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OBJECTIVE: This study seeks to explain the relationship between systemic conditions and hard exudate formations in diabetic macular edema patients. Besides, the study aimed to quantitatively examine changes in the area, location, and impact on visual function of hard exudates following intravitreal dexamethasone implant injections. METHODS: A retrospective analysis was conducted, including 40 patients (40 eyes) diagnosed with non-proliferative diabetic retinopathy and concurrent macular edema between January 1, 2022, and January 1, 2024. Preoperative evaluations included glycated hemoglobin, lipid profile, and renal function examinations. Based on the location of HE, patients were divided into two groups: Group A, with HE in 1 mm of the central fovea, and Group B, with HE outside 1 mm of the central fovea. Selected eyes were subject to pre- and postoperative examinations, including best-corrected visual acuity (BCVA), intraocular pressure, slit-lamp biomicroscopy, scanning laser ophthalmoscopy (SLO), optical coherence tomography, and multifocal electroretinography. Following screening and examination, patients received an immediate intravitreal injection of the DEX implant, with an injection administered at the four-month mark. Hard exudate (HE) areas were measured utilizing SLO fundus imaging. RESULTS: Total cholesterol, low-density lipoprotein, and triglyceride levels were found to be positively correlated with the presence of HE. Following surgical intervention, all patients demonstrated an improvement in BCVA. The mean BCVA increased from a preoperative measurement of 0.79 ± 0.04 to 0.39 ± 0.02 at the 6 month follow-up, indicating a statistically significant difference (p < 0.001). The baseline HE area for the entire patient cohort was 2.28 ± 0.22. One month post-operation, the HE area exhibited a slight increase to 2.27 ± 0.22. However, by the 6 month follow-up, the HE area had significantly decreased to 0.8 ± 0.87, representing a 35.09% reduction from the baseline measurement (p < 0.001). It is worth noting that Patient P1 did not exhibit a statistically significant difference between preoperative and six-month postoperative HE area (p = 0.032). Preoperative BCVA measurements for Group A and Group B were 0.81 ± 0.03 and 0.77 ± 0.03, respectively, with no statistically significant intergroup difference (p = 0.333). The baseline HE area for Group A was 2.61 ± 0.16, which decreased to 0.38 ± 0.20 at the six-month follow-up, representing a 14.60% reduction from the baseline total area. For Group B, the baseline HE area was measured at 1.95 ± 0.09, then decreasing to 1.21 ± 0.13 at the six-month follow-up, indicating a 62.05% reduction from the baseline total area. A statistically significant difference in the postoperative 6 month HE area was observed between Group A and Group B (p < 0.001). In Group A, the reduction in HE area (initial HE area-final HE area) was positively correlated with the improvement in P1 (initial P1-final P1) (r = 0.610, p = 0.004). In Group B, a similar positive correlation was found (initial HE area-final HE area with initial P1-final P1) (r = 0.488, p = 0.029). In Group B, the reduction in HE area (initial HE area-final HE area) correlated positively with the improvement in BCVA (initial BCVA-final BCVA) (r = 0.615, p = 0.004). Additionally, in Group B, the reduction in HE area (initial HE area-final HE area) was positively correlated with the improvement in CMT (initial CMT-final CMT) (r = -0.725, p< 0.001). Aggravated cataracts were observed in thirteen eyes during a follow-up examination 6 months later. CONCLUSION: HE formation is associated with lipid levels. Dexamethasone implants demonstrate effectiveness in reducing HE areas in the short term, reducing macular edema, improving retinal structure, and enhancing visual function. The incidence of postoperative complications such as cataracts and glaucoma remains low.
