Intramolecular Hydrogen Bonds Assisted Construction of Planar Tricyclic Structures for Insensitive and Highly Thermostable Energetic Materials.

Safety is fundamental for the practical development and application of energetic materials. Three tricyclic energetic compounds, namely, 1,3-di(1H-tetrazol-5-yl)-1H-1,2,4-triazol-5-amine (ATDT), 5'-nitro-3-(1H-tetrazol-5-yl)-2'H-[1,3'-bi(1,2,4-triazol)]-5-amine (ATNT), and 1-(3,4-dinitro-1H-pyrazol-5-yl)-3-(1H-tetrazol-5-yl)-1H-1,2,4-triazol-5-amine (ATDNP), were effectively synthesized through a simple two-step synthetic route. The introduction of intramolecular hydrogen bonds resulted in excellent molecular planarity for the three new compounds. Additionally, they exhibit regular crystal packing, leading to numerous intermolecular hydrogen bonds and π-π interactions. Benefiting from planar tricyclic structural features, ATDT, ATNT, and ATDNP are insensitive (IS > 60 J, FS = 360 N) when exposed to external stimuli. Furthermore, ATNT (Td = 361.1 °C) and ATDNP (Td = 317.0 °C) exhibit high decomposition temperatures and satisfying detonation performance. The intermolecular hydrogen bonding that produced this planar tricyclic molecular structure serves as a model for the creation of innovative multiple heterocycle energetic materials with excellent stability.

Film dressings from Thai mango seed kernel extracts versus nanocrystalline silver dressings in antibacterial properties.

Introduction: The extract from the Mango Seed Kernel (MSK) has been documented to exhibit antibacterial activity against Gram-positive and Gram-negative bacteria, including Staphylococcus aureus and Pseudomonas aeruginosa. This suggests that biomaterials containing MSK extract could be a viable alternative to conventional wound treatments, such as nanocrystalline silver dressings. Despite this potential, there is a notable gap in the literature regarding comparing the antibacterial effectiveness of MSK film dressings with nanocrystalline silver dressings. This study aimed to develop film dressings containing MSK extract and evaluate their antibacterial properties compared to nanocrystalline silver dressings. Additionally, the study aimed to assess other vital physical properties of these dressings critical for effective wound care. Materials and methods: We prepared MSK film dressings from two cultivars of mango from Thailand, 'Chokanan' and 'Namdokmai'. The inhibition-zone method was employed to determine the antibacterial property. The morphology and chemical characterization of the prepared MSK film dressings were examined with scanning electron microscopy (SEM) and Fourier-Transform Infrared Spectroscopy (FTIR), respectively. The absorption of pseudo-wound exudate and water vapor transmission rate (WVTR) of film dressings were evaluated. Results: The results showed that 40% of MSKC film dressing had the highest inhibition zone (20.00 ± 0.00 mm against S. aureus and 17.00 ± 1.00 mm against P. aeruginosa) and 20%, 30%, and 40% of MSKC and MSKN film dressings had inhibition zones similar to nanocrystalline silver dressing for both S. aureus and P. aeruginosa (p > 0.05). In addition, all concentrations of the MSK film dressings had low absorption capacity, and Chokanan MSK (MSKC) film dressings had a higher WVTR than Namdokmai MSK (MSKN) film dressings. Conclusion: 20%, 30%, and 40% of MSK film dressing is nearly as effective as nanocrystalline silver dressing. Therefore, it has the potential to be an alternative antibacterial dressing and is suitable for wounds with low exudate levels.

Accuracy, Repeatability, and Reproducibility of a Hand-Held Structured-Light 3D Scanner across Multi-Site Settings in Lower Limb Prosthetics.

