Advances in wound care最新文献

{"title":"Efficacy of D33 Sealed Foam in Preventing Skin Injury from Surgical Positioning: Randomized Clinical Trial.","authors":"Camila de Assunção Peixoto, Maria Beatriz Guimarães Raponi, Márcia Marques Dos Santos Felix, Maíla Fidalgo de Faria, Isadora Braga Calegari, Patrícia da Silva Pires, Maria Helena Barbosa","doi":"10.1089/wound.2023.0100","DOIUrl":"10.1089/wound.2023.0100","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the efficacy of density-33 (D33) sealed foam in preventing skin injuries from surgical positioning. <b>Approach:</b> The study, reported according to the Consolidated Standards of Reporting Trials, is characterized as a randomized clinical trial, double mask, with 64 adult patients undergoing elective surgery, 35 allocated to the control group (CG), positioned on a conventional surgical table, and 29 to the experimental group (EG), positioned on a conventional surgical table overlaid with a D33 sealed foam support surface (SS) in the occipital, sacral, and heel regions. Simple randomization was carried out, as was masking of the researcher who evaluated the skin of the patient and the statistician. Data collection was carried out immediately preoperatively, intraoperatively, and postoperatively until the third day or until patient discharge. Statistical analysis included measures of association in contingency tables, <i>χ</i>², and relative risk to compare the incidence of injuries between groups. <b>Results:</b> Skin injuries were greater in the CG, with blanchable erythema being the main injury. The use of D33 sealed foam reduced the incidence of injury in the EG by 61.2% (relative risk: 0.39; 95% confidence interval: 0.220-0.684; <i>p</i> < 0.001). <b>Innovation:</b> One of the first clinical studies to demonstrate that using a D33 sealed foam SS decreased the incidence of blanchable erythema from surgical positioning. <b>Conclusion:</b> D33 sealed foam was effective in preventing skin injury from surgical positioning in patients undergoing elective surgeries.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"210-221"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incisional Negative Pressure Wound Therapy Versus Primary Wound Suturing after Intestinal Ostomy Closure: A Systematic Review and Meta-Analysis.","authors":"Michał Kisielewski, Karolina Richter, Magdalena Pisarska-Adamczyk, Michał Wysocki, Nikola Kłos, Tomasz Stefura, Tomasz Wojewoda, Wojciech M Wysocki","doi":"10.1089/wound.2024.0100","DOIUrl":"10.1089/wound.2024.0100","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; Wound infection after intestinal ostomy closure is a very common postoperative complication. An alternative to primary wound suturing by single sutures or purse string sutures (PSS) is applying incisional negative pressure wound therapy (iNPWT). The aim of the following systematic review and meta-analysis was to assess and compare clinical outcomes in patients after PSS and iNPWT use. &lt;b&gt;Approach:&lt;/b&gt; The aim of the study was to find relevant clinical data comparing outcomes of iNPWT and primary wound closure after intestinal ostomy closure. The search was conducted using the MEDLINE/PubMed, ScienceDirect, EMBASE, Scopus, Cochrane Controlled Register of Trials, SciELO, and Web of Science databases and took place up to November 12, 2022. The authors did not use date or language filters. Statistical analysis was performed using Review Manager 5.4 (The Cochrane Collaboration, 2020, London, UK). The authors conducted a meta-analysis of the following four parameters: wound healing time (WHT), surgical site infections (SSIs), complications, and length of hospital stay (LOS). Odds ratios (OR) and inverse variance (IV) were generated with 95% confidence intervals (CI). The meta-analysis was registered in the International Prospective Register of Systematic Reviews database under registration number CRD42023391640. &lt;b&gt;Results:&lt;/b&gt; The analysis revealed that the iNPWT group and the control group did not differ significantly with regard to the WHT parameter (Z = 2,73; &lt;i&gt;p&lt;/i&gt; = 0.006; χ&lt;sup&gt;2&lt;/sup&gt; = 0.37, &lt;i&gt;df&lt;/i&gt; = 1, &lt;i&gt;p&lt;/i&gt; = 0.54, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%). Meta-analysis of SSI incidence revealed a significant difference favoring the iNPWT group over the observational group (OR = 0.42; 95% CI = 0.25-0.72; &lt;i&gt;p&lt;/i&gt; = 0.002; &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 14%). Patients included in the iNPWT group had a significantly lower pooled incidence of overall complications than the observational group (OR = 0.52; 95% CI = 0.35-0.77; &lt;i&gt;p&lt;/i&gt; = 0.001, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 71%). Subgroup analysis