Search Results (2,958)

In this study, a hydrogel was developed based on a chondroitin sulfate–iron complex (CSFe) incorporated into a sodium alginate matrix. The CSFe complex was first prepared through the interaction of chondroitin sulfate (CS) with Fe³⁺ ions, achieving an iron content of 2.06%. Structural characterization confirmed that Fe³⁺ coordinated with the carboxyl, sulfate, and N-acetyl groups of CS, resulting in increased molecular weight and altered physicochemical properties. The CSFe complex exhibited significant antibacterial activity against Escherichia coli and Staphylococcus aureus (S. aureus), and was further incorporated into a sodium alginate matrix to form an injectable hydrogel with favorable physicochemical properties such as spreadability, shear-thinning behavior, and a compact porous microstructure. In a mouse model of S. aureus-infected wounds, the CSFe hydrogel significantly accelerated wound closure, reduced the levels of pro-inflammatory cytokines (TNF-α and IL-6), and increased the anti-inflammatory cytokine IL-10, indicating potent anti-infective and immunomodulatory functions. Overall, this work presents a multifunctional CSFe-incorporated hydrogel system that integrates antibacterial, anti-inflammatory, and tissue-regenerative properties, offering a promising strategy for infected wound healing and highlighting the potential of trivalent iron–polysaccharide coordination complexes in the development of advanced biomedical materials. Full article

Introduction: Periprosthetic joint infections (PJI) are among the most serious and costly complications in orthopedic surgery, significantly affecting patient prognosis and healthcare systems. Despite rigorous aseptic measures, intraoperative contamination of sterile fields, instruments, and air remains a persistent source of potential infection. This study investigates the relationship between the microbial contamination of sterile fields during arthroplasty and postoperative inflammatory markers, with the objective of determining whether the contamination of sterile fields correlates with the presence of periprosthetic joint infection (PJI). Material and Methods: This prospective observational study included 33 patients undergoing total hip or knee arthroplasty in a university-affiliated orthopedic center. Intraoperative samples were collected from sterile fields and equipment to detect microbial contamination, while postoperative monitoring involved the C-reactive protein (CRP); erythrocyte sedimentation rate (ESR); leukocyte count; temperature; and wound assessment on days 1, 3 and 7. All patients received 48 h of prophylactic cefuroxime. Statistical analysis was conducted using the International Business Machines (IBM) Statistical Product and Service Solutions (SPSS) software for Windows, version 30.0 (IBM Corporation, Armonk, New York, United States of America) with significance set at p ≤ 0.05. Results: Postoperative inflammatory markers showed distinct patterns depending on the isolated microorganism, with Proteus vulgaris and Staphylococcus hominis ssp. consistently associated with higher CRP and leukocyte values, indicating a more intense systemic response. Staphylococcus epidermidis was the most frequently isolated species but showed moderate inflammatory profiles, suggesting its potential role in subclinical colonization. A strong correlation between CRP on day 3 and leukocyte count (r = 0.81) confirms their combined utility in the early detection of infectious complications, while ESR appeared less dynamic and more complementary in nature. Discussion: This study highlights the significant role of intraoperative contamination and microbial virulence in shaping the postoperative inflammatory response after arthroplasty. Elevated CRP and leukocyte levels, particularly on day 3, were closely associated with pathogens known for biofilm formation and chronic infections. Despite prophylactic antibiotic use, confirmed infections still occurred, suggesting the need to reassess current protocols and enhance intraoperative contamination control. Conclusions: Pathogen presence in sterile fields during arthroplasty increases the risk of periprosthetic joint infections, often without early clinical symptoms. CRP on day 3 and leukocyte count were the most reliable early indicators of persistent inflammation. Full article

