Wound infection is becoming a considerable healthcare crisis due to the abuse of antibiotics and the substantial production of multidrug-resistant bacteria.Seawater immersion wounds usually become a mortal trouble bec...Wound infection is becoming a considerable healthcare crisis due to the abuse of antibiotics and the substantial production of multidrug-resistant bacteria.Seawater immersion wounds usually become a mortal trouble because of the infection of Vibrio vulnificus.Bdellovibrio bacteriovorus,one kind of natural predatory bacteria,is recognized as a promising biological therapy against intractable bacteria.Here,we prepared a B.bacteriovorus-loaded polyvinyl alcohol/alginate hydrogel for the topical treatment of the seawater immersion wounds infected by V.vulnificus.The B.bacteriovorus-loaded hydrogel(BG)owned highly microporous structures with the mean pore size of 90μm,improving the rapid release of B.bacteriovorus from BG when contacting the aqueous surroundings.BG showed high biosafety with no L929 cell toxicity or hemolysis.More importantly,BG exhibited excellent in vitro anti-V.vulnificus effect.The highly effective infected wound treatment effect of BG was evaluated on mouse models,revealing significant reduction of local V.vulnificus,accelerated wound contraction,and alleviated inflammation.Besides the high bacterial inhibition of BG,BG remarkably reduced inflammatory response,promoted collagen deposition,neovascularization and re-epithelization,contributing to wound healing.BG is a promising topical biological formulation against infected wounds.展开更多
In clinical applications,there is a lack of wound dressings that combine efficient resistance to drug-resistant bacteria with good self-healing properties.In this study,a series of adhesive self-healing conductive ant...In clinical applications,there is a lack of wound dressings that combine efficient resistance to drug-resistant bacteria with good self-healing properties.In this study,a series of adhesive self-healing conductive antibacterial hydrogel dressings based on oxidized sodium alginate-grafted dopamine/carboxymethyl chitosan/Fe3+(OSD/CMC/Fe hydrogel)/polydopamine-encapsulated poly(thiophene-3-acetic acid)(OSD/CMC/Fe/PA hydrogel)were prepared for the repair of infected wound.The Schiff base and Fe3+coordination bonds of the hydrogel structure are dynamic bonds that can be repaired automatically after the hydrogel network is disrupted.Macroscopically,the hydrogel exhibits self-healing properties,allowing the hydrogel dressing to adapt to complex wound surfaces.The OSD/CMC/Fe/PA hydrogel showed good conductivity and photothermal antibacterial properties under near-infrared(NIR)light irradiation.In addition,the hydrogels exhibit tunable rheological properties,suitable mechanical properties,antioxidant properties,tissue adhesion properties and hemostatic properties.Furthermore,all hydrogel dressings improved wound healing in the infected full-thickness defect skin wound repair test in mice.The wound size repaired by OSD/CMC/Fe/PA3 hydrogel+NIR was much smaller(12%)than the control group treated with Tegaderm™film after 14 days.In conclusion,the hydrogels have high antibacterial efficiency,suitable conductivity,great self-healing properties,good biocompatibility,hemostasis and antioxidant properties,making them promising candidates for wound healing dressings for the treatment of infected skin wounds.展开更多
Bacterial infection causes wound inflammation and makes angiogenesis difficult.It is urgent to develop effectively antibacterial and pro-vascularizing dressings for wound healing.The hydrogel is developed with pH-resp...Bacterial infection causes wound inflammation and makes angiogenesis difficult.It is urgent to develop effectively antibacterial and pro-vascularizing dressings for wound healing.The hydrogel is developed with pH-responsive drug-releasing microcarriers which were loaded with vascular endothelial growth factor(VEGF)that promotes angiogenesis and actively respond to wound pH for control and prolong VEGF release.The surfaces of the microcarriers were coated with polydopamine which can reduce the silver nanoparticles(AgNPs)in situ,and dynamically crosslink with the polyacrylamide,which forms a stable slow-release system with different release behavior for the VEGF and AgNPs.The hydrogel inhib-ited bacterial formation and accelerated wound healing.With the hydrogel dressing,83.3%±4.29%of the wound heals at day 7,which is 40.9%±8.5%higher than the non-treatment group in defect infected model.The antibacterial properties of hydrogel down-regulate early inflammation-related cytokines,and the release of VEGF in the middle and late phases of wound healing in response to pH changes pro-motes angiogenesis and up-regulate the expression of angiogenesis-associated cytokine.The sequential release of antibacterial agents and pro-vascularizing agents in response to the change in wound microen-vironmental cues facilitate temporally controlled therapy that suites the need of different wound healing phases.Collectively,the hydrogel loaded with multifunctional microcarriers that enable controlled release of AgNPs and VEGF is an effective system for treating infected wounds.展开更多
Medical cotton dressing is cheap and widely used in diversified fields,but in the application of promoting wound healing,the continuous research of multifunctional medical cotton dressing is still of great significanc...Medical cotton dressing is cheap and widely used in diversified fields,but in the application of promoting wound healing,the continuous research of multifunctional medical cotton dressing is still of great significance.Here,we developed a fresh type of antibacterial cotton dressing through a succinct strategy based on chemically anchoring polyhexamethylene biguanide(PHMB).Intriguingly,after PHMB modification,the cotton dressing exhibited outstanding antibacterial performance which could maintain>99.99%antibacterial rate after several treatments,including washing 50 times,repeated use 10 times,UV irradiation for 7 days,cationic dyes dying,and conditioned under 90℃water bath for 2 h.In addition,the water contact angle of cotton dressing increased dramatically from 0°to 111°,which could facilitate bacterial adhesion,thus further enhance the antibacterial efficiency,and easily remove the bacterial debris.Apart from that,the developed cotton dressing showed good cytocompatibility,promoted blood clotting and expression of platelets,and promoted the wound healing process in the infection intervened skin wound model.Taken together,this antibacterial cotton dressing with desirable blood clotting,sustained protection against bacterial infection and bacterial removal features shows the potential to be a candidate for infected skin wound healing.展开更多
Bio-adhesive polysaccharide-based hydrogels have attracted much attention in first-aid hemostasis and wound healing for excellent biocompatibility,antibacterial property and pro-healing bioactivity.Yet,the inadequate ...Bio-adhesive polysaccharide-based hydrogels have attracted much attention in first-aid hemostasis and wound healing for excellent biocompatibility,antibacterial property and pro-healing bioactivity.Yet,the inadequate mechanical properties and bio-adhesion limit their applications.Herein,based on dynamic covalent bonds,photo-triggered covalent bonds and hydrogen bonds,multifunctional bio-adhesive hydrogels comprising modified carboxymethyl chitosan,modified sodium alginate and tannic acid are developed.Multi-crosslinking strategy endows hydrogels with improved strength and flexibility simultaneously.Owing to cohesion enhancement strategy and self-healing ability,considerable bio-adhesion is presented by the hydrogel with a maximal adhesion strength of 162.6 kPa,12.3-fold that of commercial fibrin glue.Based on bio-adhesion and pro-coagulant activity(e.g.,the stimulative aggregation and adhesion of erythrocytes and platelets),the hydrogel reveals superior hemostatic performance in rabbit liver injury model with blood loss of 0.32 g,only 54.2%of that in fibrin glue.The healing efficiency of hydrogel for infected wounds is markedly better than commercial EGF Gel and Ag+Gel due to the enhanced antibacterial and antioxidant properties.Through the multi-crosslinking strategy,the hydrogels show enhanced mechanical properties,fabulous bio-adhesion,superior hemostatic performance and promoting healing ability,thereby have an appealing application value for the first-aid hemostasis and infected wound healing.展开更多
BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal ...BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal surgery;however,the number of infec-tion cases is increasing owing to the increasing number of elderly citizens.CASE SUMMARY A 75-year-old male with a chronic spinal defect due to previous spine surgery underwent reconstruction using a perforator-based island flap.After bursectomy and confirmation that there was no connection with the deep tissue,reconstruction was performed.However,wound disruption occurred with abscess formation on postoperative day 29,which led to an imaging workup revealing delayed deep tissue infection.CONCLUSION Infection is one of the most common causes of surgical wound dehiscence and is associated with devastating results if not controlled promptly and definitively.Surgeons should always suspect delayed infections when reconstructing chronic soft tissue defects.展开更多
BACKGROUND: This prospective observational study aimed to determine the infection rate of simple hand laceration(SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were...BACKGROUND: This prospective observational study aimed to determine the infection rate of simple hand laceration(SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were not.METHODS: The study was performed at two urban hospitals enrolling 125 emergency department(ED) patients with SHL. Exclusion criteria included patients with lacerations for more than 12 hours, immunocompromized patients, patients given antibiotics, and patients with gross contamination, bites or crush injuries. Wound infection was defined as clinical infection at a follow-up visit(10–14 days) or wound was treated with antibiotics. Patient satisfaction was also measured using a visual analogue scale 1–10, asking the patients about wound appearance. Demographic data and wound characteristics were compared between the infected and non-infected wounds. The infection rates were also compared between patients who received prophylactic antibiotics and those who did not. The results were presented with medians and quartiles or percentages with 95% confidence intervals(CI).RESULTS: In the 125 patients with SHL [median age: 28(18, 43); range: 1–102 years old; 36% female], 44(35%, 95% CI: 27%–44%) were given antibiotics in the ED. Wound infection was reported in 6 patients(4.8%, 95% CI: 2%–10%). Age, gender, history of diabetes and wound closure were not associated with wound infection(P>0.05). The infection rate was not significantly different between patients with or without antibiotic prophylaxis [7%(3/44), 95% CI: 2%–10% vs. 4%(3/81), 95% CI: 1%–11%, P=0.66]. Patient's satisfaction with appearance ofinfected and non-infected wounds were significantly different [7.5(6, 8) vs. 9(8, 10), P=0.01].CONCLUSION: Approximately 5% of simple hand lacerations become infected. Age, gender, diabetes, prophylactic antibiotics and closure technique do not affect the risk ofinfection.展开更多
Chromobacterium violaceum is a Gram negative, facultative anaerobe, generally present in water, soil in tropical and subtropical regions. This bacterium is an emerging environmental pathogen that causes life threateni...Chromobacterium violaceum is a Gram negative, facultative anaerobe, generally present in water, soil in tropical and subtropical regions. This bacterium is an emerging environmental pathogen that causes life threatening infection in humans and animals. It can cause wound infection, visceral abscess, septicaemia, meningitis, diarrhoea, UTI. It is associated with significant mortality due to severe systemic infection. As the bacteria have high spreading tendency leading to sepsis, early identification and prompt treatment is necessary. Here we report a case of Chromobacterium violaceum wound infection in a 9 years old male from Dhaka, who was successfully treated with combination of cefixime and flucloxacillin antibiotics as per culture sensitivity report.展开更多
Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the ...Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m<sup>2</sup>. There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.展开更多
Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, w...Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, while the Society of Thoracic Surgeons’ guidelines suggest that optimal postoperative prophylactic antibiotics be given for 48 hours or less. Very few studies have compared the same antibiotic with 2 different administration durations. The study was designed to compare the efficacy of 24-hour administration of cefamandole vs intraoperative cefamandole to prevent deep sternal wound infection and endocarditis after cardiac surgery. Methods: This retrospective and observational study compared the rates of severe surgical site infections (deep sternal wound infection, endocarditis) after cardiac surgery between period 1, 01/01/2008-31/08/2008, with 24-hour administration of cefamandole, and period 2, 01/09/2008-30/04/2009 with intraoperative cefamandole. Results: Among 933 patients, 14 patients (1.5%) developed surgical site infection during the 16-month study: 1.3% during the first period and 1.7% during the second (ns). The populations (470 patients in period 1 and 463 in period 2) were homogeneous and comparable for pre-, intra- and postoperative characteristics. Surgical site infection characteristics (pathogens involved, time to diagnosis) and consequences (longer hospital stay, outcomes) were comparable in the 2 groups. Conclusions: Intraoperative cefamandole was as safe as its 24-hour administration to prevent deep sternal wound infection and endocarditis after adult cardiac surgery.展开更多
To evaluate the effect of extensive excision of invasive burn wound infection on hypermeta-bolic response in burn patients with sepsis. Methods:Eight patients with major burn, complicated by invasive burn wound infect...To evaluate the effect of extensive excision of invasive burn wound infection on hypermeta-bolic response in burn patients with sepsis. Methods:Eight patients with major burn, complicated by invasive burn wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. REEs were monitored by means of Cardiorespiratory Diagnostic System (Medical Graphics Corporation, USA) at patients bedside. Plasma concentration of IL-6、IL-8、TNF-α and LPS were assayed before an...展开更多
Damaged skin cannot prevent harmful bacteria from invading tissues,causing infected wounds or even severe tissue damage.In this study,we developed a controlled-release antibacterial composite hydrogel system that can ...Damaged skin cannot prevent harmful bacteria from invading tissues,causing infected wounds or even severe tissue damage.In this study,we developed a controlled-release antibacterial composite hydrogel system that can promote wound angiogenesis and inhibit inflammation by sustained releasing Cu-Epigallocatechin-3-gallate(Cu-EGCG)nano-capsules.The prepared SilMA/HAMA/Cu-EGCG hydrogel showed an obvious inhibitory effect on Escherichia coli(E.coli)and Staphylococcus aureus(S.aureus).It could also promote the proliferation and migration of L929 fibroblasts.In vivo full-thickness infected wound healing experiments confirmed the angiogenesis and inflammation regulating effect.Accelerate collagen deposition and wound healing speed were also observed in the SilMA/HAMA/Cu-EGCG hydrogel treated group.The findings of this study show the great potential of this controlled-release antibacterial composite hydrogel in the application of chronic wound healing.展开更多