The aim of this work was to assess the accuracy, repeatability, and reproducibility of a hand-held, structured-light 3D scanner (EINScan Pro 2X Plus with High Definition Prime Pack, SHINING 3D Tech. Co., Ltd., Hangzhou, China), to support its potential use in multi-site settings on lower limb prosthetics. Four limb models with different shapes were fabricated and scanned with a metrological 3D scanner (EINScan Laser FreeScan 5X, SHINING 3D Tech. Co., Ltd., Hangzhou, China) by a professional operator (OP0). Limb models were then mailed to three sites where two operators (OP1, OP2) scanned them using their own structured-light 3D scanner (same model). OP1 scanned limb models twice (OP1-A, OP1-B). OP0, OP1-A, and OP2 scans were compared for accuracy, OP1-A and OP1-B for repeatability, and OP1-A and OP2 for reproducibility. Among all comparisons, the mean radial error was <0.25 mm, mean angular error was <4°, and root mean square error of the radial distance was <1 mm. Moreover, limits of agreement were <3.5% for perimeters and volumes. By comparing these results with respect to clinically-relevant thresholds and to the literature available on other 3D scanners, we conclude that the EINScan Pro 2X Plus 3D Scanner with High Definition Prime Pack has good accuracy, repeatability, and reproducibility, supporting its use in multi-site settings.

The hemostatic and comforting effects of oral adhesive bandages in tooth extraction: a randomized controlled clinical study.

OBJECTIVES: To compare oral adhesive bandages with the classic compression method and evaluate the clinical efficacy of this wound dressing material in improving postoperative comfort, wound healing, and hemostasis in tooth extraction. MATERIALS AND METHODS: The study was designed as a randomized controlled clinical trial. A total of 120 patients were recruited and randomly assigned to the study group and the control group. In the study group, oral adhesive bandages were used as wound dressing. In the control group, patients bit on cotton balls and gauze, as usual. Hemorrhage, comfort, and healing levels were evaluated at postoperative 1 h, 24 h, and 7 days. The adhesion time of the oral adhesive bandages was also recorded. RESULTS: The average adhesion time of the oral adhesive bandages was 26.6 h. At postoperative 1 and 24 h, the hemostatic levels of the oral adhesive bandage group were significantly higher than those of the control group. The oral adhesive bandage group also reported significantly higher comfort scores than the control group. Both groups had similar healing levels and side effects. But the mean score for wound healing was slightly higher in the oral adhesive bandage group. CONCLUSIONS: Oral adhesive bandages were more effective than cotton balls and gauze in providing hemostatic and comfort effects on extraction wounds. CLINICAL RELEVANCE: Oral adhesive bandages possess clinical value in the management of extraction wounds.

Use of person-centred music to manage wound dressing-related pain: a mixed method case study.

OBJECTIVE: To determine whether person-centred music (PCMusic) contributes to reducing pain during painful leg ulcer dressing change procedures indicated by: decreased levels of indicators related to stress; decreased pain scores; and a more favourable treatment climate during the dressing change procedure. METHOD: A case study of a 51-year-old female patient with chronic inherited disease weakening her connective tissues. Quantitative data entailed temporal measurements of stress indicators including: heart pulse rate; oxygen saturation (SpO2); saliva cortisol; and a visual analogue scale (VAS). Qualitative data comprised phenomenological treatment descriptions and patient/licensed practical nurse (LPN) questionnaires. RESULTS: The patient's body temperature remained steady throughout all treatments. Blood pressure was excluded due to missing data. No significant pulse rate differences in relation to music/no music could be observed during treatment. Comparing PCMusic to the patient's own other music (POOM), the pulse rate was greater in both magnitude and variation when the patient listened to POOM. Oxygen saturation showed no significant difference between PCMusic and music/no music. No significant difference was observed pre-/post-debridement with music. Similarly, no significant difference was observed pre-/post-debridement with no music. Treatment with no music showed the highest VAS score; PCMusic treatments had the lowest scores. Qualitative data showed that both patient and LPNs found that PCMusic decreased pain during dressing change. CONCLUSION: The results of this case study indicate that PCMusic is a suitable complementary treatment to decrease patient pain. Patients' general health status is important when using quantitative stress/pain marker measurements. For cohort selection in future studies, we suggest healthy patients undergoing slightly painful or unpleasant treatments, patients in postoperative care and obstetric care.