Postoperative complications in gastrointestinal (GI) cancer patients remain a significant challenge for physicians. It leads to increased morbidity, prolonged hospital stays, and higher healthcare costs. Enteral immunonutrition (EIN) has emerged as a promising add-on treatment to modulate immune response following surgery. In fact, it reduces inflammation and promotes patients’ recovery. Indeed, the literature data on its real clinical impact for the patients are inconsistent and, yet, poorly investigated. Thus, the aim of this review was to narratively assess the current evidence for the use of EIN in postoperative GI cancer patients, evaluating the effect on clinical and immunological outcomes of patients. Therefore, a literature search was conducted using the following keywords and associations: enteral immunonutrition, gastrointestinal cancer, immune response, inflammation, and postoperative complication. GI cancers, mainly esophageal and gastric cancer, represent a significant global health burden, characterized by high incidence and mortality rates. The complex interplay between tumor progression, systemic inflammation, and host nutritional status profoundly impacts patient outcomes. Traditional cancer treatments are effective and often lead to severe side effects. The latter includes malnutrition and immunosuppression and can significantly affect patients’ recovery. In recent times, the concept of immunonutrition has emerged as a promising add-on therapy able to consensually modulate immune response and improve nutritional status. Several studies and meta-analyses suggest that EIN can reduce postoperative infections (e.g., wound infections and sepsis incidence), shorten hospital stays, and improve overall outcomes in GI cancer surgery patients vs. standard enteral feeding. EIN is a promising add-on approach for the management of postoperative GI cancer patients. It can significantly reduce postoperative complications and enhance their recovery. However, the result seems consistent for gastric but not yet esophageal cancer patients. EIN shows high tolerance and a high safety profile. Full article

Bacterial biofilms are structured microbial communities enclosed within a self-produced extracellular polymeric substance matrix composed of polysaccharides, proteins, extracellular DNA, and lipids. This matrix promotes adhesion, structural stability, and the development of heterogeneous microenvironments that restrict antimicrobial penetration and shield bacteria from host immune responses. As a result, biofilms are major contributors to chronic, recurrent, device-related, and difficult-to-treat infections, posing a major challenge for clinical management and antimicrobial stewardship. This review summarizes current understandings of biofilm biology, its clinical relevance, including the stages of biofilm development, the composition and protective roles of the matrix, and the physiological heterogeneity that arises during maturation. It also examines key mechanisms underlying biofilm tolerance and resistance, such as limited antibiotic diffusion, and sequestration, enzymatic inactivation, efflux pump upregulation, persister cell formation, and horizontal gene transfer. In addition, it highlights important clinical settings in which biofilms are implicated, including cystic fibrosis, chronic wounds, osteomyelitis, implant- or device-associated infections, and breast implant illness, in which persistent implant-associated biofilms and the resulting chronic inflammatory milieu have been hypothesized to contribute to local and systemic manifestations in a subset of patients. The review further discusses conventional and emerging approaches for biofilm detection alongwith real-time monitoring. Biofilm-associated infections remain difficult to eradicate because persistence is driven by multiple interconnected protective mechanisms. Effective management therefore requires integrated strategies that combine accurate detection with multifaceted therapies, including antibiotics alongside matrix-disrupting enzymes, quorum-sensing inhibitors, bacteriophages, metabolic reactivators, and nanotechnology-based delivery systems. Advances in multi-omics and system-level modeling will be essential for developing next-generation strategies to prevent, monitor, and treat biofilm-associated disease. Full article

