Healing Rate Research Articles

Efficacy and safety of tegoprazan for duodenal ulcers in Chinese patients: a multicenter, randomized, double-blind, non-inferiority, phase III study

Objective Tegoprazan represents a newly developed potassium-competitive acid blocker utilized for the treatment of acid-related disorders. The present study aimed to explore the therapeutic effectiveness of tegoprazan in Chinese individuals with duodenal ulcers (DU). Methods In the current multicenter, randomized, double-blind, double-dummy, parallel-group, non-inferiority, phase III clinical trial, individuals with DU underwent randomization 1:1 to be administered tegoprazan 50 mg or lansoprazole 30 mg once daily. The primary efficacy endpoint was the 6-week cumulative endoscopic ulcer healing rate. Secondary endpoints included 4-week endoscopic ulcer healing rate and relief of DU-related gastrointestinal symptoms at weeks 2, 4, and 6. Safety analysis encompassed adverse events (AEs) and laboratory indexes. Results The 6-week cumulative endoscopic ulcer healing rates were 96.9% (188/194) and 99.0% (189/191) in the tegoprazan and lansoprazole groups, respectively, indicating a difference of -2.0% (95% confidence interval (CI), -4.9 to 0.8) in the full analysis set (FAS). The corresponding healing rates were 98.4% (185/188) and 99.5% (183/184) in the per-protocol set, respectively, indicating a difference of -1.1% (95% CI -3.1 to 1.0). The 4-week healing rates in the tegoprazan and lansoprazole groups were 89.2% (173/194) and 88.5% (169/191) in the FAS, respectively, with a difference of 0.7% (95% CI -5.6 to 7.0). Treatment-related AEs, all mild to moderate, were reported in 38.2% (78/204) and 48.2% (94/195) of participants in the tegoprazan and lansoprazole groups, respectively. Conclusions Tegoprazan 50 mg once daily is effective and non-inferior to lansoprazole 30 mg once daily in Chinese patients with DU, showing a promising safety and tolerability profile. ClinicalTrials.gov registration number NCT05010954.

TOpClass Class 4 Perineal Crohn's Disease: A Systematic Review and Meta-analysis of Perineal Wound Complication After Proctectomy in Crohn's Patients.

Nonhealing perineal wounds have been reported to be common after proctectomy for Crohn's disease (CD). We performed a systematic review and meta-analysis of perineal wound healing after proctectomy for CD and assessed the risk factors for nonhealing. A comprehensive literature search was conducted in PubMed, Embase, and Scopus databases from 2010 to 2023, and articles reporting perineal wound healing rates after proctectomy for CD were included. Data on study characteristics and proportion of healed wounds, and risk factors, were extracted. Random-effects meta-analysis was performed to estimate the pooled proportion and 95% CIs using the "meta" package in R. Heterogeneity was assessed using the I2 statistic. We identified 501 articles, of which 252 remained after de-duplication. After screening, 4 retrospective cohort studies involving 333 patients were included. Across the 4 studies, the pooled proportion of completely healed perineal wounds at 6 months was 65% (95% CI 52%-80%), and 70% (95% CI 60%-83%) at 12 months. Significant heterogeneity was found between studies (I2 = 86% at 6 months). Three studies examined risk factors for impaired healing after proctectomy. One study identified preoperative perineal sepsis as the only independent factor associated with impaired healing (P = .001) on multivariable analysis. In 1 study, male sex, shorter time from diversion to proctectomy, and higher preoperative C-reactive protein levels were all associated with delayed healing in univariate analysis. Another study found that close rectal dissection was associated with significantly lower healing rates than total mesorectal excision (P = .01). Prior use of tumor necrosis factor inhibitors was not associated with wound healing outcomes. This meta-analysis revealed complete perineal healing in only 70% of patients 12 months after proctectomy for CD. This highlights knowledge gaps, including the identification of modifiable risk factors and methods for preventing or as rescue therapy, such as vacuum-assisted closure and flap reconstruction, for nonhealing perineal wounds after proctectomy for CD. Poor perineal wound healing outcomes are likely related to imperfectly understood underlying inflammatory dysregulation and systemically impaired wound healing in patients with CD.