limited to randomized studies also presented significant differences favoring the iNPWT group over the observational group (OR = 0.27; 95% CI = 0.14-0.52; &lt;i&gt;p&lt;/i&gt; &lt; 0.001, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 67%). Our analysis showed that LOS did not differ significantly between the groups treated with and without iNPWT (IV = 0.19; 95% CI = -0.66 -1,04; &lt;i&gt;p&lt;/i&gt; = 0.76, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 0%). In addition, subgroup analysis of randomized studies also did not present a significant difference (IV = 0.25; 95% CI = -0.80 -1,30; &lt;i&gt;p&lt;/i&gt; = 0.33, &lt;i&gt;I&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt; = 10%). &lt;b&gt;Innovation:&lt;/b&gt; This study shows that the use of iNPWT can reduce the risk of SSIs with other complications, such as wound hematomas, wound seromas, wound dehiscence, fistulas, and ileus, in patients undergoing intestinal ostomy closure without extended hospital stay. &lt;b&gt;Conclusions:&lt;/b&gt; Use of iNPWT can be considered in postoperative care after elective ostomy closure to decrease the rate o","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"199-209"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141970359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dynamic Prediction of Time to Wound Healing at Routine Wound Care Visits.","authors":"Doranne Thomassen, Stella F Amesz, Niels P Stol, Saskia le Cessie, Ewout W Steyerberg","doi":"10.1089/wound.2024.0069","DOIUrl":"10.1089/wound.2024.0069","url":null,"abstract":"<p><p><b>Objective:</b> Having a wound decreases patients' quality of life and brings uncertainty, especially if the wound does not show a healing tendency. The objective of this study was to develop and validate a model to dynamically predict time to wound healing at subsequent routine wound care visits. <b>Approach:</b> A dynamic prediction model was developed in a cohort of wounds treated by nurse practitioners between 2017 and 2022. Potential predictors were selected based on literature, expert opinion, and availability in the routine care setting. To assess performance for future wound care visits, the model was validated in a new cohort of wounds visited in early 2023. Reporting followed TRIPOD guidelines. <b>Results:</b> We analyzed data from 92,098 visits, corresponding to 14,248 wounds and 7,221 patients. At external validation, discriminative performance of our developed model was comparable with internal validation (concordance statistic = 0.70 [95% confidence interval 0.69, 0.71]), and the model remained well calibrated. Strong predictors were wound-level characteristics and indicators of the healing process so far (e.g., wound surface area). <b>Innovation:</b> Going beyond previous prediction studies in the field, the developed model dynamically predicts the remaining time to wound healing for many wound types at subsequent wound care visits, in line with the dynamic nature of wound care. In addition, the model was externally validated and showed stable performance. <b>Conclusion:</b> The developed model can potentially contribute to patient satisfaction and reduce uncertainty around wound healing times when implemented in practice. When the predicted time of wound healing remains high, practitioners can consider adapting their wound management.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"188-198"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Counting the Cost of Cellular and/or Tissue-Based Products in Diabetic Foot Ulcers: Is There a Justifiable Price Limit per Square Centimeter?","authors":"Marissa J Carter, Caroline E Fife","doi":"10.1089/wound.2024.0087","DOIUrl":"10.1089/wound.2024.0087","url":null,"abstract":"<p><p><b>Objective:</b> To identify how cellular and/or tissue-based products (CTPs) relate to value in terms of cost per quality-adjusted life years (QALYs) in wound care in comparison with treatments in other medical fields. <b>Approach:</b> This is a cross-sectional study and a cost-effectiveness analysis. Payment limits for each CTP were obtained via the Healthcare Common Procedure Coding System Q codes and formulated as cost inputs into a cost-utility model published for treatment of Wagner 1 diabetic foot ulcers using dehydrated human amnion and chorion allograft versus standard of care (SOC). Additional changes to cap the number of CTP applications and adjustments for recent inflation were made. The literature was searched for other cost-utility models in other diabetes-related diseases as a comparison. <b>Results:</b> When the payment limit was ≤$140 per square centimeter, interventions were dominant (less costly, better outcomes) compared with SOC. When the limit exceeded $430 per square centimeter, the cost-effectiveness threshold of $100,000/QALY was exceeded. Newer Q codes are generally much more expensive and likely to not be cost-effective, similar to the results for many other chronic diabetes-related diseases . <b>Innovation:</b> This study presents decision makers with tools, by which they can determine as to whether a given CTP is likely to be cost-effective for patients. <b>Conclusion:</b> Over a third of all CTPs will very likely result in noncost-effective interventions. This number is likely to be higher when wounds are larger or used in other wound types where they are less efficacious. The recent trend in much higher costs for CTPs is worrisome.