Scar formation, with persistent alteration of the normal tissue structure, is an undesirable and significant result of both wound healing and fibrosing disorders. There are few strategies to prevent ...or to treat scarring. The transforming growth factor beta (TGF‐β) superfamily is an important mediator of tissue repair. Each TGF‐β isoform may exert a different effect on wound healing, which may be context‐dependent. In particular, TGF‐β1 may mediate fibrosis in adults’ wounds, while TGF‐β3 may promote scarless healing in the fetus and reduced scarring in adults. Thus, TGF‐β3 may offer a scar‐reducing therapy for acute and chronic wounds and fibrosing disorders.
Deep learning is a branch of artificial intelligence that uses computational networks inspired by the human brain to extract patterns from raw data. Development and application of deep learning ...methods for image analysis, including classification, segmentation, and restoration, have accelerated in the last decade. These tools have been progressively incorporated into several research fields, opening new avenues in the analysis of biomedical imaging. Recently, the application of deep learning to dermatological images has shown great potential. Deep learning algorithms have shown performance comparable with humans in classifying skin lesion images into different skin cancer categories. The potential relevance of deep learning to the clinical realm created the need for researchers in disciplines other than computer science to understand its fundamentals. In this paper, we introduce the basics of a deep learning architecture for image classification, the convolutional neural network, in a manner accessible to nonexperts. We explain its fundamental operation, the convolution, and describe the metrics for the evaluation of its performance. These concepts are important to interpret and evaluate scientific publications involving these tools. We also present examples of recent applications for dermatology. We further discuss the capabilities and limitations of these artificial intelligence-based methods.
Background
Chronic wounds are a worldwide problem. One advanced biological therapy is platelet-rich plasma (PRP). Many studies have demonstrated the efficacy of PRP therapy in chronic wounds of ...different etiologies, but results are not conclusive.
Objective
This systematic review intends to identify high-level clinical trials or randomized controlled trials (RCTs) that compare autologous platelet-rich plasma with alternative treatments for chronic cutaneous wounds in humans. Moreover, it investigates whether patients who have received autologous PRP therapy for chronic wound care for diverse etiologies have a better clinical outcome than patients treated with alternative treatments.
Methods
PubMed, Scopus, Web of Science (WOS), The Cochrane Library, and Cumulative Index of Nursing and Allied Literature Complete (CINAHL) were searched in May 2021. The search was performed without any restriction. The studies were selected and reviewed by two authors on the basis of predefined inclusion criteria and following PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) guidelines, and a third author was consulted in the event of disagreement. All of the studies included were assessed using the Study Quality Assessment Tool for Controlled Intervention Studies published by the National Heart, Lung, and Blood Institute (NIH, USA).
Results
Of the 2686 studies identified in the search, 16 RCTs met the inclusion criteria. Of the studies included, nine deal with diabetic wounds, five with venous wounds, one with arterial wounds, and one with pressure wounds. The studies included showed different PRP obtention and application methods due to a lack of standardized clinical guidelines. All studies dealing with venous ulcers showed an increase in wound healing among patients treated with PRP compared with the control group. Diabetic wound trials are non-conclusive due to the heterogeneity of the reported results. Only one study of arterial and one of pressure ulcers were identified, so no comparison can be made. Most of the articles included in the study had an unclear or low risk of bias, except in sample size power calculation.
Conclusions
PRP may improve the healing of venous ulcers; however, there is no strong evidence regarding this positive effect in other wound etiologies. Although autologous PRP therapy is widely used, its effectiveness according to wound etiology is still not clear. The heterogenicity of the protocols to prepare and apply PRP therapy and the different methods for measuring chronic wound outcomes hinder the comparison of studies, thereby limiting the possibility of conducting a more robust analysis.
The systematic review was prospectively registered with PROSPERO under number CRD42021251501.
Chronic wounds resulting from a number of conditions do not heal properly and can pose serious health problems. Beyond clinician visual inspection, an objective evaluation of the wound is required to ...assess wound evolution and the effectiveness of therapies.
Our objective is to provide a methodology for the analysis of wound area vs. time for the early prediction of non-healing wounds evolution.
We propose a two-step approach consisting of: i) wound area quantification from planimetries and ii) classification of wound healing through the inference of characteristic parameters. For the first step, we describe a user-friendly software (Woundaries) to automatically calculate the wound area and other geometric parameters from hand-traced planimetries. For the second, we use a procedure for the objective classification of wound time evolution and the early assessment of treatment efficacy. The methodology was tested on simulations and retrospectively applied to data from 85 patients to compare the effect of a biological therapy with respect to general basic therapeutics.
Woundaries provides measurements of wound surface equivalent to a validated device. The two-step methodology allows to determine if a wound is healing with high sensitivity, even with limited amount of data. Therefore, it allows the early assessment of the efficacy of a therapy.
The performance of this methodology for the quantification and the objective evaluation of wound area evolution suggest it as a useful toolkit to assist clinicians in the early assessment of the efficacy of treatments, leading to a timely change of therapy.
