Superficial Wounds Research Articles

Detection of Traumatic Ankle Arthrotomies: Computed Tomography Scan Versus Saline Load Test.

Periarticular wounds present a common diagnostic dilemma for emergency providers and orthopedic surgeons because traumatic arthrotomies (TA) often necessitate different management from superficial soft tissue wounds. Historically, TA have been diagnosed with the saline load test (SLT). Computed tomography (CT) scan has been studied as an alternative to SLT in diagnosing TA in several joints, but there are limited data specifically pertaining to the ankle. This study aimed to compare the ability of a CT scan to identify an ankle TA versus a traditional SLT. The hypothesis was that there would be no significant difference between a CT scan and SLT in diagnosing ankle TA in a cadaveric model. This cadaveric study used 10 thawed fresh-frozen cadaveric ankles. A baseline CT scan was performed to ensure no intra-articular air existed before simulated TA. After the baseline CT, a 1 cm TA was created in the anterolateral arthroscopy portal site location. The ankles then underwent a postarthrotomy CT scan to evaluate for the presence of intra-articular air. After the CT scan, a 30 mL SLT was performed using the anteromedial portal site location. After arthrotomy, intra-articular air was visualized in 7 of 10 cadavers in the postarthrotomy CT scan. All the ankles had fluid extravasation during the SLT with <10 mL of saline. The sensitivity of the SLT for TA was 100% versus 70% for the CT scan. The SLT was more sensitive in diagnosing 1-cm ankle TA than a CT scan in a cadaveric model.

Medial Femoral Condyle Free Flap: A Systematic Review and Proportional Meta-analysis of Applications and Surgical Outcomes

Background: Recalcitrant bone nonunion and osseous defect treatment is challenging and often requires vascularized bone transfer. The medial femoral condyle flap has become an increasingly popular option for reconstruction. The study aims at reviewing its different applications and synthesizing its surgical outcomes. Method: A systematic review including all studies assessing surgical outcomes of free medial femoral condyle flap for bone reconstruction in adults was conducted on January 31, 2023. Flap failure and postoperative complications were synthesized with a proportional meta-analysis. Results: Forty articles describing bony reconstruction in the head and neck, upper limb, and lower limb areas were selected. Indications ranged from bony nonunion and bone defects to avascular bone necrosis. Multiple flaps were raised as either pure periosteal, cortico-periosteal, cortico-cancellous-periosteal, or cortico-chondro-periosteal. A minority of composite flaps were reported. Overall failure rate was 1% [95% confidence interval (CI), 0.00–0.08] in head &amp; neck applications, 4% in the lower limb (95% CI, 0.00–0.16), 2% in the upper limb (95% CI, 0.00–0.06), and 1% in articles analyzing various locations simultaneously (95% CI, 0.00–0.04). Overall donor site complication rate was 4% (95% CI, 0.01–0.06). Major reported complications were: femoral fractures (n = 3), superficial femoral artery injury (n = 1), medial collateral ligament injury (n = 1), and septic shock due to pace-maker colonization (n = 1). Conclusion: The medial femoral condyle flap is a versatile option for bone reconstruction with high success rates and low donor site morbidity.

A self-elastic chitosan sponge integrating active and passive hemostatic mechanisms for effectively managing uncontrolled coagulopathic hemorrhage

Developing a self-elastic sponge integrating active and passive hemostatic mechanisms for the effective management of uncontrolled coagulopathic hemorrhage remains a challenge. We here developed a chitosan-based sponge by integrating freeze-drying, chemical decoration of alkyl chains and phosphate groups, and physical loading of thrombin. The sponge exhibited high mechanical strength, self-elasticity, and rapid shape recovery. The sponge facilitated blood cell adhesion, aggregation, and activation through hydrophobic and electrostatic interactions, as well as accelerated blood clotting. The sponge exhibited higher efficacy than commercial gauze and gelatin sponge in managing uncontrolled hemorrhage from heparinized rat tail amputation, liver superficial injury, and liver perforating wound models. In addition, the sponge exhibited favorable biodegradability and biocompatibility. These findings revealed that the developed sponge holds great potential as a novel hemostat for effectively managing uncontrolled coagulopathic hemorrhage from superficial and perforating wounds.