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Dexametasona , Retinopatía Diabética , Implantes de Medicamentos , Glucocorticoides , Inyecciones Intravítreas , Edema Macular , Tomografía de Coherencia Óptica , Agudeza Visual , Humanos , Edema Macular/tratamiento farmacológico , Edema Macular/etiología , Edema Macular/diagnóstico , Retinopatía Diabética/tratamiento farmacológico , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/complicaciones , Masculino , Dexametasona/administración & dosificación , Estudios Retrospectivos , Persona de Mediana Edad , Femenino , Glucocorticoides/administración & dosificación , Tomografía de Coherencia Óptica/métodos , Anciano , Exudados y Transudados , Resultado del Tratamiento , Estudios de SeguimientoRESUMEN
OBJECTIVE: Pleural effusion is a common medical problem. It is important to decide whether the pleural fluid is a transudate or an exudate. This study aims to measure the attenuation values of pleural effusions on thorax computed tomography and to investigate the efficacy of this measurement in the diagnostic separation of transudates and exudates. MATERIALS AND METHODS: 380 cases who underwent thoracentesis and thorax computed tomography with pleural effusion were classified as exudates or transudates based on Light's criteria. Attenuation measurements in Hounsfield units were performed through the examination of thorax computed tomography images. RESULTS: 380 patients were enrolled (39 % women), the mean age was 69.9 ± 15.2 years. 125 (33 %) were transudates whereas 255 (67 %) were exudates. The attenuation values of exudates were significantly higher than transudates (15.1 ± 5.1 and 5.0 ± 3.4) (p < 0.001). When the attenuation cut-off was set at ≥ 10 HU, exudates were differentiated from transudates at high efficiency (sensitivity is 89.7 %, specificity is 94.4 %, PPV is 97 %, NPV is 81.9 %). When the cut-off value was accepted as < 6 HU, transudates were differentiated from exudates with 97.2 % specificity. CONCLUSION: The attenuation measurements of pleural fluids can be considered as an efficacious way of differentiating exudative and transudative pleural effusions.
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Exudados y Transudados , Derrame Pleural , Sensibilidad y Especificidad , Tomografía Computarizada por Rayos X , Humanos , Femenino , Derrame Pleural/diagnóstico por imagen , Masculino , Exudados y Transudados/diagnóstico por imagen , Anciano , Diagnóstico Diferencial , Persona de Mediana Edad , Tomografía Computarizada por Rayos X/métodos , Anciano de 80 o más Años , Toracocentesis/métodos , Reproducibilidad de los Resultados , Valores de Referencia , AdultoRESUMEN
OBJECTIVE: This study assessed the cellular composition and effects of leukocyte-platelet-rich fibrin (L-PRF) exudate on whole blood platelets from healthy volunteers. Key objectives included evaluating leukocyte subpopulations, platelet activation markers, platelet-leukocyte interactions and quantifying inflammatory cytokines within the L-PRF exudate. MATERIALS AND METHODS: L-PRF was obtained from 20 healthy donors. Flow cytometry methodologies were used to assess intracellular calcium kinetics and activated GPIIbIIIa, and P-selectin expression. Leukocyte subpopulations and platelet-leukocyte interactions were characterized using monoclonal antibodies. Inflammatory cytokines (IL-8, IL-1ß, IL-6, IL-10, TNF, IL-12p70) within L-PRF exudate were quantified using a cytometric bead array. RESULTS: The expression of activated GPIIbIIIa, and P-selectin exhibited a significant increase (p < 0.001) when L-PRF exudate was added to platelets of whole blood. Regarding intracellular Ca2+ mobilization, the L-PRF exudate elicited significant responses (p < 0.001). L-PRF exudate contained different leukocytes populations, being TCD4 + the most representative of T cells. It was possible to stablish a profile of cytokines produced by the L-PRF exudate, with human IL-8 cytokine exhibiting the highest average (16.90 pg/mL). CONCLUSIONS: Despite the study limitations, the research yielded important insights: 1- L-PRF exudate can stimulate platelet activation, essential in healing, tissue inflammation and remodeling. 2-The presence of leukocyte subpopulations within L-PRF exudate reflexes its complexity and potential to enhance immune responses. 3-The analysis of inflammatory cytokines within L-PRF exudate revealed its immunomodulatory potential. These findings are valuable evidences for understanding the potential role of L-PRF exudate in regenerative dentistry and medicine, offering innovative therapeutic strategies. CLINICAL RELEVANCE: This research highlights crucial aspects that could significantly influence the clinical use of L-PRF exudate in the oral cavity. The findings support the application of L-PRF exudate in both surgical and regenerative dentistry, facilitating the development of innovative therapeutic strategies to enhance patient outcomes.