Thermal wounds are complex and lethal with irregular shapes, risk of infection, slow healing, and large surface area. The mortality rate in patients with infected burns is twice that of non-infected burns. Developing ...Thermal wounds are complex and lethal with irregular shapes, risk of infection, slow healing, and large surface area. The mortality rate in patients with infected burns is twice that of non-infected burns. Developing multifunctional skin substitutes to augment the healing rate of infected burns is vital. Herein, we 3D printed a hydrogel scaffold comprising carboxymethyl chitosan (CMCs) and oxidized alginate grafted catechol (O-AlgCat) on a hydrophobic electrospun layer, forming a bilayer skin substitute (BSS). The functional layer (FL) was fabricated by physiochemical crosslinking to ensure favorable biodegradability. The gallium-containing hydrophobic electrospun layer or backing layer (BL) could mimic the epidermis of skin, avoiding fluid penetration and offering antibacterial activity. 3D printed FL contains catechol, gallium, and biologically active platelet rich fibrin (PRF) to adhere to both tissue and BL, show antibacterial activity, encourage angiogenesis, cell growth, and migration. The fabricated bioactive BSS exhibited noticeable adhesive properties (P ≤ 0.05), significant antibacterial activity (P ≤ 0.05), faster clot formation, and the potential to promote proliferation (P ≤ 0.05) and migration (P ≤ 0.05) of L929 cells. Furthermore, the angiogenesis was significantly higher (P ≤ 0.05) when evaluated in vivo and in ovo. The BSS-covered wounds healed faster due to low inflammation and high collagen density. Based on the obtained results, the fabricated bioactive BSS could be an effective treatment for infected burn wounds.展开更多
Bacterial infection of wounds is an escalating medical problem,issuing threats to both global public health and personal health.Photothermal antibacterial technology as a novel sterilization strategy has outstanding s...Bacterial infection of wounds is an escalating medical problem,issuing threats to both global public health and personal health.Photothermal antibacterial technology as a novel sterilization strategy has outstanding sterilization efficiency,high safety and low risk of emergence of drug-resistant bacteria.By combining inherent antibacterial activity and light-assisted antibacterial treatment,developing novel multifunctional dressings with synergistic high-efficiency antibacterial effects and also promoting wound healing possesses attractive advantages in the field of treating bacterial wound infections in clinical care.Herein,a multifunctional hydrogel formed by in situ photo-cross linking was designed and prepared by first grafting methacrylic anhydride as a photosensitizer onto chitosan,and then introducing oxidatively synthesized polydopamine(PDA).The physicochemical characterizations of the synthesized hydrogels demonstrated their tunability certainly associated with PDA concentration,including pore size,water swelling,rheological properties and in vitro degradability.In addition,the composite hydrogels exhibited good adhesion,anti-oxidation and photothermal properties due to the existence of PDA.Within 10min upon exposure to 808 nm near-infrared(NIR)light irradiation,this hydrogel system displayed outstanding antibacterial activity against Staphylococcus aureus with almost 100%killing efficiency,of which rapid efficient sterilization plays a significant role in wound healing.Moreover,the hydrogel is capable of cytocompatibility and has low toxicity to murine fibroblasts(L929 and NIH/3T3).In the full-thickness wound defect infection model in mice,the wound closure ratio,inflammatory response,fibroblasts,neovascularization and epithelialization were measured.Animal experiments also reveal that the hydrogel assisted with NIR laser irradiation can inhibit effectively infection at an early stage and accelerate the wound healing process.In summary,this novel multifunctional injectable hydrogel exhibits excellent swelling capacity,bio-adhesion,antioxidant property,photothermal activity,efficient antibacterial property and facilitates skin healing,which has great promising application as a medical dressing biomaterial in infected wound carefields.展开更多
BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the ...BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.展开更多
It is of great importance to treat a bacterial-infected wound by a smart dressing capable of delivering antibiotics in a smart manner without causing drug resistance.The construction of smart release nanocontainers re...It is of great importance to treat a bacterial-infected wound by a smart dressing capable of delivering antibiotics in a smart manner without causing drug resistance.The construction of smart release nanocontainers responsive to near-infrared(NIR)laser irradiation in an on-demand and stepwise way is a promising strategy for avoiding the emergence of multidrug-resistant bacteria.Here,we develop a hydrogel composite made of alginate and nanotubes with an efficient NIR-triggered release of rifampicin and outstanding antibacterial ability.This composite hydrogel is prepared through co-encapsulating antibacterial drug(rifampicin),NIR-absorbing dye(indocyanine green),and phase-change materials(a eutectic mixture of fatty acids)into halloysite nanotubes,followed by incorporation into alginate hydrogels,allowing the in-situ gelation at room temperature and maintaining the integrity of drug-loaded nanotubes.Among them,the eutectic mixture with a melting point of 39℃ serves as the biocompatible phase-change material to facilitate the NIR-triggered drug release.The resultant phase-change material gated-nanotubes exhibit a prominent photothermal efficiency with multistep drug release under laser irradiation.In an in vitro assay,composite hydrogel provides good antibacterial potency against Staphylococcus aureus,one of the most prevalent microorganisms of dangerous gas gangrene.A bacterial-infected rat full-thickness wound model demonstrates that the NIR-responsive composite hydrogel inhibits the bacteria colonization and suppresses the inflammatory response caused by bacteria,promoting angiogenesis and collagen deposition to accelerate wound regeneration.The NIR-responsive composite hydrogel has a great po-tential as an antibacterial wound dressing functionalized with controlled multistep treatment of the infected sites.展开更多
With the increasing prevalence of drug-resistant bacterial infections and the slow healing of chronically infected wounds,the development of new antibacterial and accelerated wound healing dressings has become a serio...With the increasing prevalence of drug-resistant bacterial infections and the slow healing of chronically infected wounds,the development of new antibacterial and accelerated wound healing dressings has become a serious challenge.In order to solve this problem,we developed photo-crosslinked multifunctional antibacterial adhesive anti-oxidant hemostatic hydrogel dressings based on polyethylene glycol monomethyl ether modified glycidyl methacrylate functionalized chitosan(CSG-PEG),methacrylamide dopamine(DMA)and zinc ion for disinfection of drug-resistant bacteria and promoting wound healing.The mechanical properties,rheological properties and morphology of hydrogels were characterized,and the biocompatibility of these hydrogels was studied through cell compatibility and blood compatibility tests.These hydrogels were tested for the in vitro blood-clotting ability of whole blood and showed good hemostatic ability in the mouse liver hemorrhage model and the mouse-tail amputation model.In addition,it has been confirmed that the multifunctional hydrogels have good inherent antibacterial properties against Methicillin-resistant Staphylococcus aureus(MRSA).In the full-thickness skin defect model infected with MRSA,the wound closure ratio,thickness of granulation tissue,number of collagen deposition,regeneration of blood vessels and hair follicles were measured.The inflammation-related cytokines(CD68)and angiogenesis-related cytokines(CD31)expressed during skin regeneration were studied.All results indicate that these multifunctional antibacterial adhesive hemostatic hydrogels have better healing effects than commercially available Tegaderm™Film,revealing that they have become promising alternative in the healing of infected wounds.展开更多
AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre.METHODS: The data of patients who underwen appendectomy between January 2011 and June 2013 were collected. The data...AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre.METHODS: The data of patients who underwen appendectomy between January 2011 and June 2013 were collected. The data included patients' demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale o pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded Patients with surgery converted from laparoscopic appendectomy(LA) to mini-incision open appendectomy(MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physica examination, laboratory values, and radiological tests(abdominal ultrasound or computed tomography). Al operations were performed with general anaesthesia The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients.RESULTS: Of the 243 patients, 121(49.9%) underwen MOA, while 122(50.1%) had laparoscopic appendectomy There were no significant differences in operation time between the two groups(P = 0.844), whereas the visua analog scale of pain was significantly higher in the open appendectomy group at the 1st hour(P = 0.001), 6th hour(P = 0.001), and 12 th hour(P = 0.027). The need for analgesic medication was significantly higher in the MOA group(P = 0.001). There were no differences between the two groups in terms of morbidity rate(P = 0.599)The rate of total complications was similar between the two groups(6.5% in LA vs 7.4% in OA, P = 0.599). Al wound infections were treated non-surgically. Six ou of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient requiredsurgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain.CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients.展开更多
BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg...BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.展开更多
Introduction: Despite extensive experience with civilian gunshot fractures or wounds, no consensus exists on a standard protocol to manage these injuries. Many authors recommended immediate debridement, but the optima...Introduction: Despite extensive experience with civilian gunshot fractures or wounds, no consensus exists on a standard protocol to manage these injuries. Many authors recommended immediate debridement, but the optimal timing of internal fixation and the use of antibiotic have not been determined. The purpose of this paper is to present and discuss our experience. Material and methods: In January 2007, a treatment protocol was put in place for the evaluation and management of fractured extremities resulting from civilian gunshot wounds. Sixty-three patients with 64 fractures had been managed by this protocol for gunshot fractures between January 2005 and January 2012. There were 56 male and seven female. Their mean age was 33.1 years (range: 17 - 61 years). Thirteen patients (20.6%) were able to provide a description of the weapon. Only 15 patients had entry and exit wounds. The mean follow-up period was 27 (range, 20 - 58) months. The main factors assessed were the surgical site infection, the fracture union and the functional status. Results: Out of the 63 patients, 14 patients developed a wound infection (five superficial and seven deep infections). Wound infection was significantly associated with associated injuries (p = 0.0388), fractures sites requiring fixation (p = 0.024), the fracture pattern (p = 0.0412), operative modalities (p = 0.0400). There were nine cases (14.1%) of fracture non-union. The mean time to union was 15 weeks (range: 5 - 32 weeks). Five patients developed chronics osteomyelitis. The average SMFA score for all of the patients was 23.8 (range: 0 - 56.3). The mean dysfunctional and bother indexes were 18.3 (range: 0 - 52.7) and 22.6 (range: 0 - 66.1), respectively. The SMFA total score and dysfunction index had a significant correlation based on presence or absence of associated injuries (p < 0.0001). But bother index did not show the same correlation (p = 0.452). The average length of hospital stay was 11.3 days (range: 3 - 64). Conclusion: In civilian’s gunshot induced fractures, internal fixation can be made according to standard protocol, with acceptable result.展开更多
基金supported by the National Natural Science Foundation of China(82073791)。
文摘Wound infection is becoming a considerable healthcare crisis due to the abuse of antibiotics and the substantial production of multidrug-resistant bacteria.Seawater immersion wounds usually become a mortal trouble because of the infection of Vibrio vulnificus.Bdellovibrio bacteriovorus,one kind of natural predatory bacteria,is recognized as a promising biological therapy against intractable bacteria.Here,we prepared a B.bacteriovorus-loaded polyvinyl alcohol/alginate hydrogel for the topical treatment of the seawater immersion wounds infected by V.vulnificus.The B.bacteriovorus-loaded hydrogel(BG)owned highly microporous structures with the mean pore size of 90μm,improving the rapid release of B.bacteriovorus from BG when contacting the aqueous surroundings.BG showed high biosafety with no L929 cell toxicity or hemolysis.More importantly,BG exhibited excellent in vitro anti-V.vulnificus effect.The highly effective infected wound treatment effect of BG was evaluated on mouse models,revealing significant reduction of local V.vulnificus,accelerated wound contraction,and alleviated inflammation.Besides the high bacterial inhibition of BG,BG remarkably reduced inflammatory response,promoted collagen deposition,neovascularization and re-epithelization,contributing to wound healing.BG is a promising topical biological formulation against infected wounds.
基金Deanship of Scientific Research at Najran University for funding this work,under the Research Groups Funding Program grant code(NU/RG/MRC/12/5)the National Natural Science Foundation of China(grant numbers:51973172,52273149)+2 种基金Supported by 111 Project 2.0(BPO618008)the Natural Science Foundation of Shaanxi Province(No.2020JC-03)State Key Laboratory for Mechanical Behavior of Materials,and the World-Class Universities(Disciplines)and the Characteristic Development Guidance Funds for the Central Universities.
文摘In clinical applications,there is a lack of wound dressings that combine efficient resistance to drug-resistant bacteria with good self-healing properties.In this study,a series of adhesive self-healing conductive antibacterial hydrogel dressings based on oxidized sodium alginate-grafted dopamine/carboxymethyl chitosan/Fe3+(OSD/CMC/Fe hydrogel)/polydopamine-encapsulated poly(thiophene-3-acetic acid)(OSD/CMC/Fe/PA hydrogel)were prepared for the repair of infected wound.The Schiff base and Fe3+coordination bonds of the hydrogel structure are dynamic bonds that can be repaired automatically after the hydrogel network is disrupted.Macroscopically,the hydrogel exhibits self-healing properties,allowing the hydrogel dressing to adapt to complex wound surfaces.The OSD/CMC/Fe/PA hydrogel showed good conductivity and photothermal antibacterial properties under near-infrared(NIR)light irradiation.In addition,the hydrogels exhibit tunable rheological properties,suitable mechanical properties,antioxidant properties,tissue adhesion properties and hemostatic properties.Furthermore,all hydrogel dressings improved wound healing in the infected full-thickness defect skin wound repair test in mice.The wound size repaired by OSD/CMC/Fe/PA3 hydrogel+NIR was much smaller(12%)than the control group treated with Tegaderm™film after 14 days.In conclusion,the hydrogels have high antibacterial efficiency,suitable conductivity,great self-healing properties,good biocompatibility,hemostasis and antioxidant properties,making them promising candidates for wound healing dressings for the treatment of infected skin wounds.
文摘Bacterial infection causes wound inflammation and makes angiogenesis difficult.It is urgent to develop effectively antibacterial and pro-vascularizing dressings for wound healing.The hydrogel is developed with pH-responsive drug-releasing microcarriers which were loaded with vascular endothelial growth factor(VEGF)that promotes angiogenesis and actively respond to wound pH for control and prolong VEGF release.The surfaces of the microcarriers were coated with polydopamine which can reduce the silver nanoparticles(AgNPs)in situ,and dynamically crosslink with the polyacrylamide,which forms a stable slow-release system with different release behavior for the VEGF and AgNPs.The hydrogel inhib-ited bacterial formation and accelerated wound healing.With the hydrogel dressing,83.3%±4.29%of the wound heals at day 7,which is 40.9%±8.5%higher than the non-treatment group in defect infected model.The antibacterial properties of hydrogel down-regulate early inflammation-related cytokines,and the release of VEGF in the middle and late phases of wound healing in response to pH changes pro-motes angiogenesis and up-regulate the expression of angiogenesis-associated cytokine.The sequential release of antibacterial agents and pro-vascularizing agents in response to the change in wound microen-vironmental cues facilitate temporally controlled therapy that suites the need of different wound healing phases.Collectively,the hydrogel loaded with multifunctional microcarriers that enable controlled release of AgNPs and VEGF is an effective system for treating infected wounds.