Occupational accidents in Slovak Military Forests and Estates: incidence, timing, and trends over 10 years.

Forestry provides a wide range of employment opportunities worldwide and is seen as one of the high-risk industries in terms of occupational accidents. The submitted study analyzed the injury rate in the Military Forests and Estates of the Slovak Republic (62.6 thousand ha) between 2013 and 2022. The data analyses included regression and correlation analyses, χ2 tests to analyze the relationships between studied variables, and incidence rates. During the observed period, employees suffered 26 occupational accidents, of which 19.2% were light, 57.7% were registered, 23.1% were severe, and 0% were fatal. For every 1 million m3 of harvested timber, 7.7 accidents occurred. The incidence rate during the observed period was 672.1/100,000 employees. The highest proportion of accidents was in the age group 51-60 years and in employees with the lowest length of work experience <5 years. Regarding time, the highest proportion of occupational accidents occurred between 8:01 and 10:00 AM (53.8%) and day-wise on Thursdays (46.2%). The highest proportion of accidents occurred among forest workers (65.3%) during pruning and silviculture activities (42.3%). The most common injury site was forest stands (65.3%). Superficial injuries (34.6%) were the most common, mainly affecting the lower limbs (50%). The most frequent material agents causing the accidents were work and transport areas as sources of worker fall (38.5%), and the most frequent reason for an accident to occur was the lack of personal requirements for proper work performance (92.4%), whereas only (3.8%) of accidents occurred due to the use of forbidden or hazardous working procedures. The presented study identified the most vulnerable worker groups and provided an overview of the overall injury rate at the state forest company in Slovakia. The documentation can be incorporated into the safety strategies of forest enterprises.

A randomised investigation of film-forming silicone gel in superficial partial thickness face and neck burn patients: Indication of improved early scar pigmentation outcomes

IntroductionBurns to the face and neck are a source of considerable distress and a challenge to manage with dressings. Further, these often superficial injuries pose a risk of scarring and altered pigmentation. Silicone gels have emerged as a potential solution to the challenges of conservative management for face and neck burn injuries. The aims of this study were to explore the effect of topical silicone compared to routine treatment of conservatively managed burns to the face and neck. MethodsThis single-blind, randomised, controlled trial compared topical silicone film-forming dressing to standard of care for superficial partial thickness burns to the face and neck. Time to healing was the primary outcome and secondary outcomes included: 1) scar assessments (modified Vancouver Scar Scale, Dermalab Combo and Patient and Observer Scar Assessment Scale) at six weeks and three months; and 2) pain intensity scale at wound review appointments. ResultsOf the 55 participants in the face/neck study, 34 were male and 21 were female. Median age was 36 years (range from 25 to 47 years). The median time to healing for the silicone group was 9 days (CI 7.6 −10.4) and the control group was 7 days (CI 5.3- 8.7), p = 0.056. Analysis demonstrated significantly reduced pigmentation at six weeks in mVSS scores for the silicone group (Md = 0, IQR = 0) compared to the control group (Md = 0, IQR = 0 – 3), p = 0.043. We found no evidence of differences in reported pain between the groups (Silicone - Md = 1.15, IQR 0.3 – 4.5 vs control group - Md = 1.5, IQR 0.6 – 3.8, z = −0.63, p = 0.53). No other differences were observed, and no adverse events were associated with the topical silicone in the study whereas an infection and a reaction were experienced in the control group. ConclusionFilm-forming silicone gel had comparable effects to standard of care emollient on wound healing of superficial partial thickness burns of the face and neck. Silicone treated wounds were associated with a significant improvement in scar pigmentation outcome at six weeks post-burn.