Deprivation of loading during rat Achilles tendon healing affects extracellular matrix composition and structure, and reduces cell density and alignment.

Tendon healing involves mechanosensitive cells that adapt to mechanical stimuli through mechanotransduction, resulting in increased tissue strength. However, detailed insights into this process in response to different loads remain limited. We aimed to investigate how different loading regimes impact the spatial composition of elastin and collagens during Achilles tendon healing. Histological analysis was conducted on healing rat Achilles tendons exposed to (1) full loading, (2) reduced loading, or (3) minimal loading. Histological analysis included Hematoxylin & Eosin and immunohistochemical staining targeting elastin, Collagen1, Collagen3, and CD31. Our results showed that the impact of mechanical stimuli on healing tendons varied with the degree of loading. Unexpectedly, minimal loading led to higher staining intensity for collagens and elastin. However, tendons exposed to minimal loading appeared thinner and exhibited a less organized matrix structure, with fewer, less aligned, and more rounded cells. Additionally, our findings indicated an inverse correlation between angiogenesis and load level, with more blood vessels in tendons subjected to less loading. Tissue integrity improved by 12 weeks post-injury, but the healing process continued and did not regain the structure seen in intact tendons even after 20 weeks. This study reveals a load-dependent effect on matrix alignment, cell density, and cell alignment.

Percutaneous Deep Venous Arterialization by Balloon Angioplasty without Stent Implantation for Patients with Chronic Limb-Threatening Ischemia Undergoing Hemodialysis: A Retrospective Cohort, Single-Center, Single-Arm Study.

This retrospective, single-center study aimed to determine the efficacy of percutaneous deep venous arterialization in patients on hemodialysis with chronic limb-threatening ischemia. Twenty-one consecutive limbs on hemodialysis with chronic limb-threatening ischemia were treated with percutaneous deep venous arterialization using balloon angioplasty following a failed pedal arterial reconstruction between May 2021 and June 2022. An arteriovenous fistula near the ankle joint was created to ensure sufficient venous flow reversal to the pedal veins. In case of occlusion of the tibial artery, a guidewire was advanced (subintimal) to the ankle joint vicinity was technically important. The primary outcome measures were the 6-month complete wound healing and freedom from major amputation rates; the secondary outcome measure was the 6-month amputation-free survival. Occlusion of all pedal arteries was observed in 17 limbs (81.0%). Arteriovenous fistulas were predominantly created at the distal portions of the posterior tibial artery and vein in 18 limbs (85.7%). No extravasation at the fistulas was observed. Re-intervention was required in 16 limbs (76.2%) due to tibial artery or deep vein occlusion. The 6-month complete wound healing rate was 42.9% (nine limbs), with a median healing time of 85 days (interquartile range: 58-151 days). The 6-month freedom from major amputation and amputation-free survival rates were 90.5% (19 limbs) and 61.9% (13 limbs), respectively. Balloon angioplasty without stent implantation for percutaneous deep venous arterialization is promising for improving the complete wound healing and amputation-free survival rates after pedal artery reconstruction failure. Level 3b, retrospective cohort study.

Detection of human papillomavirus in plantar warts and its impact on outcome.

Cutaneous warts are caused by human papillomavirus (HPV) infection. Distinguishing plantar warts from clavus and tylosis can be difficult. A less-invasive method of examining these lesions is necessary. Previously, we collected data on 90 patients with warts and related diseases to explore differentiation methods using HPV typing of tissue from the wart surface. In that study, 21 patients were diagnosed as cases with plantar warts, however, 10 of those 21 cases showed HPV-negative by polymerase chain reaction analysis, causing some ambiguity, thus their outcomes should be confirmed. To assess the role of HPV typing in clinical practice, we followed up these 21 cases (11 HPV-positive and 10 HPV-negative) and analyzed their outcomes. The HPV-positive group included HPV1a (one case), HPV27 (four cases), HPV57 (three cases), and HPV65 (three cases). The median age of the 21 patients was 43 years, that of the 11 HPV-positive cases was 37 years, and that of the 10 HPV-negative cases was 44 years. The sex ratios (male:female) of the HPV-positive and HPV-negative groups were 6:5 and 2:8, respectively. All 21 patients were treated with liquid nitrogen after surface keratin removal, concomitant with salicylic acid topical plaster or oral administration of Yokuinin. The longest follow-up period was 548 days. Kaplan-Meier analysis was performed to assess the healing rate according to HPV-positivity. The healing rate in HPV-positive cases was significantly higher than in HPV-negative cases (P = 0.001). Although the sample size was small, the results suggest HPV typing using non-invasive surface materials facilitates accurate diagnosis and prevents prolonged treatment of plantar warts.