基金the National Natural Science Foundation of China(Nos.51803128,52073186,21802097)Fundamental Research Funds for the Central Universities(No.20826041D4160)+2 种基金Sichuan Science and Technology Programs(Nos.2020KJT0031-2020ZHCG0051,2020KJT0061-2020ZHFP0148)State Key Laboratory of Polymer Materials Engineering(No.sklpme20213–01)Funding of Engineering Characteristic Team,Sichuan University(No.2020SCUNG122)。
文摘Medical cotton dressing is cheap and widely used in diversified fields,but in the application of promoting wound healing,the continuous research of multifunctional medical cotton dressing is still of great significance.Here,we developed a fresh type of antibacterial cotton dressing through a succinct strategy based on chemically anchoring polyhexamethylene biguanide(PHMB).Intriguingly,after PHMB modification,the cotton dressing exhibited outstanding antibacterial performance which could maintain>99.99%antibacterial rate after several treatments,including washing 50 times,repeated use 10 times,UV irradiation for 7 days,cationic dyes dying,and conditioned under 90℃water bath for 2 h.In addition,the water contact angle of cotton dressing increased dramatically from 0°to 111°,which could facilitate bacterial adhesion,thus further enhance the antibacterial efficiency,and easily remove the bacterial debris.Apart from that,the developed cotton dressing showed good cytocompatibility,promoted blood clotting and expression of platelets,and promoted the wound healing process in the infection intervened skin wound model.Taken together,this antibacterial cotton dressing with desirable blood clotting,sustained protection against bacterial infection and bacterial removal features shows the potential to be a candidate for infected skin wound healing.
基金sponsored by the National Natural Science Foundation of China(Grant No.32171351)the“1.3.5”Project for Disciplines of Excellence,West China Hospital,Sichuan University(Grant No.ZYJC18002)Med-X Innovation Programme of Med-X Center for Materials,Sichuan University(Grant No.MCM202104).
文摘Bio-adhesive polysaccharide-based hydrogels have attracted much attention in first-aid hemostasis and wound healing for excellent biocompatibility,antibacterial property and pro-healing bioactivity.Yet,the inadequate mechanical properties and bio-adhesion limit their applications.Herein,based on dynamic covalent bonds,photo-triggered covalent bonds and hydrogen bonds,multifunctional bio-adhesive hydrogels comprising modified carboxymethyl chitosan,modified sodium alginate and tannic acid are developed.Multi-crosslinking strategy endows hydrogels with improved strength and flexibility simultaneously.Owing to cohesion enhancement strategy and self-healing ability,considerable bio-adhesion is presented by the hydrogel with a maximal adhesion strength of 162.6 kPa,12.3-fold that of commercial fibrin glue.Based on bio-adhesion and pro-coagulant activity(e.g.,the stimulative aggregation and adhesion of erythrocytes and platelets),the hydrogel reveals superior hemostatic performance in rabbit liver injury model with blood loss of 0.32 g,only 54.2%of that in fibrin glue.The healing efficiency of hydrogel for infected wounds is markedly better than commercial EGF Gel and Ag+Gel due to the enhanced antibacterial and antioxidant properties.Through the multi-crosslinking strategy,the hydrogels show enhanced mechanical properties,fabulous bio-adhesion,superior hemostatic performance and promoting healing ability,thereby have an appealing application value for the first-aid hemostasis and infected wound healing.
文摘BACKGROUND Orthopedic surgeries after device implantation are susceptible to infections and may require device removal in the worst cases.For this reason,many efforts are being made to control infections after spinal surgery;however,the number of infec-tion cases is increasing owing to the increasing number of elderly citizens.CASE SUMMARY A 75-year-old male with a chronic spinal defect due to previous spine surgery underwent reconstruction using a perforator-based island flap.After bursectomy and confirmation that there was no connection with the deep tissue,reconstruction was performed.However,wound disruption occurred with abscess formation on postoperative day 29,which led to an imaging workup revealing delayed deep tissue infection.CONCLUSION Infection is one of the most common causes of surgical wound dehiscence and is associated with devastating results if not controlled promptly and definitively.Surgeons should always suspect delayed infections when reconstructing chronic soft tissue defects.
基金in part was funded by a medical student grant($2500)by the Emergency Medicine Foundation
文摘BACKGROUND: This prospective observational study aimed to determine the infection rate of simple hand laceration(SHL), and to compare infection rates between patients who were prescribed antibiotics and those who were not.METHODS: The study was performed at two urban hospitals enrolling 125 emergency department(ED) patients with SHL. Exclusion criteria included patients with lacerations for more than 12 hours, immunocompromized patients, patients given antibiotics, and patients with gross contamination, bites or crush injuries. Wound infection was defined as clinical infection at a follow-up visit(10–14 days) or wound was treated with antibiotics. Patient satisfaction was also measured using a visual analogue scale 1–10, asking the patients about wound appearance. Demographic data and wound characteristics were compared between the infected and non-infected wounds. The infection rates were also compared between patients who received prophylactic antibiotics and those who did not. The results were presented with medians and quartiles or percentages with 95% confidence intervals(CI).RESULTS: In the 125 patients with SHL [median age: 28(18, 43); range: 1–102 years old; 36% female], 44(35%, 95% CI: 27%–44%) were given antibiotics in the ED. Wound infection was reported in 6 patients(4.8%, 95% CI: 2%–10%). Age, gender, history of diabetes and wound closure were not associated with wound infection(P>0.05). The infection rate was not significantly different between patients with or without antibiotic prophylaxis [7%(3/44), 95% CI: 2%–10% vs. 4%(3/81), 95% CI: 1%–11%, P=0.66]. Patient's satisfaction with appearance ofinfected and non-infected wounds were significantly different [7.5(6, 8) vs. 9(8, 10), P=0.01].CONCLUSION: Approximately 5% of simple hand lacerations become infected. Age, gender, diabetes, prophylactic antibiotics and closure technique do not affect the risk ofinfection.
文摘Chromobacterium violaceum is a Gram negative, facultative anaerobe, generally present in water, soil in tropical and subtropical regions. This bacterium is an emerging environmental pathogen that causes life threatening infection in humans and animals. It can cause wound infection, visceral abscess, septicaemia, meningitis, diarrhoea, UTI. It is associated with significant mortality due to severe systemic infection. As the bacteria have high spreading tendency leading to sepsis, early identification and prompt treatment is necessary. Here we report a case of Chromobacterium violaceum wound infection in a 9 years old male from Dhaka, who was successfully treated with combination of cefixime and flucloxacillin antibiotics as per culture sensitivity report.