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Plaquetas , Citocinas , Exudados y Transudados , Citometría de Flujo , Fibrina Rica en Plaquetas , Humanos , Masculino , Citocinas/metabolismo , Femenino , Adulto , Voluntarios Sanos , Activación Plaquetaria , Leucocitos , Biomarcadores/sangreRESUMEN
PURPOSE: Diabetic macular edema is one of the leading causes of vision loss across the world. Hard exudates at the macula can lead to structural abnormalities in the retina leading to irreversible vision loss. Systemic dyslipidemia and other modifiable risk factors when identified and treated early may help prevent substantial vision loss. The purpose of this study was to study the association between serum lipid levels and other systemic risk factors like hemoglobin, HbA1c, and serum creatinine with hard exudates and macular edema in patients with diabetic retinopathy. METHODS: It is a prospective cross-sectional study conducted in a tertiary health care center in South India. 96 patients having diabetic retinopathy with hard exudates were included. Modified Airlie house classification was used to grade the hard exudates. Blood investigations including serum lipid profile, hemoglobin, HbA1c, and serum creatinine were carried out. Central subfield macular thickness was measured using optical coherence tomography. RESULTS: 96 patients of type II DM with diabetic retinopathy were divided into three groups of hard exudates. A statistically significant correlation was observed between the severity of hard exudates and total cholesterol (p = 0.00), triglycerides (p = 0.00), LDL (p = 0.00), and VLDL (p = 0.00). HbA1c levels showed a statistically significant correlation with the severity of hard exudates (p = 0.09), no significant correlation was noted between hard exudates and hemoglobin levels (p = 0.27) and with serum creatinine (p = 0.612). A statistically significant association between CSMT and hard exudates (p = 0.00) was noted. CONCLUSION: In our study, we concluded that the severity of hard exudates is significantly associated with increasing levels of serum total cholesterol, triglycerides, LDL, VLDL, and HbA1c levels in type II DM patients presenting with diabetic retinopathy. The increasing duration of diabetes is significantly associated with increasing severity of hard exudates. Central subfield macular thickness increases with increasing severity of hard exudates in diabetic retinopathy.
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Retinopatía Diabética , Exudados y Transudados , Lípidos , Tomografía de Coherencia Óptica , Humanos , Retinopatía Diabética/sangre , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/etiología , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Tomografía de Coherencia Óptica/métodos , Lípidos/sangre , Edema Macular/etiología , Edema Macular/sangre , Edema Macular/diagnóstico , India/epidemiología , Anciano , Hemoglobina Glucada/metabolismo , Hemoglobina Glucada/análisis , Adulto , Agudeza Visual , Biomarcadores/sangreRESUMEN
OBJECTIVE: Managing the gap between the dressing and the wound bed can facilitate the healing of exuding wounds. A silicone foam dressing (Biatain Silicone; Coloplast A/S, Denmark) was developed for application to exuding wounds. A sub-analysis of the real-world, prospective, observational VIPES (Observatoire en Ville des Plaies ExSudatives) study was conducted to investigate the use and performance of the silicone foam dressing in a community nursing setting in France. METHOD: The sub-analysis included patients from the VIPES study who received the silicone foam dressing as a primary dressing for an acute or hard-to-heal (chronic) wound. Epidemiological and wound healing outcomes were reported via a smartphone application. RESULTS: Overall, 64 patients were included in the sub-analysis. At baseline, most wounds (n=33/40; 82.5%) were in treatment failure (i.e., were stagnant, non-healing or had poor exudate management). At the last follow-up visit, a median of 22.5 (range: 3-151) days post baseline, 48.4% of wounds had healed and 25.0% were progressing towards healing. From baseline to the last follow-up visit, significant reductions in exudate level (p<0.0001) and exudate pooling (p<0.0001), and significant improvements in wound edges (p≤0.0001) and periwound skin (p<0.01) were observed. A total of 62.3% of patients had re-epithelialising wounds at the last follow-up visit. The majority of nurses (88.3%) and patients (85.0%) reported that the wound had improved and, at most dressing removals (93.5%), nurses reported that the dressing conformed closely to the wound bed. CONCLUSION: Overall, the data suggest that use of the silicone foam dressing in community practice supported the healing of wounds, illustrating the importance of exudate and gap management.
