Wound Healing Status Research Articles

TcPO2 Value Can Predict Wound Healing Time in Clinical Practice of CLTI Patients

Transcutaneous oxygen pressure (TcPO2) is a noninvasive, nonradiological test to measure local oxygen released from capillaries through the skin. Since it reflects the metabolic state of the lower limb, it can predict wound healing in patients with critical limb threatening ischemia (CLTI). The purpose of this study was to determine the effectiveness of TcPO2 test in evaluating wound healing potential of patients with CLTI. This was a retrospective, single-center, nonrandomized, and observational study. A prospectively registered database of patients who visited Vascular Surgery Department of St. Mary's Hospital for CLTI and underwent TcPO2 tests from October 1, 2015 to July 1, 2021 was reviewed. Patients were divided into 2 groups: (1) those who had amputation only; and (2) those who underwent revascularization procedures. Patients whose wound healing status could not be determined were excluded. The clinical characteristics of patients, patient characteristics related to lower TcPO2 value, treatment success rate, and time for the wound to be healed were analyzed. A total of 84 patients were included in this study. There was no difference in background patient characteristics between the 2 groups despite better survival within 12months and shorter healing time in the revascularization group. A total of 76 patients survived 12months after surgery, and 63 patients were healed. Higher HbA1c, higher serum creatinine, history of stroke, and history of coronary artery disease were related to lower TcPO2 value on multiple linear regression. The cutoff value of TcPO2 was determined to be 40mm Hg for predicting wound healing. This value was similar to those of previous studies. In addition, there was a negative correlation between TcPO2 and wound healing time. Correlations among the anklebrachial index (ABI), toe-brachial index (TBI), and TcPO2 were not determined because ABI and TBI for some patients could not be obtained due to wound condition. The TcPO2 value can predict the wound healing process of ischemic lower extremity injury.

Outcomes of Infrapopliteal Bypass for Chronic Limb-Threatening Ischemia are Worse in Renal Transplant Patients than in Hemodialysis-Dependent Patients

Comparisons of distal bypass outcomes between hemodialysis-dependent (HD) and renal transplant (RT) patients have been reported, but the influences of immunosuppressive therapy on the outcomes remain unclear because of the limited number of RT patients who underwent distal bypass or cohort heterogenicity. We compared outcomes of distal bypass for chronic limb-threatening ischemia (CLTI) with homogenous ischemic limb pathology. Between January 2014 and December 2019, we performed 334 infrapopliteal bypass procedures using vein grafts for 275 consecutive CLTI patients with tissue loss. Among them, there were 130 HD patients (47.3%) (163 limbs) and 11 RT patients (4%) (15 limbs), and 30-day mortality, 5-year primary and secondary patency (PP and SP), limb salvage (LS), amputation-free survival rates, and wound healing (WH) status were compared between the HD and RT patient groups. Nine HD patients died within 30days after surgery (7%), whereas no deaths were observed among the RT patients. Five-year PP and SP rates in the RT group 39% and 41%, which were significantly worse compared to 64% and 82% in the HD group (P<0.01). Unsuccessful rate of revision surgery including hemodynamically failed grafts after revision reached over 80% in the RT group, which was technically unfeasible pathology for graft salvage (vs. 3% in the HD group), and WH, and LS rates were significantly worse in the RT group. In comparison with HD patients, RT patients showed a lower LS rate for CLTI. The lower LS rate was associated with a lower SP rate, which was caused by disease progression of distal arteries in the foot.

Can Wound Surface pH and Temperature Predict Wound Healing in Diabetic Foot Ulcer?

Introduction: Diabetic foot ulcer (DFU) is dreaded and one of the most intricate medical conditions in diabetes. Improving the healing of DFU is imperative for improved patient outcomes. To consider a biomarker of comprehensive value to patients and health care professionals, it should be cost effective, user friendly, reliable, acceptable, and it should be transferable among various health care settings. We aimed to assess 2 such potential factors: wound surface pH and wound surface temperature as a predictor of healing in DFU. Methods: DFU patients (n = 54) were assessed in terms of non-healing while evaluating them routinely. The patient’s wound was examined every week till 4 weeks or complete healing, whichever was earlier, and was given a score according to leg ulcer measurement tool (LUMT). Temperature of wounds was measured by “handheld Infrared thermometer” at room temperature. Wound surface pH was measured by handheld Potentiometric pH meter. All these parameters were compared with healing status of the wound which was assessed clinically with the LUMT score. Results: Wound surface temperature values ranged from 89-92°F (baseline) and 84-88°F (week 4), Leg ulcer measurement tool (LUMT) score was ranging from 43-56 (baseline) and 12-29 (week 4) and wound surface pH was ranging from 7.40-8.10 (baseline) and 7.20-7.40 (week 4). However, correlation studies among them were statistically insignificant. Conclusion: The possible advantages offered by objective, chair side methods for quick, precise, and sensitive monitoring of wound healing status, suggest that this process will become an important tool in wound healing surveillance and clinical decision making in resolution of non-healing of DFU in future.

