Developing a Practical Tool for Predicting Wound Healing Outcomes of Patients with Diabetic Forefoot Ulcers: Focus on Vasculopathy and Infection.

OBJECTIVE: To develop a preliminary risk scoring system to predict the prognosis of patients with diabetic forefoot ulcers based on the severity of vasculopathy and infection, which are the major risk factors for amputation. METHODS: Forefoot was defined as the distal part of the foot composed of the metatarsal bones and phalanges and associated soft tissue structures. The degree of vasculopathy was graded as V0, V1, or V2 according to transcutaneous partial oxygen tension values and toe pressure. The degree of infection was graded as I0, I1, or I2 according to tissue and bone biopsy culture results. The risk scores were calculated by adding the scores for the degree of vasculopathy and infection and ranged from 0 to 4. Wound healing outcomes were graded as healed without amputation, minor amputation, or major amputation. The authors evaluated wound healing outcomes according to risk scores. RESULTS: As the risk score increased, the proportion of patients who underwent both major and minor amputations increased (P < .001). In the multivariate logistic analysis, the odds ratios of amputation also increased as the risk score increased. Patients with a risk score of 4 were 75- and 19-fold more likely to undergo major and minor amputations, respectively, than patients with a risk score of 0 (P = .006 and P < .001). CONCLUSIONS: The risk score can be used as an indicator to predict the probability of amputation in patients with diabetic forefoot ulcers.

Exsolution of Ru Nanoparticles on BaCe0.9 Y0.1 O3-δ Modifying Geometry and Electronic Structure of Ru for Ammonia Synthesis Reaction Under Mild Conditions.

Green ammonia is an efficient, carbon-free energy carrier and storage medium. The ammonia synthesis using green hydrogen requires an active catalyst that operates under mild conditions. The catalytic activity can be promoted by controlling the geometry and electronic structure of the active species. An exsolution process is implemented to improve catalytic activity by modulating the geometry and electronic structure of Ru. Ru nanoparticles exsolved on a BaCe0.9 Y0.1 O3-δ support exhibit uniform size distribution, 5.03 ± 0.91 nm, and exhibited one of the highest activities, 387.31 mmolNH3  gRu -1  h-1 (0.1 MPa and 450 °C). The role of the exsolution and BaCe0.9 Y0.1 O3-δ support is studied by comparing the catalyst with control samples and in-depth characterizations. The optimal nanoparticle size is maintained during the reaction, as the Ru nanoparticles prepared by exsolution are well-anchored to the support with in-plane epitaxy. The electronic structure of Ru is modified by unexpected in situ Ba promoter accumulation around the base of the Ru nanoparticles.

Developing and Establishing a Wound Dressing Team: Experience and Recommendations.

BACKGROUND: The existing literature has comprehensively examined the benefits of specialized wound-care services and multidisciplinary team care. However, information on the development and integration of wound-dressing teams for patients who do not require specialized wound care is scarce. Therefore, the present study aimed to elucidate the benefits of a wound-dressing team by reporting our experiences with the establishment of a wound-dressing team. METHODS: The wound-dressing team was established at Korea University Guro Hospital. Between July 2018 and June 2022, 180,872 cases were managed for wounds at the wound-dressing team. The data were analyzed to assess the types of wounds and their outcomes. In addition, questionnaires assessing the satisfaction with the service were administered to patients, ward nurses, residents/internists, and team members. RESULTS: Regarding the wound type, 80,297 (45.3%) were catheter-related, while 48,036 (27.1%), 26,056 (14.7%), and 20,739 (11.7%) were pressure ulcers, dirty wounds, and simple wounds, respectively. In the satisfaction survey, the scores of the patient, ward nurse, dressing team nurse, and physician groups were 8.9, 8.1, 8.2, and 9.1, respectively. Additionally, 136 dressing-related complications (0.08%) were reported. CONCLUSION: The wound dressing team can enhance satisfaction among patients and healthcare providers with low complications. Our findings may provide a potential framework for establishing similar service models.

Facile one-pot iodine gas phase doping on 2D MoS2/CuS FET at room temperature.

