Chronic Wound

Bo s a n q u e t, D. C., S a n d e r s , A. J. , R u g e , F., La n e, J. , M o r ri s, C. A., Jia n g, W. G. a n d H a r di n g, K. G. 2 0 1 9. D ev elo p m e n t a n d v alid a tio n of a g e n e e x p r e s sio n t e s t t o id e n tify h a r d-t o-h e al c h r o ni c v e n o u s le g ul c e r s . B ritis h Jou r n al of S u r g e r y 1 0 6 (8) , p p . 1 0 3 5-1 0 4 2. 1 0. 1 0 0 2/ bj s. 1 1 1 6 1 P u blis h e r s p a g e : h t t p:// dx. d oi.o r g/ 1 0. 1 0 0 2/ bj s. 1 1 1 6 1 Pl e a s e n o t e: C h a n g e s m a d e a s a r e s ul t of p u blis hi n g p r o c e s s e s s u c h a s c o py-e di ti n g, fo r m a t ti n g a n d p a g e n u m b e r s m a y n o t b e r efl e c t e d in t hi s v e r sio n. Fo r t h e d efi nitiv e v e r sio n of t hi s p u blic a tio n, pl e a s e r ef e r t o t h e p u blis h e d s o u r c e . You a r e a d vis e d t o c o n s ul t t h e p u blis h e r's v e r sio n if yo u wis h t o ci t e t hi s p a p er. This ve r sio n is b ei n g m a d e a v ail a bl e in a c c o r d a n c e wi t h p u blis h e r p olici e s. S e e h t t p://o r c a . cf. a c. u k/ p olici e s. h t ml fo r u s a g e p olici e s. Co py ri g h t a n d m o r al ri g h t s fo r p u blic a tio n s m a d e a v ail a bl e in ORCA a r e r e t ai n e d by t h e c o py ri g h t h ol d e r s . Development and validation of a gene expression test to identify hard-to-heal chronic venous leg ulcers; a three-stage cohort study

Chronické, tzv. nehojící se rány mohou být a často také reálně jsou nepříjemnou zkušeností v životě mnoha pacientů. Existence nehojící se rány znamená pro pacienta a jeho rodinu významný problém a s tím spojené narušení kvality života. Důležitá je prevence vzniku nehojící se rány, v případě již existující rány včasná a správná diagnostika a efektivně nastavený terapeutický postup, který respektuje individuální dopad procesu hojení na pacienta. Specifický standardizovaný dotazník Wound-QoL byl vytvořen v roce 2014 za účelem hodnocení kvality života pacientů s chronickou/nehojící se ránou autory z Německa. Překladem do českého jazyka a následným ověřením psychometrických vlastností získáme hodnoticí nástroj pro výzkumné účely a především každodenní praxi. Článek popisuje překlad dotazníku do českého jazyka, který byl proveden dle pokynů autorů dotazníku a platných norem v této oblasti (double blind translation) a byl také původními autory schválen. Další fáze výzkumného šetření (ověření validity, reliability a citlivosti nástroje) aktuálně probíhají.

Objective: Chronic wounds are projected to reach epidemic proportions due to the aging population and the increasing incidence of diabetes. There is a strong clinical need for an improved wound dressing that can balance wound moisture, promote cell migration and proliferation, and degrade at an appropriate rate to minimize the need for dressing changes. Approach: To this end, we have developed a bioactive, hydrogel microsphere wound dressing that incorporates a collagen-mimetic protein, Scl2 GFPGER , to promote active wound healing. A redesigned Scl2 GFPGER , engineered collagen (eCol GFPGER ), was created to reduce steric hindrance of integrin-binding motifs and increase overall stability of the triple helical backbone, thereby resulting in increased cell adhesion to substrates. Results: This study demonstrates the successful modification of the Scl2 GFPGER protein to eCol GFPGER , which displayed enhanced stability and integrin interactions. Fabrication of hydrogel microspheres provided a matrix with adaptive moisture technology, and degradation rates have potential for use in human wounds. Innovation: This collagen-mimetic wound dressing was designed to permit controlled modulation of cellular interactions and degradation rate without impact on other physical properties. Its fabrication into uniform hydrogel microspheres provides a bioactive dressing that can readily conform to irregular wounds. Conclusion: Overall, this new eCol GFPGER shows strong promise in the generation of bioactive hydrogels for wound healing as well as a variety of tissue scaffolds.

Modern wound treatment calls for hydroactive dressings. Among the variety of materials that have entered the field of wound care in recent years, the carbohydrate polymer bacterial cellulose (BC) represents one of the most promising candidates as the biomaterial features a high moisture-loading and donation capacity, mechanical stability, moldability, and breathability. Although BC has already gained increasing relevance in the treatment of burn wounds, its potential and clinical performance for “chronic wound” indications have not yet been sufficiently investigated. This article focuses on experimental and clinical data regarding the application of BC within the indications of chronic, non-healing wounds, especially venous and diabetic ulcers. A recent clinical observation study in a chronic wound setting clearly demonstrated its wound-cleansing properties and ability to induce healing in stalling wounds. Furthermore, the material parameters of BC dressings obtained through the sta...

In the final Session, John D. Williams (UWCM, Cardiff) highlighted that changes in the peritoneal membrane affect peritoneal dialysis in patients undergoing this treatment for kidney failure. David W. Thomas (Dental School, UWCM, Cardiff), proposed that the oral mucosa heals without scarring due to excellent reepithelialisation and organisation of the matrix. After proposing that evolution has developed an ineffective wound healing process, designed principally to cope with a surface scratch Gus McGrouther (London) gave the concluding lecture on the clinical perspective, the approach to assessment and treatment of surgical wounds.

