Search Results (1,441)

Hard-to-heal wounds pose a significant challenge in clinical practice due to the fact that the conventional treatments used are not always effective. For this reason, it is necessary to design alternatives to achieve an adequate resolution. In this context, a new Advanced Therapy product was produced in a Good Manufactured Practices Facility in the setting of a clinical trial authorised for the European Medicines Agency (EUCT 2023-505017-25-02). Briefly, an autologous plasma scaffold containing bone marrow mononuclear cells was applied to a 63-year-old male patient who presented a non-healing wound despite two months of self-care and three months of primary care treatment. After cleaning the affected area, a single-dose plasma scaffold with embedded bone marrow mononuclear cells was applied over the wound. Six weeks after treatment, the wound exhibited remarkable healing with complete closure as evidenced by follow-up assessments at different time points. Quality of life measures significantly improved, aligning with clinical findings, and no adverse effects were observed. While further studies are needed, the issues presented in this case report show the promising results obtained forthe first patient included in the trial and treated with this innovative alternative, which supports the potential of mononuclear cells combined with plasma as a therapeutic option for chronic wounds. Full article

Background/Objectives: The increased prevalence of multidrug-resistant Escherichia coli and carbapenemase-producing Enterobacteriaceae poses a critical threat to global health and food safety. Antimicrobial Blue Light (aBL) in the 400–470 nm spectrum has emerged as a promising, chemical-free disinfection strategy that targets intracellular porphyrins and flavins to induce oxidative stress. However, the influence of wavelength, dosimetry, and environmental stressors on endogenous photoinactivation remains poorly standardized regarding optical parameters and biological exposure protocols. This systematic review aimed to evaluate the antimicrobial efficacy of pure blue light (400–470 nm) against E. coli across various phenotypes and environmental conditions, excluding the use of exogenous photosensitizers. Methods: PubMed, Scopus, and Web of Science were searched for studies that utilized 400–470 nm light as an antimicrobial agent against E. coli. Data extraction focused on spectral efficiency, total fluence (J/cm²), and log₁₀ reduction. The Risk of Bias was assessed using an adapted Office of Health Assessment and Translation tool for in vitro studies. Results: Synthesis of 11 high-quality studies indicated that wavelengths near 405 nm have the highest germicidal efficiency due to the Soret band absorption of endogenous porphyrins. Efficacy is highly dose-dependent: significant log₁₀ reductions were achieved in planktonic cells, although biofilms required substantially higher fluences. Sub-lethal environmental stressors such as acidic pH, high salinity, and thermal fluctuations demonstrated a synergistic effect, which significantly enhanced the rate of photoinactivation. Multidrug-resistant and carbapenemase-producing Enterobacteriaceae strains showed similar susceptibility to aBL relative to antibiotic-sensitive strains, suggesting no cross-resistance between light and traditional drugs. Conclusions: Endogenous blue light is a highly effective, non-thermal technology for E. coli decontamination. Its efficacy is modulated by the interplay between optical parameters and environmental conditions. These findings provide a framework for the development of standardized protocols for applying aBL to clinical wound care and food industry use cases. They also highlight the potential of aBL as a critical tool in the post-antibiotic era. This systematic review was registered in the International prospective register of systematic reviews (PROSPERO) under protocol CRD420261331871. Full article

