Search Results (1,630)

Background: Anal fissure is a common benign condition, yet its management varies widely. The International Society of University Colon and Rectal Surgeons (ISUCRS) conducted a global snapshot audit to describe contemporary real-world management patterns. Methods: During a 2-week period (June–July 2022), 56 colorectal surgeons from 21 countries prospectively recorded data for consecutive patients presenting with anal fissure. Exclusion criteria included inflammatory bowel disease, pregnancy or lactation, psychiatric disorders, immunosuppression, and anorectal sepsis. Acute fissure was defined as symptoms <6 weeks without sentinel pile; chronic fissure as > 6 weeks or fibrotic edges/sentinel pile. The “Cure” was defined as complete symptom resolution or healed fissure on clinical or tele-follow-up. Results: A total of 302 patients were analyzed (mean age 41 ± 13 years; 52% women). Acute fissure was present in 42%, chronic in 58%. Conservative treatment (dietary advice, stool-softeners, topical agents, botulin toxin, pelvic-floor training) was initiated in 236 (78%) patients, while 66 (22%) underwent surgery, most commonly lateral internal sphincterotomy (LIS). At 8-week follow-up, 73% of patients treated conservatively and 88% of those treated surgically achieved clinical resolution of symptoms or healed fissure. Conclusions: Global management of anal fissure remains heterogeneous. Most surgeons favor conservative measures such as first-line therapy, reserving LIS for chronic or refractory fissures. Standardized definitions and outcome reporting are needed to improve comparability and guide future international guidelines. Full article

Deep wounds often lead to severe complications such as persistent infection, biofilm formation, and high patient morbidity. While skin injuries can usually be managed with functional dressings, wounds in deep layers without sufficient treatment may serve as primary entry points for bacterial infection, thereby posing a significant life-threatening risk to patients. With the rising prevalence of chronic diseases and an aging population, effective strategies for enhanced wound healing are still in high demand. In this study, an injectable and thermoresponsive hexamethylene diisocyanate–Pluronic F127 copolymer–hyaluronic acid composite hydrogel loaded with polyhexamethylene biguanide (PHMB) and epidermal growth factor (EGF), named PEHHPG, was developed for joint therapy of deep wounds. PEHHPG self-gels at 37 °C and stabilizes both agents in the gel matrix. Based on the results of microbial colony assay and analysis of fibroblast growth kinetics, PEHHPG with ≥200 ppm of PHMB and ≥0.15 μg/mL of EGF can eradicate bacteria and enhance cell proliferation in vitro, illustrating the functionalities of PEHHPG. Given the aforementioned effects, together with the recognized advantages of injectable hydrogels such as wound shape/depth adaptation, low adhesiveness, exudate absorptiveness, and moisture maintenance, the developed PEHHPG is anticipated to be a feasible dressing material for deep wound treatment after further in vivo examinations. Full article

Background: While ibuprofen is a widely used non-opioid analgesic with growing evidence in surgical settings, its safety and efficacy in acute burn care remain poorly characterized. This review aims to address this gap. Methods: A systematic search was conducted in accordance with PRISMA-ScR (September 2025) across PubMed, MEDLINE, CENTRAL, CINAHL, and Scopus for original, English-language studies evaluating the safety and/or efficacy of ibuprofen, distinguishable from multimodal regimens, for acute burn analgesia. Results: Of 136 studies, six met inclusion criteria (5 adult, 1 pediatric). Populations primarily consisted of second- and third-degree burns; only two studies included >10% total body surface area (TBSA). Study designs were heterogeneous, all with moderate to high risk of bias, including one retrospective study (oral ibuprofen), two experimental double-blind placebo randomized controlled trials (RCTs) (topical; oral), and three clinical RCTs (intravenous; topical; topical and oral). No study reported associations with increased adverse events; a retrospective study found no increased bleeding risk with perioperative ibuprofen in skin graft patients. Analgesic outcomes were not directly comparable across studies due to heterogeneity. Experimental models found that ibuprofen did not reduce acute burn pain, but attenuated pain within hyperalgesic skin. Among clinical studies, both oral and dressing ibuprofen formulations demonstrated reduced procedural pain. One topical study noted faster wound healing, though this was confounded by less frequent dressing changes. Conclusions: The available studies were insufficient to draw definitive conclusions, limited by sample size, heterogeneity, bias, and exclusion of high-risk patients. Nonetheless, no study reported increased adverse events across diverse ibuprofen protocols. These findings underscore the need for adequately powered, agent-specific trials in clinically representative burn populations to inform evidence-based multimodal compositions amidst growing advocacy for opioid-sparing analgesia. Full article