The frictional energy absorber effectiveness and its impact on the pressure ulcer prevention performance of multilayer dressings.

Pressure ulcers including heel ulcers remain a global healthcare concern. This study comprehensively evaluates the biomechanical effectiveness of the market-popular ALLEVYN® LIFE multilayer dressing in preventing heel ulcers. It focuses on the contribution of the frictional sliding occurring between the non-bonded, fully independent layers of this dressing type when the dressing is protecting the body from friction and shear. The layer-on-layer sliding phenomenon, which this dressing design enables, named here the frictional energy absorber effectiveness (FEAE), absorbs approximately 30%-45% of the mechanical energy resulting from the foot weight, friction and shear acting to distort soft tissues in a supine position, thereby reducing the risk of heel ulcers. Introducing the novel theoretical FEAE formulation, new laboratory methods to quantify the FEAE and a review of relevant clinical studies, this research underlines the importance of the FEAE in protecting the heels of at-risk patients. The work builds on a decade of research published by our group in analysing and evaluating dressing designs for pressure ulcer prevention and will be useful for clinicians, manufacturers, regulators and reimbursing bodies in assessing the effectiveness of dressings indicated or considered for prophylactic use.

Silver nanoparticle dressing: The knowledge of advantages and limits improves the indications in clinical practice.

Silver nanoparticle dressings have gained popularity recently as a way to treat challenging wounds. Notwithstanding the properties of Ag-NPS (silver nanoparticles) described by several articles, there is a lack of clinical studies that guide healthcare professionals to specific and conscious use. In this case series, Ag-NPS dressing was tested on a randomized group of 10 patients with complex wounds requiring conservative treatment. Each case was analysed, recording the patient's history, the peculiar characteristics and the progressive changes in the wound. The wound bed and the quality of the peri-wound skin improved and a decrease in signs of infection was observed. The application of the dressing was simple and comfortable for the patient and it was appreciated for its sealing ability. A few capacity restrictions showed up: those should be read as elements to improve the indications for this peculiar dressing. The thin tissue matrix of the Ag-NPS dressing does not allow for massive absorption and also performs poorly in reducing little exudate. The reduction in wound width is also limited: reconstructive surgery was required in half of the enrolled patients to achieve wound healing.

A new dressing system for accelerating wound recovery after primary total knee arthroplasty: a feasibility study.

PURPOSE: Currently, postoperative wound infection and poor healing of total knee arthroplasty have been perplexing both doctors and patients. We hereby innovatively invented a new dressing system to reduce the incidence of postoperative wound complications. METHODS: We enrolled 100 patients who received primary unilateral total knee arthroplasty and then applied the new dressing system. The data collected included the number of dressing changes, postoperative hospital stay, Visual Analogue Scale score (VAS), the Knee Society Score (KSS), the Knee Injury and Osteoarthritis Outcome Score (KOOS), ASEPSIS scores, The Stony Brook Scar Evaluation Scale (SBSES), wound complications, dressing cost, the frequency of shower and satisfaction. Subsequently, a statistical analysis of the data was performed. RESULTS: Our findings demonstrated the average number of postoperative dressing changes was 1.09 ± 0.38, and the average postoperative hospital stay was 3.72 ± 0.98 days. The average cost throughout a treatment cycle was 68.97 ± 12.54 US dollars. Collectively, the results of VAS, KSS, and KOOS revealed that the pain and function of patients were continuously improved. The results of the four indexes of the ASEPSIS score were 0, whereas the SBSES score was 3.58 ± 0.52 and 4.69 ± 0.46 at two weeks and one month after the operation, respectively. We observed no wound complications until one month after the operation. Remarkably, the satisfaction rate of the patients was 91.85 ± 4.99% one month after the operation. CONCLUSION: In this study, we invented a new dressing system for surgical wounds after total knee arthroplasty and further confirmed its clinical feasibility and safety. CHINESE CLINICAL TRIAL REGISTRY: ChiCTR2000033814, Registered 13/ June/2020.