Electronic devices composed of semiconducting two-dimensional (2D) materials and ultrathin 2D metallic electrode materials, accompanying synergistic interactions and extraordinary properties, are becoming highly promising for future flexible and transparent electronic and optoelectronic device applications. Unlike devices with bulk metal electrode and 2D channel materials, devices with ultrathin 2D electrode and 2D channel are susceptible to chemical reactions in both channel and electrode surface due to the high surface to volume ratio of the 2D structures. However, so far, the effect of doping was primary concerned on the channel component, and there is lack of understanding in terms of how to modulate electrical properties of devices by engineering electrical properties of both the metallic electrode and the semiconducting channel. Here, we propose the novel, one-pot doping of the field-effect transistor (FET) based on 2D molybdenum disulfide (MoS2) channel and ultrathin copper sulfide (CuS) electrodes under mild iodine gas environment at room temperature, which simultaneously modulates electrical properties of the 2D MoS2channel and 2D CuS electrode in a facile and cost-effective way. After one-pot iodine doping, effective p-type doping of the channel and electrode was observed, which was shown through decreased off current level, improvedIon/Ioffratio and subthreshold swing value. Our results open up possibility for effectively and conveniently modulating electrical properties of FETs made of various 2D semiconductors and ultrathin contact materials without causing any detrimental damage.

Vapor-Mediated Infiltration of Nanocatalysts for Low-Temperature Solid Oxide Fuel Cells Using Electrosprayed Dendrites.

Electrode architecturing for fast electrochemical reaction is essential for achieving high-performance of low-temperature solid oxide fuel cells (LT-SOFCs). However, the conventional droplet infiltration technique still has limitations in terms of the applicability and scalability of nanocatalyst implementation. Here, we develop a novel two-step precursor infiltration process and fabricate high-performance LT-SOFCs with homogeneous and robust nanocatalysts. This novel infiltration process is designed based on the principle of a reversible sol-gel transition where the gelated precursor dendrites are uniformly deposited onto the electrode via controlled nanoscale electrospraying process then resolubilized and infiltrated into the porous electrode structure through subsequent humidity control. Our infiltration technique reduces the cathodic polarization resistance by 18% compared to conventional processes, thereby achieving an enhanced peak power density of 0.976 W cm-2 at 650 °C. These results, which provide various degrees of freedom for forming nanocatalysts, exhibit an advancement in LT-SOFC technology.

Fast Magneto-Ionic Switching of Interface Anisotropy Using Yttria-Stabilized Zirconia Gate Oxide.

Voltage control of interfacial magnetism has been greatly highlighted in spintronics research for many years, as it might enable ultralow power technologies. Among a few suggested approaches, magneto-ionic control of magnetism has demonstrated large modulation of magnetic anisotropy. Moreover, the recent demonstration of magneto-ionic devices using hydrogen ions presented relatively fast magnetization toggle switching, tsw ∼ 100 ms, at room temperature. However, the operation speed may need to be significantly improved to be used for modern electronic devices. Here, we demonstrate that the speed of proton-induced magnetization toggle switching largely depends on proton-conducting oxides. We achieve ∼1 ms reliable (>103 cycles) switching using yttria-stabilized zirconia (YSZ), which is ∼100 times faster than the state-of-the-art magneto-ionic devices reported to date at room temperature. Our results suggest that further engineering of the proton-conducting materials could bring substantial improvement that may enable new low-power computing scheme based on magneto-ionics.

Risk Factors for Major Amputation for Midfoot Ulcers in Hospitalized Patients With Diabetes: A Retrospective Study.

