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.

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.

The Impact of Extracorporeal Shock Wave Therapy on Microcirculation in Diabetic Feet: A Pilot Study.

BACKGROUND: Patients with diabetic foot commonly experience vascular insufficiency and compromised tissue perfusion. Extracorporeal shockwave therapy (ESWT) reportedly promotes wound healing and angiogenesis, but clinical studies on the effect of ESWT on angiogenesis are scarce and the exact mechanism remains unclear. OBJECTIVE: To investigate the effect of ESWT on cutaneous microcirculation in diabetic feet. METHODS: Ten patients with diabetic feet received ESWT twice weekly for a total of six sessions. Transcutaneous partial oxygen pressure (TcPO2) and cutaneous blood flow were measured before and after ESWT. MAIN RESULTS: The treated feet showed statistically significant improvements in the mean TcPO2 (P < .01) and cutaneous blood flow level (P < .05) compared with control feet. In treated feet, TcPO2 increased by 19.6%, from 41.4 ± 9.9 to 49.5 ± 8.7 mm Hg (P < .05). In control feet, TcPO2 decreased by 11.6%, from 39.5 ± 14.0 to 34.9 ± 14.5 mm Hg (P = .059). The average cutaneous blood flow level of treated feet before ESWT was 36.9 ± 25.6, which increased to 48.3 ± 32.4 AU after ESWT (30.9% increase; P = .646). In control feet, the cutaneous blood flow level decreased from 80.5 ± 36.7 to 60.4 ± 38.8 AU, a decrease of 25.0% (P = .241). CONCLUSIONS: These results demonstrate that ESWT may have beneficial effects on microcirculation in diabetic feet.

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.

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.

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.

Photosynthetic responses of large old Zelkova serrata (Thunb.) Makino trees to different growth environments.

Large old trees, which provide ecosystem services and serve as a historical and cultural heritage, are exposed to various environmental threats, such as habitat fragmentation and climate change, necessitating diagnosis of tangible and intangible stresses and their effects on tree growth for effective management. This study investigated the photosynthetic characteristics of 25 large old Zelkova serrata (Thunb.) Makino trees in Chungcheong Province, Korea, and identified the physical environmental factors affecting their physiological responses. Maximum assimilation rate (Amax) was the highest in July (summer), transpiration rate (E) and stomatal conductance (gs) increased from May (spring) to September (fall), and water use efficiency (WUE) was the highest in May (spring) and decreased until September (fall). Amax decreased as tree height increased. Ambient CO2 and vapor pressure deficit (VPD) were negatively correlated with photosynthetic parameters throughout the growth season and in July (summer) and September (fall), respectively. Physical environmental factors exhibited complex effect on physiological activities, which increased with wide growth space and decreased with deep soil covering and high impervious ground surface ratio. Physiological responses differed with surface types within the growth space, with bare land showing higher mean Amax, E, and gs than areas with mulching material or concrete. This study quantitatively determined the physiological activities of large old Z. serrata and proposes appropriate management measures for ensuring their healthy growth in abiotic stress environment.

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.

A comprehensive investigation of direct ammonia-fueled thin-film solid-oxide fuel cells: Performance, limitation, and prospects.

Ammonia is a promising carbon-free hydrogen carrier. Owing to their nickel-rich anodes and high operating temperatures, solid oxide fuel cells (SOFCs) can directly utilize NH3 fuel-direct-ammonia SOFCs (DA-SOFCs). Lowering the operating temperature can diversify application areas of DA-SOFCs. We tested direct-ammonia operation using two types of thin-film SOFCs (TF-SOFCs) under 500 to 650°C and compared these with a conventional SOFC. The TF-SOFC with a nickel oxide gadolinium-doped ceria anode achieved a peak power density of 1330 mW cm-2 (NH3 fuel under 650°C), which is the best performance reported to date. However, the performance difference between the NH3 and H2 operations was significant. Electrochemical impedance analyses, ammonia conversion quantification, and two-dimensional multi-physics modeling suggested that reduced ammonia conversion at low temperatures is the main cause of the performance gap. A comparative study with previously reported DA-SOFCs clarified that incorporating a more active ammonia decomposition catalyst will further improve low-temperature DA-SOFCs.

