搜索结果：Advances in skin & wound care

Severe burn injury is associated with profound physiological derangement and remains a major cause of infection-related morbidity and mortality worldwide. Disruption of the skin barrier sustained immune dysregulation, prolonged intensive care unit (ICU) exposure, and extensive use of invasive devices create a uniquely infection-prone host environment. Infectious complications, particularly those caused by multidrug-resistant organisms (MDROs), continue to account for a substantial proportion of deaths in critically ill burn patients despite advances in surgical and critical care management. This narrative review aims to provide a comprehensive, clinically focused overview of infectious complications in critically ill burn patients, integrating current evidence on epidemiology, pathophysiology, microbial dynamics, diagnostic strategies, and contemporary management approaches relevant to daily ICU practice. A narrative synthesis of the published literature was performed, including international guidelines, observational studies, randomised trials, systematic reviews, and translational research focusing on burn-related infections, antimicrobial resistance, diagnostics, and emerging therapies. The review examines the multifactorial pathophysiology underlying infection susceptibility following major burns, including loss of the cutaneous barrier, hyperinflammatory responses followed by immune paralysis, and burn-induced hypermetabolism. Dynamic patterns of microbial colonisation, biofilm formation, microbiome disruption, and the global rise of MDROs are explored. Diagnostic challenges in distinguishing colonisation from invasive infection are discussed, alongside traditional and advanced diagnostic modalities such as quantitative tissue cultures, biomarkers, multiplex molecular assays, and next-generation sequencing. Contemporary management strategies are reviewed, emphasising early surgical source control, pharmacokinetically optimised antimicrobial therapy, antimicrobial stewardship, and rigorous infection prevention and control practices. Emerging adjunctive therapies, including bacteriophage therapy, nanotechnology-based antimicrobials, microbiome-directed interventions, and immunomodulatory approaches, are also highlighted. Effective infection management in burn patients requires an integrated, multidisciplinary approach that combines rapid diagnosis, early surgical intervention, tailored antimicrobial therapy, and robust infection prevention strategies. Advances in molecular diagnostics, precision medicine, and microbiome science hold promise for improving outcomes and mitigating the growing burden of antimicrobial resistance in burn ICUs. Infectious complications remain a leading determinant of outcome following severe burn injury. Optimising infection care through early recognition, precise diagnostics, coordinated surgical and antimicrobial strategies, and emerging precision-based interventions is essential to reduce infection-related morbidity and mortality in this vulnerable patient population.

Burn wounds are common worldwide and often require prolonged treatment and recovery time. Such injuries are associated with local and systemic changes, both of which require effective action to prevent deterioration and improve long-term outcomes. The most common division of burns is based on injury depth. Treatment differs depending on the extent of the injury. The social and financial burden of burns is heavy, with some survivors being excluded from society. Due to high treatment costs and restricted availability of some management options, patients in low-resource settings may not receive the most advanced care. Therefore, new cost-effective and easily accessible management options are desired to improve clinical outcomes and provide an alternative to traditional methods. Nile tilapia skin showed promising results in burn wound treatment in preclinical and clinical studies. Unique antimicrobial, anti-inflammatory, and molecular properties of tilapia skin, combined with a structure similar to human cutis, are associated with enhanced wound healing and faster re-epithelialization. In animals, tilapia skin showed promising results in wound healing of various depths. In humans, superficial partial-thickness burns were mostly examined. In comparison to conservative management, patients treated with tilapia skin experienced lower pain intensity, required fewer dressing changes, and decreased analgesic intake. Re-epithelialization was faster. Advantages over traditional methods include a lack of local adverse reactions, low infection risk, reduced pain, cost-effectiveness, ease in tilapia skin acquisition, and application. Clinical studies restricted to a small number of participants and a lack of research on humans in various burn depths limit the broader employment of tilapia skin. Data on long-term outcomes are scarce; therefore, more studies need to be performed in that area to create clear guidelines and standardized treatment protocols. However, the beneficial effects of tilapia skin on wound healing are very promising and have high potential for development. In the future, it might become a cornerstone of burn injury treatment and improve clinical outcomes, particularly in low-resource settings.