Background/Objectives: Diabetic wound healing faces significant challenges due to the harsh microenvironment of wounds such as high blood glucose levels, excessive inflammation, persistent infection, upregulated reactive oxygen species (ROS), and damaged new blood vessels. Therefore, developing hydrogel dressings with microenvironmental regulation functions has become an important strategy in treating diabetic wounds. Methods: In this study, an ultraviolet in situ crosslinked hydrogel (D@H/E) was developed using methacrylic anhydride modified hyaluronic acid (HA-MA) and glycidyl methacrylate modified ε-polylysine (EPL-GMA), loaded with the iron chelating agent desferrioxamine (DFO). The physicochemical and biochemical properties of the hydrogel were comprehensively characterized, and its efficacy as a dressing for diabetic wounds was evaluated in a STZ-induced hyperglycemic mouse model. Results: This hydrogel demonstrated remarkable multidimensional effects by alleviating oxidative stress damage, inhibiting bacterial infection, regulating inflammatory responses, mitigating ferroptosis, and promoting cell migration and tubule formation. Specifically, the DFO-loaded hydrogel achieved a high DPPH radical scavenging efficiency of 80.8% and exhibited excellent antibacterial activity, with over 99.8% inhibition against both S. aureus and E. coli. In streptozotocin (STZ)-induced diabetic mice, the hydrogel accelerated wound closure to near completion by day 14. Mechanistically, it significantly upregulated CD206 expression to promote M2 macrophage polarization, upregulated the expression of angiogenesis-related factors to promote angiogenesis at the wound site, and enhanced GPX4 expression to alleviate ferroptosis. Conclusions: By orchestrating multi-dimensional synergy that combines ROS scavenging, infection control, immune regulation, and anti-ferroptosis, this D@H/E hydrogel system effectively remodels the harsh diabetic wound microenvironment, offering a promising platform for chronic wound management. Full article

Background: This study evaluated the independent predictive value of preoperative Systemic Immune–Inflammation Index (SII) for postoperative wound infection (WI) in diabetic patients undergoing isolated Coronary Artery Bypass Grafting (CABG). Methods: A retrospective cohort of 300 diabetic patients (2024–2025) was analyzed. The primary outcome was 30-day postoperative WI. Preoperative SII was calculated from blood counts within 24 h before surgery. Multivariable logistic regression was performed using both a primary model (adjusting for age, BMI, and comorbidities) and an extended model including glycemic control (HbA1c), smoking status, operative duration, and transfusion requirements. Model discrimination was evaluated via Area Under the ROC Curve (AUC). Statistical power and sensitivity analyses were conducted to ensure the robustness of the findings. Results: WI occurred in 7% (n = 21). Preoperative SII was significantly lower in the WI group (958.48 ± 493.49 vs. 1293.56 ± 758.15, p = 0.047). SII remained an independent predictor in the adjusted model (Adjusted OR per 100-unit increase: 0.93; 95% CI: 0.86–1.00; p = 0.048). ROC analysis confirmed an inverse predictive pattern (AUC: 0.374, 95% CI: 0.312–0.436). Comparative analysis showed that SII provided superior additional insight compared to NLR and PLR in this population. Conclusions: Preoperative SII is an independent predictor for WI in diabetic CABG patients. However, given the modest discriminative performance (AUC: 0.374), it should be integrated into a broader clinical risk assessment. Contrary to conventional expectations, lower SII values indicated increased susceptibility, suggesting that immune exhaustion rather than hyperinflammation may drive infectious risk in diabetic patients. Full article

Calcium peroxide nanoparticles (CaO₂ NPs) have recently attracted increasing attention as oxygen-generating nanomaterials with potential biomedical applications. Their ability to release molecular oxygen and reactive oxygen species (ROS) in aqueous environments enables modulation of hypoxic and oxidative microenvironments, which play critical roles in infection control, tumor progression, and tissue regeneration. Despite growing interest in oxygen-releasing biomaterials, the literature specifically addressing CaO₂ nanomaterials remains comparatively limited and fragmented, particularly when compared with the extensive body of work on calcium oxide-based systems. This review provides a comprehensive overview of CaO₂ nanoparticles, focusing on synthesis strategies, physicochemical properties, and emerging biomedical applications. Conventional bottom-up synthesis routes based on calcium salts, calcium hydroxide, and calcium oxide are critically compared, highlighting the influence of reaction parameters and stabilizing agents on particle size, morphology, crystallinity, and colloidal stability. Surface modification strategies, including polyethylene glycol, polyvinylpyrrolidone, and hyaluronic acid, are also discussed for their role in improving nanoparticle stability, regulating decomposition kinetics, and enhancing biocompatibility. The mechanisms governing oxygen and ROS generation are analysed in relation to antibacterial activity, hypoxia alleviation in tumor microenvironments, and oxygen-supplying biomaterials for tissue engineering and wound healing. In addition, key challenges associated with oxidative stress responses are discussed. Finally, the review outlines current limitations and perspectives regarding the clinical translation of CaO₂-based nanotherapeutic systems. Overall, this work aims to consolidate the currently dispersed knowledge on CaO₂ nanoparticles and provide a critical framework to guide future research in oxygen-releasing nanomedicine. Full article

