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Surgical site infections (SSIs) remain among the most frequent healthcare-associated infections worldwide and are associated with significant morbidity, mortality, and healthcare costs. Despite availability of evidence-based guidelines, adherence to SSI prevention measures varies substantially across countries and institutions. In Ukraine, reliable data describing SSI prevention practices remain limited due to absence of nation-wide monitoring of infection prevention and control practices. We conducted two rounds of a national survey among surgeons and anaesthesiologists in Ukraine in 2021 and 2025. The survey was based on the World Health Organization (WHO) Global Guidelines for the Prevention of Surgical Site Infection (2018 edition) and assessed knowledge, attitudes, and self-reported adherence to recommended and non-recommended SSI prevention practices. Both surveys were distributed online via professional societies' platforms, targeting practicing surgeons and anaesthesiologists across different levels of healthcare facilities. In 2021, a total of 294 responses were received, followed by 145 responses in 2025. Across both survey periods, respondents represented a wide range of clinical specialties and geographic regions, with anaesthesiologists comprising the majority. In the 2025 survey, perioperative antimicrobial prophylaxis was reported as universally practiced (100%). In addition, active intraoperative warming was implemented by 82.6% of respondents and goal-directed fluid therapy by 93.8%. Despite these encouraging figures, several evidence-based measures were only partially adopted. For instance, alcohol-based chlorhexidine for skin preparation was used by 51%, surgical hand preparation with antiseptic soap by 60%, and intensive perioperative blood glucose control by 71.7% of respondents. Conversely, certain non-recommended practices, such as extended antimicrobial prophylaxis after surgery, remained prevalent, with 82.6% of respondents reporting its use. Although self-rated knowledge of WHO guidelines was generally high, notable gaps between awareness and actual practice were observed. This national survey, conducted in two rounds (2021 and 2025), was instrumental in understanding which SSI prevention practices are currently used in Ukraine. The continued use of non-recommended practices remains evident. These results underscore the need for targeted educational interventions, systematic monitoring, and strengthened institutional support to improve adherence to evidence-based guidelines and ultimately reduce the burden of SSIs nationwide.

Diabetic wounds often arise from a dysregulated wound microenvironment characterized by persistent inflammation, impaired angiogenesis, and aberrant macrophage polarization, leading to delayed healing and severe disability. In this study, we fabricated a stem cell-derived artificial nanovesicles-salidroside@gelatin methacryloyl/polyvinyl alcohol composite microneedle system (CNV-Sa@GelMA/PVA-MN) composed of a GelMA/PVA hydrogel matrix integrated with salidroside loaded stem cell-derived artificial nanovesicles to achieve efficient therapy for diabetic wound. The system penetrated the skin barrier for precise delivery, with stem cell-derived artificial nanovesicles enabling sustained salidroside release and collectively enhancing its anti-inflammatory and pro-angiogenic activities in vitro. Mechanistically, network pharmacology, molecular dynamics simulations, and proteomics revealed the system suppressed the NF-κB pathway, promoted macrophage M1 to M2 polarization, and alleviated inflammatory responses. In vivo experiments confirmed it significantly accelerated wound closure and inhibited inflammatory factor release. These findings highlighted a promising strategy for diabetic wound therapy through inflammatory microenvironment regulation and coordinated tissue repair.

The global transition from non-alcoholic fatty liver disease (NAFLD) to steatotic liver disease (SLD), encompassing metabolic dysfunction-associated steatotic liver disease (MASLD), metabolic dysfunction-associated steatohepatitis (MASH), and metabolic dysfunction-associated alcohol-related liver disease (Met-ALD), aims to improve pathophysiologic accuracy and reduce stigma. Asia-Pacific countries have been early adopters of metabolic dysfunction-associated fatty liver disease (MAFLD), which has demonstrated strong prognostic performance and operational simplicity. How MASLD implementation aligns with existing MAFLD-oriented clinical practice in the region remains unclear. A 27-item cross-sectional survey was distributed to clinicians across 19 Asia-Pacific regions to assess readiness to adopt SLD terminology. Respondents evaluated willingness across clinical practice, research, patient education, and stigma-reduction domains. Additional items explored metabolic syndrome (MetS) definitions, alcohol-assessment practices, and access to fibrosis testing. Multivariable ordered logistic regression identified predictors of adoption. Among 462 respondents, gastroenterology and hepatology specialists demonstrated greater willingness to adopt MASLD across clinical management (p = 0.0194), research (p = 0.0208), and patient education (p = 0.0157). Alcohol assessment showed operational gaps, with lower effort among non-specialists (≥1 min: 35.6% vs 26.5%), potentially complicating Met-ALD classification. Definitions of MetS were heterogeneous, and access to fibrosis assessment differed, with specialists reporting higher use of vibration-controlled transient elastography, magnetic resonance elastography, and corrected T1 imaging (adjusted odds ratio 2.18-2.41). Successful regional implementation of MASLD will require alignment with MAFLD-informed practice, improved exposure to evolving nomenclature, operationally feasible workflows, strengthened alcohol assessment, and enhanced access to fibrosis testing to ensure coherent SLD adoption across primary care and specialist settings.