PURPOSE: The purpose of this study was to investigate the risk factors for major amputation in persons hospitalized with diabetic foot ulcers involving the midfoot. DESIGN: Retrospective study. SUBJECTS AND SETTING: Between January 2003 and May 2019, a total of 1931 patients with diabetes were admitted to the diabetic wound center for the management of foot ulcers. Among the admitted patients, 169 patients with midfoot ulcers were included in this study. One hundred fifty-four patients (91%) healed without major amputation, while 15 patients (9%) healed post-major amputation. METHODS: Data related to 88 potential risk factors including demographics, ulcer condition, vascularity, bioburden, neurology, and serology were collected from patients in these 2 groups for comparison. Univariate and multivariate logistic regression analyses were performed to analyze risk factors for major amputation. RESULTS: Among the 88 potential risk factors, 15 showed statistically significant differences between the 2 groups. Using univariate analysis of 88 potential risk factors, 8 showed statistically significant differences. Using stepwise multiple logistic regression analysis, 3 of the 8 risk factors remained statistically significant. Multivariate-adjusted odds ratios for deep ulcers invading bone, cardiac disorders, and Charcot foot were 26.718, 18.739, and 16.997, respectively. CONCLUSION: The risk factors for major amputation in patients hospitalized with diabetic midfoot ulcers included deep ulcers invading the bone, cardiac disorders, and Charcot foot.

Highly Hydrophilic Polyurethane Foam Dressing Versus Early Hydrophilic Polyurethane Foam Dressing on Skin Graft Donor Site Healing in Patients with Diabetes: An Exploratory Clinical Trial.

OBJECTIVE: To compare the effects of early hydrophilic polyurethane (EHP) foam dressing and highly hydrophilic polyurethane (HHP) foam dressing on wound healing in patients with diabetes. METHODS: Twenty patients with diabetes with skin graft donor sites on the lateral thigh were enrolled in this study. Each donor site was divided into two equal-sized areas for the application of HHP or EHP foam dressing. The study endpoint was the time required for healing, defined as complete epithelialization of the donor site without discharge. All possible adverse events were also documented. MAIN RESULTS: Donor site healing was faster in 15 patients on the HHP half and 1 patient on the EHP half. In four patients, healing rates were the same between the HHP and EHP areas. Donor sites treated with HHP and EHP foam dressings healed in 17.2 ± 4.4 and 19.6 ± 3.7 days (P = .007), respectively. During the study period, no adverse event associated with the dressings occurred in either group. CONCLUSIONS: The HHP foam dressing might provide faster healing than EHP foam dressing for skin graft donor sites in patients with diabetes.

Identification of an Actual Strain-Induced Effect on Fast Ion Conduction in a Thin-Film Electrolyte.

Strain-induced fast ion conduction has been a research area of interest for nanoscale energy conversion and storage systems. However, because of significant discrepancies in the interpretation of strain effects, there remains a lack of understanding of how fast ionic transport can be achieved by strain effects and how strain can be controlled in a nanoscale system. In this study, we investigated strain effects on the ionic conductivity of Gd0.2Ce0.8O1.9-δ (100) thin films under well controlled experimental conditions, in which errors due to the external environment could not intervene during the conductivity measurement. In order to avoid any interference from perpendicular-to-surface defects, such as grain boundaries, the ionic conductivity was measured in the out-of-plane direction by electrochemical impedance spectroscopy analysis. With varying film thickness, we found that a thicker film has a lower activation energy of ionic conduction. In addition, careful strain analysis using both reciprocal space mapping and strain mapping in transmission electron microscopy shows that a thicker film has a higher tensile strain than a thinner film. Furthermore, the tensile strain of thicker film was mostly developed near a grain boundary, which indicates that intrinsic strain is dominant rather than epitaxial or thermal strain during thin-film deposition and growth via the Volmer-Weber (island) growth mode.

Open-cell voltage and electrical conductivity of a protonic ceramic electrolyte under two chemical potential gradients.

BaZr0.8Y0.2O3-δ, which is a proton-conducting oxide used as an electrolyte for protonic ceramic fuel cells (PCFCs), possesses two mobile ionic charge carriers-oxygen ions and protons-in a crystalline lattice below 500 °C. The equilibrium concentrations of these charge carriers are dependent on water activity. This feature induces a complexity in the distribution of charge carriers within the electrolyte under the influence of the two chemical potential gradients of oxygen and water, which is a typical operating condition in PCFCs. This makes the theoretical derivations of the open-cell voltage and the electrical resistance of the electrolyte difficult. Here, we calculate the distributions of oxygen vacancies and protons across the electrolyte by solving diffusion equations based on the defect chemistry of BaZr0.8Y0.2O3-δ at 500 °C. We then extract the theoretical open-cell voltage and electrical conductivity of the electrolyte in a range of water and oxygen activities that is of interest for PCFCs.