Display omitted
•User friendly tools can help clinicians to automatically measure wound areas.•Area vs. time is an important descriptor for the monitoring of wound healing.•Characteristic healing time make it possible to evaluate wound evolution.•Wound evolution measurement may be used to compare therapies outcomes.•An early prediction of non-healing wounds is helpful for clinical decision making.
PurposeOlder people living in nursing homes have complex care needs and frequently need specialists’ advice and support that can be challenging to deliver in a rural setting. The aim of this paper is ...to describe a model of integrated care in a rural area supported by a nurse case manager.Design/methodology/approachA real-world evidence study of people living in Ribes de Freser nursing home, was conducted between specific timeframes in 2019 and 2022, comparing the casemix and outcomes of a traditional care model with the integrated interdisciplinary model.FindingsThe integrated care model led to a significant reduction in transfers to the emergency department, hospitalisations, outpatient medical visits and a reduction in the number of medicines. In addition, the number of residents receiving end-of-life care at the nursing home showed a substantial increase.Originality/valueThis case study contributes valuable evidence supporting the implementation of an integrated model of nurse case manager support in nursing homes, particularly in the rural contexts, where access to specialist medical staff may be limited. The findings highlight the potential benefits of person-centred integrated care for older adults, addressing their complex needs and improving end-of-life care in nursing home settings.
Collective cell migration is a hallmark of wound repair, cancer invasion and metastasis, immune responses, angiogenesis, and embryonic morphogenesis. Wound healing is a complex cellular and ...biochemical process necessary to restore structurally damaged tissue. It involves dynamic interactions and crosstalk between various cell types, interaction with extracellular matrix molecules, and regulated production of soluble mediators and cytokines. In cutaneous wound healing, skin cells migrate from the wound edges into the wound to restore skin integrity. Analysis of cell migration in vitro is a useful assay to quantify alterations in cell migratory capacity in response to experimental manipulations. Although several methods exist to study cell migration (such as Boyden chamber assay, barrier assays, and microfluidics-based assays), in this short report we will explain the wound healing assay, also known as the “in vitro scratch assay” as a simple, versatile, and cost-effective method to study collective cell migration and wound healing.
β2-Adrenoceptors (β2-AR) are prototypical G-protein-coupled receptors and important pharmacological targets with relevant roles in physiological processes and diseases. Herein, we introduce ...Photoazolol-1–3, a series of photoswitchable azobenzene β2-AR antagonists that can be reversibly controlled with light. These new photochromic ligands are designed following the azologization strategy, with a p-acetamido azobenzene substituting the hydrophobic moiety present in many β2-AR antagonists. Using a fluorescence resonance energy transfer (FRET) biosensor-based assay, a variety of photopharmacological properties are identified. Two of the light-regulated molecules show potent β2-AR antagonism and enable a reversible and dynamic control of cellular receptor activity with light. Their photopharmacological properties are opposite, with Photoazolol-1 being more active in the dark and Photoazolol-2 demonstrating higher antagonism upon illumination. In addition, we provide a molecular rationale for the interaction of the different photoisomers with the receptor. Overall, we present innovative tools and a proof of concept for the precise control of β2-AR by means of light.
The incidence of frailty and non-healing wounds increases with patients' age. Knowledge of the relationship between frailty and wound healing progress is greatly lacking.
The aim of this study is to ...characterize the degree of frailty in elderly patients attending a multidisciplinary wound care centres (MWCC). Additionally, we seek to assess the impact of frailty on the wound healing rate and wound healing time. An open cohort study was conducted on 51 consecutive patients aged > 70 years treated for wounds at an MWCC of an intermediate care hospital. The frailty score was determined according to the Frail-VIG index. Data were collected through patient questionnaires at the beginning of the study, and at 6 months or upon wound healing. Wounds were followed up every 2 weeks. To analyse the relationship between two variables was used the Chi-square test and Student's or the ANOVA model. The t-test for paired data was used to analyse the evolution of the frailty index during follow-up.
A total of 51 consecutive patients were included (aged 81.1 ± 6.1 years). Frailty prevalence was 74.5% according to the Frail-VIG index (47.1% mildly frail, 19.6% moderately frail, and 7.8% severely frail). Wounds healed in 69.6% of cases at 6 months. The frailty index (FI) was higher in patients with non-healing wounds in comparison with patients with healing wounds (IF 0.31 ± 0.15 vs IF 0.24 ± 0.11, p = 0.043). A strong correlation between FI and wound healing results was observed in patients with non-venous ulcers (FI 0.37 ± 0.13 vs FI 0.27 ± 0.10, p = 0.015). However, no correlation was observed in patients with venous ulcers (FI 0.17 ± 0.09 vs FI 0.19 ± 0.09, p = 0.637). Wound healing rate is statically significantly higher in non-frail patients (8.9% wound reduction/day, P25-P75 3.34-18.3%/day;AQ6 p = 0.044) in comparison with frail patients (3.26% wound reduction/day, P25-P75 0.8-8.8%/day).
Frailty is prevalent in elderly patients treated at an MWCC. Frailty degree is correlated with wound healing results and wound healing time.
PDF
