating chronic non-healing wounds which helps in faster wound healing, decreases the frequency of dressing and reduces hospitalization time. The aim of our study is to evaluate the outcome of vacuum-assisted dressing (VAD) in the management of orthopaedic wounds. Materials and methods A case series including 20 patients with post-traumatic open fracture wounds, post-operative infected wounds and wounds with underlying chronic osteomyelitis were treated with VAD. Wound size was measured pre- and post-debridement and every five days, at the time of dressing change until the wound healed or grafted. The duration of wound healing or wound closure was measured and documented. Results Wound size decreased significantly and healthy granulation tissues were observed in all wounds after the application of vacuum-assisted dressing. Wound size decreased by an average of 22% after debridement and first vacuum-assisted dressing removal. Infection control was achieved in 18 out of 20 patients (90%) who had wounds closed either by secondary closure or by skin grafting. Conclusion We conclude that VAD is an efficient technique in the management of orthopaedic wounds, especially in the management of open fracture wounds but less effective in chronically infected wounds with underlying osteomyelitis.

Natural biopolymer-based hydrogels: an advanced material for diabetic wound healing.

A diabetic foot ulcer (DFU) is an open sore or wound that typically develops on the bottom of the foot. Almost 15% of people with diabetes are suffering from delayed wound healing worldwide. The main vehicle for the development of ulcers in the diabetic population is poor circulation and peripheral neuropathy. Chronic injuries from diabetes frequently lead to traumatic lower leg amputations. Hydrogels are three-dimensional gels that can be fabricated from natural polymers and synthetic polymers. Biopolymers are flexible, elastic, or fibrous materials that come from a natural source, such as plants, animals, bacteria, or other living things. Some of the naturally occurring polymers that are frequently employed in wound dressing applications include polysaccharides and proteins. These polymers can be employed for many therapeutic applications because of their inherent biocompatibility, low immunogenicity, non-toxicity, and biodegradability. They represent a tuneable platform for enhancing skin healing. Therefore, this review paper interprets how natural biopolymers and their various hydrogel forms can be potentially used for diabetic wound healing.

Antiinflammatory and antibacterial polytetrahydropyrimidine loaded on degradable thermosensitive hydrogels for treatment of open wounds

Open wound is one of the concerns of modern medicine. The early wound has not been closed, there will be easy to enter the bacteria leading to bacterial infection. When the wound deteriorates further, the inflammation at the wound will continue to strengthen, and eventually become a chronic wound or non-healing wound. Therefore, an antibacterial anti-inflammatory tissue recovery environment will greatly promote the wound healing process. In this work, we prepared a hyaluronic acid/gelatin hydrogel that provides a comfortable recovery environment for wound healing. We also synthesized an anti-bacterial and anti-inflammatory polytetrahydropyrimidine (PTHP) polymer and loaded it into the hydrogel. The PTHP can be released in the hydrogel at a human body temperature of 37 °C, thereby achieving bactericidal and anti-inflammatory effects on the wound. Moreover, the hyaluronic acid/gelatin hydrogel can be degraded automatically at 37 °C. Therefore, PTHP-loaded hyaluronic acid/gelatin hydrogel system is an open wound care material with antibacterial, anti-inflammatory and microenvironment-responsive tissue recovery environment. It is an ideal candidate for the treatment of open wounds.

Operational wind forecast over the offshore Campos basin and adjacent coastal region in Brazil: support for the oil and gas industry toward renewable energy transition

Operational wind forecast over the offshore Campos basin and adjacent coastal region in Brazil: support for the oil and gas industry toward renewable energy transition

A comprehensive approach to wind turbine power curve modeling: Addressing outliers and enhancing accuracy