文摘Background: Deep sternal wound infection (DSWI), or mediastinitis, is a devastating complication of coronary artery bypass grafting (CABG). This prospective study aimed to assess our management of DSWI in view of the published literature. Methods: Over 2-years (ending in January 2016), 29 patients (20 males) developed DSWI amongst 520 patients who underwent standard CABG surgeries (5.6%). Pre-, intra- and postoperative variables were documented. Whenever possible, the infections were culture-verified. Besides antibiotics, patients received one or more of the following therapies: drainage, debridement, closed irrigation, sternal re-wiring, vacuum-assisted closure (VAC), and bone resection. Results: the male to female ratio was 2.2:1. Mean age was 58.1 ± 7.3 years. The mean body mass index (BMI) was 27.9 ± 3.4 kg/m<sup>2</sup>. There were 18, 16 and 11 patients with diabetes mellitus (DM), hypertension and chronic obstructive pulmonary disease (COPD) respectively. Cardiopulmonary bypass (CPB) was utilized in 26 (89.7%) patients with a mean time of 117.5 ± 23.3 minutes. Most surgeries (n = 21, 72.4%) lasted 5 - 6 hrs. According to Pairolero classification, there were 3 (10.3%) Type I, 22 (75.9%) Type II and 4 (13.8%) Type III infections. Four (13.8%) cases were culture-verified. Twenty-three (79.3%) DSWIs were surgically managed. Sternal re-wiring was performed in 14 (48.3%) cases while VAC was added to other therapies in 2 (6.9%) patients. DSWIs completely resolved in 18 (62.0%) patients within 3 - 24 weeks while two (6.9%) patients died within 30 days. Conclusion: We have identified six independent risk factors for DSWI (male gender, obesity, DM, hypertension, COPD and CPB), five of them are modifiable.
文摘Background and Objectives: Duration of antibiotic prophylaxis for cardiac surgery is still debated and controversial. International guidelines are vague: French guidelines recommend an intraoperative administration, while the Society of Thoracic Surgeons’ guidelines suggest that optimal postoperative prophylactic antibiotics be given for 48 hours or less. Very few studies have compared the same antibiotic with 2 different administration durations. The study was designed to compare the efficacy of 24-hour administration of cefamandole vs intraoperative cefamandole to prevent deep sternal wound infection and endocarditis after cardiac surgery. Methods: This retrospective and observational study compared the rates of severe surgical site infections (deep sternal wound infection, endocarditis) after cardiac surgery between period 1, 01/01/2008-31/08/2008, with 24-hour administration of cefamandole, and period 2, 01/09/2008-30/04/2009 with intraoperative cefamandole. Results: Among 933 patients, 14 patients (1.5%) developed surgical site infection during the 16-month study: 1.3% during the first period and 1.7% during the second (ns). The populations (470 patients in period 1 and 463 in period 2) were homogeneous and comparable for pre-, intra- and postoperative characteristics. Surgical site infection characteristics (pathogens involved, time to diagnosis) and consequences (longer hospital stay, outcomes) were comparable in the 2 groups. Conclusions: Intraoperative cefamandole was as safe as its 24-hour administration to prevent deep sternal wound infection and endocarditis after adult cardiac surgery.
文摘To evaluate the effect of extensive excision of invasive burn wound infection on hypermeta-bolic response in burn patients with sepsis. Methods:Eight patients with major burn, complicated by invasive burn wound infection and sepsis were consecutively admitted to our hospital from September 1997 to October 1998. REEs were monitored by means of Cardiorespiratory Diagnostic System (Medical Graphics Corporation, USA) at patients bedside. Plasma concentration of IL-6、IL-8、TNF-α and LPS were assayed before an...
基金funded by National Key Research and Development Program of China(2017YFA0105602,2018YFA0108700)NSFC Projects of INTERNATIONAL COOPERATION and Exchanges(81720108004)+6 种基金National Natural Science Foundation of China(81974019,82100275)Guangdong Provincial Special Support Program for Prominent Talents(2021JC06Y656)Science and Technology Planning Project of Guangdong Province(2020B1111170011,2022B1212010010)Guangdong special funds for science and technology innovation strategy,China(Stability support for scientific research institutions affiliated to Guangdong Province-GDCI 2021)Guangzhou Science and Technology Plan Project(202201000006)The Special Project of Dengfeng Program of Guangdong Provincial People’s Hospital(DFJH201812,KJ012019119,KJ012019423)The Marine Economy Development Project of Department of Natural Resources of Guangdong Province(No.GDNRC[2022]039).
文摘Damaged skin cannot prevent harmful bacteria from invading tissues,causing infected wounds or even severe tissue damage.In this study,we developed a controlled-release antibacterial composite hydrogel system that can promote wound angiogenesis and inhibit inflammation by sustained releasing Cu-Epigallocatechin-3-gallate(Cu-EGCG)nano-capsules.The prepared SilMA/HAMA/Cu-EGCG hydrogel showed an obvious inhibitory effect on Escherichia coli(E.coli)and Staphylococcus aureus(S.aureus).It could also promote the proliferation and migration of L929 fibroblasts.In vivo full-thickness infected wound healing experiments confirmed the angiogenesis and inflammation regulating effect.Accelerate collagen deposition and wound healing speed were also observed in the SilMA/HAMA/Cu-EGCG hydrogel treated group.The findings of this study show the great potential of this controlled-release antibacterial composite hydrogel in the application of chronic wound healing.
基金the National Key Research and Development Program of China(2021YFA1201304/2021YFA1201300)the Fundamental Research Funds for the Central Universities(2232022D-01)+1 种基金the Science and Technology Commission of Shanghai Municipality,China(20DZ2254900)the Young Elite Scientists Sponsorship Program by CAST(YESS20220259).
文摘Thermal wounds are complex and lethal with irregular shapes, risk of infection, slow healing, and large surface area. The mortality rate in patients with infected burns is twice that of non-infected burns. Developing multifunctional skin substitutes to augment the healing rate of infected burns is vital. Herein, we 3D printed a hydrogel scaffold comprising carboxymethyl chitosan (CMCs) and oxidized alginate grafted catechol (O-AlgCat) on a hydrophobic electrospun layer, forming a bilayer skin substitute (BSS). The functional layer (FL) was fabricated by physiochemical crosslinking to ensure favorable biodegradability. The gallium-containing hydrophobic electrospun layer or backing layer (BL) could mimic the epidermis of skin, avoiding fluid penetration and offering antibacterial activity. 3D printed FL contains catechol, gallium, and biologically active platelet rich fibrin (PRF) to adhere to both tissue and BL, show antibacterial activity, encourage angiogenesis, cell growth, and migration. The fabricated bioactive BSS exhibited noticeable adhesive properties (P ≤ 0.05), significant antibacterial activity (P ≤ 0.05), faster clot formation, and the potential to promote proliferation (P ≤ 0.05) and migration (P ≤ 0.05) of L929 cells. Furthermore, the angiogenesis was significantly higher (P ≤ 0.05) when evaluated in vivo and in ovo. The BSS-covered wounds healed faster due to low inflammation and high collagen density. Based on the obtained results, the fabricated bioactive BSS could be an effective treatment for infected burn wounds.
基金funded by the National Natural Science Foundation of China(Nos.U21A20417 and 31930067)1.3.5 project for disciplines of excellence,West China Hospital,Sichuan University(No.ZYGD18002).