Chronic ulceration of the leg represents a major, underestimated problem of modern health care, involving physical and cosmetic impairment and social stigma along with high community costs for patients' treatment. The increasing prevalence of chronic ulcers, currently reported to be as much as 0.3% in the general population, should stimulate identification of more efficacious therapeutic approaches to achieve complete healing. The strategies of regenerative medicine based on small molecules, biomimetic scaffolds, gene or cell therapy, and electromagnetic field manipulation represent some of the modern therapeutic alternatives for wound healing. Here we review in an integrated, interdisciplinary approach the modern cellular and molecular mechanistic concepts regarding the involvement of extremely low frequency electromagnetic fields (ELF-EMF) in the complex process of tissue repair, with particular focus on chronic wounds. The data analysis supports three main effects of electromagnetic fields on the wound healing pathways: 1) an antiinflammatory effect, by modulation of cytokine profile that induces the transition of the healing process from a chronic pro-inflammatory to an anti-inflammatory state; 2) a neo-angiogenic effect, by increased endothelial cells proliferation and tubulization and production of fibroblast growth factor (FGF)-2; and 3) a reepithelialization effect, by stimulation of collagen formation. We believe that utilization of ELF-EMF in larger clinical trials designed to optimize these functional parameters would facilitate a better understanding of ELF-EMF-induced healing mechanisms and lead to improved therapeutic outcomes for this disabling condition which is often totally resistant to treatment.

Chronic ulceration of the leg represents a major, underestimated problem of modern health care, involving physical and cosmetic impairment and social stigma along with high community costs for patients' treatment. The increasing prevalence of chronic ulcers, currently reported to be as much as 0.3% in the general population, should stimulate identification of more efficacious therapeutic approaches to achieve complete healing. The strategies of regenerative medicine based on small molecules, biomimetic scaffolds, gene or cell therapy, and electromagnetic field manipulation represent some of the modern therapeutic alternatives for wound healing. Here we review in an integrated, interdisciplinary approach the modern cellular and molecular mechanistic concepts regarding the involvement of extremely low frequency electromagnetic fields (ELF-EMF) in the complex process of tissue repair, with particular focus on chronic wounds. The data analysis supports three main effects of electromagnetic fields on the wound healing pathways: 1) an antiinflammatory effect, by modulation of cytokine profile that induces the transition of the healing process from a chronic pro-inflammatory to an anti-inflammatory state; 2) a neo-angiogenic effect, by increased endothelial cells proliferation and tubulization and production of fibroblast growth factor (FGF)-2; and 3) a reepithelialization effect, by stimulation of collagen formation. We believe that utilization of ELF-EMF in larger clinical trials designed to optimize these functional parameters would facilitate a better understanding of ELF-EMF-induced healing mechanisms and lead to improved therapeutic outcomes for this disabling condition which is often totally resistant to treatment.

Wound repair is a quiescent mechanism to restore barriers in multicellular organisms upon injury. In chronic wounds, however, this program prematurely stalls. It is known that patterns of extracellular signals within the wound fluid are crucial to healing. Extracellular pH (pH e ) is precisely regulated and potentially important in signaling within wounds due to its diverse cellular effects. Additionally, sufficient oxygenation is a prerequisite for cell proliferation and protein synthesis during tissue repair. It was, however, impossible to study these parameters in vivo due to the lack of imaging tools. Here, we present luminescent biocompatible sensor foils for dual imaging of pH e and oxygenation in vivo. To visualize pH e and oxygen, we used time-domain dual lifetime referencing (tdDLR) and luminescence lifetime imaging (LLI), respectively. With these dual sensors, we discovered centripetally increasing pH e -gradients on human chronic wound surfaces. In a therapeutic approach, we identify pH e -gradients as pivotal governors of cell proliferation and migration, and show that these pH e -gradients disrupt epidermal barrier repair, thus wound closure. Parallel oxygen imaging also revealed marked hypoxia, albeit with no correlating oxygen partial pressure (pO 2 )-gradient. This highlights the distinct role of pH e -gradients in perturbed healing. We also found that pH e -gradients on chronic wounds of humans are predominantly generated via centrifugally increasing pH e -regulatory Na + /H + -exchanger-1 (NHE1)-expression. We show that the modification of pH e on chronic wound surfaces poses a promising strategy to improve healing. The study has broad implications for cell science where spatial pH e -variations play key roles, e.g. in tumor growth. Furthermore, the novel dual sensors presented herein can be used to visualize pH e and oxygenation in various biomedical fields.

Chronic wound treatment currently relies heavily on visual assessment by clinicians; however, the clinical signs and symptoms of infection and inflammation are unreliable in chronic wounds. The specialty of wound care has witnessed the advent of advanced interventions, such as cellular and/or tissue based products (CTP). The success of advanced therapies relies on preparing the wound bed by reducing bacterial burden and inflammation. The lack of diagnostics in chronic wound care leads to uncertainty in the adequacy of wound bed preparation. Recent research suggests that two novel point-of-care diagnostic tests can assist in the detection of chronic inflammation known as elevated neutrophil derived protease activity (EPA) and bacterial pathogenesis known as bacterial protease activity(BPA) in chronic wounds. Despite the evidence, however, clinicians report that incorporating diagnostics into every day practice is challenging and across the globe, they have requested guidance on their...

Introduction: Synchronous carcinomas are defined multiple primary neoplasms occurring in different locations belonging to different morphologic or histologic origin ocurrin at the same time in a patient. This is the first report of a cutaneous squamous cell carcinoma presenting synchronically with a clear renal cell carcinoma, confirming is not a metastatic process. Case Report: A 53-year-old man had a clinical course of eight months of evolution, of a continuously growing mass in the left gluteus and thigh with inguinal adenopathies, in the same place of a previously burn area, for which complementary imaging studies were indicated to establish the extent of the lesion, with an incidental finding of a tumor in left kidney. Biopsies of the gluteal and left kidney lesions were performed, showing a verrucous variant squamous cell carcinoma in gluteal region and a clear cell differentiation concordant with clear cell renal cell carcinoma in left kidney. Conclusion: Synchronous carcinoma implies a complex interactions between genetic and environmental factors for its development. Clinical manifestations usually presents in advance stages of both carcinomas, but can be detected with extension studies as in this case.