'Illusional' nano-size effect due to artifacts of in-plane conductivity measurements of ultra-thin films.

The nano-size effect, which indicates a drastic increase in conductivity in solid electrolyte materials of nano-scale microstructures, has drawn substantial attention in various research fields including in the field of solid oxide fuel cells (SOFCs). However, especially in the cases of the conductivity of ultra-thin films measured in an in-plane configuration, it is highly possible that the 'apparent' conductivity increase originates from electrical current flowing through other conduction paths than the thin film. As a systematic study to interrogate those measurement artifacts, we report various sources of electrical current leaks regarding in-plane conductivity measurements, specifically insulators in the measurement set-up. We have observed a 'great conductivity increase' up to an order of magnitude at a very thin thickness of a single layer yttria-stabilized zirconia (YSZ) film in a set-up with an intentional artifact current flow source. Here we propose that the nano-size effect, reported to appear in ultra-thin single layer YSZ, can be a result of misinterpretation.

A comparative study of catalytic partial oxidation of methane over CeO2 supported metallic catalysts.

In the present study, the catalytic partial oxidation of methane (CPOM) over various active metals supported on CeO2 (M/CeO2, M = Ir, Ni, Pd, Pt, Rh and Ru) has been investigated. The catalysts were characterized by X-ray diffraction (XRD), BET surface area, H2-temperature programmed reduction (H2-TPR), CO chemisorption and transmission electron microscope (TEM) analysis. Ir/CeO2 catalysts showed higher BET surface area, higher metal dispersion, small active metal nano-particles (approximately 3 nm) than compared to other M/CeO2 catalysts. The catalytic tests were carried out in a fixed R(mix) ratio of 2 (CH4/O2) in a fixed-bed reactor, operating isothermally at atmospheric pressure. From time-on-stream analysis at 700 degrees C for 12 h, a high and stable catalytic activity has been observed for Ir/CeO2 catalysts. TEM analysis of the spent catalysts showed that the decrease in the catalytic activity of Ni/CeO2 and Pd/CeO2 catalysts is due to carbon formation whereas no carbon formation has been observed for Ir/CeO2 catalysts.

Comparing volumetric and biological aspects of 3D-printed interim restorations under various post-curing modes.

PURPOSE: This study aims to compare the volumetric change, degree of conversion (DOC), and cytotoxicity of 3D-printed restorations post-cured under three different conditions. MATERIALS AND METHODS: 3D-printed interim restorations were post-cured under three different conditions and systems: 5 min, 30 min, and 24 h. Three-unit and six-unit fixed dental prostheses (n = 30 for each case) were printed; ten specimens from each group were post-cured and then scanned to compare their volumetric changes. Root-mean-squared (RMS) values of the data were acquired by superimposing the scanned files with original files. Thirty disk-shaped specimens were printed to evaluate the DOC ratio. Fourier transform infrared spectroscopy was used to compare the DOCs of 10 specimens from each group. Human gingival fibroblasts were used to measure the cell viability of every specimen (n = 7). The data from this experiment were employed for one-way analysis of variance and Tukey's post-hoc comparisons. RESULTS: Differences between the three-unit restorations were statistically insignificant, regardless of the post-curing conditions. However, for the six-unit restorations, a high RMS value was acquired when the post-curing duration was 30 min. The average DOC was approximately 56 - 62%; the difference between each group was statistically insignificant. All the groups exhibited cell viability greater than 70%, rendering them clinically acceptable. CONCLUSION: The post-curing conditions influenced the volume when the length of the restoration was increased. However, this deviation was found to be clinically acceptable. Additionally, post-curing did not significantly influence the DOC and cytotoxicity of the restorations.