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"181-187"},"PeriodicalIF":5.8,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141236647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing Therapeutic Solutions for Burn Wounds: Potential Use of Noninvasive Ultrasound-Driven Splenic Stimulation.","authors":"Ahmed Sami Raihane, David G Armstrong, T Justin Gillenwater, Robert D Galiano","doi":"10.1089/wound.2024.0181","DOIUrl":"https://doi.org/10.1089/wound.2024.0181","url":null,"abstract":"<p><p><b>Significance:</b> Burn wound injuries are a global health challenge, affecting millions annually and resulting in significant morbidity, mortality, and economic burden. The urgent need for accessible and cost-effective therapeutic alternatives, especially for underserved populations, has driven interest in novel approaches such as noninvasive splenic stimulation using pulsed-focused ultrasound (pFUS). This technique targets systemic inflammation, a key factor in delayed wound healing, offering a potential shift in burn care management. <b>Recent Advances:</b> Preclinical studies have shown that pFUS applied to the spleen can accelerate wound healing by activating the cholinergic anti-inflammatory pathway, promoting pro-angiogenic and anti-inflammatory responses. While current treatments-including biologics, antioxidants, and growth factors-have limitations, pFUS presents a noninvasive alternative. One interventional study and ongoing clinical trials are now investigating its application in burn wound care, marking an important step toward clinical translation. <b>Critical Issues:</b> Despite encouraging results, research on splenic stimulation for wound healing remains limited. The small number of studies highlights the need for further investigation into the underlying mechanisms, optimal treatment parameters, and potential risks. Additionally, the scalability and cost-effectiveness of pFUS in diverse clinical settings require thorough evaluation. <b>Future Directions:</b> Ongoing clinical trials will provide critical data on the efficacy and safety of splenic pFUS in burn patients. Future research should focus on expanding clinical studies, refining stimulation protocols, and exploring its broader application in tissue repair. If validated, this approach could offer a cost-effective, noninvasive treatment, particularly valuable in socioeconomically challenged regions.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143727388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Alpha-1-Antitrypsin Enhances Fat Graft Survival in a Murine Model.","authors":"Dor Halpern, Idan Farber, Yuval Anav, Alexandra Tsitrina, Eli C Lewis, Eldad Silberstein","doi":"10.1089/wound.2024.0176","DOIUrl":"https://doi.org/10.1089/wound.2024.0176","url":null,"abstract":"<p><p><b>Objective:</b> Fat grafting is widely applied for various purposes, including volume restoration, improving tissue quality, and promoting wound healing, but it has poor long-term graft survival predictability. Alpha-1-antitrypsin (AAT) administration is hypothesized to improve fat graft outcomes by expediting inflammatory resolution and graft vascularity and reducing necrosis. <b>Approach:</b> Mice heterozygote to human AAT was grafted fat under the scalp alongside 400 µg/graft AAT or albumin (ALB) on days 0 and 3. Graft volume was determined by micro-magnetic resonance imaging, and explants were assessed for viability, histology, immunohistochemistry, and expression of selected genes. AAT expression was examined in hypoxia-exposed adipose-derived stem cells (ADSCs). <b>Results:</b> After 90 days, AAT-treated grafts maintained higher volumes (70.06% vs. 34.54%, <i>n</i> = 8, <i>p</i> = 0.02) and displayed improved tissue quality. On day 10 after grafting, grafts exhibited more blood vessels (mean 1.94/mm² vs. 0.33/mm²) and 6.25-fold more adiponectin transcript levels (<i>n</i> = 12, <i>p</i> = 0.02). Although day-3 interleukin (IL)-1β expression was 5-fold greater in AAT-treated grafts (<i>n</i> = 6, <i>p</i> = 0.4), day-10 IL-1β expression was 2-fold lower compared to ALB-treated grafts (<i>n</i> = 