Tkáně v okolí chronické/nehojící se rány jsou velmi křehké a vyžadují správné ošetřování v celém průběhu tzv. fázového hojení. Cílem je udržovat kůži v okolí rány zdravou, klidnou, čistou a hydratovanou, a tím podporovat proces uzávěru rány cestou epitelizace. Péče o okolí rány v rámci managementu rány vyžaduje pozornost pečující osoby a včasný zásah v případě výskytu komplikací. Na trhu je velké množství produktů k čištění a ošetřování tkáně v okolí rány. Pojednání Péče o okolí rány věnuje pozornost tématu péče o okolí rány obecně a předkládá také kazuistiku. Klíčová slova: okolí rány, chronická rána, nehojící se rána, péče o ránu a okolí. Periwound tissue of the chronic/non-healing wound is fragile and requires proper treatment throughout the so-called phase healing. The main goal is to keep the wound environment and periwound skin calm, clean and hydrated, thus supporting the wound closure process through epithelization. Care of the wound environment within wound management requires the attention of caregivers and early intervention in case of complications. There are many products on the market to clean and treat periwound skin and appropriate products selection is important. We deal with the topic of periwound tissue and skin care in general and we also present a case report.

Chronic wounds cause substantial morbidity and disability. Infection in chronic wounds is clinically defined by routine culture methods that can take several days to obtain a final result, and may not fully describe the community of organisms or biome within these wounds. Molecular diagnostic approaches offer promise for a more rapid and complete assessment. We report the development of a suite of real-time PCR assays for rapid identification of bacteria directly from tissue samples. The panel of assays targets 14 common, clinically relevant, aerobic pathogens and demonstrates a high degree of sensitivity and specificity using a panel of organisms commonly associated with chronic wound infection. Thirty-nine tissue samples from 29 chronic wounds were evaluated and the results compared with those obtained by culture. As revealed by culture and PCR, the most common organisms were methicillin-resistant Staphylococcus aureus (MRSA) followed by Streptococcus agalactiae (Group B streptococcus) and Pseudomonas aeruginosa. The sensitivities of the PCR assays were 100% and 90% when quantitative and qualitative culture results were used as the reference standard, respectively. The assays allowed the identification of bacterial DNA from ten additional organisms that were not revealed by quantitative or qualitative cultures. Under optimal conditions, the turnaround time for PCR results is as short as 4-6 h. Real-time PCR is a rapid and inexpensive approach that can be easily introduced into clinical practice for detection of organisms directly from tissue samples. Characterization of the anaerobic microflora by real-time PCR of chronic wounds is warranted.

Background-Wound assessment relies on visual evaluation by physicians. Such assessment is largely subjective and presents the opportunity to explore the use of emergent technologies. Methods-Emergent and powerful noninvasive imaging technologies applicable to assess burn and chronic wounds are reviewed. Results-The need to estimate wound depth is critical in both chronic wound and burn injury settings. Harmonic ultrasound technology is powerful to study wound depth. It addresses the limitations of optical imaging with limited depth of penetration. What if a wound appears epithelialized by visual inspection, which shows no discharge yet is covered by repaired skin that lacks barrier function? In this case although the wound is closed as defined by current standards, it remains functionally open, presenting the risk of infection and other postclosure complications. Thus, assessment of skin barrier function is valuable in the context of assessing wound closure. Options for the study of tissue vascularization are many. If noncontact and noninvasive criteria are of importance, laser speckle imaging is powerful. Fluorescence imaging is standard in several clinical settings and is likely to serve the wound clinics well as long as indocyanine green injection is not of concern. A major advantage of harmonic ultrasound imaging of wound depth is that the same system is capable of providing information on blood flow dynamics in arterial perforators. Conclusion-With many productive imaging platforms to choose from, wound care is about to be transformed by technology that would help assess wound severity. In current clinical practice, assessment of wounds mostly relies on visual evaluation by physicians and clinical staff. 1 As a result, the assessment is largely subjective and presents a major opportunity to explore the use of emergent technologies. Visual evaluation of wounds, the current gold standard, has served us well but is clearly not the future of wound care. Key limitations include heavy reliance of experience and subjective variations. Current imaging modalities offer a more in-depth assessment of the wound bed and its surroundings. The ability to obtain 3-dimensional (3D) visualization of the structure as well as function of the

a1-Antichymotrypsin (a1-ACT) is a secreted serine proteinase inhibitor of the serpin family. It is strongly upregulated during the inflammatory phase of wound repair to control the undesirable destructive side effects of cathepsin G which is released from infiltrating neutrophils. We have shown that a1-ACT and its mouse homologue spi2 exhibit a classic acute phase response after cutaneous injury in murine and human skin. The induction of spi2 gene expression following wounding is significantly less pronounced in diabetic mice. Transient overexpression of spi2 or a1-ACT significantly increased wound tensile strength in two independent diabetic models: in genetically diabetic mice, gene gun mediated delivery of spi2 or a1-ACT cDNA increased the average wound strength by 42% (P ¼ 0.001) and 21% (P ¼ 0.013) at d5 post-wounding respectively. In a STZ induced diabetic rat model the breaking strength of adenovirally spi2-or a1-ACT-infected wounds increased by 20% (P ¼ 0.049) and 23% (P ¼ 0.004) at d7 after injection respectively. Moreover, the topical application of human a1-ACT protein to wounds of diabetic mice had a significant and dose dependent effect on tensile strength at d5 post-wounding (21% increase, P ¼ 0.003). Histological analyses of these wounds indicated less infiltration of neutrophils in the treated wounds. a1-ACT appears to be a key mediator between proteolysis and cytokine agonism and antagonism. Our data indicate that this balance is disturbed in diabetic wounds and that a1-ACT might act as a switch to initiate wound healing in diabetic ulcers.