The Therapeutic Shoe Benefit (TSB) allows Medicare insurance beneficiaries to reduce their diabetic foot ulcer risk by providing offloading shoes. Anecdotal evidence suggests that the process is cumbersome and that not all providers are aware of this benefit. This study evaluated TSB awareness across multiple healthcare disciplines and documented barriers to utilization. An online study surveyed healthcare providers practicing in the United States to determine familiarity with TSB and barriers to prescribing therapeutic shoes. The project was IRB-reviewed and received exempt status. The survey was sent to a wide variety of healthcare practitioners including: podiatrists, primary care providers, physical therapists, orthotist/prosthetists, specialty providers, and diabetes educators. This was done through targeted emails from professional organizations, word-of-mouth messaging through private practice groups, and marketing on LinkedIn. The survey was administered via Qualtrics with embedded branching logic used to gather data from the TSB’s three classifications of healthcare specialists: certifying physicians, prescribing practitioners, and suppliers. A total of 580 valid completions of the survey were analyzed. Irrespective of the TSB, podiatric physicians and medical professionals providing direct patient care recommend supportive shoes for patients with diabetes 98.2% (336/342) of the time. When asked about knowledge of the TSB, 522 or 90% of respondents indicated awareness of this Medicare benefit. Knowledge by specialty was hard to differentiate due to low responses by some specialties; however, prescribing podiatrists and prosthetic providers both responded with a familiarity rate above 92%. Common obstacles to providers prescribing shoes were: complexity of documentation (67.8%), challenges communicating with other providers (55.0%), and financial reasons/labor-to-reimbursement ratio (38.4%). TSB has the potential to reduce amputations and wound care costs. However, therapeutic shoes are underutilized with less than 20% of potential beneficiaries accessing this benefit. This research strengthens the argument that streamlining the process may increase access to therapeutic shoes. Full article

Background and Objectives: Cardiac implantable electronic device (CIED) infections remain among the most serious complications of pacemaker, implantable cardioverter-defibrillator, and cardiac resynchronization therapy procedures. They are associated with substantial morbidity, mortality, prolonged hospitalization, system extraction, long-term antimicrobial therapy, and increased healthcare costs. As most infections arise from perioperative contamination or procedure-related complications, prevention has become a major priority in contemporary electrophysiology practice. This review aimed to summarize current evidence on the prevention of CIED infections, with particular emphasis on modifiable risk factors and perioperative preventive measures. Materials and Methods: A focused narrative review was undertaken using targeted searches of PubMed/MEDLINE and Scopus, supplemented by major international guideline and consensus documents, with priority given to contemporary guidelines, randomised trials, meta-analyses, and major observational studies relevant to CIED infection prevention. Results: Prevention of CIED infection requires a structured, multifactorial approach spanning the entire procedural pathway. Key preventive strategies include careful reassessment of device indication, individualized device selection, correction of modifiable risk factors, postponement of elective implantation in the presence of active infection, appropriate perioperative antibiotic prophylaxis, and optimized management of anticoagulant and antiplatelet therapy to minimize pocket hematoma. Additional relevant measures include meticulous skin antisepsis, limitation of temporary invasive devices and unnecessary hardware, appropriate venous access selection, careful generator pocket creation and wound closure, and avoidance of early reintervention whenever feasible. Antibacterial envelopes may reduce major CIED infections in selected high-risk patients, whereas routine escalation of preventive measures without proven benefit is not supported. Conclusions: CIED infection prevention is inherently multifactorial and depends on the consistent application of evidence-based measures before, during, and after device implantation. Rigorous control of modifiable risk factors, prevention of pocket hematoma, appropriate antimicrobial prophylaxis, and meticulous procedural technique remain the cornerstones of effective infection prevention in patients undergoing CIED procedures. Full article

