Search Results (334)

Ultrasound-guided femoral vascular access (UFVA) is a crucial step in cardiovascular intervention, yet training models remain costly, anatomically limited, or insufficiently durable. This research aimed to develop and evaluate a reusable, self-healing vascularised leg phantom in collaboration with clinicians. This bifurcating vascular model was cast in Plastisol using a customisable silicone mould design. The material exhibited a Shore OO hardness of 18.0 ± 2.2, a speed of sound of 1454 ± 15 m/s, an acoustic attenuation of 1.66 ± 0.02 × 106 kg/m²s, and healed 18G needle lesions within 3 h. Training capabilities were evaluated in a workshop involving 18 medical students: FVA times improved by more than 60% after 5 min of free practice. Qualitative feedback was collected from 31 medical educators via a seven-question Likert survey, with most reporting they would adopt the phantom for teaching. Phantoms cost £7.87 for materials, yet educators valued the models at £100–£500, underscoring its perceived utility. Compared to commercial alternatives, this in-house production approach reduced costs by 10–60 times, achieving comparable durability and anatomical fidelity. This study establishes a scalable, ultra-low-cost method for producing anatomically realistic, self-healing vascular phantoms, validated for effective skill acquisition in both educational and research settings. Full article

Hard-to-heal wounds remain a significant challenge for healthcare professionals, particularly in aging populations. Although most chronic wounds are associated with diabetes or chronic venous insufficiency, rare etiologies should also be considered. One such cause is envenomation by Phoneutria spp. (native to South America, rare in Europe). Their venom contains potent neurotoxins. While systemic manifestations are more commonly reported, localized necrotic skin lesions may also occur. This case report presents a rare chronic wound following a suspected Phoneutria spider bite and highlights the importance of an individualized, multimodal treatment approach. A 61-year-old male patient with a progressive thigh wound following a spider bite sustained during work. Despite initial self-treatment and pharmacotherapy the wound deteriorated. The patient was admitted to the authors’ facility, where surgical treatment included necrosectomy and a sandwich graft using an acellular dermal matrix combined with a split-thickness skin graft. Adjunctive therapies included negative pressure wound therapy and hyperbaric oxygen therapy. After discharge, outpatient wound care was continued. Treatment was monitored with photographic documentation and serial microperfusion measurements. Complete wound closure was achieved after 4 months of specialized therapy. Management of chronic wounds requires a multidisciplinary and individualized approach with surgical intervention, advanced wound care and specialized outpatient follow-up. Full article

Objectives: Post-extraction remodelling of hard and soft tissues results in volume reduction, leading to aesthetic challenges in planning prosthetic restorations, particularly in the anterior maxilla. This study assessed whether atraumatic vertical extraction, versus conventional extraction, could reduce postoperative volume loss and aesthetic compromises at the extraction site and adjacent teeth. Methods: Following randomized tooth extraction with unassisted healing in the test (Benex^® extraction, n = 10) and control group (conventional extraction, n = 10), postoperative scans were conducted at 30 days (t₁), 60 days (t₂), 90 days (t₃) and 12 months (t₄). Each scan was aligned with the baseline scan (t₀), and surface comparison was performed with five regions of interest (ROIs: central, mesial, distal, papilla mesial and papilla distal). Aesthetic parameters, including recession and Pink Esthetic Score (PES) of adjacent teeth, were clinically evaluated at each follow-up appointment. Statistical analysis used a mixed linear model accounting for confounding factors such as smoking, buccal bone integrity, gingival phenotype, and provisional use. Results: Both groups showed significant volume reduction from baseline to t₃ and t₄. The largest volume loss occurred in the central ROI in both test (t₄: −65.34 ± 36.89 mm³) and control group (t₄: −70.85 ± 30.96 mm³), with no significant difference between groups. A decline in PES and recession at the adjacent teeth was noted in both groups at 12 months. Conclusions: Both groups showed significant volume reduction with aesthetic impairment at the adjacent teeth’s soft tissue. Full article