Skin repair and skin wound healing are tightly regulated biological processes that require coordinated control of inflammation, redox homeostasis, angiogenesis, and tissue remodelling. In this context, natural extracts are increasingly recognized as sources of chemically diverse phytochemicals capable of modulating defined molecular signalling pathways that govern cutaneous repair. This review provides a mechanism-informed synthesis of current evidence by examining representative botanical sources, including Aloe vera, Centella asiatica, Curcuma longa, Calendula officinalis, and Panax ginseng, which have been extensively investigated in preclinical wound-healing models. Rather than providing an exhaustive catalogue of plant species or individual compounds, the analysis emphasizes how distinct phytochemical classes interact with conserved molecular pathways involved in skin repair. Flavonoids, terpenoids, phenolic acids, alkaloids, and polysaccharides influence inflammatory signalling pathways, redox-sensitive pathways, growth factor-mediated responses, and cellular migration, thereby supporting phase-appropriate progression of wound healing. Recurrent modulation of NF-κB, TGF-β, VEGF, and Nrf2 signalling emerges as a central mechanistic theme. Advances in dermopharmaceutical formulation strategies, including hydrogels and lipid-based carriers, may enhance local delivery and stability of phytochemicals; however, their translational value remains dependent on chemical standardization and mechanistic validation. This review provides a mechanism-informed synthesis of current evidence, highlighting how phytochemical diversity, molecular signalling pathways, and dermopharmaceutical formulation strategies collectively shape the therapeutic potential of plant-derived extracts in cutaneous wound healing and may guide future mechanistic and translational research in phytochemical-based wound therapeutics.

Chronic leg ulcers are a significant source of morbidity in elderly patients, particularly those with multiple comorbidities. The most common etiologies are vascular, including chronic venous insufficiency, peripheral arterial disease, and diabetic neuropathy. However, ulcers that are non-healing and refractory to standard treatment may reflect rarer underlying pathologies, warranting comprehensive reassessment. We report the case of an 87-year-old woman presenting with recurrent, painful, bilateral lower-limb ulcers, persisting for 18 months on the right leg and 10 months on the left. Her medical history was notable for chronic kidney disease, heart failure, and a previous myocardial infarction managed with dual coronary artery stenting. The ulcers had been treated in the community with dressings and multiple courses of oral antibiotics, with recurrent hospital admissions for secondary infection. She re-presented to the emergency department with worsening ulceration, rigours, raised inflammatory markers, and clinical features of infection. Initial management included intravenous antibiotics, analgesia, specialist wound care, and tissue viability input. Vascular surgical assessment confirmed adequate arterial supply, and there was no clinical evidence of peripheral neuropathy. Despite optimal conventional management, wound healing remained poor, prompting consideration of alternative diagnoses, including pyoderma gangrenosum, vasculitic ulceration, and cutaneous malignancy. Extensive autoimmune and vasculitis screening was negative. Punch biopsy demonstrated a vasculopathic pattern with increased vascular proliferation, fibrinoid necrosis of small vessels, diffuse neutrophilic infiltrates, and fibrin deposition extending into the deeper dermis. These findings were consistent with coexisting livedoid vasculopathy (LV) and acroangiodermatitis (AAD) secondary to chronic venous stasis, excluding other differentials. This combination is rare, particularly in advanced age. Treatment included topical clobetasol 0.05% cream to peri-wound skin, topical potassium permanganate 0.01% to infected areas, oral dapsone 50 mg twice daily for 3 months, and clopidogrel 75 mg daily, alongside compression therapy and multidisciplinary wound care. Marked clinical improvement was observed within two weeks. This case highlights the diagnostic complexity of chronic leg ulcers, the importance of maintaining a broad differential diagnosis, and the pivotal role of skin biopsy and multidisciplinary collaboration in guiding effective, individualised management.