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Siliconas , Cicatrización de Heridas , Humanos , Femenino , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Anciano , Adulto , Anciano de 80 o más Años , Heridas y Lesiones/terapia , Exudados y Transudados , Francia , VendajesAsunto(s)
Drenaje , Fluorocarburos , Desprendimiento de Retina , Telangiectasia Retiniana , Humanos , Desprendimiento de Retina/diagnóstico , Desprendimiento de Retina/cirugía , Desprendimiento de Retina/etiología , Fluorocarburos/administración & dosificación , Drenaje/métodos , Telangiectasia Retiniana/diagnóstico , Telangiectasia Retiniana/complicaciones , Masculino , Cristalino , Exudados y Transudados , Agudeza Visual , Endotaponamiento/métodosRESUMEN
OBJECTIVE: To evaluate the use and performance of a gelling fibre dressing (Biatain Fiber; Coloplast A/S, Denmark) in the management of wounds in community nursing practice. METHOD: A sub-analysis of the prospective, observational, real-world VIPES (Observatoire en Ville des Plaies ExSudatives) study was conducted. Patients with exuding wounds, for which nurses chose to apply the gelling fibre as a primary dressing, were included. Outcomes included assessments of wound condition and patient/nurse opinion. RESULTS: Overall, 149 patients with acute (n=52; 34.9%) or hard-to-heal (chronic) (n=97; 65.1%) wounds were included. At baseline, mean±standard deviation wound age was 351.5±998.2 days, 108 (72.5%) wounds were moderately-to-highly exuding, and 126 (84.6%) showed exudate pooling in the wound bed. At the last follow-up visit, 29 (19.5%) wounds had healed, within a median of 36 days, and 64 (43.0%) were progressing towards healing. From baseline to the last follow-up visit, significant reductions in wound surface area (p<0.05), depth (p<0.01), exudate level (p<0.0001), and in the proportion of wounds with sloughy tissue (p<0.0001) were observed. Most wounds had no (n=86; 58.5% (two missing values)) or low exudate pooling (n=45; 30.6% (two missing values)) at the last visit and proportions of patients with healthy wound edges/periwound skin increased from baseline. At the last visit, wounds were considered improved by nurses in 71.4% (n=105) of cases, and by patients in 66.7% (n=98) of cases (two patients missing). CONCLUSION: Patients who received treatment with the gelling fibre experienced improvements in the condition of a range of complex wounds. This analysis highlights the importance of adequate exudate management, and indicates how the selection of an appropriate wound dressing can encourage healing progression. DECLARATION OF INTEREST: This study was financially supported by Laboratoires Coloplast SAS, Paris, France. Coloplast A/S funded the writing and editing of the article and contributed to its content. Coloplast A/S and Laboratoires Coloplast SAS reviewed the article for scientific accuracy. Nurses received financial compensation for their participation in the study. NA is a full-time employee of Coloplast A/S. APJ was an employee of Coloplast A/S when this article was written. FA was a full-time employee of Laboratoires Coloplast SAS at the time of publication development. RS and CJ are full-time employees of CEN Biotech. AK received an educational grant from Coloplast A/S to provide scientific input to the publication. The authors have no other conflicts of interest to declare.