Background: Extended platelet-rich fibrin (e-PRF) membranes are a novel 100% autologous biomaterial with a longer resorption time (4–6 months) than traditional solid-PRF membranes (two weeks). In part 1 of this 2-part publication series, four clinical variations for using these novel e-PRF membranes for socket preservation were introduced. In this randomized clinical trial (RCT), all four iterations of e-PRF membranes were compared to traditional collagen membranes in alveolar ridge preservation for hard and soft tissue dimensional changes and early wound healing outcomes. Methods: A single-center RCT was conducted, including 55 patients requiring the extraction of a single tooth with planned implant placement. All sockets were grafted with a “sticky bone” (bone allograft mixed with PRF) and secured with either a collagen membrane (control) or e-PRF membranes utilizing the four variations present in Part 1 (both formed extra-orally or intra-orally, each with or without an overlying solid PRF membrane). The time of fabrication and application of each e-PRF iteration was recorded. Cone beam computed tomography was utilized to evaluate horizontal and vertical ridge dimensions at baseline and 3 months post-operatively, and soft tissue thickness was also measured at both time intervals utilizing an endodontic reamer. Early wound healing was recorded at 2 weeks, utilizing the Landry, Turnbull, and Howley Index by three blinded clinicians. Results: The results demonstrated that, at 3 months, the e-PRF membranes fabricated utilizing all 4 treatment variations demonstrated equal improvements in horizontal and vertical ridge dimensions and soft tissue thickness when compared to collagen membranes. Additionally, the membrane (p = 0.029) and membrane w/solid (p = 0.021) groups demonstrated statistically significant superior early wound healing compared to the collagen membrane group. Notably, the Bio-Filler groups demonstrated statistically significant reduction in fabrication/application time compared to the membrane groups. Conclusions: Within the limitations of this RCT, all e-PRF iterations performed comparably to collagen membranes in maintaining both hard and soft tissue ridge dimensions when combined with sticky bone, while also significantly improving soft tissue wound healing. Future RCTs with alternative grafting materials, direct wound-margin assessment, and evaluation of patient-reported outcomes are necessary to clarify the advantages of each membrane type. Full article

Background/Objectives: Wound healing represents a pervasive and urgent clinical challenge. Hard-to-heal chronic wounds are frequently complicated by infections, inflammatory responses, and oxidative stress. Currently, wound dressings are broadly categorized into dry and moist types, with moist wound dressings for chronic wounds accounting for approximately 70% of market revenue. Recently, adipose-derived stem cells (ADSCs), which possess self-renewal and multi-lineage differentiation capabilities, have emerged as a promising strategy for promoting tissue regeneration and wound repair. Methods: In this study, we developed a novel luteolin nanoparticle–ADSCs composite hydrogel (GelCA@LUT@ADSCs). This system was constructed by first encapsulating ADSCs within a chitosan/alginate hydrogel (GelCA), followed by coating the hydrogel with luteolin-loaded nanoparticles (LUT@NPs). Results: The sustained release of LUT@NPs from the hydrogel modulates the wound microenvironment, enhancing the pro-healing functions of ADSCs at the wound site. The GelCA hydrogel exhibited excellent biocompatibility. Both in vitro and in vivo results demonstrated that GelCA@LUT@ADSCs treatment effectively reduced inflammation, promoted angiogenesis and collagen deposition, stimulated cell proliferation and migration, and polarized macrophages toward an anti-inflammatory, pro-healing M₂ phenotype, thereby accelerating wound healing. Conclusions: Overall, this innovative therapeutic approach provides a novel strategy for wound management through a synergistic division of labor between pharmaceutical agents and stem cells. Full article

The development of functionality in wound dressings has progressed since the discovery by Winter that moist wounds heal more rapidly. Approaches to incorporate functionality on several fronts of wound healing have been targeted. Here, we consider three functional features that have received increased attention for their role in promoting healing in hard-to-heal wounds: control of protease levels, hydrogen peroxide generation, and antibacterial efficacy against multidrug resistance bacteria, the ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) pathogens. We review some clinically employed dressings used to treat chronic and burn wounds that have been characterized by their functional protease-modulating activity and contrast one well-studied analog with a cotton-based technology. Similarly, hydrogen peroxide generation profiles were obtained for dressings in different moist wound healing categories and contrasted with a modified form of a known hemostatic cotton-based technology. We examined ascorbic acid-modified forms of a cotton-based technology used for bleeding control in an ESKAPE antibacterial assessment using the AATCC 100 TM. The results for the cotton-based technology were significant protease uptake, hydrogen peroxide generation capacities at proliferative and antimicrobial levels, and >99.99% efficacy against ESKAPE pathogens. These results reflect the importance of considering new forms of cotton fiber technology for incorporation in advanced wound dressing approaches. Full article