Three-dimensional microstructure of high-performance pulsed-laser deposited Ni-YSZ SOFC anodes.

The Ni-yttria-stabilized zirconia (YSZ) anode functional layer in solid oxide fuel cells produced by pulsed laser-deposition was studied using three-dimensional tomography. Anode feature sizes of ~130 nm were quite small relative to typical anodes, but errors arising in imaging and segmentation were shown using a sensitivity analysis to be acceptable. Electrochemical characterization showed that these cells achieved a relatively high maximum power density of 1.4 W cm(-2) with low cell resistance at an operating temperature of 600 °C. The tomographic data showed anode three-phase boundary density of ~56 µm(-2), more than 10 times the value observed in conventional Ni-YSZ anodes. Anode polarization resistance values, predicted by combining the structural data and literature values of three-phase boundary resistance in an electrochemical model, were consistent with measured electrochemical impedance spectra, explaining the excellent intermediate-temperature performance of these cells.

Synthesis and biological evaluation of 2-substituted quinoline 6-carboxamides as potential mGluR1 antagonists for the treatment of neuropathic pain.

A series of 2-amino and 2-methoxy quinoline-6-carboxamide derivatives have been synthesized and their metabotropic glutamate receptor type 1 (mGluR1) antagonistic activities were evaluated in a functional cell-based assay. The compound 13c showed the highest potency with IC50 value of 2.16 µM against mGluR1. Finally, in vivo evaluation of 13c in the rat spinal nerve ligation (SNL) model exhibited weak analgesic effects with regard to both mechanical allodynia and cold allodynia.

Nanoplastics from disposable paper cups and microwavable food containers.

Nanoplastics (NPs, <1 µm) pose greater risks due to their increased absorption rates in biological systems. In this study, we investigated the release of NPs from paper cups and microwavable food containers coated with low-density polyethylene (LDPE) and polylactic acid (PLA). For disposable paper cups, we found that LDPE-coated cups released up to 26-fold more NPs (maximum 1.9 × 107 per cup) than PLA-coated ones. The NPs release from LDPE-coated cups was increased at high temperatures above 80 °C, and further increased by physical agitation. However, negligible NP release was observed when the inner coating thickness exceeded 1 mm. For microwavable food containers, those with PLA coatings were more susceptible to the effects of microwave. Depending on the cooking time, we noticed a significant difference (up to 40000 times) in the number of released NPs between LDPE and PLA coatings. Additionally, higher microwave power level led to an increase of NPs, even with constant total energy input. Considering the release of NP, PLA coatings for disposable paper cups and LDPE coatings for microwavable food containers seem more suitable. Furthermore, our results suggest that multi-use cups significantly reduce NPs release due to their material thickness, making them a safer alternative to disposable ones.

Value addition of MXenes as photo-/electrocatalysts in water splitting for sustainable hydrogen production.

The energy transition from fossil fuel-based to renewable energy is a global agenda. At present, a major concern in the green hydrogen economy is the demand for clean fuels and non-noble materials to produce hydrogen through water splitting. Researchers are focusing on addressing this concern with the help of the development of appropriate non-noble-based photo-/electrocatalytic materials. A new class of two-dimensional materials, MXenes, have recently shown tremendous potential for water splitting to produce H2via a photoelectrochemical process. The unique properties of emerging 2D MXene materials, such as hydrophilic surface functionalities, higher surface-to-volume ratios, and inherent flexibility, present these materials as appropriate photo-/electrocatalytic materials. Unique value addition and innovative strategies such as the introduction of end-group modification, heterojunctions, and nanostructure engineering have shown the potential of MXene materials as emerging photo-/electrocatalysts for water splitting. When integrated with conventional noble metal catalysts, MXene-based catalysts demonstrated a lower overpotential for hydrogen and oxygen evolution reactions and a remarkable boost in performance for enhanced H2 production rates surpassing those of pristine noble metal-based catalysts. These promote future perspectives for the utilization of chemically synthesized MXenes as alternative photo-/electrocatalysts. Future research direction should focus on MXene synthesis and utilization for surface modification, composite formation, stabilization, and optimization in synthesis methods and post-synthesis treatments. This review highlights the progress in the understanding of fundamental mechanisms and issues associated with water splitting, influencing factors of MXenes, their value addition role, and application strategies for water splitting, including performance, challenges, and outlook of MXene-based photo-/electrocatalysts, in the last five years.