Introduction: Wounds increase the risk of hospitalization in home health (HH) settings by up to 52%. They also consume a notable portion of HH budgets due to frequent nursing visits for wound assessment and care. To address these challenges, a U.S.-based HH enterprise adopted a Digital Wound Care Solution (DWCS) to enhance wound management and operational efficiency. This study examines the impact of integrating the DWCS into practice, focusing on clinical and operational indicators and potential cost savings. Methods: This study employed a quasi-experimental pre–post design to evaluate the impact of the DWCS on clinical and operational outcomes. Data were extracted from the DWCS and EMR databases, encompassing pre-adoption (2022) and post-adoption (2023) periods. The analysis included wound data from 16,276 patients in 2023 and 19,252 patients in 2022, covering an 8-month period (March–October) across 11 branches. The key performance indicators included skilled nursing (SN) visits per episode (VPE), time to complete SN visits, hospitalization rates, and staff optimization. Results: The adoption of the DWCS was associated with clinical and operational improvements. SN VPE decreased by 7.5%, resulting in an estimated annual savings of $1.3 million. A directional change in wound-related hospitalization rates was observed at 30 days (20.7% to 20.3%) and 60 days (32.4% to 31.5%); however, these changes did not reach statistical significance and should be interpreted as trends. The projected prevention of 200 hospitalizations with estimated annual cost savings of $3.4 million to the health system represents modeled projections based on observed directional trends rather than realized savings. A 1.9% shift in staff roles increased the utilization of licensed practical nurses with no adverse indicators identified within the scope of this analysis, saving $112,748 annually. Conclusions: The adoption of the DWCS was associated with fewer and shorter SN visits and a shift toward more LPN utilization, with anticipated reductions in costs Wound-related admissions showed downward trends but did not reach statistically significant levels. This pre–post design precludes causal attribution, and findings should be interpreted as associations rather than definitive effects of the intervention. These findings support further investigation of wound care models integrating AI within a value-based home health setting. Full article

Polymer-based dressings constitute an important class of macromolecular biomaterials enabling controlled drug delivery and enhanced wound healing performance. This review summarizes recent advances in the design, fabrication, and functionalization of polymer dressings, with emphasis on natural and synthetic polymer systems applied in biomedical topical and transdermal drug administration. Key material properties, including biocompatibility, mechanical stability, porosity, and degradation behavior, are discussed in relation to drug loading capacity and release kinetics. Current fabrication strategies, such as electrospinning, hydrogel formation, casting, and multilayer assembly, are critically evaluated with respect to structural control and scalability. Particular attention is given to antimicrobial and stimuli-responsive platforms capable of dynamic interaction with the wound microenvironment. Furthermore, challenges related to long-term stability, regulatory requirements, and clinical translation are addressed. By integrating recent experimental findings, this review highlights essential structure–function relationships governing polymer dressing performance and provides design guidelines for next-generation macromolecular topical and transdermal care systems with improved multifunctionality and clinical applicability. Full article

Background: Nursing students are at high risk of exposure to blood and body fluids due to limited clinical experience. Ensuring adequate knowledge and proper post-exposure protocols is vital for improving safety and post-exposure management. Aim: This study aimed to evaluate the level of knowledge, previous exposure experience, and reporting practices regarding occupational exposure incidents among nursing students at the Faculty of Health Sciences, University of Split, Croatia. Methods: A cross-sectional study was conducted among 274 nursing students using a structured self-administered questionnaire. Descriptive statistical methods were applied, along with univariate and multivariate linear regression analyses. Results: Exposure incidents were experienced by 36.3% of students, with needlestick injuries being the most common (80.1%). In terms of reporting practices, fewer than half (40.8%) of those affected officially reported the incident. While students demonstrated adequate overall performance on the knowledge assessment (median score 12, IQR: 11–14), significant gaps were identified in hepatitis B and C protocols and immediate wound care. Multivariate analysis identified full-time student status (β = 1.24; p = 0.010) and first-year students (β = 0.82; p = 0.036) as factors significantly associated with higher knowledge scores. Conclusions: Although nursing students possess solid fundamental knowledge of exposure-related risks, a significant gap remains in their practical application and incident reporting. The high incidence of needlestick injuries (80.1%) underscores the importance of moving beyond theory toward enhanced clinical supervision. To address these gaps, nursing education should prioritize targeted practical training and cultivate a robust safety culture that encourages incident reporting. Full article

Loneliness and social isolation are increasingly recognized as major determinants of health, with physiologic and behavioral effects that rival traditional biomedical risk factors. Populations commonly treated in podiatric practice, including older adults, patients with diabetes, rural residents, and veterans, are disproportionately affected by social isolation, yet its impact on foot and ankle outcomes remains underrecognized. Emerging evidence demonstrates that loneliness alters immune regulation, inflammatory signaling, pain perception, adherence behaviors, and healthcare utilization, all of which directly influence wound healing, postoperative recovery, and limb preservation. This paper introduces the Podiatric Connection Model (PCM), a clinically actionable framework designed to integrate social connection into podiatric care. The PCM provides a structured approach for identifying social risk factors, strengthening therapeutic relationships, engaging caregivers, tailoring follow-up intensity, and monitoring evolving psychosocial needs throughout the course of treatment. By reframing loneliness as a modifiable comorbidity rather than a background social issue, the PCM offers a practical strategy for improving adherence, reducing complications, and strengthening healing trajectories in high-risk foot and ankle populations. Full article