Excess wound exudate can cause tissue maceration and delayed healing. Fluctuating exudate levels, combined with the impact of gravity, increase dressing leakage risk, affecting patient quality of life. Bacteria and proteases found in hard-to-heal (chronic) wounds pose additional barriers to healing if not promptly removed. Absorbent dressings must therefore address these multiple challenges, and so were explored in this series of preclinical investigations. Standard in vitro absorbency tests were conducted to compare the performance of several dressings with a new advanced five-layer silicone polyurethane foam dressing with superabsorbent particles (ASFS). Dressing functionality was explored using clinically relevant test conditions, including the impact of gravity and fluid bolus events on absorbency, combined with the dressing's ability to absorb and retain bacteria and proteases. ASFS demonstrated superior performance across standard absorbency tests versus most of the alternative absorbent dressings and outperformed a comparator five-layer silicone foam dressing with superabsorbent fibres (SFD) in run-off testing. Under clinically relevant dynamic bolus conditions, including gravitational challenge, no leakage was observed with ASFS, whereas dressing failure due to fluid spill or leakage was observed with SFD. ASFS was also shown to retain matrix metalloproteinases and the majority of bacteria, even under increasing fluid volumes. Functionality of absorbent wound dressings in both standard and clinically relevant tests is critical to support healthcare professionals' decision-making in selecting optimal interventions for their patients' wounds. Effective exudate management combined with removal of bacteria and proteases by the new ASFS dressing supports healthcare professional and patient confidence in continuing with daily activities, with the potential for fewer dressing changes and associated resource benefits, warranting further evaluation in clinical practice.

Myofascial pain syndrome (MPS) is a musculoskeletal system disorder that is exceedingly painful and distinct from other chronic pain syndromes. MPS can occur on its own or in conjunction with other muscle disorders. Symptoms of MPS include tense bands in muscles, weakening at the afflicted region, radial or repeated pain, restricted range of motion (ROM), and hot and red skin. In addition, symptoms of MTrPs include tense bands in muscles, weakening at the afflicted region, radial or repeated pain, restricted range of motion (ROM), and/or hot and red skin. Kenzo Kase, a Japanese chiropractor, invented Kinesiology Tape (KT) in the 1970s, with a potential role in modulating pain, enhancing muscle function and improving ROM. This review aims to examine the underlying mechanisms of MPS and evaluate current therapeutic strategies, with particular emphasis on the mechanism and clinical application of KT in managing MPS. Recent literature highlights the advances in understanding the pathophysiology of MTrP, conventional therapies and their limitations. KT is a dynamic, stretchable tape that resembles human skin which may be utilised to treat pain and muscle activity as well as increase range of motion (ROM). The majority of the time, KT is used in the treatment and prevention of sports injuries. Clinical studies report improvements in pain intensity, muscle flexibility, and ROM following KT application in individuals with MPS, particularly in sports and rehabilitation settings. MPS is a complex pain disorder requiring multimodal management. KT represents a promising non-invasive intervention that may address both pain and functional restoration through neurophysiological and biomechanical mechanisms. While clinical findings are promising, regulatory protocols are yet to be standardised to ensure long term safety and efficacy of KT in the treatment of MPS.