Non-pharmacological interventions of intermittent fasting and pulsed radiofrequency energy (PRFE) combination therapy promote diabetic wound healing

ObjectiveThis study aims to conduct an unbiased assessment of the synergistic effects of non-pharmacological Interventions of intermittent fasting and pulsed radiofrequency energy (PRFE) combination therapy on the facilitation of diabetic wound healing, while also exploring the underlying mechanisms. The findings of this research will provide a theoretical framework and innovative strategy for unconventional therapeutic interventions aimed at enhancing the healing process of diabetes-related wounds.MethodsIn vivo experiments involved the induction of diabetic models in C57 mice through streptozotocin injection. To simulate a combined therapeutic approach, diabetic mice underwent fasting on days 2 and 6, accompanied by twice daily PRFE applications for 8 days. In vitro experiments were conducted using a serum-free culture medium to replicate fasting conditions. The investigation encompassed wound healing rate, proliferation, migration, angiogenesis, oxidative stress, fibrogenesis, and sensory nerve growth through histological analysis and functional assessments in vivo. Additionally, this study utilized quantitative reverse transcription polymerase chain reaction (qRT-PCR), western blotting (WB), and immunofluorescence staining techniques to elucidate the potential mechanisms underlying the effects of intermittent Fasting and PRFE combination therapy in diabetic wound healing, both in vitro and in vivo.ResultsThe intermittent fasting and PRFE combination therapy demonstrated superior efficacy in enhancing diabetic wound healing compared to either treatment alone. It harnessed the respective strengths of individual therapies, fostering migration, mitigating oxidative stress, and enhancing fibrogenesis. Furthermore, the combination therapy manifested a synergistic effect in promoting proliferation, tube formation, angiogenesis, and sensory nerve growth.ConclusionThis study demonstrates that intermittent fasting and PRFE combination therapy enhance diabetic wound healing, effectively leveraging the strengths of both therapies and even yielding synergistic benefits. Moreover, it indicates the potential engagement of the P75/HIF1A/VEGFA axis in mediating these effects.

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.

A Holistic Review of Therapeutic Potential of Palasha Kshara Sutra in Shalyaja nadivrana vis-a-vis Pilonidal Sinus

Pilonidal sinus (PNS) is characterized by the presence of a sinus tract in the sacrococcygeal region, typically containing hair and debris, which can lead to recurrent infections and abscess formation. Shalyaja Nadivrana is a type of Nadivrana explained in Sushrutha samhitha. Clinically it can be correlated with Pilonidal sinus. Conventional treatments include surgical excision, which may result in prolonged healing and high recurrence rates. Ayurveda offers Kshara Sutra chikitsa. This para surgical technique has shown promising treat conditions like fistula-in-ano and now holds potential in managing pilonidal sinus.Ksharasutra ligation is regarded as the best method in pilonidal sinus as it is safe, effective, economical and simple OPD procedure with recurrence rate of 5.88%. Kharasutra ligation its gradual and sustainable chemical action not only removes the deberis from the site of track but also helps in encouraging new healthy grannulation tissue formationThe present study aims to explore the effect of palasha kshara sutra in the management of shalyaj nadivrana.As Palasha having katu, tikta, Kashaya rasa, katu vipaka, ushna virya, is vatakaphahara, vranahara, krimihara and shothahara properties. Palasha kshara sutra has anti-inflammatory, anti-oxidant, anti-microbial, anti-fungal and analgesic properties.