This research presents a comprehensive approach to improving the accuracy of wind turbine power curve (WTPC) modeling. The WTPC is a critical tool for monitoring wind turbine performance and estimating wind power potential, but current models have limited ability to capture the complex relationship between wind speed and power output. To address these limitations, this study implements a dual-pronged refinement of WTPC modeling. First, an innovative data preprocessing technique is introduced, using a 97 % confidence interval around a KNN-estimated WTPC constructed using the Laplace distribution to meticulously eliminate prominent outliers. Second, a novel WTPC modeling approach based on quantile regression is adopted, accounting for the asymmetric error characteristics in the loss function. Four distinct quantile regression models are developed, including three tree-based algorithms - decision trees, random forests, and gradient boosting - and a deep learning-based quantile regression neural network. Comparative analysis against ten established parametric and nonparametric techniques confirms the superiority of the proposed models, with the decision tree quantile regression model achieving the lowest validation errors. The proposed techniques are validated on two real-world datasets from operational wind turbines in Turkey and China, demonstrating significant improvements in WTPC modeling accuracy compared to conventional methods. Overall, this study successfully presents a comprehensive modeling approach that addresses outliers and leverages quantile regression to significantly enhance WTPC accuracy.

A multifunctional thermosensitive hydrogel based on phototherapy for promoting the healing of dental extraction wounds.

Post-extraction wound infections are a common complication of dental extractions. More specifically, infection in the alveolar socket after tooth extraction accelerates the resorption and destruction of the alveolar bone, and ultimately affects the final restoration results. Currently, the main clinical treatment approaches applied to the socket after tooth extraction include mechanical wound debridement, chemical rinses (e.g., chlorhexidine), filling of the extraction socket with absorbent gelatin sponges, and the systemic application of antibiotics. However, these traditional treatment modalities have some limitations and their therapeutic effects are unsatisfactory. In this study, a phototherapeutic temperature-sensitive hydrogel material was constructed for injection using a tea polyphenol (TP)-modified poly-N-isopropylacrylamide (PNIPAM) hydrogel skeleton loaded with the photosensitiser indocyanine green (ICG). The resulting PNIPAM-TP/ICG system exhibited an excellent injectability and temperature-sensitive properties. In addition, it stopped haemorrhaging and acted as a wound astringent. The hydrogel steadily released ICG into the oral environment to exert photothermal/photodynamic effects along with synergistic antibacterial and anti-inflammatory properties when combined with tea polyphenols. In vivo experiments demonstrated that the application of PNIPAM-TP/ICG to infected dental extraction wounds in rats rapidly stopped the bleeding and accelerated wound healing. Overall, this study describes a drug-loaded, temperature-sensitive hydrogel for the treatment of open wound infections, and shows promise as a reference for the treatment of tooth extraction wounds.

Peceleganan Spray for the Treatment of Skin Wound Infections

Peceleganan spray is a novel topical antimicrobial agent targeted for the treatment of skin wound infections. However, its efficacy and safety remain unclear. To assess the safety and efficacy of peceleganan spray for the treatment of wound infections. This multicenter, open-label, phase 3 randomized clinical trial recruited and followed up 570 adult patients diagnosed with secondary open wound infections from 37 hospitals in China from August 23, 2021, to July 16, 2022. Patients were randomized to 2 groups with a 2:1 allocation. One group received treatment with 2% peceleganan spray (n = 381) and the other with 1% silver sulfadiazine (SSD) cream (n = 189). The primary efficacy outcome was the clinical efficacy rate (the number of patients fulfilling the criteria for efficacy of the number of patients receiving the treatment) on the first day following the end of treatment (day 8). The secondary outcomes included the clinical efficacy rate on day 5 and the bacterial clearance rate (cases achieving negative bacteria cultures after treatment of all cases with positive bacteria cultures before treatment) on days 5 and 8. The safety outcomes included patients' vital signs, physical examination results, electrocardiographic findings, blood test results, and adverse reactions. Among the 570 patients randomized to 1 of the 2 groups, 375 (98.4%) in the 2% peceleganan treatment group and 183 (96.8%) in the 1% SSD control group completed the trial (n = 558). Of these, 361 (64.7%) were men, and the mean (SD) age was 48.6 (15.3) years. The demographic characteristics were similar between groups. On day 8, clinical efficacy was achieved by 339 patients (90.4%) in the treatment group and 144 (78.7%) in the control group (P < .001). On day 5, clinical efficacy was achieved by 222 patients (59.2%) in the treatment group and 90 (49.2%) in the control group (P = .03). On day 8, bacterial clearance was achieved by 80 of 334 patients (24.0%) in the treatment group and in 75 of 163 (46.0%) in the control group (P < .001). On day 5, bacterial clearance was achieved by 55 of 334 patients (16.5%) in the treatment group and 50 of 163 (30.7%) in the control group (P < .001). The adverse events related to the application of peceleganan spray and SSD cream were similar. This randomized clinical trial found that peceleganan spray is a safe topical antimicrobial agent with a satisfactory clinical efficacy rate for the treatment of skin wound infections, while the effectiveness of bacterial clearance remains uncertain. Chinese Clinical Trial Registry Identifier: ChiCTR2100047202.