This cross-sectional study compares prices across US facilities and insurance plans for 15 dermatologic procedures.

Surgical site infections represent a prevalent postoperative complication, significantly impacting patient safety and increasing the burden on healthcare resources. As a key measure for preventing these infections, preoperative skin antisepsis plays a crucial role. However, current meta-analyses and international guidelines have yet to reach a unified agreement on the optimal type and concentration of antiseptic preparation. This study aims to compare the efficacy of chlorhexidine in alcohol and aqueous povidone-iodine in preventing surgical site infections through systematic review and meta-analysis. A systematic search was conducted in PubMed, Embase, Cochrane Library, and Web of Science databases for randomized controlled trials (RCTs) comparing the preoperative skin antisepsis effects of chlorhexidine in alcohol and aqueous povidone-iodine up to May 31, 2025. The primary outcome was the incidence of surgical site infections, while secondary outcomes included adverse events. Subgroup analyses were conducted according to chlorhexidine concentration, wound classification, and surgical category. The meta-analysis was conducted using R software, with a statistical threshold of P < 0.05 for significance. To evaluate the robustness of the findings, sensitivity analysis and trial sequential analysis (TSA) were conducted. The meta-analysis included 17 RCTs involving 13,737 patients. The results revealed that chlorhexidine in alcohol was significantly more effective than aqueous povidone-iodine in preventing surgical site infections (RR = 0.84, 95% CI: 0.73-0.95, P < 0.01; I² = 14%). Subgroup analyses further demonstrated that 2.0%-2.5% chlorhexidine in alcohol (RR = 0.83, 95% CI: 0.71-0.97, P = 0.02; I² = 32%) was associated with a lower SSI risk than aqueous povidone-iodine. Furthermore, in non-clean surgery (RR = 0.85, 95% CI: 0.75-0.97, P = 0.01; I² = 0%) and general surgery (RR = 0.70, 95% CI: 0.53-0.92, P = 0.01; I² = 65%), chlorhexidine in alcohol was associated with a significantly lower SSI risk. Sensitivity analyses showed consistent results across individual studies, and TSA suggested that the accumulated evidence has reached the required information size. However, the interpretation of subgroup findings should consider residual heterogeneity in some subgroups and the risk of bias of included trials. Compared with aqueous povidone-iodine, chlorhexidine in alcohol was associated with a lower risk of surgical site infections, particularly in non-clean surgery and at chlorhexidine concentrations of 2.0%-2.5%.

The prevalence of steatotic liver disease (SLD) with fibrosis in patients with psoriasis is unknown and no consensus on screening exists. Therefore, patients from The Copenhagen Translational Skin Immunology Biobank and Research Programme (BIOSKIN) were examined. SLD was defined as controlled attenuation parameter (CAP) > 250 dB/m and fibrosis as median liver stiffness measurement (LSM) ≥ 8 kPa using transient elastography. Biomarkers included fibrosis-4 index (FIB-4), N-terminal propeptide of collagen (type III), and enhanced liver fibrosis (ELF) test. A total of 403 patients (median age 51 years, 54% men, median BMI 27), 80% with moderate-to-severe psoriasis were enrolled. Based on the transient elastography, 40% of the patients had steatosis (mean CAP 245, ± 55 dB/m) and 5% had fibrosis (median LSM 4.8 kPa, IQR 3.8-5.8). According to self-reported alcohol consumption, all patients with steatosis except for 2 were categorized as having metabolic dysfunction-associated steatotic liver disease (MASLD). With transient elastography as the reference, FIB-4 and ELF had better diagnostic accuracy than PIIINP with Area Under the Receiver Operating Characteristic Curve (AUROC) of 0.92 (95% confidence interval 0.87-0.97) for FIB-4, 0.90 (0.83-0.97) for ELF test, and 0.77 (0.66-0.87) for PIIINP.