Effect of platelet-rich plasma combined with negative pressure wound therapy in treating patients with chronic wounds: A meta-analysis.

A meta-analysis was conducted to comprehensively explore the effects of platelet-rich plasma (PRP) combined with negative pressure wound therapy (NPWT) in treating patients with chronic wounds. Computer searches were conducted, from database infection to November 2023, in EMBASE, Google Scholar, Cochrane Library, PubMed, Wanfang and China National Knowledge Infrastructure databases for randomized controlled trials (RCTs) on the use of PRP combined with NPWT technology for treating chronic wounds. Two researchers independently screened the literature, extracted data and conducted quality assessments according to the inclusion and exclusion criteria. Stata 17.0 software was employed for data analysis. Overall, 18 RCTs involving 1294 patients with chronic wounds were included. The analysis revealed that, compared with NPWT alone, the use of PRP combined with NPWT technology significantly improved the healing rate (odds ratios [OR] = 1.92, 95% confidence intervals [CIs]: 1.43-2.58, p < 0.001) and total effective rate (OR = 1.31, 95% CI: 1.23-1.39, p < 0.001), and also significantly shortened the healing time of the wound (standardized mean difference = -2.01, 95% CI: -2.58 to -1.45, p < 0.001). This study indicates that the treatment of chronic wounds with PRP combined with NPWT technology can significantly enhance clinical repair effectiveness and accelerate wound healing, with a high healing rate, and is worth further promotion and practice.

Recent Advances in the Synthesis of the Marine-Derived Alkaloid Fascaplysin and Its Metabolites Homofascaplysins A-C.

The fascaplysin and homofascaplysin class of marine natural products has a characteristic 12H-pyrido[1,2-a:3,4-b']diindole pentacyclic structure. Fascaplysin was isolated in 1988 from the marine sponge Fascaplysinopsis bergquist sp. The analogs of fascaplysin, such as homofascaplysins A, B, and C, were discovered late in the Fijian sponge F. reticulate, and also have potent antimicrobial activity and strong cytotoxicity against L-1210 mouse leukemia. In this review, the total synthesis of fascaplysin and its analogs, such as homofascaplysins A, B, and C, will be reviewed, which will offer useful information for medicinal chemistry researchers who are interested in the exploration of marine alkaloids.

Changes in wound symptoms and quality of life of patients with newly diagnosed malignant fungating wounds.

OBJECTIVE: This study examined changes in wound symptoms and the health-related quality of life (HRQoL) of patients with newly diagnosed malignant fungating wounds, and explored the factors that impacted the changes in HRQoL. METHOD: This prospective longitudinal study included patients from three hospitals in China who had been diagnosed with malignant fungating wounds. Questionnaires were used to assess patients' HRQoL and their wound symptoms at the time of diagnosis (T0), as well as at one, three and six (T1, T2 and T3, respectively) months following the treatment period. Factors related to changes in HRQoL were analysed using generalised estimating equation models. RESULTS: A total of 162 patients were included in the study. The patients reported low overall HRQoL. In three health-related dimensions (functional status, social relations and mental health), patients reported lower functional status at the time of wound diagnosis (T0), which then increased slowly with treatment over time. A lower QoL was associated with odour, exudate, bleeding, pruritus, a low performance status and the need for the dressing of wounds. CONCLUSION: The HRQoL of patients with malignant fungating wounds exhibited significant changes across different periods. It is thus of great importance to formulate pragmatic, patient and family-centred palliative wound care management strategies.

Determination of the minimum soil infiltration rate of sunken green space considering the annual runoff collection ratio, sunken depth and sunken green space area of Hefei city, China.

