Advances in wound care最新文献

Objective: The risk of pressure injuries (PIs) is increasing in Japan, where an aging population imposes substantial health care burdens. Approach: This retrospective cohort study utilizing the Shizuoka Kokuho Database evaluated factors associated with PI development in hospitalized patients. Results: An analysis of over 546,000 patients aged ≥65 years from 2012 to 2022 identified 6,372 PI cases. Cox regression analyses revealed that male sex (hazard ratio [HR] 1.32, 95% confidence interval [CI]: 1.25-1.39), advanced age (HR 8.54, 95% CI: 7.40-9.87 for ≥95 years vs. 65-69 years) and comorbidities such as neurological disorders (HR 1.87, 95% CI: 1.72-2.04), dementia (HR 1.69, 95% CI: 1.59-1.80), and congestive heart failure (HR 1.19, 95% CI: 1.12-1.27) were associated with increased PI risks. Conversely, antihyperlipidemic drugs may be associated with a lower PI risk (HR 0.69, 95% CI: 0.65-0.74). Due to data limitations, factors such as nutritional status, mobility, and caregiver support could not be evaluated. Innovation: This study is the first in Japan to leverage big data to identify high-risk groups for PIs, particularly among elderly individuals with specific comorbidities. This approach offers actionable insights into PI management, potentially enhancing care strategies and preventive guidelines. Conclusion: Male sex, advanced age, and comorbidities, including neurological disorders, dementia, psychosis, and congestive heart failure, were identified as primary PI risk factors. Conversely, antihyperlipidemic drug use may be associated with a lower PI risk. These findings highlight the need for comprehensive, targeted prevention strategies to reduce the risk of PI in elderly hospitalized patients.

Objective: The primary objective of this study is to enhance the detection and staging of pressure injuries using machine learning capabilities for precise image analysis. This study explores the application of the You Only Look Once version 8 (YOLOv8) deep learning model for pressure injury staging. Approach: We prepared a high-quality, publicly available dataset to evaluate different variants of YOLOv8 (YOLOv8n, YOLOv8s, YOLOv8m, YOLOv8l, and YOLOv8x) and five optimizers (Adam, AdamW, NAdam, RAdam, and stochastic gradient descent) to determine the most effective configuration. We followed a simulation-based research approach, which is an extension of the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for dataset preparation and algorithm evaluation. Results: YOLOv8s, with the AdamW optimizer and hyperparameter tuning, achieved the best performance metrics, including a mean average precision at intersection over union ≥0.5 of 84.16% and a recall of 82.31%, surpassing previous YOLO-based models in accuracy. The ensemble model incorporating all YOLOv8 variants showed strong performance when applied to unseen images. Innovation: Notably, the YOLOv8s model significantly improved detection for challenging stages such as Stage 2 and achieved accuracy rates of 0.90 for deep tissue injury, 0.91 for Unstageable, and 0.74, 0.76, 0.70, and 0.77 for Stages 1, 2, 3, and 4, respectively. Conclusion: These results demonstrate the effectiveness of YOLOv8s and ensemble models in improving the accuracy and robustness of pressure injury staging, offering a reliable tool for clinical decision-making.

Peripheral nerve injuries, especially those with complete transection of major nerves, create significant morbidity including debilitating pain, loss of protective haptic feedback, and impaired volitional control of musculature. The societal burden and cost of medical care for these injuries are enormous, with estimates in the United States alone in excess of $670 million per year. In clinical scenarios with a segmental nerve gap where end-to-end coaptation without tension is not possible, a "bridge" or scaffold must be interposed to facilitate communication between the proximal and distal stumps to facilitate organized growth following Wallerian degeneration. A multitude of constructs have been created and studied to facilitate this regeneration. Among the three overall types of bridge employed in contemporary clinical care-conduit/scaffold, allograft, and autograft-each has significant downsides ranging from limited successful nerve ingrowth to donor site morbidity. Despite the tremendous work over the last 150 years in nerve biology and medical technology for the treatment of peripheral nerve injury, the biological processes governing nerve regeneration remain incompletely understood. Especially in cases of long segmental gaps, there remains room for significant improvement. Ongoing studies have identified several promising modalities for nerve scaffolds to facilitate more efficient and effective neuronal outgrowth but still require further investigation. Here, we review contemporary paradigms in the treatment of segmental nerve injuries with interposing scaffolds and reexamine nerve physiology, regulatory programs in nerve regeneration, and strategic targets for neurogenic pathways that may facilitate novel treatment modalities.