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Cicatrización de Heridas , Humanos , Femenino , Masculino , Estudios Prospectivos , Persona de Mediana Edad , Anciano , Heridas y Lesiones/terapia , Exudados y Transudados , Adulto , Vendajes , Anciano de 80 o más AñosRESUMEN
The purpose of the study was to detect Hard Exudates (HE) and classify Disorganization of Retinal Inner Layers (DRIL) implementing a Deep Learning (DL) system on optical coherence tomography (OCT) images of eyes with diabetic macular edema (DME). We collected a dataset composed of 442 OCT images on which we annotated 6847 HE and the presence of DRIL. A complex operational pipeline was defined to implement data cleaning and image transformations, and train two DL models. The state-of-the-art neural network architectures (Yolov7, ConvNeXt, RegNetX) and advanced techniques were exploited to aggregate the results (Ensemble learning, Edge detection) and obtain a final model. The DL approach reached good performance in detecting HE and classifying DRIL. Regarding HE detection the model got an AP@0.5 score equal to 34.4% with Precision of 48.7% and Recall of 43.1%; while for DRIL classification an Accuracy of 91.1% with Sensitivity and Specificity both of 91.1% and AUC and AUPR values equal to 91% were obtained. The P-value was lower than 0.05 and the Kappa coefficient was 0.82. The DL models proved to be able to identify HE and DRIL in eyes with DME with a very good accuracy and all the metrics calculated confirmed the system performance. Our DL approach demonstrated to be a good candidate as a supporting tool for ophthalmologists in OCT images analysis.
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Aprendizaje Profundo , Retinopatía Diabética , Exudados y Transudados , Edema Macular , Retina , Tomografía de Coherencia Óptica , Tomografía de Coherencia Óptica/métodos , Humanos , Retinopatía Diabética/diagnóstico por imagen , Retinopatía Diabética/patología , Edema Macular/diagnóstico por imagen , Exudados y Transudados/diagnóstico por imagen , Retina/diagnóstico por imagen , Retina/patología , Redes Neurales de la Computación , Procesamiento de Imagen Asistido por Computador/métodosRESUMEN
Negative pressure wound therapy is currently one of the most popular treatment approaches that provide a series of benefits to facilitate healing, including increased local blood perfusion with reduced localized oedema and control of wound exudate. The porous foam dressing is a critical element in the application of this therapy and its choice is based on its ability to manage exudate. Industry standards often employ aqueous solutions devoid of proteins to assess dressing performance. However, such standardized tests fail to capture the intricate dynamics of real wounds, oversimplifying the evaluation process. This study aims to evaluate the technical characteristics of two different commercial polyurethane foam dressings during negative pressure wound therapy. We introduce an innovative experimental model designed to evaluate the effects of this therapy on foam dressings in the presence of viscous exudates. Our findings reveal a proportional increase in dressing fibre occupancy as pressure intensifies, leading to a reduction in dressing pore size. The tests underscore the pressure system's diminished efficacy in fluid extraction with increasing fluid viscosity. Our discussion points to the need of establishing standardized guidelines for foam dressing selection based on pore size and the necessity of incorporating real biological exudates into industrial standards.
