Aquacel Ag dressing versus Acticoat™ dressing in partial thickness burns: A prospective,randomized, controlled study in 100 patients. Part 1: Burn wound healing

Introduction

Studies comparing contemporary silver dressings in burns are scarce.

Methods

In a prospective, randomized, controlled study, counting 50 patients/research group, we compared two frequently used silver dressings, Acticoat™ and Aquacel^® Ag, in the management of partial thickness burns with a predicted healing time between 7 and 21 days as assessed by laser Doppler imaging between 48 and 72 h after burn. Variables investigated were related to baseline research group characteristics, wound healing, bacteriology, economics, nurse, and patient experience.

Results

Both research groups were comparably composed taking into account gender, age and burn characteristics. Similar results were obtained as to healing time and bacterial control with both silver dressings. A statistically significant difference in favor of the Aquacel^® Ag dressing was found for average ease of use (p < 0.001), average ease of application (p = 0.001), patient pain (p < 0.001), patient comfort with the dressing (p = 0.017), silver staining (p < 0.001), and cost effectiveness (p < 0.001).

Conclusion

Both silver dressings resulted in comparable healing times and bacterial control but the Aquacel^® Ag dressing significantly increased comfort for patients as well as nurses and was significantly more cost-effective than the Acticoat™ dressing for the given indication.     

人体生物敷料在腹腔开放治疗中的临床疗效

目的 探讨人体生物敷料（灭活的同种异体皮肤）作为腹腔开放临时覆盖物的临床疗效.方法 回顾性分析2011年1月至2014年1月南京军区南京总医院收治的44例因外伤行腹腔开放治疗患者的临床资料.所有患者腹腔开放后以改良三明治法作为临时关腹技术.2011年1月至2012年12月共33例行腹腔开放治疗患者采用凡士林纱布为腹腔临时覆盖物,设为凡士林纱布组（33例）;2013年1月至2014年1月共11例行腹腔开放治疗患者采用人体生物敷料为腹腔临时覆盖物,设为人体生物敷料组（11例）.采用门诊和电话随访,随访时间截至2014年10月.比较两组患者肠道空气瘘发生率、植皮时间、术前和术后2周内血液感染学指标（WBC、中性粒细胞所占比例、降钙素原及C反应蛋白）,住院时间、住院费用以及总体预后.计量资料比较采用独立样本t检验和重复测量方差分析;率或构成比的比较采用Fisher确切概率法.结果 凡士林纱布组患者中,肠道空气瘘发生率为42.4％（14/33）,人体生物敷料组患者中无一例出现肠道空气瘘,两组比较,差异有统计学意义（P＜0.05）.凡士林纱布组植皮时间为（15±6）d,人体生物敷料组为（11±3）d,两组比较,差异有统计学意义（t =2.10,P＜0.05）.凡士林纱布组患者术前、术后第1、3、7、14天降钙素原分别为（1.20±0.60） μg/L、（2.50±0.90） μg/L、（1.70±0.30） μg/L,（1.90±0.40） μg/L、（2.70±0.60）μg/L,显著高于人体生物敷料组的（0.90 ±0.30） μg/L、（1.80±0.60） μg/L、（1.30 ±0.50） μg/L、（0.60±0.20） μg/L、（0.30±0.07） μg/L,两组比较,差异有统计学意义（F=8.50,P＜0.05）;两组患者WBC、中性粒细胞所占比例和C反应蛋白分别由术前的（13.8±2.4）×10^9/L和（12.9±2.1）×10^9/L、0.90±0.09和0.88 ±0.06、（81±19） mg/L和（136±28） mg/L变化为术后第14天的（16.2±3.3）×10^9/L和（7.9±3.0）×10^9/L?     

Synthesis and characterization of a novel controlled release zinc oxide/gentamicin–chitosan composite with potential applications in wounds care

Freshly prepared ZnO nanoparticles were incorporated into a chitosan solution in weight ratios ranging from 1:1 to 12:1. Starting from the ratio of 3:1 the chitosan solution was transformed into a gel with a high consistency, which incorporates 15 mL water for only 0.1 g solid substance. The powders obtained after drying the gel were characterized by X-ray diffraction (XRD), transmission electron microscopy (TEM) and thermal analysis (TG-DSC). The electronic (UV–vis), infrared (FTIR) and photoluminescence (PL) spectra were also recorded. ZnO particles were coated with gentamicin and incorporated into the chitosan matrix, to yield a ZnO/gentamicin–chitosan gel. The release rate of gentamicin was monitored photometrically. This ZnO/gentamicin–chitosan gel proved great antimicrobial properties, inhibiting Staphylococcus aureus and Pseudomonas aeruginosa growth in both planktonic and surface-attached conditions. The results indicate that the obtained composite can be used in cutaneous healing for developing improved wound dressings, which combine the antibacterial activity of all three components with the controlled release of the antibiotic. This wound dressing maintains a moist environment at the wound interface, providing a cooling sensation and soothing effect, while slowly releasing the antibiotic. The system is fully scalable to any other soluble drug, as the entire solution remains trapped in the ZnO–chitosan gel.     