Effect of 3D-printed polycaprolactone/osteolectin scaffolds on the odontogenic differentiation of human dental pulp cells.

Cell-based tissue engineering often requires the use of scaffolds to provide a three-dimensional (3D) framework for cell proliferation and tissue formation. Polycaprolactone (PCL), a type of polymer, has good printability, favorable surface modifiability, adaptability, and biodegradability. However, its large-scale applicability is hindered by its hydrophobic nature, which affects biological properties. Composite materials can be created by adding bioactive materials to the polymer to improve the properties of PCL scaffolds. Osteolectin is an odontogenic factor that promotes the maintenance of the adult skeleton by promoting the differentiation of LepR+ cells into osteoblasts. Therefore, the aim of this study was to evaluate whether 3D-printed PCL/osteolectin scaffolds supply a suitable microenvironment for the odontogenic differentiation of human dental pulp cells (hDPCs). The hDPCs were cultured on 3D-printed PCL scaffolds with or without pores. Cell attachment and cell proliferation were evaluated using EZ-Cytox. The odontogenic differentiation of hDPCs was evaluated by alizarin red S staining and alkaline phosphatase assays. Western blot was used to evaluate the expression of the proteins DSPP and DMP-Results: The attachment of hDPCs to PCL scaffolds with pores was significantly higher than to PCL scaffolds without pores. The odontogenic differentiation of hDPCs was induced more in PCL/osteolectin scaffolds than in PCL scaffolds, but there was no statistically significant difference. 3D-printed PCL scaffolds with pores are suitable for the growth of hDPCs, and the PCL/osteolectin scaffolds can provide a more favorable microenvironment for the odontogenic differentiation of hDPCs.

Floating electrode-dielectric barrier discharge-based plasma promotes skin regeneration in a full-thickness skin defect mouse model.

Wound healing involves a complex and dynamic interplay among various cell types, cytokines, and growth factors. Macrophages and transforming growth factor-ß1 (TGF-ß1) play an essential role in different phases of wound healing. Cold atmospheric plasma has a wide range of applications in the treatment of chronic wounds. Hence, we aimed to investigate the safety and efficacy of a custom-made plasma device in a full-thickness skin defect mouse model. Here, we investigated the wound tissue on days 6 and 12 using histology, qPCR, and western blotting. During the inflammation phase of wound repair, macrophages play an important role in the onset and resolution of inflammation, showing decreased F4/80 on day 6 of plasma treatment and increased TGF-ß1 levels. The plasma-treated group showed better epidermal epithelialization, dermal fibrosis, collagen maturation, and reduced inflammation than the control group. Our findings revealed that floating electrode-dielectric barrier discharge (FE-DBD)-based atmospheric-pressure plasma promoted significantly faster wound healing in the plasma-treated group than that in the control group with untreated wounds. Hence, plasma treatment accelerated wound healing processes without noticeable side effects and suppressed pro-inflammatory genes, suggesting that FE-DBD-based plasma could be a potential therapeutic option for treating various wounds.

Immediate and Late Effects of Pulse Widths and Cycles on Bipolar, Gated Radiofrequency-Induced Tissue Reactions in in vivo Rat Skin.