Sunken green space is one of the urban rainwater collection facilities, which belongs to Low Impact Development (LID) techniques. It plays a key role in the construction of sponge city, and the amount of runoff collection is usually affected by the area of the sunken green space, the infiltration rate of the soil, and the annual runoff collection rate. To determine the minimum soil infiltration rate of sunken green space considering the annual runoff collection ratio of sponge cities, this paper selects a residential district in Hefei city, China, as the case study. Based on 45 years of precipitation data, the designed rainfall corresponding to annual runoff collection ratios of 75%, 80% and 85% is 21.3 mm, 23.4 mm and 27.5 mm, respectively. The characteristics of rainfall infiltration in sunken green space are analyzed by using the water balance model and runoff yield and conflux model. The results reveal that the soil infiltration rate is 1.16×10-4 cm/s~3.88×10-3 cm/s when the sunken depth is 0.1 m~0.3 m and that the ratio of green space area is 5%~25%. The runoff collection of the reconstructed sunken green space is 2.87 times and 1.98 times that of the nonsunken green space and the nonreconstructed sunken green space, respectively. That is to say, under the comprehensive performance of the sunken depth, sunken green space area, the steady soil infiltration rater of the reconstructed sunken green space cannot be less than the value obtained in this paper. Otherwise, the requirements of annual total runoff reduction ratio of the sponge city cannot be met. Therefore, this study provides references for realizing the ratio of annual runoff collection and sponge city construction in similar urban areas. It can also be applied to optimal selection of sunken green space in some sponge city projects.

Fabrication and evaluation of Dillenia indica-carrageenan blend hybrid superporous hydrogel reinforced with green synthesized MgO nanoparticles as an effective wound dressing material.

An unexplored hybrid superporous hydrogel (MHSPH) of Dillenia indica fruit mucilage (DIFM) and carrageenan blend embedded with green synthesized magnesium oxide nanoparticles (MNPs) is utilized as an effective wound dressing material with appreciable mechanical strength in murine model. The prepared MNPs and the optimized MHSPH were characterized using X-ray diffraction (XRD), thermogravimetric analysis (TGA), Fourier transform infrared (FT- IR) spectroscopy. Size, zeta potential and morphology of MNPs was assessed using Dynamic light scattering technique (DLS) and field-emission scanning electron microscopy (FESEM) respectively. The MHSPH grades were further optimized using swelling study in phosphate buffer solution at pH 1.2, 7.0, and 8. Both MNPs and the optimized grade of MHSPH were evaluated based on hemolysis assay, and protein denaturation assays indicating them to be safe for biological use. Acute toxicity studies of the optimized MHSPH on Zebra fish model, revealed no observable toxic effect on the gill cells. Wound healing in Swiss albino mice with application of optimized grade of MHSPH took only 11 days for healing when compared to control mice where healing took 14 days, thus concluding that MHSPH as an effective dressing material as well as tissue regrowth scaffold.

Nitric oxide-releasing thiolated starch nanoparticles embedded in gelatin sponges for wound dressing applications.

This study introduces a novel wound dressing by combining nitric oxide-releasing thiolated starch nanoparticles (NO-TS NPs) with gelatin. First, starch was thiolated (TS), and then its nanoparticles were prepared (TS NPs). Subsequently, NPs were covalently bonded to sodium nitrite to obtain NO-releasing TS NPs (NO-TS-NPs) that were incorporated into gelatin sponges at various concentrations. The resulting spherical TS NPs had a mean size of 85.42 ± 5.23 nm, which rose to 100.73 ± 7.41 nm after bonding with sodium nitrite. FTIR spectroscopy confirmed S-nitrosation on the NO-TS NPs' surface, and morphology analysis showed well-interconnected pores in all sponges. With higher NO-TS NPs content, pore size, porosity, and water uptake increased, while compressive modulus and strength decreased. Composites exhibited antibacterial activity, particularly against E. coli, with enhanced efficacy at higher NPs' concentrations. In vitro release studies demonstrated Fickian diffusion, with faster NO release in sponges containing more NPs. The released NO amounts were non-toxic to fibroblasts, but samples with fewer NO-TS NPs exhibited superior cellular density, cell attachment, and collagen secretion. Considering the results, including favorable mechanical strength, release behavior, antibacterial and cellular properties, gelatin sponges loaded with 2 mg/mL of NO-TS NPs can be suitable for wound dressing applications.