Application of Skin-stretching Device for Closing Scalp Defect.

The scalp defect was a clinical common constructive challenge. This research verified the efficacy of the skin-stretching device in the treatment of scalp defect and assessed the associated complications. The clinical data of 12 patients with scalp defect treated with skin-stretching device from January 2020 to January 2021 were collected. We used EASApprox skin-stretching device for the treatment of scalp defect. We described a detailed reconstruction procedure for this treatment. We collected the site, distance from wound edge and other characteristics of the wound, and recorded the number of stretching cycles, operation time, closed state, healing time, and observed postoperative complications and wound healing status. In this research, the scalp defect was mainly caused by pressure ulcer, and mainly located in the parietooccipital site. The average distance from wound edge was 3.2cm, the average stretching cycles was 4.2 times during the operation, and the average operation time was 43.5 minutes. Ten patients were directly sutured after stretching, and 2 patients underwent first-stage stretching to reduce the wound. The average time of wound healing was 13.5 days. Postoperative follow-up of 3 months, no patients had wound tear, necrosis, 1 patient suffered from wound exudation and infection due to poor nutrition. Skin function and final scar was acceptable. The treatment of skin-stretching device was effective for scalp defect and has the advantages of convenient operation, acceptable functional results, without severe complications. In addition to traditional treatment, this was a promising treatment. However, more clinical and preclinical research of the skin-stretching device were required.

Multifunctional fish gelatin hydrogel inverse opal films for wound healing

BackgroundWound healing has become a worldwide healthcare issue. Attempts in the area focus on developing patches with the capabilities of avoiding wound infection, promoting tissue remolding, and reporting treatment status that are of great value for wound treatment.ResultsIn this paper, we present a novel inverse opal film (IOF) patch based on a photo-crosslinking fish gelatin hydrogel with the desired features for wound healing and dynamic monitoring. The film with vibrant structure colors was constructed by using the mixture of fish gelatin methacryloyl, chitosan, and polyacrylic acid (PAA) to replicate colloidal crystal templates. As the structures of these natural biomolecules are well-retained during the fabrication, the resultant IOF was with brilliant biocompatibility, low immunogenicity, antibacterial property, as well as with the functions of promoting tissue growth and wound healing. In addition, the IOF presented interconnected nanopores and high specific surface areas for vascular endothelial growth factor loading, which could further improve its angiogenesis capability. More attractively, as the pH-responsive PAA was incorporated, the IOF patch could report the wound healing status through its real-time structural colors or reflectance spectra.ConclusionsThese features implied the practical value of the multifunctional fish gelatin hydrogel IOFs in clinical wound management.Graphical

Adhesive-Free, Stretchable, and Permeable Multiplex Wound Care Platform.

The wound healing process remains a poorly understood biological mechanism. The high morbidity and mortality rates associated with chronic wounds are a critical concern to the health care industry. Although assessments and treatment options exist, these strategies have primarily relied on static wound dressings that do not consider the dynamic physicochemical microenvironment and can often create additional complications through the frequent dressing changing procedure. Inspired by the need for engineering "smart" bandages, this study resulted in a multifaceted approach to developing an adhesive-free, permeable, and multiplex sensor system. The electronic-extracellular matrix (e-ECM) platform is capable of noninvasively monitoring chemical and physical changes in real-time on a flexible, stretchable, and permeable biointegrated platform. The multiplex sensors are constructed atop a soft, thin, and microfibrous substrate of silicone to yield a conformal, adhesive-free, convective, or diffusive wound exudate flow, and passive gas transfer for increased cellular epithelization and unobstructed physical and chemical sensor monitoring at the wound site. This platform emulates the native epidermal mechanics and physical extracellular matrix architecture for intimate bio-integration. The multiple biosensor array can continuously examine inflammatory biomarker such as lactate, glucose, pH, oxygen, and wound temperature that correlates to the wound healing status. Additionally, a heating element was incorporated to maintain the optimal thermal conditions at the wound bed. The e-ECM electrochemical biosensors were tested in vitro, within phosphate-buffered saline, and ex vivo, within wound exudate. The "smart" wound bandage combines biocompatible materials, treatments, and monitoring modalities on a microfibrous platform for complex wound dynamic control and analysis.