Approximately 1% of skin cancers occur secondary to chronic inflammation, and approximately 95% of these are squamous cell carcinomas (SCC) with a metastasis rate of 20-30%. This case report describes the treatment of a 38year-old male patient with paraplegia and with a history of operated meningomyelocele and congenital hip dysplasia who was admitted to the  back 5.12.2025 14:33 Treatment response time in a patient with hard-to-heal ulcers: a case report | Journal of Wound Care

A wound is defined as chronic when it does not heal according to the normal repair times and mechanisms. This particular condition may be principally due to local hypoxia. Carbon dioxide (CO(2)) therapy refers to the transcutaneous or subcutaneous administration of CO(2) for therapeutical effects on both microcirculation and tissue oxygenation. In this study, we report the clinical and instrumental results of the application of CO(2) in the therapy of chronic wounds. The study included 70 patients affected by chronic ulcers. The patients were selected by aetiology and wound extension and equally divided into two homogeneous groups. In group A, CO(2) therapy was used in addition to the routine methods of treatment for such lesions (surgical and/or chemical debridement, advanced dressings according to the features of each lesion). In group B, patients were treated using routine methods alone. Both groups underwent to instrumental (laser doppler flow, measurement of TcPO(2)), clinical ...

The human placenta, a transient and necessary embryonic-maternal organ, is a promising biotherapeutic agent due to its complex bioactive components and diverse pharmacological properties. Biologically, this metabolically active organ contains enzymes, peptides, polynucleotides, cytokines, growth factors, vitamins, and trace elements that underpin its therapeutic potential. Beyond its physiological properties, human placental extract (HPE) has attracted considerable attention in early diagnostics and innovative therapy. Several studies demonstrate the anti-inflammatory, antimicrobial, antitumor, antioxidant, anti-apoptotic, analgesic, immunomodulatory, and skin-rejuvenating properties of HPE, often mediated through nuclear factor kappa B, nuclear factor erythroid 2-related factor 2, and toll-like receptor 4 pathways. The review described current knowledge on HPE, focusing on its structural, morphological, biochemical, and functional characteristics. Additionally, we highlight advantages of placental extract therapy compared to traditional cell therapies, such as cost-effectiveness, low immunogenicity, no proliferation and differentiation in the host, safe cryopreservation, low medical complications, enhanced penetration across impermeable physiological barriers, and customizable bioactivity. Recent advancements demonstrate HPE's promise in gene therapy, immune activation, drug delivery, and early diagnosis of various diseases. However, HPE's challenges, including method-dependent inconsistencies, variable compositions, lack of standardization and regulation, limited scientific validation, potential contamination, expensive procedures, data privacy issues, ethical and legal concerns, have restricted their therapeutic applications. This comprehensive overview highlights HPE as a promising agent for diagnosis, therapy, and prognosis across different medical fields.

À minha querida mãe, Idalina Gaspar, por todo o carinho e dedicação que sempre demonstrou ao longo do meu percurso académico, pelo suporte imprescindível, pelo seu grande esforço em me ter proporcionado oportunidades que me permitiram alcançar mais uma etapa da minha vida e, sobretudo, por ser a pessoa mais importante da minha vida. Ao meu irmão, Gonçalo Jesus, que apesar da distância, sempre transmitiu palavras de apoio e de incentivo ao longo da minha trajetória. Ao meu querido noivo, Bruno Abreu, por toda a atenção, amor, carinho e compreensão nos momentos mais difíceis, tornando-os incansáveis, suportáveis e transmitindo-me confiança nas minhas capacidades e conhecimento para ir mais além. Ao meu orientador, Prof. Doutor Fernando Mena Martins. Ao meu coorientador, Prof. Doutor Manuel Luís Vila Capelas, pela sua disponibilidade, orientação, paciência, incentivo e contribuição científica fundamentais para o aumento do meu conhecimento como investigadora. Obrigada pelo respeito e por me fazer acreditar que sou capaz. Ao meu grande amigo, Edgar Rodrigues, pela sua preocupação, dedicação, pelas suas palavras reconfortantes e pelo convívio alegre nos momentos mais fatigantes. À minha amiga, Tatiana Paulos, pelo seu carinho, dedicação, palavras de confiança, apoio incondicional e essencialmente pela amizade sincera demonstrada ao longo deste percurso difícil mas gratificante. Aos utentes que participaram neste trabalho de investigação e que acreditaram na sua importância. À minha colega Joana Prioste pelas jornadas de trabalho incansáveis. À Sr.ª Enfermeira Diretora, Enf.ª Conceição Vieira pelo incentivo, disponibilidade e por acreditar na contribuição desta pesquisa para a enfermagem. Às Professoras Doutoras Maria Luísa Santos e Sílvia Caldeira pelas palavras encorajadoras para o ponto de partida desta dissertação. À minha chefe, Enf.ª Ana Gouveia, por me ter ajudado a conciliar o meu horário de atividade para o mestrado com as funções exercidas no centro de saúde. Agradecida, igualmente, pela compreensão e apoio. À minha amiga, Joana Escórcio, que apesar da distância, sempre transmitiu companheirismo, apoio, disponibilidade e confiança. Obrigada pela amizade. Às Enfermeiras chefes, Enf.ª Conceição Rosa, Enf.ª João Franco, Enf.ª Susana Teles, Enf.ª Fátima Fernandes e Enf.ª Lígia Carreira, pela colaboração prestada, disponibilidade e simpatia. A todas as minhas colegas enfermeiras, Lúzia Silva, Beto Martins, Maria José, Márcia Silva, Emília Freitas, e Andreia Ascenção por participarem na colheita de dados deste estudo e por terem colaborado, consideravelmente, para a concretização deste estudo. Ao meu noivo, Bruno Abreu, por fazeres os meus dias mais felizes. À minha tia, Irene Gaspar, por todo o seu carinho, amor e por ter cooperado para a concretização deste objetivo pessoal. A todos os meus outros amigos, familiares e profissionais que contribuíram de forma direta e/ou indireta para a realização deste trabalho. Introdução: A úlcera de perna não é uma doença isolada mas é a consequência de uma ou várias patologias subjacentes, e representa um problema de saúde pública de abrangência mundial. Metodologia: Este estudo ambiciona determinar a taxa de prevalência das úlceras de perna, caraterizar os aspetos sociodemográficos, caraterizar os fatores de risco, identificar os métodos de diagnóstico utilizados para a definição da etiologia da úlcera de perna, caraterizar as úlceras de perna e identificar as caraterísticas gerais do tratamento. Estudo parcelar, epidemiológico transversal, observacional, analítico e abordagem quantitativa. A amostra do estudo incluiu 62 utentes com úlcera de perna inscritos nos centros de saúde: Machico,