Biological role of Semaphorin 6D in the proliferation, migration and invasion of gastric cancer

Background: To analyse how Semaphorin 6D (SEMA6D) expression and extracellular signal-regulated kinase (ERK), phosphatidylinositol 3-kinase/protein kinase B/mammalian target of rapamycin (PI3K/AKT/mTOR) signal pathways are activated and how they influence gastric cancer proliferation, migration, and invasion. Methodology: SEMA6D expression was knocked down in human gastric cancer cells using RNA interference technology. In vitro assays were used to analyse how SEMA6D knockdown affects clone formation, migration, and invasion. ERK and PI3K/ AKT/mTOR signaling pathway related proteins were detected by immunoblotting. Results: In the si-NC group, Sema6D protein levels were higher than those in the si-1 and si-2 groups after knockdown of Sema6D, while in the si-1 group, Sema6D protein levels were higher than those in the si-2 group (P<0.05). P-PI3K, ERK/p-ERK, AKT/p-AKT, and mTOR/p-mTOR levels in the si-NC group were significantly higher than those in the si-1 and si-2 groups after knockdown of Sema6D (P < 0.05). It was found that scratch healing rate of SGC-7901 cells in si-NC group was higher than that in si-1 and si-2 groups, and the difference was statistically significant (P < 0.05). Conclusion: SEMA6D expression level can affect the biological behavior of gastric cancer cells. Keywords: Gastric cancer; extracellular signal-regulated kinase; semaphorin 6D; ERK and PI3K/AKT/mTOR; cell proliferation.

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.

Deferoxamine Accelerates Mandibular Condylar Neck Fracture Early Bone Healing by Promoting Type H VesselProliferation.

Condylar fractures (CFs) are a common type of maxillofacial trauma, especially in adolescents. Conservative treatment of CF avoids the possible complications of surgical intervention, but prolongs the patient's suffering because of the requirement for extended intermaxillary fixation. Therefore, the development of a new strategy to accelerate the rate of fracture healing to shorten the period of conservative treatment is of great clinical importance. To investigate the potential of deferoxamine (DFO) in promoting the healing process of CF in adolescent mice. Thirty-two 4-week-old male C57BL/6J mice were randomly assigned to four groups: vehicle + sham group, vehicle + CF group, DFO + sham group and DFO + CF group. After constructing the mandibular CF model, mandibular tissue samples were collected respectively at 1, 2 and 4 weeks postoperatively. Radiographic and histomorphometric analyses were employed to assess bone tissue healing and vascular formation. Deferoxamine was observed to promote the early bone healing of fracture, both radiologically and histomorphometrically. Furthermore, this enhancement of condylar neck fracture healing was attributed to the upregulation of the hypoxia-inducible factor-1α (HIF-1α) signalling pathway while facilitating the formation of type H vessels. In addition, DFO did not produce significant effects on the condylar neck between vehicle + sham and DFO + sham group. The application of the HIF-1α inducer DFO can enhance type H vessels expansion thereby accelerating condylar neck fracture healing.

A novel approach for the treatment of diabetic foot ulcers using a multimodal wound matrix: a clinical study.

Innovation in wound healing, particularly regarding diabetic foot ulcers (DFUs), is needed to reverse the number of diabetes-related amputations. This study evaluated a novel approach and performance of a multimodal wound matrix in converting stalled DFUs into a healing trajectory. Patients with either type 1 or 2 diabetes and with foot ulcers (Wagner grade 1 and 2), were screened to determine eligibility for treatment. Ulcers improving >30% in area during a two-week screening phase were not eligible for the study treatment phase. The study was an open-label trial conducted in three phases: screening, treatment and healing confirmation. Patients enrolled in the study received a treatment protocol that included application of a wound matrix to the ulcer and offloading. A total of 19 patients (15 males, four females) with a median age of 60 years, and a median ulcer duration of 36 weeks took part in the study. Patients showed an average four-week percentage area reduction (PAR) of 62%, a 12-week PAR of 94%, and a 12-week healing rate of 57% (8/14). Results of this study support the viability and potential of a novel approach to treating DFUs that includes use of a multimodal wound matrix.

Efficacy and Safety of Potassium-competitive Acid Blockers Versus Proton Pump Inhibitors in Treating Erosive Esophagitis: A Meta-analysis Based on Randomized Controlled Trials.