Bacterial cellulose (BC) is an emerging biopolymer for skin tissue regeneration; however, its functionalization with natural antimicrobial agents remains limited. This study reports the preclinical evaluation of a BC-based dressing for diabetic wounds. BC membranes were obtained from mango pulp agro-waste by Komagataeibacter xylinus cultivation (6.32 g/L) and functionalized with grapefruit seed oil (GSO) at three v/v ratios (1:100, 1:200 and 1:500). FTIR spectroscopy confirmed GSO incorporation into the BC matrix through physical interactions, with a dose-dependent loading. Antimicrobial activity of the BC/GSO dressings was screened against Staphylococcus aureus, Escherichia coli and Candida albicans by agar diffusion, showing dose-dependent inhibition zones. Following the minimum effective dose principle, the BC/GSO 1:500 (v/v) formulation was selected for comprehensive biocompatibility evaluation (cytotoxicity, mutagenicity, pyrogenicity and sensitization) and for in vivo wound-healing testing in a streptozotocin-induced diabetic Wistar rat model. Cell viability above 70% was achieved from membrane-extract dilution 1:100,000, while mutagenicity, pyrogenicity and sensitization assays confirmed the absence of adverse biological responses. In vivo, BC/GSO 1:500 (v/v) dressings supported wound closure comparable to nitrofurazone, with no clinical signs of infection. Overall, these results position BC/GSO dressings as a sustainable, biocompatible and antimicrobial candidate for early-stage diabetic wound regeneration and demonstrate the technical feasibility of valorizing mango pulp agro-waste into a high-value biomedical biopolymer. Full article

Background/Objectives: Mesenchymal stem cells (MSCs), due to their regenerative and multipotent properties, have emerged as promising therapeutic agents in tissue repair and regeneration. These biological characteristics might contribute to optimized anastomotic healing and to a reduction in postoperative complications following digestive surgery. The present study aimed to evaluate whether intraperitoneal or perianastomotic administration of MSCs provides superior healing outcomes in colonic anastomoses in Wistar rats. Methods: MSCs were isolated from inguinal adipose tissue harvested from 2 Wistar rats. Thirty male Wistar rats were allocated to 3 groups: (i) the control group, with regular anastomosis, (ii) peri-anastomotic injection of MSCs, and (iii) intraperitoneal injection of MSCs. The animals were sacrificed on postoperative day 14. The evaluated outcomes included clinical evolution, adhesion index, histological characteristics, and tissue hydroxyproline content. Results: The incidence of anastomotic leakage and the mortality rate were 0%. Therefore, the present study primarily demonstrates changes in surrogate markers of healing, including inflammatory response, collagen deposition, adhesion formation, and hydroxyproline content. The adhesion index was similar in the groups receiving MSC administration (p = 0.05); however, intraperitoneal administration demonstrated superior outcomes when compared to standard anastomosis in reducing adhesion formation (p = 0.002). Histopathological analysis showed a decreased inflammatory process and an increased collagen deposition at the anastomotic site following MSC administration (p < 0.05). Moreover, tissue hydroxyproline levels were significantly increased after both perianastomotic (0.831 ± 0.02, p < 0.05) and intraperitoneal (0.54 ± 0.02, p < 0.05) MSC administration compared with the control group (0.251 ± 0.006). Conclusions: These results suggest that MSC administration may improve histological and biochemical markers associated with colonic anastomotic healing in a non-ischemic experimental model. The experimental model used is suitable for further studies aimed at determining the optimal indications, routes of administration, and adjunctive agents that may potentiate the effects of MSCs. Full article