It is generally acknowledged that the age of antibiotics could come to an end, due to their widespread, and inappropriate use. Particularly for chronic wounds alternatives are being thought. Antimicrobial Photodynamic Therapy (APDT) is a potential candidate, and while approved for some indications, such as periodontitis, chronic sinusitis and other niche indications, its use in chronic wounds is not established. To further facilitate the development of APDT in chronic wounds we present an easy to use animal model exhibiting the key hallmarks of chronic wounds, based on full-thickness skin wounds paired with an optically transparent cover. The moistureretaining wound exhibited rapid expansion of pathogen colonies up to 8 days while not jeopardizing the host survival. Use of two bioluminescent pathogens; methicillin resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa permits real time monitoring of the pathogens. The murine model was employed to evaluate the performance of four different photosensitizers as mediators in Photodynamic Therapy. While all four photosensitizers, Rose Bengal, porphyrin TMPyP, New Methylene Blue, and TLD1411 demonstrated good to excellent antimicrobial efficacy in planktonic solutions at 1 to 50 µM concentrations, whereas in in vivo the growth delay was limited with 24-48 h delay in pathogen expansion for MRSA, and we noticed longer growth suppression of P. aeruginosa with TLD1411 mediated Photodynamic Therapy. The murine model will enable developing new strategies for enhancement of APDT for chronic wound infections.

Background: The incidence of diabetes is rising in low-and middle-income countries, with many cases undiagnosed until complications, such as diabetic foot ulcers (DFUs), manifest. Effective management of DFUs requires a multidisciplinary approach involving various Healthcare Professionals (HCPs) such as doctors, nurses, physician assistants, and disease control officers among others. This study assessed the factors influencing the management of DFUs among HCPs at the primary healthcare level in the Bosomtwe District, Ghana. Methodology: A cross-sectional study where a quantitative approach was used across three purposively selected health facilities. A sample size of 231 respondents was selected using a simple random sampling technique. Data were collected using self-designed, pretested questionnaires and analyzed using descriptive and inferential statistics with STATA version 16. Results: Majority (71%) of the participants were registered nurses, with no podiatrist available in the district. While 69.5% of the respondents had general knowledge about managing DFUs, they lacked specific knowledge on dressings and offloading devices. Nearly all the respondents (99.75%) did not follow evidence-based guidelines for DFU management due to the absence of a universal protocol. However, there is a strong association between regularly consulting evidence-based guidelines and better DFU management outcomes (P < 0.001, odds ratio [OR] = 0.36, confidence interval [CI] =0.17-0.72). Furthermore, challenges in HCPs adhering to these guidelines (P = 0.001, OR: 0.03 CI = 0.04-0.22), patient difficulties in following treatments (P < 0.001, OR = 0.04, CI = 0.02-0.81), and low confidence in diagnosing DFUs (P < 0.001 OR = 0.65, CI = 0.55-0.76) are also significantly linked to poorer management outcomes. Conclusion: The study revealed major gaps in knowledge and adherence to guidelines in DFU management among HCPs in the Bosomtwe District. The study also found that lack of universal protocols, low diagnostic confidence, and patient noncompliance are some of the issues relating to poor DFU management. Standardized protocols, targeted training, and better patient education are needed to improve outcomes according to the study.

Yara, herhangi bir hasar ya da hücresel bozukluk sonucu doku bütünlüğünün bozulması durumudur. Kronik hastalıklarda belirli bir süre içerisinde iyileşmeyen ve genellikle tekrarlayan kronik yaralar oluşur. Diyabetik ayak, basınç yarası yaygın görülen kronik yaralardır ve yaşam kalitesi üzerinde önemli etkiye sahip bir sağlık sorunudur. Kronik yaralar hasta ve sağlık sistemi açısından önemli bir psikolojik, sosyal ve finansal yük oluşturmaktadır. Yara bakımında öncelikle en önemli husus, yara oluşumuna neden olan etkenleri belirleyip ortadan kaldırmaktır. Kronik yaraların önlenmesinde ve tedavi edilmesinde hastayla en çok ilgilenen ve bakım, tedavisini uygulayan hemşirelerin önemli bir rolü bulunmaktadır. Yara bakımı evreleme yöntemi ile izlenmeli ve yaranın özelliklerine göre uygun pansuman ve yara bakımı malzemesi kullanılmalıdır.

KRATICE KORIŠTENE U RADU: alfa-MSHalfa hormon stimulacije melanocita AMPantimikrobni peptid ARandrogeni receptor CAMP -Christie-Atkins-Munch-Peterson faktor CRHkortikotropin-oslobađajući hormon GM-CSF -stimulirajući faktor granulocitno-makrofagnih kolonija IFNγinterferon gama IGF 1inzulinu sličan faktor rasta IL-xinterleukin MMPmatriks metaloproteinaza mTORkinaza meta rapamicina NF-κBnukearni faktor kapa B PARproteazom aktivirani receptor SLSTengl. ,,single locus sequence typing˝ SREBPprotein koji veže regulacijski element sterola TEWLtransepidermalni gubitak vode TLRengl. ,,toll-like receptor˝ TNF-α -čimbenik nekroze tumora VEGFvaskularni endotelni faktor rasta

Chronic wound management becomes a complex procedure because of the persistence of forming biofilm pathogens that do not respond to antimicrobial treatment. The aim of this paper is to detect the Graphene Oxide-GO effect on Staphylococcus aureus and Pseudomonas aeruginosa dual species wound biofilm in Lubbock Chronic Wound Biofilm-LCWB model. LCWB is a recognized model that mimics the spatial microbial colonization into chronic wounds and reproduces the wound and its clot. Staphylococcus aureus PECHA 10 and P. aeruginosa PECHA 4, are the pathogens used in the study. The GO effect on both in forming and mature biofilms, is detected by the evaluation of the CFU/mg reduction, the cell viability and ultrastructural analysis of the treated LCWBs. Graphene Oxide, at 50 mg/l, shows a significant antibiofilm effect in forming and mature LCWBs. In particular, during the biofilm formation, GO reduces the S. aureus and P. aeruginosa growth of 55.05% ± 4.73 and 44.18% ± 3.91 compared to the con...