Tooth extraction induces changes in both hard and soft tissues, which may compromise implant placement. Leukocyte- and platelet-rich fibrin (L-PRF) is used to promote tissue healing, either alone or in combination with other grafting materials. Objective: This study aimed to compare post-extraction socket healing using L-PRF alone or combined with a biphasic calcium phosphate graft (HA/β-TCP) after eight weeks. Materials and Methods: 15 patients, both sexes, mean age 56.7 ± 8.2 years, requiring alveolar ridge preservation after single-rooted tooth extraction for subsequent implant placement, were included. Sockets were randomly assigned to four groups: control with blood clot only (CTR), autogenous bone graft (AB), L-PRF membrane (LPRF), and L-PRF combined with HA/β-TCP (LPRFHA). The protocol consisted of tooth extraction and immediate graft placement, followed by bone biopsy at 8 weeks for histomorphometric analysis and implant installation. New Bone Formation (NBF) was quantified from ten photomicrographs per sample using ImageJ software (version 1.54, 5 February 2025). One-way ANOVA with Bonferroni post hoc tests was applied, with statistical significance set at p ≤ 0.05. Results: A significant difference in NBF (%) was observed between the control and LPRFHA groups (p = 0.014), with greater bone formation in the control group (62.4 ± 18.6%) compared with LPRFHA (55.8 ± 17.2%; p = 0.012). No significant differences were found among AB, LPRF, and LPRFHA groups. LPRF and AB showed comparable bone formation (60.2 ± 17.5% and 60.1 ± 20.0%, respectively). Conclusions: L-PRF, either alone or combined with HA/β-TCP, can be used for alveolar ridge preservation in maxillary sockets. L-PRF, alone or with synthetic HA/β-TCP graft, effectively preserves the anterior maxillary ridge for early loading at eight weeks. All treatments achieved bone formation for implant placement, with the blood clot alone showing superior results. Full article

Chitosan, a naturally derived polysaccharide obtained by chitin deacetylation, has attracted considerable attention in dentistry as a multifunctional biomaterial owing to its excellent biocompatibility, biodegradability, and tunable physicochemical properties. This narrative review provides an up-to-date overview of the use of chitosan-based sponges in dental tissue engineering, bone regeneration, post-extraction wound management, and periodontal therapy. Chitosan sponges, characterized by high porosity, flexibility, and superior absorbency, serve as effective wound dressings, drug delivery carriers, and scaffolds that promote cell proliferation and tissue regeneration. Their intrinsic antibacterial, antifungal, hemostatic, and immunomodulatory properties further enhance their therapeutic value in managing complex oral conditions. In periodontal treatment, they enable localized drug delivery and support soft and hard tissue healing, while in post-extraction care, they aid hemostasis and reduce complications such as alveolar osteitis. Moreover, their osteoconductive and osteoinductive potential positions them as promising materials for alveolar bone repair and implantology. Chemical modification of chitosan and the incorporation of bioactive compounds allow customization of sponge formulations to meet specific clinical needs. Despite encouraging preclinical findings, challenges remain due to variability in chitosan sources, differences in the degree of deacetylation, and limited clinical validation. This review highlights the potential of chitosan sponges as innovative tools in regenerative dentistry and underscores the need for further standardization, mechanistic studies, and long-term clinical trials to ensure their safe and effective translation into dental practice. Moreover, the broad clinical applications of chitosan sponges beyond dentistry confirm their potential as a universal biomaterial platform in regenerative medicine. Full article

Background: The management of hard-to-heal wounds poses a major clinical challenge due to heterogeneous etiology and significant global healthcare costs (estimated at USD 148.64 billion in 2022). Large Language Models (LLMs), such as ChatGPT and Gemini, are emerging as potential decision-support tools. This study aimed to rigorously assess the accuracy and reliability of ChatGPT and Gemini in the visual description and initial therapeutic management of complex wounds based solely on clinical images. Methods: Twenty clinical images of complex wounds from diverse etiologies were independently analyzed by ChatGPT (version dated 15 October 2025) and Gemini (version dated 15 October 2025). The models were queried using two standardized, concise prompts. The AI responses were compared against a clinical gold standard established by the unanimous consensus of an expert panel of three plastic surgeons. Results: Statistical analysis showed no significant difference in overall performance between the two models and the expert consensus. Gemini achieved a slightly higher percentage of perfect agreement in management recommendations (75.0% vs. 60.0% for ChatGPT). Both LLMs demonstrated high proficiency in identifying the etiology of vascular lesions and recognizing critical “red flags,” such as signs of ischemia requiring urgent vascular assessment. Noted divergences included Gemini’s greater suspicion of potential neoplastic etiology and the models’ shared error in suggesting Negative Pressure Wound Therapy (NPWT) in a case potentially contraindicated by severe infection. Conclusions: LLMs, particularly ChatGPT and Gemini, demonstrate significant potential as decision-support systems and educational tools in wound care, offering rapid diagnosis and standardized initial management, especially in non-specialist settings. Instances of divergence in systemic treatments or in atypical presentations highlight the limitations of relying on image-based reasoning alone. Ultimately, LLMs serve as powerful, scalable assets that, under professional supervision, can enhance diagnostic speed and improve care pathways. Full article