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Exudados y Transudados , Microscopía Confocal , Terapia de Presión Negativa para Heridas , Poliuretanos , Cicatrización de Heridas , Terapia de Presión Negativa para Heridas/métodos , Humanos , Viscosidad , Microscopía Confocal/métodos , Vendajes , Heridas y Lesiones/terapiaRESUMEN
The monitoring of biomarkers in wound exudate is of great importance for wound care and treatment, and electrochemical biosensors with high sensitivity are potentially useful for this purpose. However, conventional electrochemical biosensors always suffer from severe biofouling when performed in the complex wound exudate. Herein, an antifouling electrochemical biosensor for the detection of involucrin in wound exudate was developed based on a wound dressing, oxidized bacterial cellulose (OxBC) and quaternized chitosan (QCS) composite hydrogel. The OxBC/QCS hydrogel was prepared using an in-situ chemical oxidation and physical blending method, and the proportion of OxBC and QCS was optimized to achieve electrical neutrality and enhanced hydrophilicity, therefore endowing the hydrogel with exceptional antifouling and antimicrobial properties. The involucrin antibody SY5 was covalently bound to the OxBC/QCS hydrogel to construct the biosensor, and it demonstrated a low limit of detection down to 0.45 pg mL-1 and a linear detection range from 1.0 pg mL-1 to 1.0 µg mL-1, and it was capable of detecting targets in wound exudate. Crucially, the unique antifouling and antimicrobial capability of the OxBC/QCS hydrogel not only extends its effective lifespan but also guarantees the sensing performance of the biosensor. The successful application of this wound dressing, OxBC/QCS hydrogel for involucrin detection in wound exudate demonstrates its promising potential in wound healing monitoring.
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Técnicas Biosensibles , Celulosa , Quitosano , Técnicas Electroquímicas , Oxidación-Reducción , Quitosano/química , Celulosa/química , Incrustaciones Biológicas/prevención & control , Humanos , Hidrogeles/química , Exudados y Transudados/química , Límite de DetecciónRESUMEN
The annual cost to the NHS of managing 3.8 million patients with a wound was estimated in 2020 to be £8.3 billion, of which £5.6 billion was spent on the 30% of wounds that did not heal and £2.7 billion on the 70% of wounds that healed (Guest, 2020). One of the main symptoms associated with chronic 'hard-to-heal' wounds is the production of excess exudate (Atkin et al, 2019). This is due to a prolonged chronic inflammatory response stimulated by a physiological cause. This article describes what exudate is and its importance in the wound healing process, highlighting the consequences of too little or excessive wound exudate associated with any wound. The article goes on to describe a case series observational study involving a range of patients (n=47; 33 male/14 female), aged between 33 and 91 years (mean 67.4 years), with a variety of acute (n=11) and chronic exuding wounds (n=44). In total, 55 wounds of various aetiologies were managed with DryMax Super (a dressing whose design includes superabsorbent polymers) in order to evaluate and report on the absorption and fluid-handling properties of the product.
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Vendajes , Exudados y Transudados , Cicatrización de Heridas , Heridas y Lesiones , Humanos , Anciano , Masculino , Anciano de 80 o más Años , Persona de Mediana Edad , Femenino , Adulto , Heridas y Lesiones/terapiaRESUMEN
Purpose: The purpose of this study was to investigate the clinical role of multi-signal quantitative optical coherence tomography angiography (OCTA) perfusion sampling in neovascular age-related macular degeneration (AMD). Methods: The study was designed as a cross-sectional case series. We collected data from already treated macular neovascularization (MNV), characterized by (I) clinically relevant recurrent exudation, (II) nonclinically relevant recurrent exudation, and (III) inactive lesion. We proposed a new OCTA metric, calculating the gap between high-resolution (HR) and high-speed (HS) OCTA samplings, hypothesizing that this gap might improve the detection of new secondary MNV branches, being also associated with exudation recurrence. Main outcome measures were the HR-HS gap-based categorization of MNV lesions and the assessment of its association with exudative, minimally exudative, and inactive lesions. Results: Our cohort (which consisted of 32 MNV eyes; 32 patients; mean disease duration 5 years) was classified as type 1 (17; 53%), type 2 (11; 34%), or mixed type (4; 13%) MNV. Subretinal fibrosis was found in 17 out of 32 eyes (53%), whereas outer retinal atrophy involved 22 of 32 eyes (69%). HR-HS MNV gap was significantly different among MNV subgroups: 18% for the exudative subgroup, 12% for the minimally exudative subgroup, and 4% for the inactive subgroup. HR-HS gap significantly correlated with best corrected visual acuity (BCVA), disease duration, fibrosis, and outer retinal atrophy. Conclusions: HR-HS gap is a novel quantitative metric to detect the secondary novel branches of AMD-related MNV. This parameter is clinically relevant because it is associated with fluid recurrence. The integration of HR-HS gap in artificial intelligence models might help to predict MNV reactivation and to optimize treatment strategies.