Polydeoxyribonucleotide (PDRN) activates the adenosine A2A receptor (A2AR), triggering anti-inflammatory signaling and providing essential nucleotides for the salvage pathway, thereby helping bypass metabolic bottlenecks and promoting tissue repair. Combining PDRN with biochemical agents and physical stimuli represents a significant shift in medical treatment, moving from monotherapy to an integrated, multi-target regenerative approach. These combinatorial strategies effectively address the limitations of PDRN, such as its rapid degradation and diffusion, by simultaneously meeting the structural, metabolic, and signaling needs of injured tissues. The mechanism of action for PDRN involves a synergistic effect with hyaluronic acid, amplification of growth factors (e.g., Platelet-Rich Plasma (PRP), Epidermal Growth Factor (EGF), Platelet-Derived Growth Factor (PDGF)), and enhancements from extracorporeal shockwave therapy (ESWT) and lasers. This results in a notable acceleration of the repair process for chronic wounds, musculoskeletal disorders, and neurological injuries. As intelligent delivery systems like responsive hydrogels and sustainable L-PDRN production continue to advance, these synergistic protocols are poised to redefine global standards of care in regenerative medicine and esthetic dermatology. Future clinical success will hinge on the standardization of sequence-specific protocols and large-scale validation to ensure long-term safety and efficacy. Full article

Background: NexoBrid^® (NXB), an enzymatic debridement agent approved in Japan in 2022, provides a less invasive alternative to surgical excision for burn treatment. However, its optimal therapeutic benefit depends on appropriate patient selection and proper application technique. Existing international consensus documents are not fully applicable to clinical practice in Japan because of differences in available devices and drugs. Therefore, a Japan-specific consensus document was developed by a panel of seven Japanese burn experts, including four plastic surgeons and three emergency physicians. Methods: A questionnaire-based survey was conducted using the Delphi method to achieve expert consensus. Consensus was defined as agreement by at least 80% of committee members for each statement. A total of 27 statements were evaluated over two rounds. Results: Consensus was achieved for 20 of 27 statements (74.1%) in the first round and for 21 of 27 statements (77.8%) in the second round. The finalised statements were organised into seven categories according to their attributes: indications, pain management, application timing, application technique, post-application wound care, skin grafting, and scarring/aesthetic outcomes. Conclusions: This consensus document integrates the opinions of plastic surgeons and emergency physicians in Japan, while also incorporating relevant international perspectives, to provide practical guidance on the use of NXB for burn treatment. It is intended to improve the quality of burn care by clarifying efficacy, safety, and precautions associated with NXB use. These recommendations should be updated as further clinical experience accumulates. Full article