Association of Timing With Postoperative Complications in the Management of Open Distal Radius Fractures

Background: This study investigates whether open distal radius fractures (ODRFs) treated after 24 hours from time of injury have an increased risk of infection or overall complication profile compared with those treated within 24 hours. Methods: Retrospective review was performed of all patients treated for ODRF over a 6-year period at a single large academic institution. Postoperative complications included surgical site infections, need for revision irrigation and debridement, delayed soft tissue healing, loss of reduction, nonunion, and malunion. Results: One-hundred twenty patients were treated for ODRF. Mean (SD) age at time of injury was 59.92 (17.68) years. Twenty patients (16.7%) had postoperative complications. Regarding mechanism of injury, 78 (65.0%) had a low-energy and 42 (35.0%) had a high-energy injury. Age and fracture grade were not significant factors. Mean (SD) open wound size was 1.18 (1.57) cm. Mean (SD) time from injury presentation to the emergency department (ED) and first dose of intravenous antibiotics was 3.07 (4.05) hours and mean (SD) time from presentation to the ED and operative treatment was 11.90 (6.59) hours, which did not show a significant association with postoperative complications. Twenty-four patients (20.0%) were treated greater than 24 hours after presentation to the ED, which was not significantly distinct from those treated within 24 hours. Conclusion: Patients with ODRFs treated after 24 hours were not associated with a greater risk of postoperative complications. Factors including age, energy and mechanism of injury, and fracture grade did not alter outcome in any statistically significant manner. Level of Evidence: Level IV

The Wound Environment Agent-based Model (WEABM): a digital twin platform for characterization and complex therapeutic discovery for volumetric muscle loss.

Volumetric Muscle Loss (VML) injuries are characterized by significant loss of muscle mass, usually due to trauma or surgical resection, often with a residual open wound in clinical settings and subsequent loss of limb function due to the replacement of the lost muscle mass with non-functional scar. Being able to regrow functional muscle in VML injuries is a complex control problem that needs to override robust, evolutionarily conserved healing processes aimed at rapidly closing the defect in lieu of restoration of function. We propose that discovering and implementing this complex control can be accomplished by the development of a Medical Digital Twin of VML. Digital Twins (DTs) are the subject of a recent report from the National Academies of Science, Engineering and Medicine (NASEM), which provides guidance as to the definition, capabilities and research challenges associated with the development and implementation of DTs. Specifically, DTs are defined as dynamic computational models that can be personalized to an individual real world "twin" and are connected to that twin via an ongoing data link. DTs can be used to provide control on the real-world twin that is, by the ongoing data connection, adaptive. We have developed an anatomic scale cell-level agent-based model of VML termed the Wound Environment Agent Based Model (WEABM) that can serve as the computational specification for a DT of VML. Simulations of the WEABM provided fundamental insights into the biology of VML, and we used the WEABM in our previously developed pipeline for simulation-based Deep Reinforcement Learning (DRL) to train an artificial intelligence (AI) to implement a robust generalizable control policy aimed at increasing the healing of VML with functional muscle. The insights into VML obtained include: 1) a competition between fibrosis and myogenesis due to spatial constraints on available edges of intact myofibrils to initiate the myoblast differentiation process, 2) the need to biologically "close" the wound from atmospheric/environmental exposure, which represents an ongoing inflammatory stimulus that promotes fibrosis and 3) that selective, multimodal and adaptive local mediator-level control can shift the trajectory of healing away from a highly evolutionarily beneficial imperative to close the wound via fibrosis. Control discovery with the WEABM identified the following design principles: 1) multimodal adaptive tissue-level mediator control to mitigate pro-inflammation as well as the pro-fibrotic aspects of compensatory anti-inflammation, 2) tissue-level mediator manipulation to promote myogenesis, 3) the use of an engineered extracellular matrix (ECM) to functionally close the wound and 4) the administration of an anti-fibrotic agent focused on the collagen-producing function of fibroblasts and myofibroblasts. The WEABM-trained DRL AI integrates these control modalities and provides design specifications for a potential device that can implement the required wound sensing and intervention delivery capabilities needed. The proposed cyber-physical system integrates the control AI with a physical sense-and-actuate device that meets the tenets of DTs put forth in the NASEM report and can serve as an example schema for the future development of Medical DTs.