Background: Enterocutaneous fistulas (ECFs) and enteroatmospheric fistulas (EAFs) are rare but highly morbid complications that most commonly arise after abdominal surgery. Outcomes have improved with advances in multidisciplinary care and with increasing research on how to best manage them; however, they remain associated with significant morbidity, high mortality, and prolonged hospitalization. Optimal timing of definitive repair is unknown, with many high-volume centers waiting 6–12 months, though emerging data suggest that earlier intervention may be feasible in carefully selected patients. Given their complexity and variability in management, a comprehensive review of current evidence is needed. Methods: A narrative review of the literature was conducted with emphasis on the classification, pathophysiology, and multidisciplinary management of ECFs and EAFs. Relevant studies addressing fluid and sepsis control, nutritional optimization, wound care, pharmacologic therapies, and interventional strategies were reviewed. Results: The management of ECFs requires a staged approach focused on fluid resuscitation, sepsis control, wound management, and nutritional optimization. Spontaneous closure can occur, and is most commonly within the first two months. Nutritional optimization through enteral and/or parenteral nutrition or fistuloclysis plays a vital role in improving outcomes. Therapies such as negative pressure wound therapy, biologics, and pharmacologic agents may support spontaneous closure and fistula control. In non-healing fistulas, surgical repair remains necessary, with optimal time for surgery at least 6–12 months from fistula development. Conclusions: ECFs and EAFs remain complex surgical challenges. Outcomes have improved due to advances in nutritional support and wound management, and the emergence of minimally invasive techniques. Standardization of treatment protocols and further research into novel therapy may further enhance outcomes and limit variability in management. Full article

Polymerised type I collagen (polymerised collagen) and pirfenidone (PFD) reduce fibrosis. However, their use as pharmacological monotherapy for tracheal stenosis (TS) has not been evaluated. This study aimed to evaluate the effects of polymerised collagen or PFD, used either as monotherapy for TS, or in combination with tracheal resection (TRE) on the development of restenosis (RTS), apoptotic body (AB) formation, production of profibrotic proteins, ITGβ1 expression and metalloproteinase (MMP) expression in a rat model of TS. Eighty Wistar rats underwent TS. Forty received monotherapy (treatment A) with: saline solution (SS), mitomycin C (MMC), polymerised collagen, or PFD. The other forty received TRE combined with the pharmacological treatment (treatment B). They were clinically evaluated. Four weeks after treatment, AB formation, ITGβ1, TGF-β, profibrotic proteins, and MMPs expression were assessed in TS tissue and post-TRE tissue. Our findings showed that treatment A with polymerised collagen or PFD did not reverse TS but halted its progression, reduced the expression of profibrotic proteins, ITGβ1 and MMP-9, and increased AB and MMP-1. Treatment B promoted normal tracheal healing and prevented RTS. We conclude that the use of polymerised collagen or PFD as monotherapy does not reverse TS. However, they halt disease progression by modulating the production of profibrotic factors. In combination with TRE, these agents promote favourable tracheal healing and prevent RTS. Full article