This meta-analysis aimed to investigate the efficacy and safety of potassium-competitive acid blockers (P-CABs) and proton pump inhibitors (PPIs) in treating erosive esophagitis (EE). PubMed, Embase, Cochrane Library, and Web of Science were systematically searched using predefined search terms up to January 2024. Relevant randomized controlled trials were included. The outcoming were the EE healing rate and treatment-related adverse events incidence. Nine randomized controlled trials involving 4012 patients were included. Patients receiving P-CAB exhibited a significantly better overall healing rate compared with PPI at week 2 [risk ratio (RR) = 1.06], but no statistical difference was observed at week 4 and week 8. Subgroup analysis revealed that P-CAB demonstrated a higher healing rate for patients with Los Angeles (LA) grade C/D, regardless of the assessment at week 2 (RR = 1.17), week 4 (RR = 1.10), or week 8 (RR = 1.08). However, no significant difference was found between PPI and P-CAB for patients with LA grade A/B at week 2, week 4, or week 8. Furthermore, patients treated with P-CAB had lower recurrence rates during maintenance therapy compared with PPI (RR = 0.79). In terms of safety, P-CAB was associated with a lower incidence of headache compared with PPI (RR = 0.32), with no statistical difference found in any treatment-related adverse events between the two groups. P-CAB was found to be safe and effective for EE treatment compared with PPI, particularly in 2-week short-term treatment, severe EE (LA grade C/D) treatment, or maintenance therapy. Limitations such as potential heterogeneity among included trials should be considered in the interpretation of these findings.

Arthroscopic Chondral Nail Fixation for Treating Acetabular Cartilage Delamination Results in Improved Pain Relief at Minimum 2-year Follow-up in Patients with Femoroacetabular Impingement Syndrome: A Propensity-Matched Study

PurposeTo investigate the clinical outcomes following arthroscopic chondral nail fixation for acetabular cartilage delamination (ACD) in patients with femoroacetabular impingement syndrome (FAIS), and the presentation of ACD on MRI at follow-up. MethodsA retrospective review was performed between March 2021 and March 2022 at our institute. Patients undergoing primary hip arthroscopy for FAIS and diagnosed with ACD intraoperatively were included. Exclusion criteria were incomplete data or loss of minimum 2-year follow-up, and concomitant hip conditions including hip osteoarthritis with a Tönnis grade > 1, avascular necrosis, Legg-Calvé-Perthes disease, osteoid osteoma, synovial chondromatosis, pigmented villonodular synovitis, and developmental dysplasia of the hip (DDH). Patients who underwent chondral nail fixation were matched 1:1 with a control cohort of patients who only underwent simple debridement. Preoperative and minimum 2-year postoperative patient-reported outcome (PRO) scores including Visual Analog pain Scale (VAS), modified Harris Hip Score (mHHS), and percentage of achieving minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) were collected and compared. MRI was performed preoperatively and at final follow-up to assess ACD. ResultsFifty-eight patients were included in the study (29 patients in each group). Both groups demonstrated improved VAS and mHHS following surgery (all with P < .05). The chondral nail group demonstrated better postoperative VAS (P = .022) compared to the control group, while the postoperative mHHS was comparable between the two groups (P = .852). No significant difference was found in the achievement of MCID between the two groups (all with P > .05). More patients in the chondral nail group achieved PASS of VAS compared to the control group (75.9% vs 48.3%, P = .030). No patient underwent revision surgery or conversion to total hip arthroplasty (THA). The chondral nail group demonstrated significantly higher rate of ACD healing on MRI compared to the control group (P < .001). ConclusionPatients undergoing arthroscopic chondral nail fixation for treating ACD demonstrated significant pain relief, more achievement of PASS of VAS, and higher rate of ACD healing on MRI compared to those undergoing simple debridement. Level of EvidenceLevel III; retrospective cohort study.