Multifunctional hydrogel as wound dressing for intelligent wound monitoring

• The hydrogel exhibits antibacterial, hemostatic and adhesive properties. • The hydrogel dressing monitors the wound pH in real-time through colorimetry. • The whole intelligent wound monitoring process mainly include three parts. • A combination of multifunctional hydrogel dressing and machine learning technology. Chronic wound remains a significant challenge in clinical care due to the long treatment process and the poor quality of tissue regeneration affected by bacterial infection, calling timely and effective wound management approach to achieve real-time intelligent wound monitoring and promote wound healing. In this work, a multifunctional hydrogel is employed as wound dressing for intelligent wound monitoring, which not only have the functions of antibacterial, hemostatic and adhesive properties for effectively promoting wound healing, but also can realize real-time wound status monitoring (e.g., pH). The whole intelligent wound monitoring process mainly includes three parts: wound recognition, real-time status monitoring and personalized wound management. Among them, the customized hydrogel wound dressing can accurately match the contour of the wound for precise treatment. Moreover, the personalized wound management model with high accuracy (94.47%) based on the convolutional neural network (CNN) machine learning algorithm can analyze and evaluate the wound healing and infection status through the colorimetric signal of the hydrogel dressing. This multifunctional hydrogel wound dressing, which integrates precise treatment, real-time monitoring and personalized management for intelligent wound monitoring, provides an advanced solution to accelerate wound healing and reduce bacterial infections and plays an inestimable step for future intelligent wound management.

The Effect of a Compound Protein on Wound Healing and Nutritional Status.

Proteins provide the main building blocks for tissue growth, cell renewal, and repair during wound healing. We aimed to examine the effect of a compound protein on wound healing, nutritional status, and underlying mechanisms. We first performed a preliminary experiment to identify the appropriate wound healing assessment points. In the formal experiment, there were five groups (control group: 8.3750 g/kg/day saline solution; model group: 8.3750 g/kg/day saline solution; whey protein group: 8.3750 g/kg/day whey protein; low-dose compound protein group: 4.1875 g/kg/day compound protein; and high-dose compound protein group: 8.3750 g/kg/day compound protein) with eight rats in each group. At each turning point, we observed the wound healing rate and nutritional status of the different groups of rats. In addition, biochemical assays were used to determine the mechanisms underlying the effects of the compound protein. In the preliminary experiment, the third day after modeling was the turning point between the inflammatory and proliferation phases, and the eighth day was the turning point between the proliferation and remodeling phases. The formal experiment evaluated wound healing condition, inflammatory response, angiogenesis, collagen deposition, and nutritional status. A pathological report showed increased vascularization, collagen deposition, and epithelialization in compound protein-treated groups. Protein-treated mice showed decreased interleukin (IL)-6, IL-8, neutrophils, and lymphocytes and increased IL-10, albumin, prealbumin, total protein levels, insulin-like growth factor 1 (IGF-1), fibroblast growth factor 2 (FGF-2), and vascular endothelial growth factor (VEGF) expressions. All parameters were significant (p < 0.05) compared to the model group. There was a dose-dependent effect of the compound protein. The accelerated wound healing mechanism may be that the compound protein accelerates the whole wound healing process, making wounds transition from the inflammatory phase to the proliferation phase faster, entering the remodeling phase earlier. Administration of a compound protein can accelerate wound healing and improve the nutritional status.

Effect of Preoperative Serum Transthyretin Levels on Postoperative Clinical Results and Morbidity in Patients Undergoing Spinal Surgery.