Background: Single to multiple pulse packs of bipolar, alternating current radiofrequency (RF) oscillations have been used for various medical purposes using invasive microneedle electrodes. This study was designed to evaluate the effects of pulse widths and cycles of RF pulse packs on immediate and delayed thermal tissue reactions in in vivo rat skin. Methods: RF energy at the frequency of 1 MHz and power of 70 W was delivered at each experimental setting into in vivo rat skin at 1.5-mm microneedle penetration, and then, tissue samples were obtained after 1 h and 3, 7, 14, and 21 days and histologically analyzed. Results: A single-pulse-pack RF treatment generated coagulative necrosis zones in the dermal peri-electrode area and zones of non-necrotic thermal reactions in the dermal inter-electrode area. Multiple pulse-pack, RF-treated rat skin specimens revealed that the number and size of peri-electrode coagulative necrosis were markedly decreased by increasing the number of pulse packs and accordingly decreasing the conduction time of each pulse pack. The microscopic changes in RF-induced non-necrotic thermal reaction in the inter-electrode area were more remarkable in specimens treated with RF of 7 or 10 pulse packs than in specimens treated with RF of 1-4 pulse packs. Conclusion: The gated delivery of multiple RF pulse packs using a bipolar, alternating current, 1-MHz RF system using insulated microneedle electrodes efficiently generates non-necrotic thermal tissue reactions over the upper, mid, and deep dermis and subcutaneous fat in the inter-electrode areas.

Improvements in desorption rate and electrode stability of membrane capacitive deionization systems by optimizing operation parameters.

The operating parameters necessary to improve the desorption rate of a membrane capacitive deionization (MCDI) system while controlling the Faradaic reactions were studied. The total charge (QT) accumulated in the carbon electrode was set as the main operating parameter determining the desorption rate of the MCDI system. After adsorption was performed until the preset QT value was reached using the MCDI unit cell, desorption was performed at a cell potential of -0.2 V. As a result of this MCDI operation, the average desorption rate increased in proportion to the QT value. Additionally, the ratio of desorption charge according to the desorption time was consistent regardless of QT. Through this, it could be seen that the desorption process of the MCDI system is similar to the discharge characteristic of a series circuit comprising a resistor (R) and a capacitor (C). If the desorption time is too short during the MCDI operation, some charges will remain in the carbon electrode. When the adsorption charge (Qad) is supplied again, QT increases. When QT exceeds the maximum allowable charge (MAC), which is the total charge at the onset of Faradaic reactions, electrode reactions can occur. Through RC circuit analysis, a model equation for calculating the minimum desorption time required to operate a MCDI system without the occurrence of Faradaic reactions was derived. As a result of MCDI operation while changing the desorption time, the desalination performance almost matched the result predicted through the model equation. Additionally, it was found that the smaller Qad is, the shorter the desorption time, resulting in a higher desalination rate of the MCDI system.

A Pilot Study Comparing a Micronized Adipose Tissue Niche versus Standard Wound Care for Treatment of Neuropathic Diabetic Foot Ulcers.

Numerous studies have demonstrated the various properties of micronized adipose tissue (MAT), including angiogenic, anti-inflammatory, and regenerative activities, which can be helpful in wound healing. This exploratory clinical trial aimed to report the efficacy and safety of MAT niche for treating diabetic foot ulcers. Twenty subjects were randomly divided into MAT niche treatment (n = 10) and control groups (n = 10). All patients were followed up weekly for 16 weeks. We evaluated the efficacy of the MAT niche treatment by assessing the (1) reduction in wound area after 4 weeks and (2) percentage of patients who achieved complete wound closure after 16 weeks. All possible adverse events were recorded. The wound area was reduced by 4.3 ± 1.0 cm2 in the treatment group and by 2.0 ± 1.1 cm2 in the control group (p = 0.043). Complete wound healing was achieved after 16 weeks in eight out of 10 patients (80%) in the treatment group and three out of six (50%) in the control group (p = 0.299). No serious adverse events related to MAT niche treatment were observed. Although the present study's findings do not support the use of this therapy to treat foot ulcers of patients with diabetes owing to the small number of patients included and the absence of statistical significance, the results of this pilot preliminary study are promising in that MAT niche autografts may offer the possibility of a simple and effective treatment for diabetic ulcers. Further follow-up studies with a larger number of patients are required to validate our findings.

Systemic Infection of Mycobacterium abscessus in a Free-Ranging Wild Eurasian Eagle Owl (Bubo bubo).

An adult Eurasian Eagle Owl (Bubo bubo) rescued from drowning was unable to fly. After euthanasia, necropsy and histopathologic examination showed granulomatous inflammation and intracellular acid-fast stain-positive rod-shaped bacteria in the skin, lung, liver, and spleen, which were identified by using molecular analysis as Mycobacterium abscessus.