Analysis of a Poloxamer Hydrogel Composed of Human Mesenchymal Stromal Cells for Reepithelization of Skin Injuries

The body's natural response to tissue damage is wound healing. Hydrogels have compelling benefits in the healing of wounds, not only because of their permeability, biodegradability, and biocompatibility, but also because they offer an optimal environment for cell migration and proliferation. The primary goal of this work was to create and characterize a hydrogel that contained human mesenchymal stromal cells (hMSCs) in order to facilitate the healing of superficial skin injuries. hMSCs were embedded using a biocompatible biomaterial called Poloxamer 407®. The hydrogel that was created, with 20 percent (w/w) of polymer, had the best formulation in terms of its mechanical, morphological, biological, and physical characteristics.. The hydrogel's remarkable swelling capacity spoke to its ability to absorb wound exudate. The LIVE/DEAD® assay verifies that when hMSCs were injected into the hydrogels, they stayed viable for at least 48 hours. The keratinocytes' ability to proliferate and mend was unaffected by the addition of progressively higher concentrations of hMSC-loaded hydrogel to the epithelium; the entire wound healed in less than a day. Our research provides new avenues for the application of poloxamer hydrogels as skin superficial wound carriers.

The effects of a synthetic epidermis spray on secondary intention wound healing in adult horses.

To evaluate secondary intention wound healing in the horse's limbs when treated with the synthetic epidermis spray (Novacika®, Cohesive S.A.S, France) or with a standard bandaging technique. Six Standardbred mares were included in the study. Four 2.5 x 2.5 cm full-thickness skin wounds were created on each thoracic limb. Two wounds were located on the dorsoproximal aspect of the cannon bone and the other two at the dorsoproximal aspect of the fetlock. Six hours after creation, wounds were randomly treated with synthetic epidermis spray or standard bandaging. The wounds were assessed every 4 days by gross visual assessment and using a 3D imaging camera. Analysis was performed with a 3D imaging application. Out of 46 wounds, 22 showed exuberant granulation tissue and were part of the standard bandaging group. Whether the wounds were treated with synthetic epidermis spray or standard bandaging, the time for healing was the same. The synthetic epidermis spray studied in this model has allowed healing without the production of exuberant granulation tissue but did not reduce the median wound healing time compared to a standard bandaging technique. The synthetic epidermis spray is potentially an interesting alternative for the management of secondary intention wound healing of superficial and non-infected distal limb wounds in adult horses on economical and practical aspects. However, all statistical inference (p-values especially) must be interpreted with caution, given the size of the sample.

Vaginal foreign bodies in pediatric population - presentation, diagnostic challenges, and role of vaginoscopy: A case series

Background: Vaginal foreign bodies (VFBs) in the pediatric population pose diagnostic and management challenges. This is due to the usual difficulty in obtaining an appropriate history, difficulty in conducting a vaginal examination, and the fallibility of conventional imaging modalities in picking most of the vaginal foreign bodies. In prepubertal who present with abnormal vaginal discharge or vaginal bleeding, the diagnosis of a vaginal foreign body should be considered, and appropriate care should be provided. Vaginoscopy is an excellent diagnostic and therapeutic modality for these cases. Case series: Between 2018 and 2023, 6 children aged between 3 and 6 years underwent vaginoscopy at our institution, having presented with diverse vaginal symptoms. The mean age was 4.5 years. Three presented with vaginal bleeding, two had recurrent vaginal discharge, and one had a history of trauma to the genitalia. There were no cases suspicious of sexual abuse. All except two had a normal external genital examination, with one having a small excoriation on the labia and the other having superficial perineal injuries due to trauma. All six cases had intact hymens. Vaginoscopy was performed using a 4-mm scope. Vaginal foreign bodies of varying size and consistency were retrieved from three patients. One patient had inflammatory changes on the proximal anterior vaginal wall. Two had normal findings. All 6 children tolerated the procedure well, with an excellent response to treatment. Conclusion: Correct diagnosis and management of pediatric vaginal foreign bodies is challenging compared with the adult population. A high index of suspicion is necessary for any young girl presenting with vaginal bleeding or abnormal vaginal discharge. Vaginoscopy is a safe and efficient diagnostic and therapeutic procedure for vaginal foreign bodies in the pediatric population.