Local antibiotic delivery has gained a central role as an adjunct to radical debridement in chronic osteomyelitis, allowing high antimicrobial concentrations at the infection site while reducing systemic toxicity. This narrative review summarizes the current clinical evidence on commercially available antibiotic-loadable bone substitutes, with particular focus on calcium sulfate (CaSO₄)-based systems and biphasic calcium sulfate/hydroxyapatite (CaS/HA) composites. Nineteen studies were included. Differences in formulation, resorption kinetics, antibiotic elution profile and osteoconductive behavior are discussed, alongside clinical outcomes including recurrence of infection, reoperation rates and complication patterns. Finally, based on the currently available evidence and expert recommendations, practical guidance is proposed to support carrier selection in different clinical scenarios (cavitary vs. corticomedullary defects; high-risk soft tissue; polymicrobial or resistant infections). Across published series, although heterogeneous, infection eradication rates are generally high when local carriers are integrated into structured surgical protocols. Calcium sulfate carriers provide rapid resorption and robust early antibiotic release but are associated with higher rates of sterile wound drainage. In contrast, CaS/HA biocomposites demonstrate more gradual remodeling and radiographic integration, potentially improving defect consolidation and reducing wound-related morbidity, although leakage and cost considerations remain relevant. Full article

Carotid pseudoaneurysms are rare and potentially life-threatening, often necessitating urgent surgical intervention. Patients with myeloproliferative disorders (MPD) are predisposed to thrombotic and inflammatory complications. Pyoderma gangrenosum (PG), a rare neutrophilic dermatosis, is often misdiagnosed in postoperative settings. In the following article, we present a case of a 58-year-old woman with Philadelphia-negative MPD, neutrophilic leukocytosis, thrombocytosis, osteoporosis, and hypothyroidism, who presented with a giant left common carotid artery pseudoaneurysm. She underwent urgent surgical revascularization via bypass using an autologous reversed saphenous vein graft from the right thigh and external carotid artery ligation. Immediately postoperatively, the patient developed left hemiparesis. Initial CT scans showed bypass graft occlusion and right MCA stroke. Immediate thrombolysis resulted in complete motor recovery, although the bypass remained occluded. On postoperative day 10, necrotic wound lesions developed, initially treated as infectious. After worsening post-debridement, dermatologic evaluation raised suspicion for PG, confirmed by biopsy. She responded well to corticosteroid therapy. Four weeks later, the thigh wound became superinfected with Pseudomonas aeruginosa and Klebsiella pneumoniae, successfully treated with broad-spectrum antibiotics. The patient fully recovered within two months. This case illustrates the complex interplay between vascular, thrombotic, and inflammatory complications in patients with MPD and emphasizes the importance of multidisciplinary care and early recognition of PG. Full article