Motion-Accommodating Dual-Layer Hydrogel Dressing to Deliver Adipose-Derived Stem Cells to Wounds.

Current dressing materials cannot secure a cell survival-promoting wound environment for stem cell delivery due to insufficient assimilation to skin motion. The authors developed a novel motion-accommodating dual-layer hydrogel dressing for stem cell delivery into such wounds. Dorsal hand skin movement was evaluated to determine the potential range of deformation for a dressing. The outer hydrogel (OH) was fabricated with an alginate-acrylamide double-network hydrogel with a covalently cross-linked elastomer coat. The tough adhesive consisted of a chitosan-based bridging polymer and coupling reagents. OH material properties and adhesiveness on porcine skin were measured. An oxidized alginate-based inner hydrogel (IH) containing human adipose-derived stem cells (ASCs) was evaluated for cell-supporting and cell-releasing properties. The OH's function as a secondary dressing, and dual-layer hydrogel cell delivery potential in wounds were assessed in a rodent model. The dual-layer hydrogel consisted of OH and IH. The OH target range of deformation was up to 25% strain. The OH adhered to porcine skin, and showed significantly higher adhesion energy than common secondary dressings and endured 900 flexion-extension cycles without detachment. OH showed a similar moisture vapor transmission rate as moisture-retentive dressings. IH maintained embedded cell survival for three days with significant cell release on the contacting surface. OH showed less fibrotic wound healing than other secondary dressings in vivo. The dual-layer hydrogel successfully delivered ASCs into open wounds of nude mice (13 ± 3 cells/HPF). The novel dual-layer hydrogel can accommodate patient movement and deliver ASCs into the wound bed by securing the wound microenvironment.

Vacuum assisted closure therapy in children with complicated abdominal wounds, with or without viscero-cutaneous fistulae

BackgroundManagement of complicated abdominal wounds is challenging in children. Vacuum-assisted closure proved to be beneficial. We aimed to report the outcome of VAC over 5 years’ practice in complicated abdominal wounds with or without viscero-cutaneous fistulae. MethodsRetrospective review of children managed by VAC over 5 years, from January 2017 to December 2022. Included patients had complicated abdominal wounds. Customized VAC devices with continuous negative pressure were used for all patients. The applied pressure was tailored according to the patient's age and the wound condition. ResultsNineteen patients were included, their ages ranged from 3 months to 15 years. Peritonitis was the main pathology in 12 patients, abdominal wall infection in 4, and a combination of both in 3. VAC was applied over closed wounds in 10 patients and over open wounds in 9; 6 of them had cutaneous fistulae. The median duration of VAC application over closed wounds was 7.5 days, while it was 10 days in open wounds. VAC promoted healing in closed and narrow-gapped wounds, while it was successfully used as a bridging therapy in 4 patients with wide-gapped wounds. Patients with viscero-cutaneous fistulae were successfully managed without further surgical intervention. VAC was complicated by fascial dehiscence with evisceration and incisional hernia in two patients. ConclusionVAC could be beneficial to complicated abdominal wounds in pediatric age. It was helpful in managing small viscero-cutaneous fistulae.

Effective strategies to enhance awareness and proficiency in open wound emergency management for students

Accidents can happen at home, school, day care center, or on the street at any time of the day. Children are prone to accidents or injuries because of their curiosity and vulnerability to accidents, especially at school. Accidents can include falls, choking on food, swallowing objects, electric shock, exposure to hot water, and drowning. The empowerment was carried out to increase the knowledge and skills of students in schools in providing first aid measures for open wounds. The activity was carried out at the Kota Kinabalu Indonesian School (SIKK) with 239 participants. The results of the activity showed an increase in knowledge and skills after being given education. Good knowledge and skills will improve health services and minimize the risk of injury. Similar activities can be carried out again with health topics and more diverse participants.