Superficial Femoral Artery Pseudoaneurysm Post-Subtrochanteric Femur Fracture

Superficial femoral artery injury due to bone fragment of femoral fracture is often overlooked as it occurs only in rare cases of femoral fractures and the onset of symptoms usually happen weeks or even months later. The deep femoral artery, in fact, is more susceptible to injuries associated with femoral fractures. Moreover, a preexisting calcification lesion of the arterial wall might enhance the chance of such arterial injury, a condition that we noticed in the case we are reporting. We will illustrate a rare case of calcified superficial femoral artery injury complicating subtrochanteric femur fracture.

Factors influencing pain medication and opioid use in patients with musculoskeletal injuries: a retrospective insurance claims database study

Opioid use is only recommended in selected cases of musculoskeletal (MSK) injuries. We assessed factors associated with increased opioid use in MSK injuries. In a retrospective analysis of over four million workers with MSK injuries using the Swiss National Accident Insurance Fund (Suva) database, we analyzed risk factors by multivariate logistic regression. Injury severity was associated with pain medication, opioid, and strong opioid use. Whereas fractures, contusions, and ruptures had higher odds for any pain medication use, increased odds for strong opioids were observed in fractures, superficial injuries, and other injuries. Injuries of the shoulders, elbow, chest, back/spine, thorax, and pelvis/hips showed high odds for opioid use (odds ratio (OR) > 2.0). Injuries of the shoulders had higher odds for strong opioid use (OR 1.136; 95% CI 1.040–1.241). The odds for using strong opioids increased from 2008 OR 0.843 (95% confidence interval (CI) 0.798–0.891) to 2018 OR 1.503 (95% CI 1.431–1.578), compared to 2013. Injury severity, type of injury, and injured body parts influenced the use of pain medication and overall opioid use in musculoskeletal injuries. Strong opioids were more often used in fractures but also in superficial and other minor injuries, which indicates that other factors play a role when prescribing strong opioids.

Management of Frostbite Injury in Primary Care

Frostbite is cold-related tissue ischemia and damage that occurs after exposure to freezing temperatures. Appropriate classification of frostbite injury allows for timely diagnosis and early intervention, which can affect long-term sequelae, function, and overall well-being. Severe frostbite injury is irreversible and requires in-hospital interventions to maximize tissue salvage. Superficial frostbite injury is reversible and can be effectively managed in primary care settings. In collaboration with a multidisciplinary team, nurse practitioners can effectively manage frostbite-related complications with pharmacologic and adjunctive treatments.

Effects of endoluminal vacuum sponge therapy on the perfusion of gastric conduit in a porcine model for esophagectomy.

After esophagectomy, the postoperative rate of anastomotic leakage is up to 30% and is the main driver of postoperative morbidity. Contemporary management includes endoluminal vacuum sponge therapy (EndoVAC) with good success rates. Vacuum therapy improves tissue perfusion in superficial wounds, but this has not been shown for gastric conduits. This study aimed to assess gastric conduit perfusion with EndoVAC in a porcine model for esophagectomy. A porcine model (n = 18) was used with gastric conduit formation and induction of ischemia at the cranial end of the gastric conduit with measurement of tissue perfusion over time. In three experimental groups EndoVAC therapy was then used in the gastric conduit (- 40, - 125, and - 200 mmHg). Changes in tissue perfusion and tissue edema were assessed using hyperspectral imaging. The study was approved by local authorities (Project License G-333/19, G-67/22). Induction of ischemia led to significant reduction of tissue oxygenation from 65.1 ± 2.5% to 44.7 ± 5.5% (p < 0.01). After EndoVAC therapy with - 125 mmHg a significant increase in tissue oxygenation to 61.9 ± 5.5% was seen after 60 min and stayed stable after 120 min (62.9 ± 9.4%, p < 0.01 vs tissue ischemia). A similar improvement was seen with EndoVAC therapy at - 200 mmHg. A nonsignificant increase in oxygenation levels was also seen after therapy with - 40 mmHg, from 46.3 ± 3.4% to 52.5 ± 4.3% and 53.9 ± 8.1% after 60 and 120 min respectively (p > 0.05). An increase in tissue edema was observed after 60 and 120 min of EndoVAC therapy with - 200 mmHg but not with - 40 and - 125 mmHg. EndoVAC therapy with a pressure of - 125 mmHg significantly increased tissue perfusion of ischemic gastric conduit. With better understanding of underlying physiology the optimal use of EndoVAC therapy can be determined including a possible preemptive use for gastric conduits with impaired arterial perfusion or venous congestion.