The Mould War: Developing an Armamentarium against Fungal Pathogens Utilising Thymoquinone,Ocimene, and Miramistin within Bacterial Cellulose Matrices

An increase in antifungal resistance has seen a surge in fungal wound infections in patients who are immunocompromised resulting from chemotherapy, disease, and burns. Human pathogenic fungi are increasingly becoming resistant to a sparse repertoire of existing antifungal drugs, which has given rise to the need to develop novel treatments for potentially lethal infections. Bacterial cellulose (BC) produced by Gluconacetobacter xylinus has been shown to possess many properties that make it innately useful as a next-generation biopolymer to be utilised as a wound dressing. The current study demonstrates the creation of a pharmacologically active wound dressing by loading antifungal agents into a biopolymer hydrogel to produce a novel wound dressing. Amphotericin B is known to be highly hepatotoxic, which reduces its appeal as an antifungal drug, especially in patients who are immunocompromised. This, coupled with an increase in antifungal resistance, has seen a surge in fungal wound infections in patients who are immunodeficient due to chemotherapy, disease, or injury. Antifungal activity was conducted via Clinical & Laboratory Standards Institute (CLSI) M27, M38, M44, and M51 against Candida auris, Candida albicans, Aspergillus fumigatus, and Aspergillus niger. This study showed that thymoquinone has a comparable antifungal activity to amphotericin B with mean zones of inhibition of 21.425 ± 0.925 mm and 22.53 ± 0.969 mm, respectively. However, the mean survival rate of HEp-2 cells when treated with 50 mg/L amphotericin B was 29.25 ± 0.854% compared to 71.25 ± 1.797% when treated with 50 mg/L thymoquinone. Following cytotoxicity assays against HEp-2 cells, thymoquinone showed a 71.25 ± 3.594% cell survival, whereas amphotericin B had a mean cell survival rate of 29.25 ± 1.708%. The purpose of this study was to compare the efficacy of thymoquinone, ocimene, and miramistin against amphotericin B in the application of novel antifungal dressings.     

Evaluation of the efficacy of platelet-rich plasma on healing of clean diabetic foot ulcers: A randomized clinical trial in Tehran,Iran

Background and aimsDiabetic foot ulcers (DFUs) are among challenging hurdles both for the patient and the physician. There is a recent trend toward finding novel and clinically efficient modalities to treat this potentially hazardous complication of diabetes mellitus in a timely manner. Herein, we aim to appraise the efficacy of platelet-rich plasma (PRP) in healing of clean DFUs.Methods90 patients with clean DFUs consisting of 56 (62.2%) males and 34 (37.8%) females with mean age (±standard deviation) of 56.52 (±7.14) years were enrolled in this study between June 2017 and December 2018. They were randomly allocated into control group (47 patients who received conventional dressing along with silver sulfadiazine ointment twice daily), and case group (43 patients who received PRP gel twice weekly for 3 weeks). All the patients were followed up for 6 months.ResultsOur study showed that PRP significantly increased the healing rate of DFUs regardless of the age (p-value: 0.0), gender (p-value: 0.0), or smoking (p-value: 0.0) and blood pressure (p-value: 0.0) status of patients, but it did not have a significant impact on the need for amputation (p-value: 0.11), level of amputation (p-value: 0.16), or the need for further treatments such as graft or angioplasty (p-value: 0.52).ConclusionRegardless of the age, gender, or smoking and blood pressure status of patients, PRP can be efficiently used in diabetic patients to accelerate the healing rate of foot ulcers.     