Although diverse immunomodulatory effects of vitamin D are increasingly being recognized, the ability of oral vitamin D to rapidly modulate immune responses in vivo has not been established in humans. We designed an interventional study to test the hypothesis that oral vitamin D would be capable of rapidly attenuating experimental sunburn. Twenty healthy adults were randomized, in a double-blinded fashion, to receive either placebo or a high dose of vitamin D 3 (cholecalciferol) one hour after experimental sunburn induced by an erythemogenic dose of simulated solar radiation. As compared to placebo, participants receiving vitamin D 3 (200,000 IU) demonstrated reduced expression of the pro-inflammatory mediators TNF-a (p¼0.04) and iNOS (p¼0.02) in skin biopsy specimens 48 hours after experimental sunburn. A blinded unsupervised hierarchical clustering of participants based on global gene expression profiles revealed that participants with significantly higher serum vitamin D 3 levels after treatment (p¼0.007) demonstrated increased skin expression of the anti-inflammatory mediator arginase-1 (p¼0.005), a sustained reduction in skin redness (p¼0.02), and significant expression of skin barrier repair genes. In contrast, participants with lower serum vitamin D 3 levels had significant expression of pro-inflammatory genes. These findings demonstrate that oral vitamin D is capable of rapidly attenuating experimental sunburn, and implicate arginase-1 up-regulation as a novel mechanism by which vitamin D exerts anti-inflammatory effects in humans. These results have broad implications for the role of vitamin D in skin homeostasis, and suggest that oral vitamin D may be clinically therapeutic for its immunomodulatory properties.

Wound healing is a complex, highly regulated process that is critical in maintaining the barrier function of skin. With numerous disease processes, the cascade of events involved in wound healing can be affected, resulting in chronic, non-healing wounds that subject the patient to significant discomfort and distress while draining the medical system of an enormous amount of resources. The healing of a superficial wound requires many factors to work in concert, and wound dressings and treatments have evolved considerably to address possible barriers to wound healing, ranging from infection to hypoxia. Even optimally, wound tissue never reaches its pre-injured strength and multiple aberrant healing states can result in chronic non-healing wounds. This article will review wound healing physiology and discuss current approaches for treating a wound.

Adelay in wound closure can result from poor perfusion, infection, pressure or chronic venous hypertension. How ever, problem wounds are rarely affected by a single factor. To facilitate wound healing, systemic and local factors that may impede healing need to be addressed.

Extracellular vesicle (EV)-based therapies have attracted considerable attention as a novel class of biologics with broad clinical potential. However, their clinical translation is impeded by the fragmented and rapidly evolving regulatory landscape, with significant disparities between the United States, European Union, and key Asian jurisdictions. In this review, we systematically analyze regional guidelines and strategic frameworks governing EV therapeutics, emphasizing critical hurdles in quality control, safety evaluation, and efficacy demonstration. We further explore the implications of EVs' heterogeneity on product characterization and the emerging direct-to-consumer market for EVs and secretome preparations. Drawing on these insights, in this review, we aim to provide a roadmap for harmonizing regulatory requirements, advancing standardized analytical approaches, and fostering ongoing collaboration among regulatory authorities, industry stakeholders, and academic investigators. Such coordinated efforts are essential to safeguard patient welfare, ensure product consistency, and accelerate the responsible integration of EV-based interventions into clinical practice.

Infective complications are a major factor contributing to wound chronicity and can be associated with significant morbidity or mortality. Wound bacteria are protected in biofilm communities and are highly resistant to immune system components and to antimicrobials used in wound therapy. There is an urgent medical need to more effectively eradicate wound biofilm pathogens. In the present work, we tested the impact of such commonly used antibiotics and antiseptics as gentamycin, ciprofloxacin, octenidine, chlorhexidine, polihexanidine, and ethacridine lactate delivered to Staphylococcus aureus and Pseudomonas aeruginosa biofilms in the presence of rotating magnetic fields (RMFs) of 10–50 Hz frequency and produced by a customized RMF generator. Fifty percent greater reduction in biofilm growth and biomass was observed after exposure to RMF as compared to biofilms not exposed to RMF. Our results suggest that RMF as an adjunct to antiseptic wound care can significantly improve antibiofi...

Chronic wounds caused by infections, diabetes, and radiation exposures are becoming a worldwide growing medical burden. Recent progress highlighted the physical signals determining stem cell fates and bacterial resistance, which holds potential to achieve a better wound regeneration in situ. Nanoparticles (NPs) would benefit chronic wound healing. However, the cytotoxicity of the silver NPs (AgNPs) has aroused many concerns. This review targets the tunable physical properties (i.e., mechanical-, structural-, and size-related properties) of either dermal matrixes or wound dressings for chronic wound care. Firstly, we discuss the recent discoveries about the mechanical-and structural-related regulation of stem cells. Specially, we point out the currently undocumented influence of tunable mechanical and structural properties on either the fate of each cell type or the whole wound healing process. Secondly, we highlight novel dermal matrixes based on either natural tropoelastin or synthetic elastin-like recombinamers (ELRs) for providing elastic recoil and resilience to the wounded dermis. Thirdly, we discuss the application of wound dressings in terms of size-related properties (i.e., metal NPs, lipid NPs, polymeric NPs). Moreover, we highlight the cytotoxicity of AgNPs and propose the size-, dose-, and time-dependent solutions for reducing their cytotoxicity in wound care. This review will hopefully inspire the advanced design strategies of either dermal matrixes or wound dressings and their potential therapeutic benefits for chronic wounds.