Iatrogenic "overshoot" nerve injuries: imaging features.

Describe features of iatrogenic "overshoot" nerve injuries on ultrasound and MRI, which occur when an instrument passes through the bone and injures the nerve after it penetrates the opposite cortex. After a keyword search of the radiology database at a tertiary care orthopedic hospital from January 2016 to December 2022, those fulfilling the inclusion criteria of (1) instrumentation through the bone during surgery, (2) acute neuropathy immediately after surgery, (3) nerve injury confirmed on electrodiagnostics, and (4) imaging consistent with overshoot nerve injury were included. Imaging studies were retrospectively evaluated to determine primary and secondary signs of an overshoot nerve injury. Six patients (3 females, mean age 26.7 (range 10-49) years) had nerve injury fitting the mechanism of injury: 3 injuries to the radial nerve during fixation of distal humerus fractures, 1 tibial nerve and 1 superficial peroneal nerve injury during fixation of tibial fractures, and 1 posterior interosseous nerve injury during biceps tendon repair. Ultrasounds were performed in all while 4 also had MRI. Secondary signs included (1) cortical defect adjacent to injured nerve (n=2); (2) scar extending from bone to injured nerve (n=2); (3) screw tip pointing to injured nerve (n=1, 4) tract in bone on MRI from previous instrumentation pointing to injured nerve (n=2). In addition to primary signs such as laceration or neuroma, secondary signs of "overshoot" nerve injury include cortical defect, scar extending to nerve, screw tip pointing to nerve, and linear tract in the bone on MRI.

Medical and legal evaluation of injuries due to dog bites: a Türkiye study.

Dog bites are the most common type of injury related to animal bites in our country and worldwide. Dog bite wounds pose significant public health concerns and have medicolegal implications. In this study, we aimed to assess the problems associated with dog bites and propose potential solutions. We conducted a retrospective analysis of 149 cases submitted by judicial authorities to our institution, the Istanbul Council of Forensic Medicine, between 2015 and 2021, to obtain medicolegal expert opinion reports. Information regarding the cases included in the study was obtained from our archives and the National Judicial Network Project (UYAP) system. Data were recorded using Microsoft Excel 2016, and statistical analysis was performed using SPSS 25.0 for Windows (SPSS Inc., Chicago, IL). The mean age of the cases was 33.7 years, with 57% being male. 56.4% of the incidents occurred in the city center, and 30.9% took place during the summer months. 65.8% (n=98) of the cases were attributed to stray dogs. Superficial injuries without muscle tissue involvement were observed in 54.4% (n=81) of all cases, while 22.8% (n=34) had deep tissue defects or flap injuries, 4.7% (n=7) involved vascularnerve injuries, 16.1% (n=24) included bone fractures, and 2% (n=3) featured visceral injuries. Surgical treatment was performed on 37.5% (n=56) of the cases. Impairments were reported in 22.1% of the cases, with permanent facial scars affecting 16.7% of them. Psychiatric evaluations were required for 48.9% (n=89) of the cases, and 57.5% of them received a diagnosis of post-traumatic stress disorder. People attacked by dogs may experience serious physical or psychological sequelae. Therefore, it is crucial to evaluate all victims using a multidisciplinary approach, addressing their physical, social, and psychological needs, and providing rehabilitation when necessary. Non-governmental organizations, such as those dedicated to the prevention of cruelty to animals, in collaboration with local veterinary services, should play a role in national initiatives to provide objective and humane solutions for both victims and animals.