Plant-derived exosome like nanovesicles known for their biocompatibility, minimal immunogenicity, and capacity to transport diverse therapeutic molecules, have emerged as effective carriers for targeted drug delivery. When integrated into hydrogels, these offer improved stability, prolonged release, and precise delivery to specific skin layers, thereby enhancing treatment outcomes. We conducted structured search of the literature on plant-derived exosome-like nanovesicles (PDELNs) and hydrogel-based drug-delivery systems for skin applications. Relevant studies were identified from PubMed, ScienceDirect, and Google Scholar using keywords including plant-derived exosomes like nanovesicles, plant exosomes + skin, and plant exosomes + hydrogel. We selected Publications from 2010 to 2025 and focused on studies describing biological activity of plant-derived exosomes, as well as their therapeutic relevance for skin repair, regeneration, or wound healing. Research involving hydrogel formulations that incorporated plant-derived vesicles or comparable nano-carriers was also included. In vitro, in vivo (preclinical), and available clinical evidence were reviewed, while unrelated work (such as mammalian exosomes or non-skin studies) was excluded. The combination of plant-derived exosomes like nanovesicles and hydrogels is potential therapeutic candidate in addressing various skin disorders, including inflammatory diseases, wound healing, and skin regeneration. However, challenges remain, including the scalability of exosome production, stability of formulations, and achieving effective skin penetration. Furthermore, regulatory considerations regarding the safety, toxicity, and long-term biocompatibility of these systems must be thoroughly evaluated. The review also emphasizes future research opportunities, the development of plant-derived exosomes like nanovesicles with higher therapeutic potential and the integration of advanced technologies like phototherapy and microneedles to further improve therapeutic efficacy. The combination of PDELNs with hydrogel delivery systems have shown potential in preclinical models for the treatment of dermatological diseases, providing a novel strategy for skin care.

Chronic wounds remain a major global health burden and often stall despite guideline-based care because of persistent inflammation, oxidative stress, impaired perfusion, and dysregulated extracellular matrix remodeling. Protein-based nutrition is best positioned as an adjunct to, rather than a substitute for, standard wound care. Human studies, supported by mechanistic rationale, suggest that optimizing total protein intake (commonly ∼1.25 to 1.5 g/kg/day in appropriate patients) and, in selected settings, adding functional components such as arginine, glutamine, and β-hydroxy-β-methylbutyrate (HMB) may improve wound-area reduction and healing trajectories when integrated with standard care. Reported signals vary by etiology, including improved wound-area reduction and Pressure Ulcer Scale for Healing outcomes in pressure injuries, possible benefit in selected high-risk diabetic foot ulcer subgroups, and reduced venous ulcer area when supplementation is paired with consistent compression. Evidence remains heterogeneous across wound types and study designs, with inconsistent dosing, duration, endpoints, and patient-selection criteria that limit standardized implementation. Safety and feasibility are especially important in renal risk and diabetes, where renal function and glycemic control require monitoring. Clinical evidence was interpreted with attention to study design and reporting standards, including CONSORT, STROBE, or STARD, as applicable. This review translates current evidence into a clinician-oriented framework for patient selection, prescribing, monitoring, and treatment adjustment, emphasizing initiation triggers in stalled wounds and trajectory-based reassessment every 2-4 weeks. Future work should prioritize pragmatic, well-controlled trials comparing formulations and dosing windows by wound etiology, together with biomarker-informed stratification to improve personalization, safety, and real-world uptake.

Mitochondria are increasingly recognized as central regulators of skin health and aging, providing ATP and coordinating redox signaling, mitophagy, and cell fate decisions. In cutaneous tissues, mitochondrial integrity sustains fibroblast-driven collagen synthesis, keratinocyte proliferation, melanocyte homeostasis, and efficient wound repair. With advancing age and cumulative ultraviolet exposure, mitochondria accumulate hallmark defects. Mitochondrial DNA mutations and deletions, impaired oxidative phosphorylation, excessive reactive oxygen species production, diminished mitophagy and biogenesis, disrupted fission-fusion dynamics, NAD⁺ decline, and sirtuin dysregulation all converge to undermine energy metabolism, amplify inflammatory signaling, and accelerate fibroblast senescence, extracellular matrix degradation, pigmentary changes, and delayed wound healing. Recent research also highlights weakened antioxidant defenses and extracellular vesicle-mediated propagation of mitochondrial stress across the cutaneous microenvironment, underscoring the organelle's central role in skin aging. Against this mechanistic backdrop, mitochondria-targeted interventions are emerging as promising therapeutic strategies. Extracellular vesicles loaded with NAD⁺ precursors, antioxidant enzymes, or mitophagy stimulators show preclinical efficacy in restoring bioenergetics and accelerating wound closure. Mitochondria-directed antioxidants such as melatonin and coenzyme Q10, NAD⁺ boosters and sirtuin activators, red and near-infrared photobiomodulation, and NRF2-based redox reprogramming each enhance mitochondrial homeostasis while improving collagen synthesis, pigmentation balance, and re-epithelialization. Early translational and clinical studies indicate that these approaches protect against UV-induced mitochondrial DNA damage, reduce oxidative stress, and improve cutaneous structure and function. Collectively, these findings position mitochondria as a modifiable hub for cutaneous aging and wound repair, and highlight the potential of integrated metabolic, antioxidant, and vesicle-based approaches to transform dermatologic anti-aging and wound-care interventions.