Wound Dressing Based on Silver Nanoparticle Embedded Wool Keratin Electrospun Nanofibers Deposited on Cotton Fabric: Preparation, Characterization, Antimicrobial Activity, and Cytocompatibility.

Wool keratin (WK) protein is attractive for wound dressing and biomedical applications due to its excellent biodegradability, cytocompatibility, and wound-healing properties. In this work, WK-based wound dressings were prepared by depositing WK/poly(vinyl alcohol) (PVA) and silver nanoparticle (Ag NP)-embedded WK/PVA composite nanofibrous membranes on cotton fabrics by electrospinning. Ag NPs were biosynthesized by reduction and stabilization with sodium alginate. The formed Ag NPs were characterized by ultraviolet-visible and Fourier transform infrared (FTIR) spectroscopy, and their size was determined by transmission electron microscopy and image analysis. The formed Ag NPs were spherical and had an average diameter of 9.95 nm. The produced Ag NP-embedded WK/PVA composite nanofiber-deposited cotton fabric surface was characterized by FTIR and dynamic contact angle measurements, and the nanofiber morphologies were characterized by scanning electron microscopy. The average diameter of the nanofibers formed by 0.1% Ag NP-embedded WK/PVA solution was 146.7 nm. The antibacterial activity of the surface of cotton fabrics coated with electrospun composite nanofibers was evaluated against the two most common wound-causing pathogens, Staphylococcus aureus and Pseudomonas aeruginosa. The cotton fabric coated with 0.1% Ag NP-embedded WK/PVA nanofibers showed very good antibacterial activity against both pathogens, and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay results showed good cytocompatibility against L-929 mouse fibroblast cells. However, the increase in Ag NP content in the nanofibers to 0.2% negatively affected the cell viability due to the high release rate of Ag ions. The results achieved show that the developed wound dressing has good potential for wound healing applications.

Acute Burn Care.

LEARNING OBJECTIVES: After studying this article and viewing the videos, the participant should be able to: 1. Describe the current epidemiology of burn injuries. 2. Understand burn pathophysiology and perform a wound assessment. 3. Summarize the initial emergency management of a burn patient. 4. Calculate the anticipated fluid resuscitation requirements for a burn injury, and diagnose the complications of overresuscitation. 5. Describe the diagnosis and management of inhalation injury. 6. List the goals of wound care for superficial and deep burns, and describe the closed dressing technique. 7. Perform excision of a burn wound. 8. Compare various wound closure techniques using autografts and skin substitutes. SUMMARY: Plastic surgeons are essential members of the multidisciplinary burn team. Burn injuries remain common, and plastic surgeons have an opportunity to develop and innovate the field of acute burn care in light of workforce shortages. Burn pathophysiology is complex and dynamic, which informs the challenges encountered during the perioperative phase. Accurate burn wound assessment remains difficult, with implications for diagnosis and management. A systematic approach is required when stabilizing a major burn and/or inhalation injury with newly updated fluid resuscitation and triage guidelines. Wound care continues to evolve, with an emphasis on a closed dressing technique. For deeper burns, new surgical techniques are emerging for surgical débridement, along with improvements to traditional methods of tangential excision. Following excision, a number of established and novel techniques are available to close the wound with either autografts or skin substitutes.

Chitin nanofibrils assisted 3D printing all-chitin hydrogels for wound dressing.