22, <i>p</i> = 0.01). In the Methoxynitrosulfophenyl-tetrazolium carboxanilide (XTT) assay, day-3 AAT-treated grafts were 1.56-fold more metabolically functional (<i>n</i> = 6, <i>p</i> = 0.04) and exhibited greater perilipin-positive regions (18.5% versus 3.1%). Hypoxia-exposed ADSC expressed 9-fold higher AAT transcript levels (<i>p</i> = 0.04). <b>Innovation:</b> Fat grafting outcomes improved by early AAT treatment, probably by accelerating inflammatory resolution. Due to its marked safety profile, the study's findings are for adjunct clinical-grade AAT therapy. <b>Conclusion:</b> AAT has a promising potential to be utilized as a fat graft outcome enhancer in terms of volume retention predictability and tissue quality.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence Mapping of Clinical Practice Guideline Recommendations for Self-Management Strategies of Diabetic Foot Ulcers.","authors":"Shupeng Shi, Piaoyu Yang, Xingzhou Liu, Yongjie Li, Chuan Yang","doi":"10.1089/wound.2024.0276","DOIUrl":"https://doi.org/10.1089/wound.2024.0276","url":null,"abstract":"<p><p><b>Significance:</b> Diabetic foot ulcer (DFU) is a common complication of diabetes, characterized by chronic, hard-to-heal wounds that can lead to serious infections and amputations. Effective self-management is crucial for treatment and prevention. <b>Recent Advances:</b> A comprehensive literature search was conducted across academic databases, clinical practice guideline (CPG) databases, and the websites of diabetes societies. The characteristics, recommendations, and evaluation criteria of the CPGs were extracted and organized using Excel. Four researchers independently assessed the methodological and reporting quality of the CPGs using the Appraisal of Guidelines Research and Evaluation II instrument and the Reporting Items for practice Guidelines in HealThcare checklist. Data were synthesized and visualized through evidence mapping to provide an overview of current guideline coverage and key recommendations. <b>Critical Issues:</b> This study included 13 CPGs and synthesized 46 recommendations. Self-management strategies for patients with DFU mainly involve health education, foot self-care, lifestyle change, comorbidity/symptom management, as well as follow-up and medical help-seeking. The identified CPGs were of mixed quality, with four classified as high quality. With respect to methodology, the CPGs performed well in scope and purpose (82.6%±10.9%) and clarity (80.77%±9.19%), but showed deficiencies in stakeholder involvement (52.8%; interquartile range [IQR]: 17.3%) and editorial independence (58.3%; IQR: 82.3%). For reporting quality, limitations were noted in transparency regarding review and quality assurance (18.75%; IQR: 100%), as well as funding and declaration of interests (12.5%; IQR: 32.82%). <b>Future Directions:</b> The evidence provided by CPGs for DFU self-management varied in strength, and some recommendations were inconsistent. The results adds to our knowledge and promotes the development of trustworthy CPGs on DFU. Further research is necessary to propose more evidence-based and high-quality recommendations.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Shizuoka Study of a Population-Based Retrospective Cohort for the Evaluation of Risk of Pressure Injury in the Elderly.","authors":"Hideo Hashizume, Ammi Matsuura, Yoshiki Miyachi","doi":"10.1089/wound.2024.0256","DOIUrl":"https://doi.org/10.1089/wound.2024.0256","url":null,"abstract":"<p><p><b>Objective:</b> The risk of pressure injuries (PIs) is increasing in Japan, where an aging population imposes substantial health care burdens. <b>Approach:</b> This retrospective cohort study utilizing the Shizuoka Kokuho Database evaluated factors associated with PI development in hospitalized patients. <b>Results:</b> An analysis of over 546,000 patients aged ≥65 years from 2012 to 2022 identified 6,372 PI cases. Cox regression analyses revealed that male sex (hazard ratio [HR] 1.32, 95% confidence interval [CI]: 1.25-1.39), advanced age (HR 8.54, 95% CI: 7.40-9.87 for ≥95 years vs. 65-69 years) and comorbidities such as neurological disorders (HR 1.87, 95% CI: 1.72-2.04), dementia (HR 1.69, 95% CI: 1.59-1.80), and congestive heart failure (HR 1.19, 95% CI: 1.12-1.27) were associated with increased PI risks. Conversely, antihyperlipidemic drugs may be associated with a lower PI risk (HR 0.69, 95% CI: 0.65-0.74). Due to data limitations, factors such as nutritional status, mobility, and caregiver support could not be evaluated. <b>Innovation:</b> This study is the first in Japan to leverage big data to identify high-risk groups for PIs, particularly among elderly individuals with specific comorbidities. This approach offers actionable insights into PI management, potentially enhancing care strategies and preventive guidelines. <b>Conclusion:</b> Male sex, advanced age, and comorbidities, including neurological disorders, dementia, psychosis, and congestive heart failure, were identified as primary PI risk factors. Conversely, antihyperlipidemic drug use may be associated with a lower PI risk. These findings highlight the need for comprehensive, targeted prevention strategies to reduce the risk of PI in elderly hospitalized patients.