Stomal mucocutaneous separation is a frequent complication of colostomy, which may complicate wound care due to contamination from fecal leakage, resulting in delayed wound healing. In addition, systemic factors may further influence postoperative wound healing. We report successful combination treatment, involving full-thickness skin graft transplantation and negative-pressure wound therapy (NPWT) in a patient with a large peristomal ulcer that developed progressively in the postoperative course following complete circumferential mucocutaneous separation and infection, which occurred after neoadjuvant chemotherapy followed by laparoscopic abdominoperineal resection. A 75-year-old male, who had been diagnosed with advanced low rectal cancer, received 4 cycles of mFOLFOX6 chemotherapy (oxaliplatin, leucovorin, and fluorouracil) plus bevacizumab, followed by laparoscopic abdominoperineal resection with lymph node dissection. Approximately 4 weeks later, partial mucocutaneous separation developed, accompanied by subcutaneous abscess formation. Subsequently, this led to complete circumferential mucocutaneous separation, which evolved into a giant peristomal ulceration with a significant tissue loss. Conservative local wound care, including frequent debridement, was continued, and granulation tissue gradually filled the peristomal skin defect. Three months after the operation, full-thickness skin graft transplantation combined with NPWT was performed. At 6 years after the operation, the patient remained recurrence-free, and there were no postoperative complications or issues with the colostomy or skin graft. This combination therapy successfully treated a giant peristomal ulcer that progressively developed after mucocutaneous separation with infection, which occurred later than typical postoperative wound complications following neoadjuvant chemotherapy (mFOLFOX6 + bevacizumab) and laparoscopic surgery. Delayed wound healing, potentially related to bevacizumab, may have contributed to both the late onset and unusually extensive progression of the ulcer. The therapy proved compatible with long-term stoma care.

Epidermolysis Bullosa (EB) is a rare genetic disorder characterised by extreme skin fragility, chronic wounds, and high morbidity. Current management is largely supportive, highlighting an urgent need for innovative therapeutic strategies. This review synthesises recent advances in topical therapies, including wound dressings, tissue-engineered skin, and molecular therapies, and evaluates the potential of these approaches to improve clinical outcomes and bridge the gap toward disease-modifying interventions. Key developments in EB pathophysiology, advanced wound-care technologies, topical molecular therapies, and cell- or tissue-based interventions were examined through critical appraisal of relevant preclinical and clinical studies, with emphasis on translational potential and practical application. Next-generation dressings incorporating hydrogels, extracellular matrix-mimetic scaffolds, nanoparticles, and smart-responsive systems demonstrate enhanced protection, moisture balance, and localised therapeutic delivery, supporting wound healing while minimising trauma. Topical molecular therapies—including gene therapy, repurposed drugs, and bioactive natural compounds—show proof-of-concept for symptomatic relief and potential disease modification. Cell- and tissue-based approaches, such as ex vivo gene-corrected keratinocyte grafts and cultured skin substitutes, offer durable regeneration but remain limited by cost and accessibility. Integration of these strategies, combined with patient-centred design and co-development, holds promise for improving functional outcomes and quality of life in EB. Advanced wound dressings, bioactive topical therapies, and tissue-engineered constructs represent complementary and translationally relevant approaches to EB care. Optimising the synergy between material-based and molecular strategies, alongside standardised clinical endpoints and long-term safety evaluation, is essential for bridging supportive care and future disease-modifying therapies, ultimately improving outcomes for patients with EB.