Prevalence and risk factors of needle stick injury among healthcare workers in the emergency department, King Saud Medical City, Riyadh, Saudi Arabia

Objective: This study aimed to evaluate the risk factors and prevalence of needle stick injuries (NSIs) among healthcare workers (HCWs) working in the emergency department (ED) at King Saud Medical City (KSMC) in Riyadh, Saudi Arabia. Methods: A cross-sectional study was conducted on 194 HCWs in the ED at KSMC. A pre-designed questionnaire was used to collect the data about participants&amp;apos; demographics, work characteristics, previous exposure to NSI, and circumstances related to NSI. Results: Among the studied 194 HCWs, 45.5% had an age range from 18-30 years, 50.5% were females, 57.7% had a Saudi nationality, 41.2% had a work experience of 5-10 years, and 38.1% were nurses. Of them, 25.8% had previous exposure to NSI and among them, 60% had NSI once, 48% had a superficial injury, 16% had a penetration of gloves, and 84% wore personal protective equipment. The most common device associated with injury was a syringe (32%), 52% received medical attention within 2 hours, and 64% washed the site with soap. NSI was significantly higher among HCWs aged 31-40 years, with a work experience of 5-10 years, and among nurses. Conclusion: NSIs were frequent among the participants. Hospital managers and health policymakers should develop plans to boost healthcare professionals&amp;apos; adherence to general precautions.

Needlesticks and sharp injuries and their associated factors among health care workers of Bule Hora University Teaching Hospital, Southern Ethiopia

BackgroundThis study assessed the prevalence and associated factors of needle sticks and sharp injuries among healthcare workers at the Bule Hora University Teaching Hospital, Southern Ethiopia from December 1 to 30, 2023. MethodsA self-administered questionnaire was used to gather information on sociodemographic factors and exposure status. Epi-Data and SPSS were used to enter and analyze data. Binary and multivariate logistic regression analyses were used to identify risk factors. A P value less than 0.05 was considered statistical significance. ResultsIn this study, the prevalence of at least one Needlesticks and sharp injuries in the last 12 months was 46.4 % (95 % CI: 39.3 %-53.6 %). Of most needlesticks and sharp injuries, 47.2 % were superficial skin injuries. The majority of injuries 45.8 % were due to the syringe needle. Factors such as needle recap (AOR=3.73, 95 % CI: 1.07–12.19), Recapping with two hands (AOR=2.78, 95 % CI: 1.36–10.02), working 40 h per week (AOR=2.18, 95 % CI: 0.98–6.86), lack of training in occupational safety practices (AOR=4.01, 95 % CI: 2.60–9.91), and lack of job satisfaction were factors significantly associated with the prevalence of needlesticks and sharp injuries. ConclusionThis study found that nearly half of the respondents experienced a sharp needle poke and injury at least once in the previous year; however, the volume of NSSI remains high in the study area. Healthcare personnel should receive on-the-job training, and hospital executives should set aside time for discussions on how to solve the problem.

Randomized Trial for Comparison of Tracheostomy Tie Outcomes: Conventional by Cotton Tape and Innovative by Suction Tube

Objective: To compare the outcomes of using a tracheostomy tie between a traditional cotton tape tracheostomy tie, and an innovative model, applied from a suction tube. Materials and Methods: One hundred sixty-four patients that underwent tracheostomy tube replacement between June 2022 and March 2023 at Sawanpracharak Hospital, Nakhonsawan Province, were analyzed by the ENT group. Eighty-two cases were randomly divided into groups using traditional tracheostomy ties of cotton tape and 82 cases using an innovative suction tube as a tracheostomy tie. The general data of the patients were evaluated using descriptive statistics. For comparison of differences between the two groups of data, categorical data was analyzed by chi-square and continuous data was analyzed by independent t-test and VAS score was analyzed by Mann-Whitney test. A p-value of less than 0.05 was considered as a statistically significant difference. Results: The result of the study showed that age and gender did not have statistically significant differences in both groups of patients. In the group that received the tracheostomy tie, the tracheostomy tube displacement was more frequent, and there was more dirt and moisture around the tracheostomy tie than in the group that received an innovative tracheostomy tie with a suction tube. This was statistically significant. Patients and caring nurses were statistically significantly more satisfied using the innovative tracheostomy tie made by a suction tube. Conclusion: A suction tube is an ideal alternative material for personal care, reducing superficial injury of the skin and reducing the risk of accidental decannulation. The tracheostomy tie made of a suction tube is considered an alternative use. Keywords: Tracheostomy tie; Tracheostomy tube; Suction tube; Cotton tape

Biomimetic Injectable Hydrogel Based on Methacrylate-Modified Silk Fibroin Embedded with Kartogenin for Superficial Cartilage Regeneration.