文摘Bacterial infection of wounds is an escalating medical problem,issuing threats to both global public health and personal health.Photothermal antibacterial technology as a novel sterilization strategy has outstanding sterilization efficiency,high safety and low risk of emergence of drug-resistant bacteria.By combining inherent antibacterial activity and light-assisted antibacterial treatment,developing novel multifunctional dressings with synergistic high-efficiency antibacterial effects and also promoting wound healing possesses attractive advantages in the field of treating bacterial wound infections in clinical care.Herein,a multifunctional hydrogel formed by in situ photo-cross linking was designed and prepared by first grafting methacrylic anhydride as a photosensitizer onto chitosan,and then introducing oxidatively synthesized polydopamine(PDA).The physicochemical characterizations of the synthesized hydrogels demonstrated their tunability certainly associated with PDA concentration,including pore size,water swelling,rheological properties and in vitro degradability.In addition,the composite hydrogels exhibited good adhesion,anti-oxidation and photothermal properties due to the existence of PDA.Within 10min upon exposure to 808 nm near-infrared(NIR)light irradiation,this hydrogel system displayed outstanding antibacterial activity against Staphylococcus aureus with almost 100%killing efficiency,of which rapid efficient sterilization plays a significant role in wound healing.Moreover,the hydrogel is capable of cytocompatibility and has low toxicity to murine fibroblasts(L929 and NIH/3T3).In the full-thickness wound defect infection model in mice,the wound closure ratio,inflammatory response,fibroblasts,neovascularization and epithelialization were measured.Animal experiments also reveal that the hydrogel assisted with NIR laser irradiation can inhibit effectively infection at an early stage and accelerate the wound healing process.In summary,this novel multifunctional injectable hydrogel exhibits excellent swelling capacity,bio-adhesion,antioxidant property,photothermal activity,efficient antibacterial property and facilitates skin healing,which has great promising application as a medical dressing biomaterial in infected wound carefields.
基金the Natural Science Foundation of Shandong Province,No.ZR2020MH257。
文摘BACKGROUND Prophylactic enterostomy surgery is a common surgical approach used to reduce the risk of anastomotic leakage in patients who have undergone partial intestinal resection due to trauma or tumors.However,the traditional interrupted suturing technique used in enterostomy closure surgery has several issues,including longer surgical incisions and higher incision tension,which can increase the risk of postoperative complications.To address these issues,scholars have proposed the use of a“gunsight suture”technique.This technique involves using a gunsight incision instead of a traditional linear incision,leaving a gap in the center for the drainage of blood and fluid to reduce the risk of infection.Building on this technique,we propose an improved gunsight suture technique.A drainage tube is placed at the lowest point of the incision and close the gap in the center of the gunsight suture,which theoretically facilitates early postoperative mobility and reduces the burden of dressing changes,thereby reducing the risk of postoperative complications.AIM To compare the effectiveness of improved gunsight suture technique with traditional interrupted suture in closing intestinal stomas.METHODS In this study,a retrospective,single-center case analysis was conducted on 270 patients who underwent prophylactic ileostomy closure surgery at the Department of Colorectal Surgery of Qilu Hospital from April 2017 to December 2021.The patients were divided into two groups:135 patients received sutures using the improved gunsight method,while the remaining 135 patients were sutured with the traditional interrupted suture method.We collected data on a variety of parameters,such as operation time,postoperative pain score,body temperature,length of hospital stays,laboratory indicators,incidence of incisional complications,number of wound dressing changes,and hospitalization costs.Non-parametric tests and chi-square tests were utilized for data analysis.RESULTS There were no statistically significant differences in general patient information between the two groups,including the interval between the first surgery and the stoma closure[132(105,184)d vs 134(109,181)d,P=0.63],gender ratio(0.64 vs 0.69,P=0.44),age[62(52,68)years vs 60(52,68)years,P=0.33],preoperative body mass index(BMI)[23.83(21.60,25.95)kg/m²vs 23.12(20.94,25.06)kg/m²,P=0.17].The incidence of incision infection in the improved gunsight suture group tended to be lower than that in the traditional interrupted suture group[(n=2/135,1.4%)vs(n=10/135,7.4%),P<0.05],and the postoperative hospital stay in the improved gunsight suture group was significantly shorter than that in the traditional interrupted suture group[5(4,7)d vs 7(6,8)d,P<0.05].Additionally,the surgical cost in the modified gunsight suture group was slightly lower than that in the traditional suture group[4840(4330,5138)yuan vs 4980(4726,5221)yuan,P>0.05],but there was no significant difference in the total hospitalization cost between the two groups.CONCLUSION In stoma closure surgery,the improved gunsight technique can reduce the incision infection rate,shorten the postoperative hospital stay,reduce wound tension,and provide better wound cosmetic effects compared to traditional interrupted suture.
基金National Natural Science Foundation of China(Grant No.82002049 and 52073014,to J.X.)Key Program of Beijing Natural Science Foundation(Z200025)+1 种基金Fundamental Research Funds for the Central Universities(buctrc202020)YL thanks support by T.Pipes Nano Microsystem Endowment,Louisiana Tech University,USA.
文摘It is of great importance to treat a bacterial-infected wound by a smart dressing capable of delivering antibiotics in a smart manner without causing drug resistance.The construction of smart release nanocontainers responsive to near-infrared(NIR)laser irradiation in an on-demand and stepwise way is a promising strategy for avoiding the emergence of multidrug-resistant bacteria.Here,we develop a hydrogel composite made of alginate and nanotubes with an efficient NIR-triggered release of rifampicin and outstanding antibacterial ability.This composite hydrogel is prepared through co-encapsulating antibacterial drug(rifampicin),NIR-absorbing dye(indocyanine green),and phase-change materials(a eutectic mixture of fatty acids)into halloysite nanotubes,followed by incorporation into alginate hydrogels,allowing the in-situ gelation at room temperature and maintaining the integrity of drug-loaded nanotubes.Among them,the eutectic mixture with a melting point of 39℃ serves as the biocompatible phase-change material to facilitate the NIR-triggered drug release.The resultant phase-change material gated-nanotubes exhibit a prominent photothermal efficiency with multistep drug release under laser irradiation.In an in vitro assay,composite hydrogel provides good antibacterial potency against Staphylococcus aureus,one of the most prevalent microorganisms of dangerous gas gangrene.A bacterial-infected rat full-thickness wound model demonstrates that the NIR-responsive composite hydrogel inhibits the bacteria colonization and suppresses the inflammatory response caused by bacteria,promoting angiogenesis and collagen deposition to accelerate wound regeneration.The NIR-responsive composite hydrogel has a great po-tential as an antibacterial wound dressing functionalized with controlled multistep treatment of the infected sites.
基金jointly supported by the National Natural Science Foundation of China(grant numbers:51973172,and 51673155)the Natural Science Foundation of Shaanxi Province(No.2020JC-03 and 2019TD-020)+5 种基金State Key Laboratory for Mechanical Behavior of Materials,and the Fundamental Research Funds for the Central Universitiesthe World-Class Universities(Disciplines)and the Characteristic Development Guidance Funds for the Central UniversitiesOpening Project of Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research,College of Stomatology,Xi’an Jiaotong University(No.2019LHM-KFKT008)the Key R&D Program of Shaanxi Province(No.2019ZDLSF02-09-01,2020GXLH-Y-019)Innovation Capability Support Program of Shaanxi Province(Program No.2019GHJD-14,2021TD-40)Scientific Research Program Funded by Shaanxi Provincial Education Department(Program No.18JC027).