Wound infection represents a significant challenge in clinical practice. Traditional wound management, targeting sterility and relying on strategies of broad-spectrum bactericidal activity and antibiotic dependence, achieves partial infection control but induces severe complications, including exacerbated bacterial resistance and skin microbiota dysbiosis. With the continuous advancement of microbiome research, a novel consensus has emerged: the key to wound healing lies not in the complete eradication of all microorganisms but in maintaining the dynamic balance of the microbial ecosystem. This review aims to elaborate on the paradigm shift from "bactericidal eradication" to "microbial modulation" in wound care, analyze the inherent limitations of conventional antibacterial strategies, and systematically summarize the critical roles of skin commensal microbiota in promoting wound healing through core mechanisms such as competitive inhibition, metabolic regulation, and immune modulation. Furthermore, it proposes that the core strategy of future wound care should focus on precision microbial modulation and discusses the application prospects of cutting-edge technologies, including probiotics, postbiotics, and individualized precision interventions. The innovative significance of this paradigm in wound dressing design is envisaged, emphasizing the development of novel materials integrating microbiota-specific regulatory capabilities and smart responsive functions. This work provides theoretical support for the precision prevention and control of wound infections, the improvement of healing quality, and technological innovation in the field of wound care.

The development of multifunctional wound care materials capable of addressing bacterial infections, promoting tissue regeneration, and providing localized anticancer therapy is a growing biomedical priority. In this current study, we designed a novel therapeutic scaffold by immobilizing Bacillus-derived protease (PR)onto carboxymethyl chitosan aerogel (CMCsAE), forming aerogel matrix (PR-CMCsAE), and evaluated its antibacterial, antibiofilm, anticancer, and wound healing properties. Two loading concentrations (0.15 and 0.3 g) of PR enzyme were tested. PR0.3-CMCsAE showing superior immobilization yield (90 ± 3.7%) and retained enzymatic activity (72.5 ± 1.91%). Compared with the free enzyme, the immobilized protease demonstrated enhanced thermal and pH stability, reusability (65% activity after 10 cycles), and long-term storage performance (79.7% activity retained after 4 weeks). PR0.3-CMCsAE exhibited broad-spectrum bactericidal effects against some skin-causing bacterial infections, achieving complete bacterial inactivation at 400 μg/mL within 60-90 min. It also significantly inhibited biofilm formation over a 7-day period. Anticancer evaluation on A431 skin carcinoma cells revealed a dose-dependent reduction in viability (down to 21.6%), with apoptosis as the primary mode of cell death, supported by flow cytometry and AO/EB fluorescence imaging. Additionally, PR0.3-CMCsAE promoted the wound healing (in vitro), increasing scratch closure to 54.6% compared to 41.5% in controls. Toxicity testing confirmed the formulation's biocompatibility (EC50 > 100). Overall, PR-CMCsAE represents a therapeutic platform that combines enzymatic debridement, antimicrobial defense, anticancer activity, and regenerative support. This bioengineered aerogel holds strong potential for use in advanced wound dressings and localized skin cancer treatments.

Advances in additive manufacturing, particularly 3D and multidimensional printing, have enabled unprecedented control over the architecture, composition, and bioactivity of epidermal patches. These developments have broadened the scope of epidermal patches across biomedical and personal-care applications, supporting personalized and adaptive solutions for drug delivery, wound management, tissue regeneration, and skin-related interventions. This review summarizes next-generation printed epidermal patches, covering both conventional (non-microneedle) systems and microneedle-integrated platforms. Particular emphasis is placed on emerging material systems, including self-oxygenating hydrogels, nanomaterial-free bioinks derived from proteins and polysaccharides, and functional nanocomposite formulations. We examine key 3D printing strategies for fabricating acellular constructs, cell-laden matrices, and microneedle array patches (MAPs), alongside recent advances in multidimensional printing technologies. Biomedical applications are discussed with a focus on dermal and transdermal drug delivery, particularly insulin delivery for diabetes management as well as wound repair, regenerative therapies, photodynamic treatments, and biosensing. Additionally, the integration of printed epidermal patches with wearable sensors, smart devices, and artificial intelligence (AI) is highlighted as an emerging frontier in intelligent skin-interfaced systems, with implications for both healthcare and advanced personal-care technologies. Finally, key challenges related to clinical translation, regulatory pathways, and commercialization are addressed, providing strategic insights to guide the advancement of hydrogel-based additive manufacturing from laboratory innovation to real-world clinical and aesthetic applications.

