Collagen matrix wound dressings and the treatment of DFUs

Objective: To obtain clinical evidence on the use of a collagen wound dressing in patients with diabetic foot ulcers (DFus).   Method: A convenience sample of patients managed in the podiatry outpatient clinic over an 8-month period were included in the evaluation, if their DFus were not progressing. All participants received traditional adjunctive wound care as part of their treatment. Wound surface-area measurements and imaging of patients was carried out on a regular basis to allow the tracking of wound healing. Results: Six patients, with seven wounds were included in this study. There was an overall decrease in wound surface area over time. Three patients showed a relatively swift reduction in wound area, while one patient showed a slight increase in wound area. The percentage decrease in wound area levelled out quite quickly in three patients, with a mean wound duration of 14 months compared with 7.3 months in the remaining four wounds. one patient died of an unrelated cause. Conclusion: This case series evaluation provides a snapshot of experience at one clinical centre and the treatment of DFus, and suggests that an active biological collagen dressing may support progression to healing by modulating the wound environment. l declaration of interest: S. Haycocks and P. Chadwick received supplies of ProHeal from MedSkin Solutions Dr Suwelack for use on patients in this evaluation. K.F. Cutting is a consultant to MedSkin Solutions Dr Suwelack and received a honorarium for his participation. MedSkin Solutions Dr Suwelack did not have any editorial control over the production of this manuscript

Artificial intelligence for automated detection of diabetic foot ulcers: A real-world proof-of-concept clinical evaluation

Objective: Conduct a multicenter proof-of-concept clinical evaluation to assess the accuracy of an artificial intelligence system on a smartphone for automated detection of diabetic foot ulcers. Methods: The evaluation was undertaken with patients with diabetes (n = 81) from September 2020 to January 2021. A total of 203 foot photographs were collected using a smartphone, analysed using the artificial intelligence system, and compared against expert clinician judgement, with 162 images showing at least one ulcer, and 41 showing no ulcer. Sensitivity and specificity of the system against clinician decisions was determined and inter- and intra-rater reliability analysed. Results: Predictions/decisions made by the system showed excellent sensitivity (0.9157) and high specificity (0.8857). Merging of intersecting predictions improved specificity to 0.9243. High levels of inter- and intra-rater reliability for clinician agreement on the ability of the artificial intelligence system to detect diabetic foot ulcers was also demonstrated (Kα > 0.8000 for all studies, between and within raters). Conclusions: We demonstrate highly accurate automated diabetic foot ulcer detection using an artificial intelligence system with a low-end smartphone. This is the first key stage in the creation of a fully automated diabetic foot ulcer detection and monitoring system, with these findings underpinning medical device development

SalmoNet, an integrated network of ten Salmonella enterica strains reveals common and distinct pathways to host adaptation

Salmonella enterica is a prominent bacterial pathogen with implications on human and animal health. Salmonella serovars could be classified as gastro-intestinal or extra-intestinal. Genome-wide comparisons revealed that extra-intestinal strains are closer relatives of gastro-intestinal strains than to each other indicating a parallel evolution of this trait. Given the complexity of the differences, a systems-level comparison could reveal key mechanisms enabling extra-intestinal serovars to cause systemic infections. Accordingly, in this work, we introduce a unique resource, SalmoNet, which combines manual curation, high-throughput data and computational predictions to provide an integrated network for Salmonella at the metabolic, transcriptional regulatory and protein-protein interaction levels. SalmoNet provides the networks separately for five gastro-intestinal and five extra-intestinal strains. As a multi-layered, multi-strain database containing experimental data, SalmoNet is the first dedicated network resource for Salmonella. It comprehensively contains interactions between proteins encoded in Salmonella pathogenicity islands, as well as regulatory mechanisms of metabolic processes with the option to zoom-in and analyze the interactions at specific loci in more detail. Application of SalmoNet is not limited to strain comparisons as it also provides a Salmonella resource for biochemical network modeling, host-pathogen interaction studies, drug discovery, experimental validation of novel interactions, uncovering new pathological mechanisms from emergent properties and epidemiological studies. SalmoNet is available at http://salmonet.org

Evaluating the effect of a haemoglobin spray on size reduction in chronic DFUs

Aim: The aim of this multi-centre observational evaluation was to assess the percentage reduction in wound area of non-healing diabetic foot ulcers (DFUs), treated with Granulox haemoglobin spray over a 4-week period. Secondary outcome parameters—for example, adverse events, patient acceptability and ease of use—were also recorded. Method: After a run-in-period (2 weeks for existing patients and 4 weeks for new patients) to determine if the wounds were non-healing despite receiving local best practice, patients whose foot ulcers had decreased in size by < 20% were then entered into the evaluation. A sample of 17 patients (4 females and 13 males), comprising 4 with type 1 and 13 with type 2 diabetes, with a total of 20 DFUs, met the inclusion criteria. These data were collected from six sites across the UK. Results: There was an overall positive reduction in size in 14 of the wounds, equating to a mean reduction of 53.8% (standard deviation (SD): 26.6; range: 11.9–100%). One participant, with two ulcers, had to be withdrawn due to infection. All clinicians and participants found the product easy to use. Conclusion: The addition of a topical oxygenation therapy in this cohort of non-healing DFUs showed reduction in wound surface area and progression to healing. The product was also found to be acceptable and very easy to use by both participants and clinicians

Recent advances in traceable nanoscale dimension and force metrology in the UK

It is now fully appreciated that metrology will play an integral role in the successful development and commercialization of micro- and nanotechnology. To this end, the UK Government, through the National Measurement System, funded several groundbreaking projects in its 2002–2005 Programme for Length. This paper will briefly describe the background of the research, concentrating on the technical details of the projects. The Programme for Length normally only funds work into dimensional metrology but this funding cycle also funded work into low force metrology as this area is crucial to most mechanical probing techniques. The projects described include a traceable areal contacting instrument designed to calibrate areal transfer artefacts and hence offer traceability for industrial areal instruments, the production of the areal transfer artefacts, the development of Internet-based softgauges for profile parameters, a primary low force balance with a force resolution of 50 pN and the development of methods for measuring complex micro-scale structures. Amongst others, the projects involved collaboration with PTB, TNO, Taylor Hobson, AWE, Rubert & Co. and the Universities of Warwick, Huddersfield and Eindhoven

Network Biology Approaches to Identify Molecular and Systems-Level Differences Between Salmonella Pathovars

The field of systems biology endeavors to map, study, and simulate cellular systems and their underlying mechanisms. The internal mechanisms of biological systems can be represented with networks comprising nodes and edges. Nodes denote the constituents of the biological system whereas edges indicate the relationships among them. Likewise, every layer of cellular organization can be represented by networks. Multilayered networks capture interactions between various network types, such as transcriptional regulatory networks, protein–protein interaction networks, and metabolic networks from the same biological system. This property makes multilayered networks representative of the system while its internal mechanisms are investigated. However, there are not many multilayered networks containing integrated data for nonmodel organisms including the bacterial pathogens Salmonella. Here, we outline the steps to create such an integrated network database, through the example of SalmoNet, the first integrated multilayered data resource for multiple strains belonging to distinct Salmonella serovars