Objective: Pressure garment therapy is a common strategy for controlling hypertrophic scars; however, insufficient pressure due to reduced elasticity or joint movement limits its effectiveness around joints. The FlexiForce B201 pressure sensor offers precise pressure measurements, thereby demonstrating a promising solution. Approach: This study used a Bama pig scar model with an untreated group, a pressure garment group, and a pressure monitoring group that was treated with FlexiForce B201 sensors and pressure garments. The therapeutic effects were recorded over 1 month. The clinical research followed the Consolidated Standards of Reporting Trials and was registered as ChiCTR2200064173. Eighty-two patients with peri-joint hypertrophic scars were enrolled. Forty-one patients were randomly assigned to the control group and received conventional pressure garment therapy, whereas the remaining 41 patients were included in the monitoring group. Treatment outcomes were tracked at 3 months and 6 months. Results: The Bama pig scar model demonstrated reduced scar hypertrophy in the monitoring group. In the clinical study, the scar thickness in the monitoring group was 47.76% of the initial thickness after 6 months, thereby representing an additional 11.33% reduction compared to the control group. The Vancouver Scar Scale score of the monitoring group (6.44 ± 1.62) was significantly better than that of the control group (7.33 ± 1.53). Innovation: The FlexiForce B201 pressure sensor is soft and flexible. It provides accurate pressure measurements within the pressure garment and guides physicians in adjusting the pressure distribution. Conclusion: This study revealed that pressure monitoring technology enhances the effectiveness of pressure garments.

Significance: The skin serves as the primary defense against external stimuli, making it vulnerable to damage. Injuries can cause a dysregulated environment, resulting in chronic inflammation and inhibition of cell proliferation and migration, which delays recovery. Innovative approaches, such as three-dimensional (3D) bioprinting, can foster a controlled healing environment by promoting synergy between the skin microbiome and cells. Recent Advances: Traditional approaches to wound healing have focused on fostering an environment conducive to the interplay between cells, extracellular proteins, and growth factors. 3D bioprinting, a manufacturing technology with applications in tissue engineering, deposits biomaterial-based bioink containing living cells to fabricate custom-designed tissue scaffolds in a layer-by-layer fashion. This process controls the architecture and composition of a construct, producing multilayered and complex structures such as skin. Critical Issues: The selection of biomaterials for scaffolds has been a challenge when 3D skin tissue engineering. While prioritizing mechanical properties, current biomaterials often lack the ability to interact with environmental stimuli such as pH, temperature, or oxygen levels. Employing smart biomaterials that integrate bioactive molecules and adapt to external conditions could overcome these limitations. This innovation would enable scaffolds to create a sustainable wound-healing environment, fostering microbiome balance, reducing inflammation, and facilitating cellular recovery and tissue restoration, addressing critical gaps in existing wound care solutions. Future Directions: Novel bioink formulations for skin injury recovery are focused on improving long-term cell viability, proliferation, vascularization, and immune integration. Efficient recovery of the skin microbiome using bioactive molecules has the potential to create microenriched environments that support the recovery of the skin microbiome and restore immune regulation. This promising direction for future research aims to improve patient outcomes in wound care.

Significance: Volumetric muscle loss (VML) is caused by the loss of significant amounts of skeletal muscle tissue. VML cannot be repaired by intrinsic regenerative processes, resulting in permanent loss of muscle function and disability. Current rehabilitative-focused treatment strategies lack efficacy and do not restore muscle function, indicating the need for the development of effective regenerative strategies. Recent Advances: Recent developments implicate biomaterial-based approaches for promoting muscle repair and functional restoration post-VML. Specifically, bioscaffolds transplanted in the injury site have been utilized to mimic endogenous cues of the ablated tissue to promote myogenic pathways, increase neo-myofiber synthesis, and ultimately restore contractile function to the injured unit. Critical Issues: Despite the development and preclinical testing of various biomaterial-based regenerative strategies, effective therapies for patients are not available. The unique challenges posed for biomaterial-based treatments of VML injuries, including its scalability and clinical applicability beyond small-animal models, impede progress. Furthermore, production of tissue-engineered constructs is technically demanding, with reproducibility issues at scale and complexities in achieving vascularization and innervation of large constructs. Future Directions: Biomaterial-based regenerative strategies designed to comprehensively address the pathophysiology of VML are needed. Considerations for clinical translation, including scalability and regulatory compliance, should also be considered when developing such strategies. In addition, an integrated approach that combines regenerative and rehabilitative strategies is essential for ensuring functional improvement.