To determine the epidemiology of ranger injuries, risk factors for injury, and health support needs among members of the Game Rangers Association of Africa (GRAA). We employed a retrospective cross-sectional design to collect data online using a questionnaire developed specifically for this study. We used convenience sampling to include 120 rangers aged 18 years or older who were actively working in Africa. Our findings showed a career injury prevalence of 52 % and period prevalence (past 12 months) of 33 %. The lower limb was the most frequently injured anatomical region (38 %), followed by the upper limb (31 %) and trunk (19 %), specifically affecting the hand (19 %), ankle (14 %), and foot (13 %). The most common injury types included skin lacerations (29 %), followed by muscle injuries (23 %), and fractures (10 %). Working for more than 15 years as a ranger is associated with an increased risk for career injury (OR=2.63) compared to working for 10 years or less. Injuries resulted in a median of 7 days (IQR=0-20 days) lost from work, with most injuries requiring either emergency medical care (31 %) or consultation with a medical doctor (26 %). Rangers need better equipment, cardiovascular fitness training programs, safety training, and mental health support. One in every two rangers associated with the GRAA sustains an injury across their careers, with a third of rangers reporting being injured in the past 12 months. Working more than 15 years as a ranger was associated with an increased risk for career injury. Our findings should be used in conjunction with sound clinical reasoning to aid in the development of future injury prevention strategies for rangers working in Africa.

Effective wound care and infection prevention are critical for optimal wound healing. Recent advancements in tissue engineering have focused on developing nanofiber scaffolds using biopolymers, which mimic the natural extracellular matrix and offer enhanced healing properties. This study investigates the fabrication of nanofiber scaffolds composed of elastin (EL) protein and polyvinyl alcohol (PVA) via electrospinning, with honey (H) incorporated for its antibacterial and anti-inflammatory benefits. The morphology of the nanofibers was analyzed using Field Emission Scanning Electron Microscopy (FESEM), and their chemical composition was confirmed by Fourier Transform Infrared Spectroscopy (FTIR). Water vapor transmission rate (WVTR) was measured to evaluate moisture balance. Antibacterial activity was tested against Gram-positive and Gramnegative bacteria, and in vivo studies were conducted on rat models. FESEM analysis revealed uniform, interconnected, bead-free fibers with diameters ranging from 365 to 435 nm. FTIR confirmed the presence and physical integration of elastin and honey in the nanofibers. WVTR values ranged from 400.2 to 413.08 g/m&#xb2;/24 h, ensuring proper gas exchange. The PVA/elastin/honey (PVA/EL/H) nanofibrous mats displayed exceptional antibacterial activity and achieved a wound closure rate of 89.17% by day 14 in rats. The physicochemical tests confirmed the uniform morphology and the presence of elastin and honey in the nanofibers, supporting their structural and bioactive roles and providing a moist environment for treatment. In vitro experiments showed enhanced antibacterial effects and promoted faster wound closure. Finally, the results of in vivo tests (n = 36) confirmed superior healing in the PVA/EL/H group (p < 0.0001). The PVA/EL/H nanofibrous mats are a promising candidate for next-generation wound care solutions due to their combined antibacterial activity and improved wound healing outcomes.