Acinetobacter baumannii is a leading cause of healthcare-associated infections and is classified among the highest-priority antimicrobial-resistant pathogens. Its clinical success reflects the convergence of antimicrobial resistance (AMR) and biological traits that promote environmental persistence and transmission. Acinetobacter baumannii has undergone a remarkable transformation over the past few decades, evolving from a relatively obscure environmental bacterium into a globally recognized multidrug-resistant pathogen. Its prevalence in healthcare settings, particularly intensive care units, has made it a leading cause of ventilator-associated pneumonia, bloodstream infections, wound infections, and urinary tract infections. Beyond its antibiotic resistance, the bacterium’s ability to persist in hospital environments and adapt to host defences has amplified its clinical significance. Recent research has uncovered complex networks of virulence factors, regulatory systems, and metabolic strategies that enable A. baumannii to thrive in hostile environments and evade host immunity, providing new insights into its pathogenesis and potential therapeutic vulnerabilities. This review summarizes the main mechanisms underlying its pathogenicity, including desiccation tolerance, biofilm formation, disinfectant resistance, metal acquisition, motility, and the ability to enter viable but non-culturable states. In A. baumannii, AMR functions as a pathogenesis-adjacent trait, enhancing survival and clonal dissemination through genomic plasticity, resistance islands, efflux systems, and envelope remodeling. Key resistance pathways involve carbapenem-hydrolyzing oxacillinases, metallo-β-lactamases, permeability defects, and multidrug efflux, often coexisting within high-risk clones. From a clinical perspective, management of carbapenem-resistant strains requires accurate infection diagnosis, reliable susceptibility testing, site-specific and PK/PD-optimized therapy, and early reassessment. Overall, the success of A. baumannii reflects the integration of resistance and persistence within healthcare ecosystems, highlighting the need for coordinated strategies combining stewardship, infection control, improved diagnostics, and anti-biofilm or anti-virulence approaches. Full article

Background/Objectives: Hypoalbuminemia is a marker of poor nutritional status and has been associated with increased postoperative complications following total joint arthroplasty. However, its long-term implications in the revision total hip arthroplasty (THA) population are poorly characterized, and the utility of prealbumin to further risk-stratify these patients remains unclear. We aimed to study the association between preoperative hypoalbuminemia and complications after rTHA. Methods: We identified patients who underwent rTHA with preoperative albumin levels obtained within one month of surgery. Patients were divided into hypoalbuminemia (<3.5 g/dL) and normal albumin (3.5–6.0 g/dL) cohorts. A second analysis was conducted stratifying hypoalbuminemia patients by prealbumin level (<16 mg/dL vs. ≥16 mg/dL), measured within two weeks of surgery. Each cohort was 1:1 propensity score matched with a 1:1 nearest-neighbor greedy matching approach with a 0.10 standard deviation (SD) caliper, following a logistic regression to calculate patient propensity scores. Outcomes were compared at 90-day, 2-year, and 5-year intervals. Results: The matched cohorts included 4137 patients in both the hypoalbuminemia and normal-albumin groups. Hypoalbuminemia was significantly associated with increased short-term rates of any adverse event (38.9% vs. 22.5%; OR 2.195), wound dehiscence (5.4% vs. 3.1%; OR 1.808), surgical site infection (10.7% vs. 5.0%; OR: 2.271), and periprosthetic fracture (13.9% vs. 10.2%; OR: 1.414). Repeat revision THA was significantly more common within 90 days (6.6% vs. 4.5%; OR: 1.490). Periprosthetic fracture and prosthetic loosening were also more common within 2 years and 5 years (q = 0.001). There were no differences in repeat rTHA within 2 years and 5 years. Among hypoalbuminemic patients with prealbumin data, stratification by prealbumin level did not demonstrate any statistically significant differences in 90-day, 2-year, and 5-year complications. Conclusions: Hypoalbuminemia is a strong indicator of increased complication risk after rTHA, with increased risk for complications lasting to at least 5 years postoperatively. However, prealbumin stratification among hypoalbuminemic patients did not differentiate complication risk. These findings support preoperative albumin as a practical biomarker for risk stratification in rTHA patients. Full article