Objective: This study focuses on developing bioactive piezoelectric scaffolds that could deliver bioelectrical cues to potentially treat injuries to soft tissues such as skeletal muscles and promote active regeneration. Approach: To address the underexplored aspect of bioelectrical cues in skeletal muscle tissue engineering (SMTE), we developed piezoelectric bioink based on natural bioactive materials such as sodium alginate, gelatin, and chitosan. Extrusion-based 3D bioprinting was utilized to develop scaffolds that mimic muscle stiffness and generate electrical stimulation (E-stim) when subjected to forces. The biocompatibility of these scaffolds was tested with the C2C12 muscle cell line. Results: The bioink demonstrated suitable rheological properties for 3D bioprinting, resulting in high-resolution composite sodium alginate-gelatin-chitosan scaffolds with good structural fidelity. The scaffolds exhibited a 42-60 kPa stiffness, similar to muscle. When a controlled force of 5N was applied to the scaffolds at a constant frequency of 4 Hz, they generated electrical fields and impulses (charge), indicating their suitability as a stand-alone scaffold to generate E-stim and instill bioelectrical cues in the wound region. The cell viability and proliferation test results confirm the scaffold's biocompatibility with C2C12s and the benefit of piezoelectricity in promoting muscle cell growth kinetics. Our study indicates that our piezoelectric bioink and scaffolds offer promise as autonomous E-stim-generating regenerative therapy for SMTE. Innovation: A novel approach for treating skeletal muscle wounds was introduced by developing a bioactive electroactive scaffold capable of autonomously generating E-stim without stimulators and electrodes. This scaffold offers a unique approach to enhancing skeletal muscle regeneration through bioelectric cues, addressing a major gap in the SMTE, that is, fibrotic tissue formation due to delayed muscle regeneration. Conclusion: A piezoelectric scaffold was developed, providing a promising solution for promoting skeletal muscle regeneration. This development can potentially address skeletal muscle injuries and offers a unique approach to facilitating skeletal muscle wound healing.

Significance: Postoperative Pressure Injuries (PIs) present unique risks, requiring dedicated research for accurate assessment. Despite the increasing number of Intraoperative Acquired Pressure Injury (IAPI) prediction models, their risk of bias and clinical applicability remains unclear. Recent Advances: Adhered to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement requirements, IAPI prediction models of adult inpatients (≥18 years) were systematically retrieved from eight databases. Bias risk and applicability were evaluated using the Prediction model Risk Of Bias Assessment Tool (PROBAST), followed by narrative synthesis. Critical Issues: From 837 studies, 25 were included, covering 32 prediction models. Most studies (88%) were single-center and conducted in China, Korea, the United States, or Singapore, spanning various surgical specialties. Among 26,142 participants, IAPI incidence ranged from 4.1% to 41.75%. Common predictors included surgery duration, age, and diabetes. Areas Under the Curve (AUC) values varied from 0.702 to 0.984, but calibration was underreported. All studies had high bias risk, with 22 models exhibiting applicability concerns. Future Directions: The development of IAPI models requires a clear definition of the timing and personnel responsible for assessing PIs, with a preference for prospective data collection and thorough internal and external validation. Adherence to the critical appraisal and data extraction for systematic reviews of prediction modeling studies checklist and PROBAST guidelines can improve reporting quality. Models should be user-friendly, clinically applicable, and rigorously validated. Precisely defining and rigorously selecting predictors is critical to reducing variability. Future research should adopt more stringent designs to develop high-quality models capable of effectively guiding clinical practice. PROSPERO registration number: CRD42024502726.