Nutmeg (Myristica fragrans) Extracts Accelerate Oral Mucosal Wound Healing In Vivo

Background: Oral mucosal pain and sores are common concerns in dental care, often resulting from surgeries, infections, trauma, or autoimmune disorders. Conventional treatments like NSAIDs offer relief but carry adverse side effects. Nutmeg (Myristica fragrans) has been traditionally used for its analgesic, anti-inflammatory, and antimicrobial properties. However, its potential in oral mucosal wound healing remains underexplored. Methods: This study utilized male Wistar rats (Rattus norvegicus) to assess the wound healing effects of nutmeg extracts and fractions. Nutmeg was extracted using maceration, and the fractions were obtained through liquid-liquid extraction. Rats were divided into control and treatment groups, and topical nutmeg treatments were applied daily to incised gingival mucosa. Wound closure time was monitored daily, and healing rates were analyzed. Results: The ethyl acetate fraction of nutmeg exhibited the fastest wound healing, achieving an average healing rate of 88.79%, closely matching the positive control (94.65%). Other fractions also demonstrated efficacy, with the aqueous fraction achieving 82.46% and the ethanol fraction 75.54%. The hexane fraction showed the slowest healing at 63.67%. Statistical analysis revealed significant differences between the groups (p &lt; 0.05). Conclusion: Nutmeg extracts, particularly the ethyl acetate fraction, significantly accelerated wound healing in the oral mucosa of Wistar rats, highlighting its potential as a natural wound-healing agent. Further research is needed to isolate the bioactive compounds responsible for these effects and to explore their clinical applications in dental care.

Underwater Non‐Contact and Ultra‐Fast Adaptive Self‐Healing Elastomers Based on Programmable Dissociation of Dynamic Bonds

AbstractMost of the reported self‐healing materials focus on the structure and function recovery, the influence of the damage degree on the self‐healing process has been rarely studied. In this study, an elastomer with an adaptive self‐healing function is developed based on programmable dissociation of dynamic urea bonds. The stored entropy and reversible hydrogen bonding enable the elastomer with room‐temperature self‐healing performance as the scratch depth is less than 100 µm. Thermal treatment at 75 °C is capable of inducing the cleavage of secondary urea bonds, which accelerate the dissociation of the network, leading to the repair of the middle‐size damage. Continuous increasing the temperature to 120 °C enables the dissociation of primary urea bonds, which causes further dissociation of the network, resulting in the repair of large‐scale damage. This damage‐adaptive self‐healing performance can be well maintained in an aqueous environment, and obvious improvement in the healing rate is achieved due to the water‐accelerated dissociation of urea bonds. The underwater self‐healing rate is more than 360 times faster than that in the air. Incorporation of carbon nanotubes into the network enables remote self‐healing function due to the photo‐thermal transition after irradiated by NIR light, displaying great potential in underwater gas or liquid transportation.

Cost-effectiveness analysis of the geko™ device (an NMES technology) in managing venous leg ulcers in UK healthcare settings.

This study evaluates the cost-effectiveness of the geko device a neuromuscular electro-stimulator technology with standard of care (SoC) versus SoC alone for venous leg ulcer (VLU) treatment, from the UK National Health Service (NHS) perspective over 12 months. Research was conducted across NHS UK facilities, primarily within community services and outpatient leg ulcer clinics, encompassing a total of 51 patients. A partitioned survival model, based on a two-arm randomised controlled trial, assessed wound healing rates using Kaplan-Meier curves and parametric extrapolations over a 12-month time horizon. Costs were derived from UK reference costs the British National Formulary, and the Personal Social Services Research Unit (2021/22). The primary outcome measured was the incremental cost per quality-adjusted life-year gained. The geko device provides additional benefits by stimulating the lateral popliteal nerve, augmenting venous, arterial, and microvascular flow. The addition of the geko device to SoC significantly enhanced outcomes, increasing healing probability by 68% compared to SoC. This integration would result in a cost saving of £774.14 per patient when compared to the SoC alone across the NHS. Economic analyses indicate that integrating the geko device into SoC protocols would reduce the overall NHS expenditure on VLU wound management by as much as 15%. The approach also positively impacted health-related quality of life. The geko™ device when used adjunctively with SoC would be a cost-effective method for managing chronic VLUs within the NHS, improving healing rates and offering economic benefits.