Plasma-activated gas, an emerging technology derived from non-thermal plasma, demonstrates considerable promise in wound management through its rich repertoire of reactive oxygen and nitrogen species. Plasma-activated gas exerts broad-spectrum antimicrobial activity through multi-target mechanisms, effectively eliminating multidrug-resistant pathogens, including methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa, as well as disrupting bacterial biofilm architecture. In tissue repair, plasma-activated gas orchestrates the entire wound healing cascade. It accelerates platelet activation and coagulation, enhances proliferation and migration of epithelial cells and fibroblasts by activating vascular endothelial growth factor receptor-extracellular regulated protein kinases 1/2 and transforming growth factor-&#x3b2;/Smad signaling pathways, promotes angiogenesis via the endothelial nitric oxide synthase- vascular endothelial growth factor axis, and optimizes tissue remodeling by fine-tuning the matrix metalloproteinases and their tissue inhibitors balance. Preclinical and early clinical studies confirm that plasma-activated gas significantly shortens healing time, mitigates scar formation, and effectively controls wound infection. Although challenges remain in standardization, safety profiling, and clinical translation, advances in precise dosing strategies and intelligent device design position plasma-activated gas as a transformative approach for managing refractory chronic wounds. The results and cutting-edge advancements summarized in this review are expected to provide a valuable and forward-looking reference for the subsequent research and development upgrading and clinical translational application of plasma-activated gas. JOURNAL/mgres/04.03/01612956-990000000-00092/figure1/v/2026-04-13T130435Z/r/image-tiff.

Immune checkpoint inhibitors (ICIs) can trigger immune-related adverse events (irAEs), among which Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) is exceptionally rare but potentially fatal. Sintilimab, a PD-1 inhibitor increasingly used for advanced gastric cancer, has only sporadically been linked to SJS/TEN. We report a 60-year-old man with metastatic gastric adenocarcinoma who developed TEN 7 days after the first sintilimab infusion. He presented with rapidly progressive diffuse erythema, bullae, and epidermal detachment involving >90% of the body surface area, accompanied by fever and upper gastrointestinal bleeding leading to hemodynamic instability. Sintilimab was permanently discontinued. Multidisciplinary management was initiated, including intensive fluid and electrolyte resuscitation, high-dose intravenous immunoglobulin, systemic corticosteroids with careful bleeding surveillance, specialized burn-type wound care, tailored anti-infective therapy based on susceptibility testing, and aggressive nutritional support. This case report was prepared in accordance with the CARE (CAse REport) guidelines. Skin lesions gradually re-epithelialized, infection was controlled, and gastrointestinal bleeding stabilized. The patient fully recovered from TEN and was discharged on hospital day 32. No recurrence or secondary infection was observed on follow-up. Although effective for gastric cancer, sintilimab may rarely induce life-threatening TEN. Early recognition, immediate ICI withdrawal, and coordinated multidisciplinary care are pivotal to survival. This case highlights the importance of early recognition, immediate discontinuation of ICIs, and coordinated multidisciplinary management in patients who develop life-threatening cutaneous immune-related adverse events.

Severe burn injuries represent a major global healthcare burden, with high costs and prolonged hospitalizations. Current treatments, including autologous skin grafting, are limited by donor availability, while allografts carry risks of immune rejection. Advanced Therapy Medicinal Products (ATMPs) offer a promising alternative for skin substitution. We evaluated the efficacy of ARTSkin, an alginate-modified bacterial nanocellulose-based ATMP, in a murine model of third-degree burns. ARTSkin was manufactured under good manufacturing practice (GMP) conditions in two formulations: an acellular scaffold and a cellular construct containing human dermal fibroblasts. The acellular formulation was first assessed in vitro for cytotoxicity and wound-healing capacity using a scratch assay. In vivo, acellular and cellular ARTSkin were evaluated in immunocompetent and immunosuppressed mice, respectively. Acellular ARTSkin was non-cytotoxic and enhanced fibroblast migration and proliferation in vitro. Both formulations significantly improved wound healing in vivo, with accelerated closure and reduced bleeding, hyperemia, edema, and crust formation. Transcriptomic analysis showed that cellular ARTSkin modulated genes involved in the proliferative phase of healing by preventing burn-induced dysregulation of Rac1, Vegfa, and Itga4, and downregulating the profibrotic gene Ctgf. These findings support ARTSkin as a promising skin substitute for burn therapy.