Background. Mitogen-activated autologous peripheral blood mononuclear cells applied locally on the ulcer surface promote healing of chronic arterial and venous leg ulcers. In vitro , extremely low frequency electromagnetic fields (ELF) interact with peripheral blood mononuclear cells (PBMC) via Ca ϩϩ channels, activating signal transduction cascades, promoting cytokine synthesis, and changing cell proliferation patterns. Methods. ELF frequencies were configured to interact in vitro with the proliferation patterns of PBMC obtained from normal human volunteers. These ELF were then applied peripherally as the sole treatment to 26 patients with 42 chronic leg ulcers of predominantly arterial or venous etiology unresponsive to previous medical and/or surgical treatments in a phase I before-after design. Results. At admission, age of ulcers had a skewed distribution with a median of 639 days. Wound healing or deleterious effects began in all patients during the first 2 weeks after ELF exposure, permitting their previously unresponsive ulcers to function as internal controls. After ELF exposure, 69% of all lesions were cured or healed Ͼ 50% in a period Ͻ 4 months. Defective wound healing was observed in lesions associated with important arterial occlusion, uncontrolled arterial hypertension, severe lipodermatosclerosis, non-pitting edema, and obesity (body mass index Ͼ 30). Lesions worsened in patients with autoimmune diseases. Conclusions. Systemic effects are hypothetically explained by ELF activation of PBMC and their subsequent transportation to the ulcer site via humoral route. This therapy is effective in selected patients with chronic arterial and venous leg ulcers.

Background: Multiple Sclerosis (MS) is a progressive, degenerative disease of the central nervous system. People with advanced disease who have compromised mobility, activity, sensory and/or cognitive abilities are at risk of pressure ulcers. Having a pressure ulcer has a substantial impact on a person's quality of life; a generic pressure ulcer Health Related Quality of Life (HRQL) framework has been used in this study. Aim: To explore the views and opinions of patients with MS who have a pressure ulcer using a thematic framework and compare these to the general pressure ulcer population. Methods: Data for six MS patients was obtained through secondary analysis of transcripts from semi-structured interviews conducted during two studies which were part of a programme of HRQL Research. Findings: Patients with MS reported that their pressure ulcer affected their lives physically, psychologically and socially. All were confined to bed (as part of their pressure ulcer treatment) and therefore unable to participate in activities. Difficulties with movement and activity were partially attributed to the MS. Patients with MS did not report feeling ill with their pressure ulcer and expressed positive emotions and optimism. Pain or discomfort was a feature of the pressure ulcer for most patients. Conclusions: Pressure ulcers have a major impact on QOL for all patients. Problems with mobility and activity associated with the pressure ulcer were confounded by the MS.

Chronic wound care is a growing medical problem, reaching epidemic proportions worldwide. Even after the wound has healed, wound recurrence remains a significant issue, with rates approximating 40% in 6 months after healing. The authors evaluate a retrospective analysis of their wound care clinics healing and recurrence rates. The authors evaluate the efficacy of varying physical modalities on preventing recurrence of wounds after their healing. The authors take their evaluation out to one year.

Background: Chronic osteomyelitis is a challenging problem, and malignant transformation is a rare occurrence. We report a case of a patient with squamous cell carcinoma arising from an osteomyelitic hotbed and discuss through a literature review the etiopathogenesis, diagnosis, and treatment of this lesion. Case presentation: A 69-year-old Italian man had sustained an exposed tibial fracture 40 years ago during a road accident, for which he had undergone various surgical osteosynthesis treatments with multiple antibiotic therapies. He presented to our hospital because of recurrence of a fistula at the proximal third of the anterior region of the tibia. For 2 months, we treated the lesion with antibiotics, and local medication with curettage. We saw no evidence of lesion improvement, and we advised the patient to undergo a knee amputation, which he refused. The alternative we chose was a surgical toilet of the osteomyelitic hotbed and used bioglass as a bone substitute. After 2 months of follow-up, we noticed a fulminating, budding formation in the area of the surgical wound that turned out to be a squamous cell carcinoma on biopsy. The patient again refused the amputation and underwent a wide-margin surgical debridement. After 2 months, the carcinoma recurred, and an above-the-knee amputation was performed. Conclusions: Our experience with this case indicates that amputation is the most appropriate treatment for squamous carcinoma occurring in patients with chronic osteomyelitis. To avoid risks of lymphonodular and organ metastasization, this radical surgical procedure should not be delayed. Early diagnosis and timely therapy can prevent amputation only in selected cases. Surgeons who treat osteomyelitis and chronic wounds should be aware of the risk of tumor degeneration. Squamous cell carcinoma associated with chronic osteomyelitis has a low-grade malignancy, but implications of lymphonodular involvement and organ metastasis should not be excluded.

Introduction: Diabetic foot ulcer (DFU) is a major cause of lower limb amputations. Many treatment recommendations have been proposed. This study was conducted to evaluate the effectiveness of topical sucralfate when combined with mupirocin ointment, in the treatment of diabetic foot ulcer in comparison to topical mupirocin alone, in terms of healing rates. Methods: This open-labeled randomized study was conducted on 108 patients to evaluate the effectiveness of topical sucralfate and mupirocin combination, compared to topical mupirocin alone. The patients were administered the same parenteral antibiotic, and wounds were subjected to daily dressing. The healing rates (determined by the percentage reduction in wound area) in the two groups were calculated. The mean healing rates in both groups were expressed in percentage and compared using the Student's t-test. Results: A total of 108 patients were included in the study. Male-to-female ratio was 3:1. The incidence of diabetic foot was the highest (50.9%) in the age group of 50-59 years. The mean age of the study population was 51 years. The incidence of diabetic foot ulcers was highest in the months of July-August (42%). A total of 71.2% patients had random blood sugar levels between 150-200 mg/dL, and 72.2% patients had diabetes for five to 10 years. The mean±standard deviation (SD) of the healing rates in the sucralfate and mupirocin combination group and the control group were 16.2±7.3% and 14.5±6.6%, respectively. Comparison of the means by Student's t-test failed to show a statistical difference in healing rates between the two groups (p=0.201). We concluded that the addition of topical sucralfate does not show any obvious benefits in terms of healing rates in diabetic foot ulcers as compared to mupirocin alone.