Introduction This study aims to investigate the effects of preoperative serum transthyretin (TTR) levels on surgical success, pain scores, and postoperative morbidity. Methods Note that, in our clinic, 188 patients who were operated for spinal pathologies between June 2010 and January 2011 were included in this study. Blood samples were drawn from all patients on the morning of surgery and then serum TTR measurements were made. Demographic data of all patients were collected, and then their preoperative and postoperative neurological examinations, Karnofsky scores, visual analog scale (VAS) scores, Oswestry Disability Index (ODI) scores, postoperative infection and wound healing status, hospital stay, and morbidity levels were recorded and TTR levels were compared. Results When preoperative TTR level of patients were low, their Karnofsky scores decreased, ODI scores increased, the early postoperative VAS and late postoperative VAS values increased, and the length of hospital stay was increased. Moreover, in patients with low TTR levels, postoperative Karnofsky scores were lower, postoperative ODI levels were higher, postoperative early and late VAS scores were higher, hospital stays were longer, peroperative complication rates were higher, wound infection rates were higher, the delay in wound site healing was higher, and the morbidity rate was higher. Conclusion Consequently, preoperative low TTR levels have been reported to be an effective parameter that can be used to predict surgical results, wound infection and wound site healing status, perioperative complications, and morbidity in spinal surgery.

Qingwei San treats oral ulcer subjected to stomach heat syndrome in db/db mice by targeting TLR4/MyD88/NF-\u03baB pathway

BackgroundQingwei San (QWS), one of classic Chinese Medicine prescripts, has been widely used to treat stomach heat syndrome which manifests oral ulcer (OU), periodontitis and upper gastrointestinal bleeding for seven hundred years. However, the therapeutic effects of QWS on diabetic OU subjected to stomach heat syndrome are still ambiguous. In the study, we investigated the pharmacological mechanisms.MethodsThe main components of QWS aqueous extract were analyzed by LC–MS, and potential pathways of QWS targeting OU were predicted by network pharmacology. The db/db mice were administered with the decoction of dried Zingiber officinale Rosc. rhizome combined with NaOH cauterization to establish the model of diabetic OU subjected to stomach heat syndrome. Subsequently, the model mice were treated with QWS, and OU wound healing status were recorded. The pathological changes of gastric tissue and oral mucosa were evaluated using hematoxylin–eosin staining, and the morphology of collagen fibers in oral mucosa was assessed by Masson staining. The levels of thromboxane B2 (TXB2), 6-Keto-prostaglandin F1α (6-keto-PGF1α), interleukin-1 β (IL-1β), IL-2, IL-6, tumor necrosis factor-α (TNF-α), β-endorphin (β-EP) and 5-Hydroxytryptamine (5-HT) were determined by ELISA assay. The protein expressions of Toll-like receptor 4 (TLR4), TNF receptor associated factor 6 (TRAF6), myeloid differentiation factor 88 (MyD88), inhibitor of NF-κB alpha (IκΒα), p-IκΒα and nuclear factor kappa-B (NF-κB) p65 were measured by Western Blotting.ResultsA total of 183 compounds in QWS were identified by LC–MS, and identified 79 bioactive compounds corresponded to 269 targets and 59 pathways. QWS high-dose treatment significantly reduced the level of TXB2 and the ratio of TXB2/6-keto-PGF1α. Meanwhile, it improved mucosal pathological morphology, and reduced the area of OU and local edema. Simultaneously, the levels of TNF-α, IL-1β, IL-6, IL-2 and 5-HT, and the expressions of TLR4, TRAF6, MyD88, p-IκΒα and NF-κB p65 were decreased.ConclusionQWS treatment facilitates the healing of OU, ameliorates pathological morphologies of gastric and oral mucosa and decreases the levels of pro-inflammatory cytokines in db/db mice subjected to stomach heat syndrome, whose mechanism may be associated with the inhibition of TLR4/MyD88/NF-κB signaling pathway to exert anti-inflammatory effects.

Comparison between Two Methods of Preoperative Hair Removal with Surgical Site Infection

Background: Surgical site infections (SSI) are one of the major complications that develop in surgical patients and are the mostcommon nosocomial infection in patients undergoing surgery, carrying significant morbidity and mortality rates. Severalmeasures are taken to reduce surgical site infection. Removal of hair is also important for a surgery that helps the surgeon inoperation and also after postoperative period during bandaging. Several methods of hair removal are present as razor shaving,depilatory method, clipping etc. Razor shaving is the most popular method of hair removal from operative site of preoperativepatients in developing country like Bangladesh that can cause preoperative skin abrasion that may be source of skin infectionand can induce surgical site infection. Objective: To determine whether preoperative razor shaving or depilatory method of hair removal is preferred to reducepostoperative wound infection. In addition the study also considered variables under comparisons were age, sex, BMI &amp; Hb%,condition of wound, type of operation, length of incision, duration of operation, pre-operative hospital stay as well as status ofwound healing. Method: This crosssectional comparative study was conducted on 100 patients of which in case of 50 patients' preoperative hairremoval were done from operation site by razor shaving and in 50 patients' preoperative hair removal were done from operationsite by depilatory method. Outcome variable was wound infection. Results: Wound infection was compared of both groups of patients. Total 19% wound infections were detected. Among thegroup-I (who had razor shaving), 41 (82%) patients had satisfactory healing and among the Group-II (who had hair removal bydepilatory method), 40 (80%) patients had satisfactory healing. There is no statistically significant difference of woundinfection between the two groups of patients. Conclusion: There is the same outcome of surgical site infection in case of preoperative hair removal by razor shaving andpreoperative hair removal by depilatory method.