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Angiografía con Fluoresceína , Recurrencia , Tomografía de Coherencia Óptica , Agudeza Visual , Degeneración Macular Húmeda , Humanos , Tomografía de Coherencia Óptica/métodos , Masculino , Femenino , Estudios Transversales , Anciano , Degeneración Macular Húmeda/diagnóstico , Angiografía con Fluoresceína/métodos , Anciano de 80 o más Años , Agudeza Visual/fisiología , Inhibidores de la Angiogénesis/uso terapéutico , Fondo de Ojo , Estudios Retrospectivos , Persona de Mediana Edad , Exudados y TransudadosRESUMEN
OBJECTIVE: The aim of this systematic review was to identify and qualify the current available evidence of the wound exudate handling capabilities and the cost-effectiveness of hydration response technology (HRT). HRT combines physically modified cellulose fibres and gelling agents resulting in wound dressings that absorb and retain larger quantities of wound exudate. METHOD: A systematic search was conducted in MEDLINE (via PubMed and PubMed Central) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The search was conducted using an unlimited search period. Studies or reviews that evaluated effect on wound exudate and cost-effectiveness, as well as the impact on wound healing were considered. Records focusing on wound management using HRT devices were included. RESULTS: The literature search identified four studies and one comparative analysis, ranging from low to moderate quality, that compared HRT dressings to other interventions (carboxymethyl cellulose dressing, other superabsorbent dressings, negative pressure wound therapy). CONCLUSION: The analysed data supported the beneficial use of dressings with HRT for exuding wounds which was characterised by fewer dressing changes, improved periwound skin conditions and reduced costs.
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Vendajes , Exudados y Transudados , Cicatrización de Heridas , Heridas y Lesiones , Humanos , Heridas y Lesiones/terapia , Análisis Costo-BeneficioRESUMEN
Diabetic retinopathy's signs, such as exudates (EXs) and aneurysms (ANs), initially develop from under the retinal surface detectable from optical coherence tomography (OCT) images. Detecting these signs helps ophthalmologists diagnose DR sooner. Detecting and segmenting exudates (EXs) and aneurysms (ANs) in medical images is challenging due to their small size, similarity to other hyperreflective regions, noise presence, and low background contrast. Furthermore, the scarcity of public OCT images featuring these abnormalities has limited the number of studies related to the automatic segmentation of EXs and ANs, and the reported performance of such studies has not been satisfactory. This work proposes an efficient algorithm that can automatically segment these anomalies by improving key steps in the process. The potential area where these hyper-reflective EXs and ANs occur was scoped by our method using a deep-learning U-Net++ program. From this area, the candidates for EX-AN were segmented using the adaptive thresholding method. Nine features based on appearances, locations, and shadow markers were extracted from these candidates. They were trained and tested using bagged tree ensemble classifiers to obtain only EX-AN blobs. The proposed method was tested on a collection of a public dataset comprising 80 images with hand-drawn ground truths. The experimental results showed that our method could segment EX-AN blobs with average recall, precision, and F1-measure as 87.9%, 86.1%, and 87.0%, respectively. Its F1-measure drastically outperformed two comparative methods, binary thresholding and watershed (BT-WS) and adaptive thresholding with shadow tracking (AT-ST), by 78.0% and 82.1%, respectively.