Automating system-level nuclear thermal-hydraulic (T-H) model construction remains challenging because platform-specific API syntax, graph connectivity, parameter dependency ordering, and solver admissibility must be satisfied simultaneously. This study develops a closed-loop modeling framework on the SAFRI platform by combining supervised fine-tuning (SFT), a Plan-and-Act agent with retrieval-grounded parameter completion, and reinforcement learning based on group relative policy optimization (GRPO). The SFT stage uses a 6003-record domain corpus derived from expert-authored or expert-verified SAFRI modeling exemplars, while system-level generalization is evaluated on a held-out 50-case in-house evaluation set separated at the case-template level. At the component level, LoRA-adapted Qwen3-8B achieves 100% code accuracy, compared with 50% for zero-shot and 74% for one-shot prompting. At the system level, the SFT agent attains a 100% syntax success rate (SSR), 90% topology success rate (TSR), and 72.4% physical convergence rate (PCR), showing that local API correctness is insufficient for solver-valid model assembly. After GRPO training with schema, topology, physics, and sequence rewards, the full SAFRI-SFT-RL agent reaches a 100% SSR, 100% TSR, and 88.8% PCR on the in-house evaluation set, while an error self-healing loop resolves execution-time failures in an average of 2.3 corrective iterations. These results show that solver-grounded reinforcement learning is effective for closing the gap between syntactically correct script generation and physically convergent nuclear T-H model construction. Full article

Green synthesis of metal oxide nanoparticles (NPs) offers an eco-friendly, cost-effective alternative to conventional chemical and physical methods, minimizing energy use and hazardous reagents. This study demonstrates the biogenic production of manganese oxide (MnO) NPs using Catharanthus roseus flower extract as a reducing and capping agent, Comprehensive characterization via FTIR (Mn–O vibrations at 591–405 cm⁻¹ along the capping groups), XRD (confirms the cubic crystalline phase), FESEM (flaky, agglomerated sheets), EDX (Mn 62.37%, O 28.40% and C 9.23%), zeta potential (−0.3 mV), and TGA (33.7% phased mass loss to 985 °C) verified pure and stable MnO NPs. In vitro assays on L929 fibroblasts revealed dose-dependent MTT cytotoxicity (78.77% viability at 20 µg/mL to 39.97% at 100 µg/mL) yet enhanced scratch wound closure (−16.31% area reduction vs. −17.41% control), alongside potent antibacterial activity with highest inhibition zones of 15 mm against Klebsiella pneumoniae and Escherichia coli, and lowest of 4 mm against Pseudomonas aeruginosa at 40–100 µg/mL. These multifaceted properties highlight C. roseus-assisted MnO NPs’ promise for wound healing and antimicrobial applications, warranting dosage optimization and in vivo studies. Full article

This study presents a comprehensive analysis of self-healing concrete technologies, focusing on autogenous and autonomous self-healing methods, through a systematic literature review of peer-reviewed articles. The autogenous self-healing method relies on the natural hydration and carbonation processes of unhydrated cement particles, enhanced by additives such as fly ash, slag, and superabsorbent polymers. It is effective for small cracks (<200 μm), environmentally favorable, and cost-efficient, although it is limited by relatively slow healing rates and reduced performance over time. The autonomous self-healing method incorporates external agents, primarily bacteria like Bacillus cohnii and Bacillus sphaericus, encapsulated in protective carriers. These bacteria precipitate calcium carbonate (CaCO₃) upon activation, sealing cracks up to approximately 1240 μm. While generally more effective in terms of healing efficiency and durability, the autonomous self-healing method involves higher production costs. Life cycle assessment results indicate that the autonomous self-healing concrete can exhibit up to 85% higher environmental impact during the production phase than conventional concrete. However, during the production phase, the autogenous self-healing method shows about 32% higher CO₂ emissions than the autonomous method. Results from investigating the mechanisms, performance, repairability, environmental impacts, and economic aspects in this study demonstrate that bacterial concentration and nutrient type critically influence mechanical properties, with optimal strength gains at 10⁵ cells/mL. Both techniques reduce corrosion risk and extend service life, with the autonomous self-healing method displaying superior performance in harsh environments. However, the autogenous self-healing method is more feasible for large-scale applications due to lower costs and simpler implementation. The study concludes that method selection should align with project-specific durability, sustainability, and economic goals. Full article