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-Powered Image-Based Assessment of Pressure Injuries Using You Only Look once (YOLO) Version 8 Models.","authors":"Mehedi Hasan Tusar, Fateme Fayyazbakhsh, Niloofar Zendehdel, Eduard Mochalin, Igor Melnychuk, Lisa Gould, Ming C Leu","doi":"10.1089/wound.2024.0245","DOIUrl":"https://doi.org/10.1089/wound.2024.0245","url":null,"abstract":"<p><p><b>Objective:</b> The primary objective of this study is to enhance the detection and staging of pressure injuries using machine learning capabilities for precise image analysis. This study explores the application of the You Only Look Once version 8 (YOLOv8) deep learning model for pressure injury staging. <b>Approach:</b> We prepared a high-quality, publicly available dataset to evaluate different variants of YOLOv8 (YOLOv8n, YOLOv8s, YOLOv8m, YOLOv8l, and YOLOv8x) and five optimizers (Adam, AdamW, NAdam, RAdam, and stochastic gradient descent) to determine the most effective configuration. We followed a simulation-based research approach, which is an extension of the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for dataset preparation and algorithm evaluation. <b>Results:</b> YOLOv8s, with the AdamW optimizer and hyperparameter tuning, achieved the best performance metrics, including a mean average precision at intersection over union ≥0.5 of 84.16% and a recall of 82.31%, surpassing previous YOLO-based models in accuracy. The ensemble model incorporating all YOLOv8 variants showed strong performance when applied to unseen images. <b>Innovation:</b> Notably, the YOLOv8s model significantly improved detection for challenging stages such as Stage 2 and achieved accuracy rates of 0.90 for deep tissue injury, 0.91 for Unstageable, and 0.74, 0.76, 0.70, and 0.77 for Stages 1, 2, 3, and 4, respectively. <b>Conclusion:</b> These results demonstrate the effectiveness of YOLOv8s and ensemble models in improving the accuracy and robustness of pressure injury staging, offering a reliable tool for clinical decision-making.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the Gap: Contemporary Paradigms in Nerve Scaffolds and Regeneration.","authors":"Charles D Hwang, Seamus P Caragher, Rebekah J Bihun, Kyle R Eberlin","doi":"10.1089/wound.2024.0074","DOIUrl":"https://doi.org/10.1089/wound.2024.0074","url":null,"abstract":"<p><p>Peripheral nerve injuries, especially those with complete transection of major nerves, create significant morbidity including debilitating pain, loss of protective haptic feedback, and impaired volitional control of musculature. The societal burden and cost of medical care for these injuries are enormous, with estimates in the United States alone in excess of $670 million per year. In clinical scenarios with a segmental nerve gap where end-to-end coaptation without tension is not possible, a \"bridge\" or scaffold must be interposed to facilitate communication between the proximal and distal stumps to facilitate organized growth following Wallerian degeneration. A multitude of constructs have been created and studied to facilitate this regeneration. Among the three overall types of bridge employed in contemporary clinical care-conduit/scaffold, allograft, and autograft-each has significant downsides ranging from limited successful nerve ingrowth to donor site morbidity. Despite the tremendous work over the last 150 years in nerve biology and medical technology for the treatment of peripheral nerve injury, the biological processes governing nerve regeneration remain incompletely understood. Especially in cases of long segmental gaps, there remains room for significant improvement. Ongoing studies have identified several promising modalities for nerve scaffolds to facilitate more efficient and effective neuronal outgrowth but still require further investigation. Here, we review contemporary paradigms in the treatment of segmental nerve injuries with interposing scaffolds and reexamine nerve physiology, regulatory programs in nerve regeneration, and strategic targets for neurogenic pathways that may facilitate novel treatment modalities.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":""},"PeriodicalIF":5.8,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143603315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}