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Algoritmos , Aneurisma , Retinopatía Diabética , Exudados y Transudados , Tomografía de Coherencia Óptica , Tomografía de Coherencia Óptica/métodos , Humanos , Exudados y Transudados/diagnóstico por imagen , Retinopatía Diabética/diagnóstico por imagen , Retinopatía Diabética/patología , Aneurisma/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Aprendizaje ProfundoAsunto(s)
Antibacterianos , Exantema , Linfoma Folicular , Piel , Síndrome de Stevens-Johnson , Anciano , Femenino , Humanos , Diagnóstico Diferencial , Exantema/etiología , Piel/patología , Dolor/etiología , Tomografía Computarizada por Rayos X , Exudados y Transudados/diagnóstico por imagen , Canal Anal/diagnóstico por imagen , Antibacterianos/efectos adversos , Antibacterianos/uso terapéutico , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/tratamiento farmacológico , Síndrome de Stevens-Johnson/etiología , Combinación Amoxicilina-Clavulanato de Potasio/efectos adversos , Combinación Amoxicilina-Clavulanato de Potasio/uso terapéutico , Doxiciclina/efectos adversos , Doxiciclina/uso terapéutico , Perineo , Abdomen , Negro o Afroamericano , Biopsia , Linfoma Folicular/complicaciones , Linfoma Folicular/diagnóstico , Linfadenopatía InmunoblásticaRESUMEN
Effective fluid handling by wound dressings is crucial in the management of exuding wounds through maintaining a clean, moist environment, facilitating healing by removing excess exudate and promoting tissue regeneration. In this context, the availability of reliable and clinically relevant standardised testing methods for wound dressings are critical for informed decision making by clinicians, healthcare administrators, regulatory/reimbursement bodies and product developers. The widely used standard EN 13726 specifies the use of Solution A, an aqueous protein-free salt solution, for determining fluid-handling capacity (FHC). However, a simulated wound fluid (SWF) with a more complex composition, resembling the protein, salt, and buffer concentrations found in real-world clinical exudate, would provide a more clinically relevant dressing performance assessment. This study compared selected physicochemical parameters of Solution A, an alternative, novel simulated wound fluid (SWF A), and a benchmark reference serum-containing solution (SCS) simulating chronic wound exudate. Additionally, FHC values for eight advanced bordered and non-bordered foam dressings were determined for all three test fluids, following EN 13726. Our findings demonstrate a close resemblance between SWF A and SCS. This study highlights the critical importance of selecting a physiochemically appropriate test fluid for accurate FHC testing resulting in clinically meaningful evaluation of dressing performance.
Asunto(s)
Vendajes , Exudados y Transudados , Cicatrización de Heridas , Heridas y Lesiones , Humanos , Exudados y Transudados/química , Heridas y Lesiones/terapiaRESUMEN
OBJECTIVE: Using a dressing that expands and conforms to the wound bed upon exudate absorption is one of the best ways to promote wound healing. While many products claim wound bed conformability, no externally replicated or verified test methodology had been developed to quantify a wound dressing's ability to conform to the wound bed. The Relative Swelling Rise (RSR) test methodology was developed to measure the relative swelling rise of foam dressings upon fluid absorption, and offers a quantifiable and easily replicated method to measure wound bed conformability. METHOD: The RSR test method was developed, validated and reliability tested by Coloplast A/S, Denmark. External replication was provided by ALS Odense, Denmark (previously DB Lab). Circular fences provide a fixed diameter to apply and contain the fluid and prevent horizontal spreading in the test set-up. The swelling height is quantified relative to the fence's inner diameter, i.e., the ratio alpha (α), and allows evaluation of a material's ability to conform to the wound bed. RESULTS: Biatain Silicone foam products (n=3, Coloplast A/S, Denmark) were tested, all afforded an average α-ratio from 0.30 to 0.60. The relative standard deviations were between 1-3%, demonstrating the strength of the test. Robustness of the methodology was demonstrated through the internal validation study, the reliability study, and both an internal and external replication study, as well as a systematic literature review and expert review of the construct, content, criterion and generalisability of the method. CONCLUSION: Having a validated, effective and easily replicable testing method to quantify wound bed conformability of foam dressings is an important step towards achieving better healing outcomes.