Background: Candida isolation is common in critically ill patients, but its clinical interpretation depends strongly on microbiological source, host factors, and clinical context. Bloodstream isolation, candiduria, respiratory tract isolation, surveillance cultures, catheter-tip cultures, and wound/skin cultures have different clinical implications. We aimed to evaluate clinical characteristics, microbiological sources, species distribution, antifungal treatment patterns, and outcomes among adult ICU patients with Candida-positive ICU cultures. Methods: This single-center retrospective observational cohort study was conducted in the medical intensive care unit of Marmara University Faculty of Medicine between 1 October 2022 and 5 September 2025. Adult ICU patients with at least one Candida-positive ICU culture were included. Non-Candida fungal isolates and duplicate patient-level records were excluded. The primary outcome was all-cause 28-day mortality. ICU mortality was defined as all-cause death during ICU stay. Source-stratified analyses and expanded multivariable logistic regression models were performed to evaluate factors associated with mortality. Results: A total of 349 adult ICU patients were included. Median age was 71 years [IQR, 62–82], and 185 patients were male (53.0%). Overall, 28-day mortality was 59.0% (206/349), and ICU mortality was 65.9% (230/349). Candida colonization was identified in 247 patients (70.8%), whereas Candida infection was identified in 102 patients (29.2%). The most common species were Candida albicans (48.4%), Candida glabrata (13.8%), and Candida auris (12.9%). The most frequent microbiological sources were urine (42.4%), lower respiratory tract samples (26.4%), and blood cultures (14.9%). Blood/sterile-site isolation was associated with higher ICU mortality than non-blood/non-sterile-site isolation (79.2% vs. 63.5%, p = 0.026), whereas the difference in 28-day mortality was not statistically significant (66.0% vs. 57.8%, p = 0.260). Antifungal treatment was more frequent among patients with blood/sterile-site isolation (94.3% vs. 16.9%, p < 0.001). In the expanded 28-day mortality model, lactate, NLR, and carbapenem exposure were independently associated with mortality. In the expanded ICU mortality model, lactate and CRRT/hemodialysis were independently associated with mortality. Candida score was not independently associated with either 28-day mortality or ICU mortality after broader adjustment. Conclusions:Candida-positive ICU cultures represent a heterogeneous clinical and microbiological spectrum. Source-specific interpretation is essential, particularly when distinguishing bloodstream or sterile-site isolation from non-sterile-site colonization. Candida score may reflect a higher-risk clinical phenotype, but it should not be interpreted as a stand-alone mortality prediction tool. Full article

Current evidence on traumatic equine wounds are predominantly from expert opinion reviews or referral hospital studies. This study aimed to describe the owner-reported causes, management and outcome of equine wounds. An owner-reported cohort approach was used. Owners of horses with recent traumatic wounds were recruited through snowball sampling. Data were collected from initial injury to final healing and outcome, including horse demographics, wound cause and location, owner- and veterinary-administered treatment, and outcome. Descriptive statistics included frequency percentages (%, x/y) and median and interquartile range. Data were obtained for 219 cases, with outcome data for 139 horses. The most common wound cause was a wire/fence injury (38%, 84/219), and the most common location was distal hindlimb (31%, 79/251). Owners administered initial first aid in 67% (147/219) of cases, and 75% (165/219) of horses received veterinary treatment. A total of 19% (38/201) of owners were not confident in deciding whether veterinary attention was needed. Wound healing time was a median of 60 days (IQR 30.3–157.0), time to return to work was a median of 6.5 weeks (IQR 2.0–16.0), and 3/139 horses were euthanised. Main study limitations were small sample size, self-selection, owner-reporting and attrition bias. Key areas for future resources to support owner preventative care and decision-making were identified. Full article

Background: Necrotizing fasciitis (NF) is a rapidly progressing and life-threatening soft tissue infection. It commonly affects the extremities and is triggered by trauma, surgical wounds or compromised skin integrity. Although there have been advancements in diagnosis and treatment, NF continues to be a complex condition due to comorbidities and the wide range of involved pathogens. The aim of this study was to assess the epidemiology, risk factors, and outcomes of NF in Switzerland, focusing on the distinction between polymicrobial and monomicrobial infections and their associated management. Methods: This monocentric retrospective study analyzed 75 patients treated for intraoperatively confirmed NF from 2010 to 2022. Data collection included demographic and clinical variables, comorbidities, and laboratory results. Univariate and multivariate statistical tests were conducted to assess associations between mortality and different infection types. Results: NF was most commonly localized in the lower extremities (52% of cases). Nearly all patients (99%) had at least one comorbidity, with coronary heart disease, kidney disease, and liver disease being most frequently observed. Advanced age was associated with higher in-hospital mortality (OR (odds ratio) 3.80, p = 0.033, q = 0.500, 16 of 44 patients over 60 died), and the overall in-hospital mortality in the cohort was 27%. Kidney disease and smoking were associated with polymicrobial infections, with an OR of 6.60 (p = 0.016, q = 0.130) and 5.60 (p = 0.009, q = 0.130), respectively. Trauma was associated with monomicrobial streptococcal infections (OR 3.40, p = 0.029, q = 0.500), and showed a significant association with Streptococcus pyogenes infections (OR 8.10, p < 0.001, q = 0.004). Conclusions: This study highlights advanced age, trauma, kidney disease and smoking as factors associated with worse outcomes and specific infection patterns in patients with NF. These findings, derived from a Swiss patient population, underscore the importance of early identification of high-risk individuals to improve clinical outcomes. Recognizing these risk profiles may support clinicians in prioritizing rapid escalation of care for the patients most likely to benefit from early and aggressive intervention. Full article