Total Ankle Arthroplasty Incision Management: What Matters? A Systematic Review

Modern advancements in total ankle arthroplasty techniques and implants have increased the popularity of this treatment for ankle osteoarthritis. The preeminent approach for ankle replacement involves an anterior incision, however, wound complications with this approach provide a persistent challenge to surgeons. The present study was conducted to synthesize current data on ankle replacement wound complications via an anterior approach. A systematic review was completed including studies published from 1993 to present that employed an anterior approach and had precise criteria for wound healing and revisions. Twenty-nine studies, with level 3 to 4 evidence and moderate to serious bias, were included for a total of 6,986 ankle arthroplasties. The rate of wound healing without any complication was 90.38%. Minor dehiscence occurred in 6.00% of cases, while major wounds or infections occurred in 3.62%. Across 2,966 implants, the rate of major wounds or infections decreased from 7.03% before 2013 to 4.75% after 2013 (p = 0.034). Limited comparisons involving simple suture closure to various adjunct wound management techniques including negative pressure wound therapy, 2-octyl cyanoacrylate, platelet-rich plasma, dehydrated human amniotic membrane allograft, non-invasive skin expansion strips, compression wound dressings, tranexamic acid, surgical helmets, tourniquets, ankle arthrodesis, and lateral approach ankle arthroplasty, yielded non-significant differences (p > 0.18). Therefore, contemporary techniques, patient selection, and current implants may be leading to better soft tissue healing. As ankle replacement continues to surge in popularity, further research is needed to evaluate causative factors in successful anterior incision healing. Level of Clinical Evidence3

Use of Plasma Rich in Growth Factors for Ocular Surface Disorders: A Systematic Review.

Ocular surface disorders (OSDs) can severely affect vision and quality of life. Autologous blood products, such as plasma rich in growth factors (PRGF), are recently available to treat OSDs refractory to traditional therapies. This review aims to summarize the efficacy and safety of PRGF in OSDs. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The protocol was established a priori and published on PROSPERO (CRD42024522119). MEDLINE, Embase, and Cochrane Library were searched for primary articles until February 6, 2024. Primary outcomes included slit-lamp examination findings and patient-reported outcomes. Secondary outcomes included visual outcomes and adverse events. Risk of bias was assessed using the Cochrane Risk of Bias and ROBINS-I tools. Twenty-two studies involving 1158 eyes were included. PRGF showed notable improvement in objective and subjective outcomes in OSDs. Comparative studies did not show PRGF to be superior to a standard steroid taper for dry eye disease. However, the use of PRGF was also reported in persistent epithelial defects and corneal ulcerations. In these conditions, there were high rates of complete healing and reduced corneal staining. PRGF has also been reported to improve ocular surface healing and stability when used as an adjunct to refractive and pterygium surgeries. No serious adverse events were reported. PRGF has potential as an effective treatment of OSDs resistant to traditional therapies with minimal safety concerns. Large randomized controlled trials are needed to better evaluate the role of PRGF within the treatment armamentarium for corneal pathologies.

Surgical Management of Pediatric Dog Bites: A Systematic Review and Treatment Guideline

IntroductionDog bites are a unique and unusual injury in children, associated with atypical bacterial species, high infection rates, and controversial surgical treatment. Expert recommendations currently guide management and no surgical evidence-based guidelines exist. We conducted a systematic review to answer three management questions: (1) What are the best practices for wound management? (2) In what circumstances should prophylactic antibiotics be administered? (3) In what circumstances should rabies prophylaxis be given? MethodsA structured review was performed using a keyword search querying “pediatric” “dog bite” “management”. Results were reported according to the PRISMA methodology. The quality of nonrandomized studies was evaluated according to Methodological Index for Non-Randomized Studies (MINORS). Qualitative analysis was performed. ResultsA total of 803 studies were identified and 53 studies were included in the final analysis. Current literature suggests that primary closure of bites which are well irrigated and sharply debrided within 8 h of injury, is not associated with increased infection. While dog bites are associated with an overall high rate of infection (6–25 %), routine antibiotic prophylaxis in low-risk wounds does not lower that risk. Postexposure prophylaxis for rabies is indicated for all dog bites where the rabies status of the dog cannot be determined, or the animal cannot be quarantined for 10 days. ConclusionHigh-quality evidence regarding the surgical management of pediatric dog bites is limited. Trial data have demonstrated improved outcomes in wound healing and infection rates with a focus on copious irrigation and diligent wound debridement, although independent validation is needed. Level of EvidenceLevel II – systematic review.