文摘With the increasing prevalence of drug-resistant bacterial infections and the slow healing of chronically infected wounds,the development of new antibacterial and accelerated wound healing dressings has become a serious challenge.In order to solve this problem,we developed photo-crosslinked multifunctional antibacterial adhesive anti-oxidant hemostatic hydrogel dressings based on polyethylene glycol monomethyl ether modified glycidyl methacrylate functionalized chitosan(CSG-PEG),methacrylamide dopamine(DMA)and zinc ion for disinfection of drug-resistant bacteria and promoting wound healing.The mechanical properties,rheological properties and morphology of hydrogels were characterized,and the biocompatibility of these hydrogels was studied through cell compatibility and blood compatibility tests.These hydrogels were tested for the in vitro blood-clotting ability of whole blood and showed good hemostatic ability in the mouse liver hemorrhage model and the mouse-tail amputation model.In addition,it has been confirmed that the multifunctional hydrogels have good inherent antibacterial properties against Methicillin-resistant Staphylococcus aureus(MRSA).In the full-thickness skin defect model infected with MRSA,the wound closure ratio,thickness of granulation tissue,number of collagen deposition,regeneration of blood vessels and hair follicles were measured.The inflammation-related cytokines(CD68)and angiogenesis-related cytokines(CD31)expressed during skin regeneration were studied.All results indicate that these multifunctional antibacterial adhesive hemostatic hydrogels have better healing effects than commercially available Tegaderm™Film,revealing that they have become promising alternative in the healing of infected wounds.
文摘AIM: To compare laparoscopic vs mini-incision open appendectomy in light of recent data at our centre.METHODS: The data of patients who underwen appendectomy between January 2011 and June 2013 were collected. The data included patients' demographic data, procedure time, length of hospital stay, the need for pain medicine, postoperative visual analog scale o pain, and morbidities. Pregnant women and patients with previous lower abdominal surgery were excluded Patients with surgery converted from laparoscopic appendectomy(LA) to mini-incision open appendectomy(MOA) were excluded. Patients were divided into two groups: LA and MOA done by the same surgeon. The patients were randomized into MOA and LA groups a computer-generated number. The diagnosis of acute appendicitis was made by the surgeon with physica examination, laboratory values, and radiological tests(abdominal ultrasound or computed tomography). Al operations were performed with general anaesthesia The postoperative vision analog scale score was recorded at postoperative hours 1, 6, 12, and 24. Patients were discharged when they tolerated normal food and passed gas and were followed up every week for three weeks as outpatients.RESULTS: Of the 243 patients, 121(49.9%) underwen MOA, while 122(50.1%) had laparoscopic appendectomy There were no significant differences in operation time between the two groups(P = 0.844), whereas the visua analog scale of pain was significantly higher in the open appendectomy group at the 1st hour(P = 0.001), 6th hour(P = 0.001), and 12 th hour(P = 0.027). The need for analgesic medication was significantly higher in the MOA group(P = 0.001). There were no differences between the two groups in terms of morbidity rate(P = 0.599)The rate of total complications was similar between the two groups(6.5% in LA vs 7.4% in OA, P = 0.599). Al wound infections were treated non-surgically. Six ou of seven patients with pelvic abscess were successfully treated with percutaneous drainage; one patient requiredsurgical drainage after a failed percutaneous drainage. There were no differences in the period of hospital stay, operation time, and postoperative complication rate between the two groups. Laparoscopic appendectomy decreases the need for analgesic medications and the visual analog scale of pain.CONCLUSION: The laparoscopic appendectomy should be considered as a standard treatment for acute appendicitis. Mini-incision appendectomy is an alternative for a select group of patients.
文摘BACKGROUND Surgical site infection is a rare but serious complication associated with total joint arthroplasty(TJA).There are limited data on the effectiveness of intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure for preventing acute surgical site infection following primary total hip arthroplasty(THA)and total knee arthroplasty(TKA).AIM To investigate the effectiveness of prophylactic intraoperative application of vancomycin(1000 mg/L;2 L)solution vs.plain irrigation in reducing the incidence of acute surgical site infection following primary THA and TKA.METHODS A retrospective review of 2725 consecutive patients undergoing THA or TKA from January 2012–December 2019 was performed.These patients received either intrawound irrigation with normal saline before wound closure between January 2012 and December 2015(group 1,1018 patients;453 undergoing THA and 565 undergoing TKA)or intrawound irrigation with vancomycin solution(1000 mg/L)before wound closure between January 2016 and December 2019(group 2,1175 patients;512 undergoing THA and 663 undergoing TKA).The outcomes were the incidences of postoperative surgical site infection and wound healing complications within 3 mo of primary TJA.RESULTS There were no significant demographic differences between the 2 groups.There was a significantly higher incidence of acute infection at the surgical site in patients who received intrawound irrigation with normal saline before wound closure than in those who received intrawound irrigation with vancomycin solution(1000 mg/L;2 L)before wound closure(overall incidence of infection:group 1,2.46%vs group 2,0.09%,P<0.001).There was no significant difference in the incidence of wound healing complications between the two groups.CONCLUSION Prophylactic irrigation with vancomycin solution(1000 mg/L;2 L)significantly decreases the incidence of acute surgical site infection after primary TJA.This strategy is a safe,efficacious,and inexpensive method for reducing the incidence of acute surgical site infection after TJA.
文摘Introduction: Despite extensive experience with civilian gunshot fractures or wounds, no consensus exists on a standard protocol to manage these injuries. Many authors recommended immediate debridement, but the optimal timing of internal fixation and the use of antibiotic have not been determined. The purpose of this paper is to present and discuss our experience. Material and methods: In January 2007, a treatment protocol was put in place for the evaluation and management of fractured extremities resulting from civilian gunshot wounds. Sixty-three patients with 64 fractures had been managed by this protocol for gunshot fractures between January 2005 and January 2012. There were 56 male and seven female. Their mean age was 33.1 years (range: 17 - 61 years). Thirteen patients (20.6%) were able to provide a description of the weapon. Only 15 patients had entry and exit wounds. The mean follow-up period was 27 (range, 20 - 58) months. The main factors assessed were the surgical site infection, the fracture union and the functional status. Results: Out of the 63 patients, 14 patients developed a wound infection (five superficial and seven deep infections). Wound infection was significantly associated with associated injuries (p = 0.0388), fractures sites requiring fixation (p = 0.024), the fracture pattern (p = 0.0412), operative modalities (p = 0.0400). There were nine cases (14.1%) of fracture non-union. The mean time to union was 15 weeks (range: 5 - 32 weeks). Five patients developed chronics osteomyelitis. The average SMFA score for all of the patients was 23.8 (range: 0 - 56.3). The mean dysfunctional and bother indexes were 18.3 (range: 0 - 52.7) and 22.6 (range: 0 - 66.1), respectively. The SMFA total score and dysfunction index had a significant correlation based on presence or absence of associated injuries (p < 0.0001). But bother index did not show the same correlation (p = 0.452). The average length of hospital stay was 11.3 days (range: 3 - 64). Conclusion: In civilian’s gunshot induced fractures, internal fixation can be made according to standard protocol, with acceptable result.