The direct ink writing technique used in 3D printing technology is generally applied to designing biomedical hydrogels. Herein, we proposed a strategy for preparing all-chitin-based inks for wound dressing via direct ink writing technique. The ß-chitin nanofibers (MACNF) with a high aspect ratio were applied as a nanofiller to modulate the rheological properties of the alkaline dissolved chitin solution. The printing fidelity significantly depends on the MACNF introduction amount to the composite ink. 5-10 wt% MACNF ratio showed superior printing performance. The printed scaffold showed a uniform micron-sized pore structure and a woven network of nanofibers. Due to the good biocompatibility of chitin and the stereoscopic spatial skeleton, this scaffold showed excellent performance as a wound dressing, which can promote cell proliferation, collagen deposition and the angiogenesis of wounds, demonstrating its potential in biomedical applications. This approach successfully balanced the chitinous printability and biofunctions.

The efficacy of bandage contact lens in relieving the aggravation of dry eye disease after complicated cataract or/and IOL surgery.

PURPOSE: In the present study, we aimed to evaluate the efficacy of the bandage contact lens (BCLs) in the treatment of dry eye disease (DED) after complicated cataract or/and intraocular lens (IOL) surgery. METHODS: In this retrospective, single-centered, observational study, we collected data from 69 patients who underwent complicated cataract or/and IOL surgery. Of these, 35 cases wore their own BCLs immediately after the operation, while the other 34 cases did not have their own BCLs and were instead covered with gauze. The Ocular Surface Disease Index (OSDI) questionnaire, slit-lamp microscope examination, keratograph analysis, and Schirmer I test were measured at baseline, 1 week and 1 month postoperatively. RESULTS: In the BCL group, the score of the OSDI questionnaire was significantly decreased at 1 week and 1 month postoperatively compared with baseline levels (P = 0.000, collectively). Moreover, the fluorescein staining score of the BCL group was remarkably decreased 1-week and 1-month postoperatively compared with the non-BCL group (P = 0.000 and P = 0.000, respectively). Furthermore, the redness score of the BCL group was also better compared with the non-BCL group at 1 week and 1 month postoperatively (P = 0.014 and P = 0.004, respectively). CONCLUSIONS: Complicated cataract or/and IOL surgery would intensify the DED. Early application of BCLs postoperatively improved patients' comfort and alleviated dry eye-related symptoms and signs. Furthermore, this mechanism might involve the acceleration of corneal epithelial healing, the alleviation of ocular stress response and the stabilization of the tear film. TRIAL REGISTRATION: Trial registration ClinicalTrials, NCT04120389. Registered 10 October 2019-retrospectively registered.

Variable effects of exposure to ionic silver in wound-associated bacterial pathogens.

Silver compounds are used in wound dressings to reduce bioburden. Where infection is not rapidly resolved, bacteria may be exposed to sub-therapeutic concentrations of antimicrobials over prolonged periods of time. In this study, a panel of chronic wound bacteria, Pseudomonas aeruginosa (two strains), Staphylococcus aureus, and Escherichia coli, were exposed to silver nitrate on agar. Phenotypic characterization was achieved using broth microdilution sensitivity testing, a crystal violet biofilm assay, and a wax moth pathogenesis model. Repeated exposure to ionic silver did not result in planktonic phenotypic silver resistance in any of the test panels, although S. aureus demonstrated reversible increases in minimum bactericidal concentration. An ulcer-derived P. aeruginosa exhibited marked reductions in biofilm eradication concentration as well as significantly increased biofilm formation and wax moth killing when compared to the same progenitor. These changes were reversible, trending towards baseline measurements following 10 passages on silver-free media. Changes in virulence and biofilm formation in the other test bacteria were generally limited. In summary, phenotypic adaptation following exposure to ionic silver was manifested other than through changes in planktonic susceptibility. Significant changes in pseudomonas biofilm formation and sensitivity could have implications for wound care regimes and therefore warrant further investigation.