The management of complex acute and chronic wounds remains a formidable challenge in modern medicine, underscoring the urgent need for advanced therapeutic strategies that accelerate healing, prevent infection, and promote functional tissue regeneration. Electrospun nanofibers have attracted considerable attention in the biomedical field due to their extracellular matrix-like architecture, high surface area, interconnected porosity, and tunable physicochemical composition, which drive advances in wound regeneration, tissue engineering, and biopolymer-based therapeutics. In wound healing, nanofibrous dressings composed of natural polymers such as chitosan, gelatin, collagen, and cellulose promote cell attachment and proliferation, support angiogenesis, and enable infection control while delivering bioactive agents, thereby addressing significant challenges related to inflammation, biocompatibility, and antimicrobial resistance. In tissue engineering, aligned and hierarchically organized scaffolds fabricated from biopolymers such as collagen, gelatin, chitosan, and cellulose enhance the guided orientation of cells, differentiation, and functional regeneration of neural, musculoskeletal, vascular, and skin tissues. In addition to their conventional regenerative applications, recent studies have demonstrated that electrospun biopolymer nanofibers can be used in multifunctional biomedical platforms, including smart and stimuli-responsive systems for drug delivery, biosensing, regenerative interfaces, and wearable medical technologies. The integrated constructs that incorporate diagnostic or therapeutic functionalities, hybrid fabrication approaches that combine 3D printing with electrospinning, and intelligent biopolymer frameworks that enable telemedicine, real-time physiological monitoring, and personalized regenerative therapies offer new opportunities for developing improved biomedical systems. Overall, these advances position electrospun nanofiber systems as promising biomaterials for next-generation biomedical innovation. This review summarizes recent progress in tissue-engineered scaffolds, wound dressings, fabrication strategies for integrative therapeutics, and wearable devices with transformative potential for biomedical applications. Finally, the review addresses significant challenges related to scalability and clinical translation. It offers perspectives on future directions, including the integration of artificial intelligence and the regeneration of complex skin appendages, which will shape the next generation of nanofiber-based wound-healing therapies. Full article

Over the past decade, antibacterial materials have become a promising strategy to address both antibiotic-resistant and biomaterial-associated infections in clinical settings. Despite substantial progress, a gap remains between promising antibacterial performance in vitro and limited therapeutic outcomes in vivo. Herein, we present a mechanistic framework for understanding formulation-dependent antibacterial performance across five representative formulation architectures: nanoparticle-based systems, nanofibrous scaffolds, hydrogel matrices, surface coatings, and vesicular or microencapsulated carriers. We impart how structural organization and delivery dynamics regulate antibacterial mechanisms such as contact-mediated killing, controlled therapeutic release, and reactive oxygen species (ROS) generation and discuss their context-dependent suitability for diverse infection scenarios; these include acute wound infections, biofilm-associated implant infections, and chronic infected wounds. Particular emphasis is placed on factors contributing to the frequent failure of high in vitro log reduction efficacy translating into clinical success, including protein corona formation, biological barrier penetration, and dynamic host–pathogen interactions. Finally, we propose a comparative formulation-selection framework based on infection type, tissue environment, and therapeutic objectives to guide the rational design of next-generation antibacterial materials. This perspective bridges the gap between material innovation and clinical translation by highlighting formulation architecture as a central determinant of antibacterial performance in biomedical applications. Full article

The development of multifunctional, mechanically robust, and sustainable hydrogels from renewable biomaterials has attracted increasing attention for advanced biomedical applications; however, achieving an optimal balance between mechanical stability, biofunctionality, and infection control remains challenging. In this work, collagen (COL) extracted from raw trimming wastes from a tannery is used to fabricate COL/PAA/Fe composite hydrogels via the ammonium persulfate (APS)-initiated polymerization of acrylic acid (AA) coupled with Fe³⁺-mediated coordination cross-linking. The resulting hydrogel network is stabilized by synergistic COL-poly(acrylic acid) (PAA) hydrogen bonding and dynamic Fe³⁺–carboxylate coordination, imparting enhanced mechanical strength and elasticity. The optimized hydrogel exhibited maximum tensile and compressive strengths of ~0.176 MPa at 751% elongation and ~1.945 MPa at a strain of 80%, respectively. In addition, a high ionic conductivity of 4.11 S·m⁻¹ is achieved, enabling structural integrity under deformation and suitability for flexible electronic interfaces. The prepared hydrogel also displayed rapid autonomous self-healing behavior and substantial antibacterial properties against both Gram-positive and Gram-negative bacteria. Overall, COL is employed herein as a sustainable precursor, highlighting an eco-conscious approach to biomaterial design. This work presents a versatile strategy for producing mechanically stable and biofunctional hydrogels with strong potential for wound dressing, tissue engineering, and injectable biomedical applications. Full article