Cementitious materials are naturally brittle, which makes them prone to cracking. This study effectively employs autogenous healing techniques using microcapsules to solve this issue. The goals were twofold: first, to microencapsulate isophorone diisocyanate (IPDI) as a catalyst-free healing agent; and second, to evaluate how these microcapsules improve the healing abilities of cementitious materials. Polyurethane (PU) prepolymer with an NCO content of 19.8% was successfully created. Using interfacial polymerization, smooth, spherical microcapsules of IPDI with an average diameter of 38 to 62 micrometers were produced. The elastic modulus of the microcapsules ranged from 0.23 to 0.18 GPa, while their hardness varied between 5.29 and 4.15 MPa. Over six months, the microcapsules showed a weight loss of 9.72% to 12.47%, depending on their size, under ambient conditions. Specimens containing 3% of fabricated microcapsules demonstrated the ability to seal cracks less than 100 µm wide by up to 70%. Specimens that incorporated 3% of their cement weight in IPDI microcapsules achieved an impressive 74% recovery rate in compressive strength. In contrast, control mortars without microcapsules showed a recovery rate of less than 50%. Analysis using Energy Dispersive Spectroscopy (EDS) revealed a significant presence of carbon in areas where the microcapsules had ruptured and the cracks had healed. This confirms the effectiveness of the healing process, consistent with established self-healing theories. The water tightness recovery trace showed a recovery rate of up to 61%. Additionally, the specimens containing microcapsules exhibited higher initial compressive strength than the control specimens. However, this also indicates that some microcapsules may have ruptured unintentionally during preparation and molding. Therefore, further research on the mechanical properties of microcapsules, especially their stiffness in cementitious composites, is necessary. Full article

Background/Objectives: Wound infections represent a major category of healthcare-associated infections (HAIs) that interrupt the wound healing process, resulting in delayed wound healing and increasing the incidence of mortality, morbidity and healthcare costs. With the emergence of antibiotic resistance, there is an urgent need to find alternative therapeutic strategies capable of overcoming antibiotic resistance while simultaneously promoting wound healing. Previously, we synthesized iron oxide nanoparticles stabilized with cetyltrimethylammonium bromide (IONPs-CTAB), reported their antimicrobial activity against selected multidrug-resistant bacteria (MDR-bacteria) and SARS-CoV2 virus, and addressed their biocompatibility with the skin and eyes of rabbits. Therefore, it is hypothesized that IONPs-CTAB might be a promising alternative therapeutic agent for management of infected wounds. Methods: IONPs-CTAB were synthesized, and their successful synthesis was confirmed by FTIR, DSC-TGA, and XPS. Their antibacterial activity against three MDR-bacteria, Staphylococcus aureus (S. aureus), methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli (E. coli), isolated from infected wounds was investigated via the microdilution test to determine MIC/MBC, and a time–kill curve study was also performed. Subsequently, an in vivo study was conducted to assess their wound healing activity on both non-infected and infected wounds. Results: IONPs-CTAB had MIC and MBC values ranging from 125 to 250, and 500 to 1000 µg/mL, respectively. The time–kill curve study showed an effective control of bacterial growth for all tested bacteria. The vivo study demonstrated the superior wound healing activity of IONPs-CTAB compared to standard treatment on both non-infected and infected wounds. This was further confirmed by histopathological examination and biochemical analysis. Conclusions: IONPs-CTAB might be a good therapeutic alternative for the management of infected and non-infected wounds. However, future studies are still required to assess their long-term safety and the possibility of their extravasation to systemic circulation, with their potential accumulation in various organs after a long-term application. Full article