Background and Objectives: This prospective case series evaluated a treatment strategy in endodontic-periodontal lesions resulting from concurrent pulpal and periodontal infections. These present significant management challenges, particularly when they exhibit resistance to standard treatment modalities. Persistent microbial biofilms in regions like dentinal tubules and lateral canals can make it hard for healing to happen, even with good endodontic and periodontal care. Diode lasers have antibacterial and photobiomodulatory effects, but they are most often used as single-stage disinfection techniques. This pilot study evaluated a multi-stage diode laser protocol designed to enhance healing outcomes in refractory endo-perio lesions that had not responded to conventional treatment. Materials and Methods: Twelve patients (aged 20–60 years) with chronic endo-perio lesions, referred after unsuccessful earlier treatment, were treated utilizing a sequential diode laser regimen: Phase 1—Endodontic disinfection: Following canal instrumentation (0.75 W, pulsed mode, frequency 15 Hz, 200 μm fiber, 15 J dosage/20 s) using a 976 nm diode laser. Phase 2—Periodontal disinfection: Following SRP, intra-pocket (0.75 W, pulsed mode, frequency 15 Hz, 300 μm fiber, 3.75 J dosage/5 s) using a 976 nm diode laser; Phase 3—Post treatment photobiomodulation: After periodontal and endodontic therapy, photobiomodulation was applied using a 650 nm diode laser intra-pocket and in the periapical region (25 mW, continuous mode, 1.5 J dosage) to reduce postoperative inflammation and stimulate healing. Clinical parameters—probing depth (PD), bleeding on probing (BOP), and mobility—along with radiographic bone fill were recorded at baseline and after 6 months. Results: All twelve cases showed measurable within-patient improvements over the six-month follow-up. Median probing depth decreased from 7.6 mm to 6.0 mm, and median bleeding on probing declined from 0.9 to 0.3. Radiographically, partial bone fill was observed in all cases, with a median value of 58.3 percent. Postoperative pain decreased progressively over the first 24 h, with patients reporting mild discomfort by 24 h. No adverse events were recorded. Conclusions: Within the limitations of this small, uncontrolled pilot study, the multi-stage diode laser protocol was associated with clinical and radiographic improvements and low postoperative discomfort in refractory endo-perio lesions. These preliminary findings suggest that such a protocol may serve as a useful adjunct to conventional therapy. Larger, controlled studies are required to confirm these outcomes and determine long-term efficacy. Full article

Hard-to-heal wounds are a major burden to healthcare systems. Electrical stimulation therapy (EST) is known to improve clinical outcomes, but cost-effectiveness analysis is lacking. The aim was to explore the cost-effectiveness of EST with standard of care (SoC) versus SoC alone. A systematic review and meta-analysis of randomised controlled studies (RCTs) were conducted. Fourteen RCTs were identified, representing 783 patients. EST + SoC, versus SoC alone, significantly increased the proportion of wounds healed (odds ratio [OR] 2.46 [95% CI, 1.75–3.46], p < 0.0001) and significantly decreased the mean time to healing (−2.67 weeks (95% CI, 1.49–3.84, p < 0.00001). A cost-effectiveness model was developed based on these findings and on the usage and cost of the EST device used in the largest included RCT. Weekly costs of community wound care were taken from published estimates and inflated to 2024 levels, reflecting costs in the UK. In a hypothetical cohort of 100 patients treated over 12 weeks, EST + SoC was estimated to save over GBP 38,000 overall, reduce nursing visits by 385 and lead to 154 more ulcer-free weeks. In conclusion, EST used in the community is a cost-effective addition to SoC with the ability to improve outcomes and reduce human and financial burden of hard-to-heal wounds. Full article