Influence of selected parenteral drugs on tightness and morphological parameters of enteroanastomosis in rats

During the past few years many scientific investigations regarding the status of enteroanastomoses after surgical resections have been performed all over the world. General surgery wards perform intestinal resections on patients with neoplastic processes or with advanced nonspecific intestinal inflammation. Partial resections of the intestines are also performed on patients with necrotic changes caused by intestinal torsion or embolism of the branches of the mesenteric artery. These types of surgeries often require additional treatment which should cause a minimal strain for the patient in the postoperative period in order to obtain the highest percentage of recoveries. In proliferative diseases chemo- and radiotherapy are the most commonly used methods of treatment whereas general and local steroid therapy are used in inflammatory diseases. Additionally, immunomodulating agents are used with conventional therapy to improve the therapeutic effect. In a few studies, the influence of drugs on the local status of the intestine and wound healing status after surgeries was examined. The influence of selected agents on the status of experimental enteroanastomoses performed on the large intestine of rats was evaluated based on physical and morphometric tests. The study was performed on 60 Wistar rats, all of whom were male, of a similar body weight (250-350 grams) and the same age (2 months old). The rats were operated on to create an experimental anastomosis of the ascending colon. Then we administered selected drugs to evaluate their effect on the status of the newly created intestinal anastomosis. Selected parameters were evaluated after 4, 7 and 14 days after the surgery. In our experimental cycle animals were divided into 4 groups with 15 individuals in each group. The first group (I) was given physiological saline intraperitoneally (control group). Animals in the second group (II) were given the immuno-modulating drug interferon (Intron A) (45.000 IU/kg of b.w./day) after the surgery. Animals in the third group (III) were given the steroid Dexaven (0.5 mg/day) after the surgery. Animals in the fourth group (IV) were given a cytostatic agent (5-fluoroauracil) after the surgery (20 mg/kg/day). All of the drugs were administered in the same form as intra-peritoneal injections with the same amount of fluid. The study was planned for 5 cycles. 12 animals participated in one experimental cycle: 3 animals each from groups I, II, III and IV were operated on. The drugs were given for 5 days starting from the second day after the surgery. The rats were dissected after the 4th, 7th and 14th days of the experimental cycle to evaluate the status of the enteroanastomosis and the skin, according to previously mentioned parameters. Macroscopic changes of the enteroanastomosis were examined. Swabs were taken from all individuals with features of inflammation around this location. Next, the tightness of the anastomosis was evaluated by examining the appearance of air in the area of the anastomosis. The most important and last part of the experiment was amorphometric analysis of the large intestine with the anastomosis. In preparations stained with hematoxylin and eosin the following parameters were evaluated: amount of active intestinal crypts/mm, amount of non-active intestinal crypts/mm, total amount of intestinal crypts/mm, thickness of the mucous membrane, thickness of the submucous membrane, thickness of the muscular layer, fractal dimension of the mucosal membrane, fractal dimension of conjunctive tissue. Under the influence of steroid agents tightness disorders of the anastomosis were observed. Evaluation of the influence of the used substances on the morphometry of the enteroanastomosis revealed evident changes in the later days of the trial. In the days following the dissection of the animals from the control group histological changes were also observed that can suggest that the surgical intervention in itself influenced the morphometric parameters and caused disorders in the activity of intestinal crypts, decreased the dimension of the submucous membrane and altered the regeneration of the mucous membrane of the large intestine. Generally, agents used in the study caused disorders in the healing of the anastomosis, which significantly decreased particular dimensions of analyzed parameters. The substances examined influenced the thickness of the submucous membrane by making it thinner. Steroid and immunotherapy changed the reconstruction of conjunctive tissue which significantly affected the status and the resistance of the anastomosis. Intraperitoneal administration of selected therapeutical substances, especially Dexaven and Intron A have influenced the complete healing process of the anastomosis by disturbing the regenerative processes.