The weak regeneration ability of chondrocytes is one of the main reasons that limit the therapeutic effect of clinical cartilage injury. Injectable hydrogels are potential scaffolds for cartilage tissue engineering with advantages such as minimally invasive surgery, porous structure, and drug sustained-release ability. At present, many biomaterials have been developed for the repair of deep cartilage defects. However, cartilage injury often begins on the surface, which requires us to propose a treatment strategy suitable for superficial cartilage injury repair. In this study, we fabricated a biomimetic injectable hydrogel based on methacrylate-modified silk fibroin (SilMA) embedded with kartogenin (KGN). The SilMA/KGN hydrogels have good biohistocompatibility and the ability to promote cartilage differentiation. In addition, SEM results show that it has a porous structure conducive to cell adhesion and proliferation. Most importantly, it has demonstrated remarkable superficial cartilage repair ability in vivo, showing potential in cartilage tissue engineering.

State-of-the-Art Features for Early-Stage Detection of Diabetic Foot Ulcers Based on Thermograms.

Diabetic foot ulcers represent the most frequently recognized and highest risk factor among patients affected by diabetes mellitus. The associated recurrent rate is high, and amputation of the foot or lower limb is often required due to infection. Analysis of infrared thermograms covering the entire plantar aspect of both feet is considered an emerging area of research focused on identifying at an early stage the underlying conditions that sustain skin and tissue damage prior to the onset of superficial wounds. The identification of foot disorders at an early stage using thermography requires establishing a subset of relevant features to reduce decision variability and data misinterpretation and provide a better overall cost-performance for classification. The lack of standardization among thermograms as well as the unbalanced datasets towards diabetic cases hinder the establishment of this suitable subset of features. To date, most studies published are mainly based on the exploitation of the publicly available INAOE dataset, which is composed of thermogram images of healthy and diabetic subjects. However, a recently released dataset, STANDUP, provided data for extending the current state of the art. In this work, an extended and more generalized dataset was employed. A comparison was performed between the more relevant and robust features, previously extracted from the INAOE dataset, with the features extracted from the extended dataset. These features were obtained through state-of-the-art methodologies, including two classical approaches, lasso and random forest, and two variational deep learning-based methods. The extracted features were used as an input to a support vector machine classifier to distinguish between diabetic and healthy subjects. The performance metrics employed confirmed the effectiveness of both the methodology and the state-of-the-art features subsequently extracted. Most importantly, their performance was also demonstrated when considering the generalization achieved through the integration of input datasets. Notably, features associated with the MCA and LPA angiosomes seemed the most relevant.

Lethal threat in the use of glass doors at home: A case report

BackgroundVarious instruments, including glass fragments, can inflict sharp-force damage, resulting in injuries ranging from superficial wounds to life-threatening trauma. This case report explores the lethal consequences of a 78-year-old man accidentally sustaining a stabbed-incised wound after falling against an ordinary glass door, leading to fatal bleeding from the subclavian artery. Case Report:The man's fall caused a sharp-edged glass fragment to penetrate his neck, resulting in a fatal outcome despite resuscitation attempts. Autopsy Findings:The autopsy revealed a transected subclavian artery, additional injuries to the thorax. Notably, the type of glass used in construction played a crucial role in the severity of injuries, emphasizing the need for safety standards and awareness in architectural design. DiscussionThe discussion delves into the historical use of annealed glass in construction and the evolution of safety standards for architectural glazing materials. A comparison between annealed and tempered glass underscores the importance of the latter in preventing severe injuries. The prevalence of annealed glass in older constructions raises concerns, given its propensity to cause larger and more dangerous shards upon breakage. The report highlights cases of glass-related fatalities, emphasizing the unexpected dangers associated with glass-topped furniture. ConclusionsRecommendations include the adoption of safety glass in new constructions, particularly in residences with elderly occupants, and the installation of night lights to mitigate the risk of injuries from glass and other furniture. The report contributes to enhancing understanding in forensic pathology, emphasizing the evolving role of glass in fatal incidents.