Epoxy resins are extensively utilized in various fields for their excellent comprehensive performance. However, the inherent brittleness and lack of reprocessing ability greatly limit their sustainability. In order to obtain reprocess ability in epoxy resin with superior mechanical properties and thermal stability, a curing agent (VA) and a hyperbranched epoxy toughening agent (HVT) containing disulfide and imine bonds have been synthesized from vanillin. Owing to the distinctive topological structure and abundant epoxy terminal groups of HVT, the modified epoxy resin (5HVT/E51/VA) exhibits high toughness, enhanced mechanical strength, and favorable thermal stability. When compared to the properties of the unmodified resin, the impact and flexural strength of 5HVT/E51/VA are increased by 55.32% and 71.63%, respectively. Its glass transition temperature (T_g) and 5% weight loss temperature (T_d5%) are also enhanced by 4.74% and 11.33%, respectively. Moreover, the resins are highly stable in most solvents, but can be completely degraded in hexylamine/2-mercaptoethanol (HAE/2-ME) solution within 2.5 h. The resin also displays notable scratch-healing capability, and the healing efficiencies reach above 85%. Even after three reprocessing cycles, their strength retention rate exceeds 80%, suggesting excellent sustainability potential. This research provides a sustainable method for preparing high-performance epoxy resins, suggesting their potential applications in self-healing and reprocessable composites. Full article

The unique anatomy and physiological barriers of the human eye—particularly rapid tear turnover and limited corneal permeability—present significant obstacles to achieving effective topical drug delivery. In response to these constraints, biopolymer-based extended-release systems have emerged as a promising and transformative class of ocular therapeutics. This review provides a comprehensive overview of recent advances in natural biopolymers, including polysaccharides and protein-derived polymers, for application on the ocular surface. These materials exhibit advantageous characteristics such as mucoadhesion, biocompatibility, and stimuli-responsive behavior, which collectively enhance precorneal residence time and enable controlled, sustained drug release. We further discuss diverse delivery platforms—ranging from in situ forming hydrogels and mucoadhesive nanoparticles to drug-eluting contact lenses and microneedle-based systems. In addition, we highlight how the integration of nanotechnology and bioinspired scaffolds can augment the delivery efficiency of therapeutic agents to ocular tissues. Overall, this review underscores the ongoing transition from conventional topical eye drops to sophisticated, functionalized delivery systems capable of maintaining therapeutic drug levels while simultaneously supporting tissue repair and wound healing. Finally, we outline the remaining challenges in clinical translation and consider the future potential of smart, responsive biopolymer systems in advancing the treatment of both anterior and posterior segment diseases. Full article

Background: Biofilms consist of complex microbial communities embedded in an extracellular matrix which confer resistance to the most used antimicrobial agents. Chronic wounds are often associated with burns, trauma, surgery, diabetes and peripheral vascular disease. They are characterized by a marked delay in wound healing favoring the development of microbial biofilms, which in turn further delay tissue regeneration. Staphylococcus aureus, Staphylococcus epidermidis, and methicillin-resistant staphylococci biofilms are found in chronic wounds, seriously hindering wound treatment. Vitreoscilla filiformis, a Gram-negative non-pathogenic filamentous bacterium, has been shown to improve atopic dermatitis by reducing S. aureus colonization and inducing antioxidant responses in the skin. Objectives: The aim of the present study was to evaluate the antimicrobial, anti-inflammatory, and regenerative activities of the V. filiformis supernatant (VFS). Methods: The effect of VFS on bacteria growth was assessed by microbial growth kinetics and biofilm formation and dispersal. Antioxidant potential was determined by DPPH-scavenging ability and reduction in intracellular reactive oxygen species (ROS). The regenerative properties were assessed by scratch assay. Results: V. filiformis VFS holds strong anti-biofilm activity against S. aureus, S. epidermidis and methicillin-resistant S. aureus (MRSA), acting during both biofilm formation and dispersion. The decrease in biofilm mass is accompanied by a significant increase in the planktonic form compared to the untreated cells. Moreover, VFS is characterized by an interesting antioxidant activity, as demonstrated by a cell-free DPPH assay and a neutrophil-based in vitro assay. In addition, VFS can stimulate tissue regeneration in human dermal fibroblasts and keratinocytes. Conclusions: The demonstration of anti-biofilm, antioxidant and regenerative properties of V. filiformis supernatant could be exploited for the treatment of biofilm-associated wound infections. Full article