The emergence of multifunctional wound dressings represents a significant transformation in the care of cutaneous tissue injuries, providing advanced solutions that surpass traditional dressings. This study is poised to fabricate multifunctional hydrogels through dual-dynamic cross-linking, integrating antibacterial and antioxidant properties, which are capable of accelerating wound healing while improving therapeutic outcomes. The hydrogel, which exhibits excellent adhesion, rapid self-healing ability, and on-demand removability, was synthesized employing poly(vinyl alcohol) (PVA)–borax as the backbone, followed by the incorporation of silk fibroin (SF), tannic acid (TA), and chitosan (CS). Total saponins of Panax notoginseng flower buds (PNF) with anti-inflammatory and angiogenic properties were loaded in porous structural materials yielding the PBCTS@PNF hydrogel. The prepared hydrogel exhibited outstanding antioxidant properties and cytocompatibility, along with favorable antibacterial capabilities, achieving inhibition rates of 84.30 ± 2.34% against Escherichia coli (E. coli) and 98.12 ± 0.76% against Staphylococcus aureus (S. aureus), respectively. Animal experiments demonstrated that PBCTS@PNF significantly reduced inflammation and promoted multidimensional tissue regeneration, encompassing re-epithelialization, neovascularization, and hair follicle regeneration, along with ordered collagen matrix organization, leading to substantially accelerated wound healing. The multifunctional PBCTS@PNF hydrogel provides a potent bioengineered therapeutic platform for wound healing management through the synergistic interplay among antibacterial, anti-inflammatory, and tissue regenerative functionalities. Full article

Chronic wounds are frequently complicated by biofilm-associated infections that impair healing and limit treatment efficacy. Buddleja globosa (BG) exhibits antimicrobial and regenerative properties, making it a promising candidate for advanced wound care. This study aimed to optimize the concentration of a standardized BG extract incorporated into polymeric scaffolds for the treatment of wounds infected with the dual-species biofilm (DSB) of Pseudomonas aeruginosa and Staphylococcus aureus. Scaffolds containing increasing BG concentrations (BG1 to BG4) were fabricated by lyophilization and characterized in terms of physicochemical properties, antimicrobial activity, and cytocompatibility. Their therapeutic efficacy was further evaluated using an in vitro artificial wound model and a murine model of a DSB-infected wound. BG incorporation significantly influenced the scaffold properties. While BG1–BG3 maintained a comparable structure and mechanical integrity, BG4 exhibited a reduced pore size, swelling capacity, and mechanical resistance. All BG-loaded scaffolds reduced bacterial viability in vitro, with BG4 showing the strongest antimicrobial effect. In vivo, BG2 showed the most consistent overall performance, combining improved wound closure at day 6 with complete re-epithelialization at the endpoint. BG3 improved wound closure at day 6 but did not outperform it in re-epithelialization. In contrast, BG4 did not enhance healing despite its higher antimicrobial activity in vitro. These findings demonstrate that scaffold performance is governed by the interplay between extract loading and physicochemical properties, and that intermediate BG concentrations provide more favorable conditions for tissue repair than higher loadings. This work supports the potential of BG-loaded scaffolds as a therapeutic strategy for biofilm-infected chronic wounds. Full article