Electrochemical and X-ray Examinations of Erosion Products during Dressing of Superhard Grinding Wheels Using Alternating Current and Ecological Electrolytes of Low Concentration of Chemical Compounds

This article introduces significant cognitive and usable values in the field of abrasive technology especially in the development of new methods of the electrochemical dressing of superhard grinding wheels with metal bonds. Cognitive values mainly concern the elaboration of the theoretical backgrounds of the electrochemical digestion of compounds of grinding wheel metal bond and gumming up products of the cutting surface of grinding wheel (CSGW). Cognitive values also deal with determining the mathematical relationships describing the influence of technological conditions of dressing on shaping of cutting abilities of superhard grinding wheels. On the other hand, the useful values refer to the industry implementation of the elaborated method and equipment for the electrochemical dressing of suparhard grinding wheels using alternating current (ECDGW-AC). The cost of the device for the realization of this process is low and can be applied in the production conditions. The novel achievements presented in the article are: the elaboration of a new method and equipment for electrochemical dressing of superhard grinding wheels (ECDGW-AC), the selection of electrolytes of low concentration of chemical compounds, tests concerning the digestion of grinding wheel metal bond compounds and gumming up products of CSGW using X-ray analysis, as well as the determination of chemical reactions taking place during elaborated new dressing process, the elaboration of mathematical relationships describing influence of technological conditions of this process on dressing speed and shaping of cutting abilities of superhard grinding wheels, and the performance of technological tests of dressing of superhard grinding wheels using ECDGW-AC method. The elaborated method can be used in ambient temperature and does not cause thermal damages of abrasive grains of cutting surface of grinding wheel and is useful not only for dressing super hard grinding wheels but also for correcting their geometrical deviations.     

锁骨下静脉置管敷料更换时清洁消毒方法的改良

目的探讨改良锁骨下静脉置管敷料更换时清洁消毒的方法（简称换药方法）,对预防相关感染的效果。方法选择2012年1-6月某院重症监护室行右锁骨下静脉置管的患者120例,按置管日期分为对照组（单日）和实验组（双日）各60例。对照组采用传统的换药方法：2%碘酊消毒穿刺点及周围皮肤一遍,75％乙醇脱碘一遍;实验组采用改良换药方法：先用生理盐水擦拭穿刺点及周围皮肤3遍,清洁导管,再避开穿刺点用75％乙醇消毒周围皮肤3遍,用0.5%碘伏消毒穿刺点及周围皮肤3遍,最后消毒导管。对比两组相关感染率。结果实验组局部感染率为5.00%,导管相关性血流感染（CRBSI）率为1.67%,均显著低于对照组（分别为16.67%和13.33%）,差异均有统计学意义（均P＜0.05）。结论改良换药方法比传统换药方法效果好,能有效预防局部感染与CRBSI的发生。     

纳米银抗菌敷料治疗78例烧伤患者的疗效及护理体会

目的观察纳米银抗菌辅料对烧伤患者创面的治疗效果。方法对天津市职业病防治院外科收治的78例不同程度烧伤患者,在入院经过清创处理消毒创面后,均选择使用纳米银抗菌敷料进行换药治疗,同时辅以抗感染、抗休克治疗,责任护士严密观察病情和伤口创面变化,同时进行精心的心理和饮食护理。结果78例患者创面均达到I期愈合,未发生并发症,未留有明显瘢痕。结论应用纳米银抗菌敷料治疗烧伤具有减轻疼痛、控制感染、促进愈合、方法简便等优势,临床治疗效果满意。     

红宝石点阵激光联合胶原修复贴治疗黄褐斑的临床观察

目的:对红宝石点阵激光联合胶原修复贴治疗黄褐斑进行临床疗效观察。方法:使用Q开关红宝石固体激光治疗,点阵模式,能量密度3~4.5mJ/cm2,每2周1次,10次为1个疗程;术后1周每天外敷胶原修复贴治疗1次,观察临床疗效及副作用。结果:60例患者经治疗后,基本治愈28例,显效24例,好转8例,无效0例,总有效率86.7%,患者耐受性好,未出现严重不良反应。结论:采用红宝石点阵激光联合胶原修复贴治疗黄褐斑患者疗效显著、安全,副作用少。     

异维A酸红霉素凝胶联合胶原蛋白敷料治疗中度寻常性痤疮疗效观察

目的:观察异维A酸红霉素凝胶联合胶原蛋白敷料治疗中度寻常性痤疮的临床疗效及安全性。方法:96例中度寻常性痤疮患者,随机分为治疗组和对照组各48例。对照组外用异维A酸红霉素凝胶,1次/天,治疗6周;治疗组在对照组基础上联合使用胶原蛋白敷料,1次/天,每次30min,连续使用4周,第5~6周隔日使用1次。疗程均为6周。结果:治疗组愈显率和有效率分别为89.58%和100.00%,对照组为66.67%和91.67%,两组疗效比较差异均有统计学意义(P0.05)。治疗组发生轻度局部刺激反应率为12.50%,对照组为10.42%,均未发现任何全身不良反应,两组用药不良反应比较差异无统计学意义(P0.05)。结论:异维A酸红霉素凝胶联合胶原蛋白敷料贴敷治疗痤疮安全、有效,可临床推广应用。