Proteases have various roles in wound healing such as the migration and activation of fibroblasts, extra cellular matrix remodelling and growth factor activation. However, in some non-healing chronic wounds, protease activity remains at an elevated level which impairs wound healing and can lead to chronic inflammation .The impact of elevated protease activity on wound healing is being discussed more frequently clinically and the need to control these proteases is being considered in the selection of treatment for chronic wounds. A number of signs and symptoms are being used to alert the clinician to chronic inflammation and potential elevated protease activity. These include swelling, pain, colour, fibrin deposition and pebbled granulation tissue, to name but a few, but at present there is no visual assessment that conclusively indicates the presence of elevated protease activity in the wound microenvironment.

Chronic wound treatment currently relies heavily on visual assessment by clinicians; however, the clinical signs and symptoms of infection and inflammation are unreliable in chronic wounds. The specialty of wound care has witnessed the advent of advanced interventions, such as cellular and/or tissue based products (CTP). The success of advanced therapies relies on preparing the wound bed by reducing bacterial burden and inflammation. The lack of diagnostics in chronic wound care leads to uncertainty in the adequacy of wound bed preparation. Recent research suggests that two novel point-of-care diagnostic tests can assist in the detection of chronic inflammation known as elevated neutrophil derived protease activity (EPA) and bacterial pathogenesis known as bacterial protease activity(BPA) in chronic wounds. Despite the evidence, however, clinicians report that incorporating diagnostics into every day practice is challenging and across the globe, they have requested guidance on their use. Methods and Recommendations: A panel of wound care experts, experienced with these tests, met to develop guidelines on their use in wound care practice. The consensus panel concluded that the clinician should test for BPA first. The panel maintained that the risk of invasive infection resulting from the presence of pathogenic bacteria was the greatest threat to the patient's health. If the BPA test is negative, the panel recommended testing for EPA. In addition, it was suggested that if the wound failed to progress after the elevated BPA was treated and subsequent testing was negative for BPA, the clinician should consider testing for EPA. Conclusions: In this manuscript, the consensus panel suggests pathways for testing, treating, and retesting for EPA and BPA. The panel expects that following the algorithm has the potential to improve healing outcomes, result in more cost-effective use of advanced therapies, and improve antimicrobial stewardship by guiding antimicrobial use.

Chronic wounds are a growing medical issue around the world, with 2.4 - 4.5 million people afflicted in the United States alone. The condition currently makes up 2-3% of healthcare costs for developed countries, and this number is expected to increase as chronic wound-causing problems, like diabetes, grow in prevalence. Due to the lack of effective wound dressings, chronic wounds face a higher risk for bacterial infection and express high morbidity and mortality rates. Many current dressings are homogeneous and fail to account for the complexities of the different layers of skin. Alternatively, asymmetric electrospun nanofibers have a bilayer design that corresponds to the skin’s dermis and epidermis. We intend to demonstrate that an asymmetric electrospun nanofiber composed of polycaprolactone (PCL), chitosan (CS), and curcumin (Cur) can be utilized as a chronic wound dressing. These three biodegradable and biocompatible components were applied in an asymmetric design to mimic the ...

Chronic wounds are a growing medical issue around the world, with 2.4 -4.5 million people afflicted in the United States alone (1). The condition currently makes up 2-3% of healthcare costs for developed countries (1), and this number is expected to increase as chronic wound-causing problems, like diabetes, grow in prevalence. Due to the lack of effective wound dressings, chronic wounds face a higher risk for bacterial infection and express high morbidity and mortality rates. Many current dressings are homogeneous and fail to account for the complexities of the different layers of skin. Alternatively, asymmetric electrospun nanofibers have a bilayer design that corresponds to the skin's dermis and epidermis. We intend to demonstrate that an asymmetric electrospun nanofiber composed of polycaprolactone (PCL), chitosan (CS), and curcumin (Cur) can be utilized as a chronic wound dressing. These three biodegradable and biocompatible components were applied in an asymmetric design to mimic the protective epidermis and porous dermis. Upon electrospinning our asymmetric nanofiber and running it through a scanning electron microscope, we found that our hydrophobic PCL layer had a low porosity (52.16%) and thin nanofibers (281.82 nm), while our hydrophilic PCL/CS/Cur layer had a high porosity (61.18%) and thick nanofibers (425.54 nm). Our asymmetric nanofiber was also more effective at resisting bacterial permeation than the homogeneous PCL nanofiber. Our results highlight the superiority of asymmetric membranes for resisting bacterial infection and suggest that with further experimentation, we can establish our nanofiber as a viable wound dressing.

The interest in quality of life in healthcare has grown enormously over the past three decades. This interest stems from a shift in focus from treatments alone to a desire to really understand the disease process and impact of treatments from the perspective of the individual. This article explores the literature about pressure ulcers and quality of life. The aim

Seabirds kept in care centers frequently show secondary lesions subsequent to detention conditions: this is the case with scabs. These scabs are very often looked upon as a cause for euthanasia, mainly after an ecological disaster, such as an oil spill, when the number of oiled birds is very large. Seaducks (Melanitta nigra, Melanitta fuscus, Somateria mollissima) were very numerous at the Veterinary School of Nantes after the wreck of the tanker Erika in December 1999. A protocol for the treatment of sternum wounds of seaducks is described. This protocol had a high success rate, with more than 65% of the treated Scoters being completely healed and more than 40% being either released or removed to Dutch care centers to await their molt.