Adolescents with Lisfranc Injury Frequently Have Different Pathology with Higher Incidence of Proximal Extension of the Ligamentous Disruption

Category:Midfoot/Forefoot; TraumaIntroduction/Purpose:Lisfranc injuries are rare injuries in the adolescent age group and can be easily missed. Ligamentous Lisfranc injuries have been classically descried as disruption of the Lisfranc ligament (between medial cuneiform and second metatarsus) and ligamentous disruption of the first metatarso-phalangeal joint. The study aimed to report pathological pattern of Lisfranc injury in adolescent patient and if it was different from the common adult forms.Methods:This is a retrospective study of patients with Lisfranc injury treated at a Level 1 trauma center between 2012 and 2019. This study has been IRB approved. The inclusion criteria were of adolescents with isolated Lisfranc injuries and treated via surgical intervention. The surgical intervention helped to identify the exact pathology. The study excluded patients over the age of 18, patient with high energy injuries and patients treated non-operatively. Patients' demographics including age and gender, were recorded. Other variables included the mechanism of injury, side of injury, fracture type, the intraoperative findings of the ligamentous injury and follow-up data. Follow up radiographs were reviewed for time to bony union and any post-traumatic complications. Outcomes include wound healing status, the union status of the fracture, and complications that may arise along with treatment and follow-up.Results:A total of 9 patients met the study inclusion criteria. Mean age was 15.4 years old, male to female ratio of 5:4, mean follow-up time was 9.5 months. All patients achieved full union at the final follow-up. The postoperative course went without complications except one for patient. The patient had prominent screw under the skin. The screw removed in the office under local anesthesia. Intraoperative findings in 6/9 (66.6 %) cases demonstrated a Lisfranc injury pattern with proximal extension through the inter-cuneiform ligament. Operative treatment in cases of proximal extension included added fixation between the middle cuneiform and middle cuneiform (screws or plates). Also noted in 2 cases, that the 1st tarso-metatrsal joint was not affected (in contrast to classic Lisfranc injury in adults). In these cases, no fixation was need for the 1st TMT joint.Conclusion:Lisfranc injury in adolescent has frequently different pathology compared to adults' counterparts. It commonly involves proximal extension with the ligament disruption. It also sometimes spares the ligaments of the 1st TMT joint. Orthopedic surgeons should be aware of these changes as it implies changes in the treatment strategy and fixation construct.

Low-Level Laser and Bovine Amniotic Fluid-derived Cream Accelerating Skin Neck Wound Healing and Reducing Inflammation and Wound Scar in a Rat Animal Model.

Nowadays, wound healing is one of the main problems of patients. Therefore, extensive research is underway to discover mechanisms associated with non-scarring of wounds. Using amniotic fluid and laser may potentially play a key role in wound healing and scar reduction due to its presence in tissue growth and repair agents. The present study evaluated the effect of bovine amniotic fluid (BAF)-derived cream and low-power laser (LPL) on accelerating skin wound healing and reducing scarring in an animal model. Therefore, 72 male Wistar rats were randomly divided into three groups (each group: 24). A wound 6 mm in diameter was then inflicted on the rats' backs. In the first group that was the control group, the wound was only used. Moreover, BAF was implemented for the second group, and in the third group, LPL radiation was utilized. On the 1st, 3rd, 5th, 14th, and 21st days, the healing condition of the wound and scar created were examined. Hence, evaluation of wound healing status on days 5 and 14 showed that the wound healing scale in the BAF group and LPL group was significantly better than that of the control group. On the 21st day, the average Scar Scoring Scale in the BAF and LPL groups was significantly lower than that of the control group. Histological images showed a significant repair in the LPL and BAF groups. To conclude, considering the positive effect of LPL and BAF on wound healing and less scarring, it seems that LPL and BAF can heal wounds faster. Moreover, they can be used to prevent scarring after wound healing.