In recent years, the automotive industry has experienced increasing demand for advanced paint protection solutions aimed at improving vehicle durability, preserving aesthetic appeal, and promoting environmental sustainability. This paper critically examines the main categories of paint protection coatings on wax, ceramic, graphene, and hybrid formulations by focusing on their chemical composition, application methods, protective performance, and limitations. Wax coatings remain widely adopted due to their affordability and ease of use, though they offer limited longevity. Ceramic coatings, in contrast, provide superior hardness, hydrophobicity, and resistance to scratches, corrosion, and ultraviolet (UV) degradation, albeit with higher costs and complex application procedures. Emerging graphene-based coatings demonstrate exceptional hydrophobicity, thermal stability, and durability, positioning them as potential next-generation solutions, though their environmental and economic feasibility remains under exploration. Hybrid and self-healing coatings further highlight the trend toward multifunctional, intelligent protection systems. This work also emphasizes the critical role of surface preparation in determining coating performance. Future research directions are outlined, including the development of biodegradable, zero-VOC, and intelligent self-aligning coatings, which could significantly advance sustainable automotive surface protection. Overall, this work provides a comprehensive synthesis of current technologies and identifies pathways for innovation in automotive paint protection materials. Full article

Chronic and hard-to-heal wounds remain burdensome because microbial contamination, dysregulated inflammation, and fragile tissue regeneration slow closure, while passive dressings often injure new tissue during removal. This review synthesizes polymer- and lipid-based nanostructures through a barrier-resolved lens that links composition, architecture, and processing to performance in protease- and salt-rich exudate across topical and transdermal routes. Quantitative trends include effective diameters of approximately 50–300 nm, practical constraints of sterile filtration at 0.2 μm, and therapeutic windows that prioritize contamination control on the first day, support proliferation around day three, and sustain remodeling beyond one week. Mechanistic evidence indicates that interfacial charge and the protein corona govern residence and uptake, lipid bilayers enable dual loading, degradable polymer matrices provide depot-like behavior, and hybrid constructs temper the early burst while improving storage stability. Full article

Background/Objectives: Tooth extraction is known to cause both bone loss and soft tissue collapse, changes that can complicate implant placement. While alveolar ridge preservation techniques have been proposed to limit these alterations, they often fail to maintain both hard and soft tissue dimensions at the same time. Placental-derived extracellular matrices offer a biologically active adjuvant, providing structural proteins that may support healing. The purpose of this study was to assess whether a flowable decellularized Human Placental Connective Tissue Matrix (HPCTM), combined with an allogeneic bone substitute, could improve ridge preservation by addressing changes in soft tissue as the primary outcome and underlying bone volume as the secondary outcome. Methods: In a split-mouth, randomized pilot trial, hopeless teeth in opposite quadrants were atraumatically extracted. Test sockets were grafted with allograft mixed with HPCTM, while control sockets received allograft alone. Healing was followed clinically and digitally using intra-oral scans; standardized photographs at 10, 21, and 30 days post-operatively; and cone-beam computed tomography at 4 months post-operatively. Results: Ten patients completed the study (10 test sites and 10 control sites). Sites treated with HPCTM showed faster and more stable healing. Gingival shrinkage was consistently reduced at test sites, with Hodges–Lehmann median differences of 0.50 mm at Day 10 (95% CI: 0.29–0.62; p = 0.0039), 0.54 mm at Day 21 (95% CI: 0.42–0.65; p = 0.002), and 0.54 mm at Day 30 (95% CI: 0.39–0.68; p = 0.002). Radiographically, test sites lost significantly less bone volume (28.24 ± 2.43%) compared with controls (38.85 ± 1.29%; p = 0.019). Conclusions: Within the limits of this study, HPCTM appears to support better preservation of both gingival architecture and alveolar bone after extraction. Full article

Background: Pediatric hard-to-heal wounds are rare but clinically demanding due to skin immaturity, comorbidities, and infection risk. Methods: This prospective case series evaluated the feasibility, safety, and clinical outcomes of an injectable hyaluronic acid-amino acid complex administered to fifteen children and adolescents (aged 4–16 years) with chronic hard-to-heal wounds, treated between November 2022 and August 2025 within a standardized wound-hygiene protocol. The primary outcome was time to complete re-epithelialization; secondary outcomes included pain, tolerability, and safety. Results: Complete healing was achieved in most patients within a few weeks of treatment. The injectable therapy was well tolerated, with minimal discomfort and no serious adverse events observed. Conclusions: The injectable hyaluronic acid-amino acid complex appears to be a safe, feasible, and potentially effective therapy for pediatric hard-to-heal wounds. These preliminary findings support its integration into multidisciplinary wound-care strategies, although controlled multicenter studies are warranted to confirm efficacy and define optimal protocols. Full article