Chitooligosaccharide-europium (III) functional micron complex with visualized inflammation monitoring, immunomodulation and pro-vascularization activities for effective wound healing of pressure ulcers injury

Ischaemia and inflammation can hinder the wound healing process in pressure ulcer (PU) injuries. Direct monitoring of the healing status and multi-stage adaptive repair have not been realised in the PU treatment. This study proposes a method to monitor the status of wound healing, while being able to modulate the inflammation and promote vascularization for effective healing of PU injuries, using a complex of chitooligosaccharides (COS) and europium ions (Eu3+). The COS-Eu complex was prepared via one-pot coordination, and its morphology, structure, physicochemical, and fluorescence properties were studied. The results indicate that the COS-Eu complex not only monitors wound healing through fluorescence changes, but also modulates inflammation and promotes vascularization, which were verified both in vitro and in vivo. Noticeably, the COS-Eu complex could shift M1 macrophages to M2 macrophages, demonstrating anti-inflammatory activity. Furthermore, it played a synergistic role with Eu to promote vascularization and tissue regeneration. This simple construction of COS-Eu complex enabled visual monitoring and multi-stage adaptive wound repair, providing a comprehensive solution for PU injury with integrated treatment and monitoring throughout the healing process.

Effect of Preoperative Serum Transthyretin Levels on Postoperative Clinical Results and Morbidity in Patients Undergoing Spinal Surgery.

Introduction:This study aims to investigate the effects of preoperative serum transthyretin (TTR) levels on surgical success, pain scores, and postoperative morbidity.Methods:Note that, in our clinic, 188 patients who were operated for spinal pathologies between June 2010 and January 2011 were included in this study. Blood samples were drawn from all patients on the morning of surgery, and then, serum TTR measurements were made. Demographic data of all patients were collected, and then their preoperative and postoperative neurological examinations, Karnofsky scores, Visual Analog Scale (VAS) scores, Oswestry disability index (ODI) scores, postoperative infection and wound healing status, hospital stay, and morbidity levels were recorded, and TTR levels were compared.Results:When preoperative TTR level of patients was low, their Karnofsky scores decreased, ODI scores increased, the early postoperative VAS and late postoperative VAS values increased, and the length of hospital stay was increased. Moreover, in patients with low TTR levels, postoperative Karnofsky scores were lower, postoperative ODI levels were higher, postoperative early and late VAS scores were higher, hospital stays were longer, peroperative complication rates were higher, wound infection rates were higher, the delay in wound site healing was higher, and the morbidity rate was higher.Conclusion:Consequently, preoperative low TTR levels have been reported to be an effective parameter that can be used to predict surgical results, wound infection and wound site healing status, perioperative complications, and morbidity in spinal surgery.

Gardeniae Fructus Attenuates Thioacetamide-Induced Liver Fibrosis in Mice via Both AMPK/SIRT1/NF-κB Pathway and Nrf2 Signaling.

Liver fibrosis, which means a sort of the excessive accumulation of extracellular matrices (ECMs) components through the liver tissue, is considered as tissue repair or wound-healing status. This pathological stage potentially leads to cirrhosis, if not controlled, it progressively results in hepatocellular carcinoma. Herein, we investigated the pharmacological properties and underlying mechanisms of Gardeniae Fructus (GF) against thioacetamide (TAA)-induced liver fibrosis of mice model. GF not only attenuated hepatic tissue oxidation but also improved hepatic inflammation. We further confirmed that GF led to ameliorating liver fibrosis by ECMs degradations. Regarding the possible underlying mechanism of GF, we observed GF regulated epigenetic regulator, Sirtuin 1 (SIRT1), in TAA-injected liver tissue. These alterations were well supported by SIRT1 related signaling pathways through regulations of its downstream proteins including, AMP-activated protein kinase (AMPK), p47phox, NADPH oxidase 2, nuclear factor erythroid 2–related factor 2 (Nrf2), and heme oxygenase-1, respectively. To validate the possible mechanism of GF, we used HepG2 cells with hydrogen peroxide treated oxidative stress and chronic exposure conditions via deteriorations of cellular SIRT1. Moreover, GF remarkably attenuated ECMs accumulations in transforming growth factor–β1-induced LX-2 cells relying on the SIRT1 existence. Taken together, GF attenuated liver fibrosis through AMPK/SIRT1 pathway as well as Nrf2 signaling cascades. Therefore, GF could be a clinical remedy for liver fibrosis patients in the future.

Sensitivity of the Wound Edge Gene Signature "WD14" in Responding to Clinical Change: A Longitudinal Cohort Study.

Introduction: WounD14 (WD14) gene signature is a recently developed tool derived from genetic interrogation of wound edge biopsies of chronic venous leg ulcers to identify heard-to-heal wounds and enable clinicians to target aggressive therapies to promote wound healing. This study aimed to evaluate if changes in wound clinical healing status were detected by the WD14 gene signature over time as this is currently poorly understood. Material and methods: WD14 was developed through gene screening and subsequent validation in 3 patient cohorts involving 85 consecutive patients with chronic venous leg ulcers referred to a tertiary wound healing unit. Patients underwent a wound edge biopsy to interrogate for a "healing" or "non-healing" genotype. A smaller cohort (18%) underwent a second biopsy, which comprised this pilot cohort reported herein. Twelve weeks following biopsy, wounds were clinically assessed for healing status based on reduction in size and compared to WD14 genotype. Results: Sequential biopsies and WD14 scores were derived from 16 patients. WD14 signature predicted wound healing status among this cohort at either visit (32 wound edge biopsies) with a positive predictive value (PPV) of 85.2% (95% CI 74.1%-92.0%) and negative predictive value (NPV) of 80.0% (95% CI 34.2%-96.9%). A total of 6 wounds underwent altered clinical status between the 2 visits. In this cohort, WD14 has a PPV of 66.7% (95% CI 47.3%-81.7%) and NPV of 100%. Conclusion: Although the WD14 gene signature did change with wound healing status, larger studies are required to precisely clarify its role and ability to prognosticate wounds of differing clinical status over time.

Greener therapeutic pH-sensing wound dressing based on Curcuma Longa and cellulose hydrogel

• pH-sensing wound dressing was developed to indicate the wound healing status. • Curcuma Longa extract was used as easy and cost-effective pH monitoring detector. • Transparent, soft and neutral hydrogels were prepared based on green monomer. • Hydrogel matrix loaded on cotton gauze showed explicit color changes as pH changes. The moist dressing has been taken as an approach to maintain a wet environment for the wound and accelerate its healing process. Recently, more functionality has been imparted to wound dressings to monitor changes in skin pH and visually indicate the wound healing status. However, providing a biocompatible pH-sensing hydrogel made of green components, at a neutral medium, is yet to investigate. In this work, pH-sensitive natural dye, Curcuma Longa extract (CLE), was utilized as an easy and cost-effective pH-sensitive indicator. CLE was loaded in hydrogel made of hydroxyethyl cellulose grafted with green monomer, itaconic acid (IA), to prepare transparent, soft, and neutral pH-sensitive wound dressing. IA concentrations tuned gel porous structure (370–100 µm), mechanical (686–1186 N, load at break), swelling (up to1839% at neutral medium), and release properties. Hydrogel showed higher release percentages at pH (7.4), and longer release profiles at pH (8 ± 0.2) which suits wound healing applications. The coloristic properties of the CLE as a function of pH were confirmed by UV–Vis spectroscopy. Hydrogel matrices, loaded on cotton gauze and submerged in different pH buffer solutions, showed explicit color changes from visibly yellow for pH ≤ 7 and dark red for pH > 7.

Novel Cellulose Fibre-Based Flexible Plasmonic Membrane for Point-of-Care SERS Biomarker Detection in Chronic Wound Healing

BackgroundWound management is stretching the limits of health systems globally, challenging clinicians to evaluate the effectiveness of their treatments and deliver appropriate care to their patients. Visual inspection and manual measurement of wound size are subjective, often inaccurate and inconsistent. Growth factors, such as pro-inflammatory cytokines and proteases, play important roles in cutaneous wound healing. However, little is known about the point-of-care monitoring of the changes in such markers during the healing process. Here, we explore the capability of surface-enhanced Raman spectroscopy (SERS) as a viable point-of-care platform to monitor the changes of these surrogate indicators of healing status in chronic wounds.MethodsWe developed a biofunctionalized flexible, cost-effective, scalable and easy-to-fabricate plasmonic SERS substrate using cellulose fibre (CF), which is used for sensing of wound markers based on a modified immunoassay method.ResultsWe evaluated and selected the reliable silver nano-island thickness that will be sputtered onto the CF-based substrate for the highest SERS enhancement. Using this biofunctionalized SERS substrate, we detected varying concentrations of MMP-9 (10–5000 ng/mL) and TNF-α (5–100 ng/mL) proteins to model the wound exudates. This SERS detection method demonstrates a linear response within biologically relevant concentrations, ranging from 10 to 500 ng/mL for MMP-9 and 5 to 25 ng/mL for TNF-α for these surrogate indicators.ConclusionOur SERS sensing platform achieved detection limits in the µM to sub-nM range and displayed high sensitivity and selectivity. This could result in a cheap, point-of-care device that provides a non-invasive measure of cutaneous wound healing in real time. We envision that these flexible substrates after activation may be incorporated into wound dressings in future for routine monitoring of wound healing status.