The present study develops a comprehensive computational framework to model the coupled transport, deposition, and release behaviour of Ibuprofen-loaded (IBU) core-shell sub-micron particles (MPs) delivered by dual-channel hollow microneedles (HMNs). The model integrates laminar fluid flow within the MN lumen and Darcy-based porous flow in the viable epidermis (VE) and dermis layers of the skin. In addition, the model incorporates advection-diffusion of the dissolved drug (IBU) after release from the core-shell particles, along with Lagrangian particle transport and core- and shell-controlled drug release kinetics. The setup allows simultaneous evaluation of particle transport, deposition, residence time, and spatial drug-release profiles. The effects of polymer chemistry, particle size (2 to 8 μm), dual-channel HMN lumen diameter (40 to 70 μm), and needle array configuration have been systematically investigated. Core and shell particles made of polyvinyl alcohol (PVA), polylactic acid (PLA), and polyglycolic acid (PGA) have been used in this study. It has been found that material and size dependent transport occurs, with PVA shells enabling rapid penetration and early release, whereas PGA shells promote sustained delivery. Smaller particles accumulate and release more drug due to greater penetration through the porous skin microstructure, whereas larger particles exhibit transport limitations. An increase in dual-channel lumen diameter from 40 μm to 70 μm resulted in greater penetration through the porous skin microstructure, whereas larger particles exhibited an 80% rise in particle deposition and a corresponding increase in cumulative IBU release from 18% to 32.4%. Increasing HMN array density enhances parallel transport channels, resulting in a significant increase in drug release from 8% for a single needle to 50.64% for a 4 × 4 array at 500 s, corresponding to a more than six-fold improvement. Overall, this study presents a mechanistic, particle-resolved modelling approach that enhances understanding of HMN-mediated TDD and informs rational system design.

Chronic skin wounds with delayed healing due to underlying disorders necessitate advanced dressings. Thus, this study aimed to develop a nanofibrous dressing loaded with selenium nanoparticles (Se NPs) and quercetin (Que) to accelerate the wound healing process. The combination was designed to exploit the complementary antioxidant and anti-inflammatory properties of Se NPs and quercetin, which together help modulate oxidative stress and promote tissue regeneration. First, Se NPs were synthesized, characterized, and co-loaded with quercetin into PVA/CS nanofibers via electrospinning. Their properties, antioxidant activity, and release profile were assessed, and wound healing was evaluated in a full-thickness rat model with histopathological validation. The synthesized Se NPs demonstrated nanoscale dimensions with a uniform, spherical morphology. Electrospinning of PVA/CS nanofibers loaded with Se NPs and Que at 10 wt% (1:1 ratio) produced fibers with an average diameter of 312 ± 43 nm, exhibiting a ribbon-like structure without droplets or beads. The nanofibers exhibited high porosity, fluid absorption, and full wettability, with strong antioxidant activity and a sustained 72-hour release profile. Animal wound healing assessments demonstrated the highest healing rate and wound closure, averaging around 98%, after 14 days. Histopathological evaluations further confirmed the complete regeneration of skin layers and significant tissue repair. The Se NPs-quercetin nanofibrous mat shows strong potential as a multifunctional dressing for enhanced wound healing and skin regeneration.

In the study, the morphological and structural properties of bunches and berries, as well as the chemical characterisation of three interspecific grapevine cultivars-'Bronner', 'Muscaris', and 'Morava'-were studied. Sugars and organic acids in the grapes were analysed using high-performance liquid chromatography (HPLC), while phenolic compounds were analysed by HPLC-mass spectrometry. 'Morava' and 'Muscaris' showed higher Hue angle values, indicating a greener skin coloration compared with 'Bronner', which exhibited a more yellow skin colour. 'Muscaris' and 'Bronner' had higher bunch weights than 'Morava', while the 100-berry weight did not differ significantly among the varieties. 'Bronner' must had the highest titratable acidity, and 'Muscaris' had the highest sugar content. Flavanols were the main phenolic compounds in the grapes, accounting for 76-88% of the total phenolic content. The highest concentrations of flavanols and caftaric acid were found in 'Bronner' and 'Muscaris' berries, while 'Morava' had the highest flavonol content. All studied varieties achieved good grape and must quality and are therefore recommended for wine production. 'Bronner' and 'Muscaris' stood out for their high bunch weight and high concentrations of flavanols and total phenolics, which contribute significantly to wine taste and overall quality. 'Muscaris' berries had a high sugar content, making this variety suitable for producing wines with higher alcohol content. In contrast, 'Bronner' is recommended for wines requiring higher acidity levels.

Background/Objectives : Primary cytoreductive surgery for advanced ovarian cancer is associated with a high risk of postoperative complications, particularly surgical site infections, which may delay recovery and adjuvant treatment. This study aimed to evaluate the impact of a revised infection-prevention bundle, centered on chlorhexidine-alcohol skin antisepsis, on surgical site infection rates and cost-effectiveness. Methods : In this single-center cohort study, 636 patients undergoing primary cytoreductive surgery between January 2019 and December 2023 were included. A historical control group ( n = 300) received povidone-iodine for intraoperative skin preparation, while a prospective intervention group ( n = 336) received chlorhexidine gluconate 2% in 70% isopropyl alcohol. Both groups were managed within a standardized perioperative care pathway. Surgical site infections within 30 days were defined according to established criteria. Comparative and descriptive statistical analyses were performed. Results : Baseline clinicopathological characteristics were comparable between groups. The overall surgical site infection rate was significantly lower in the chlorhexidine-alcohol group compared with the povidone-iodine group (8.3% vs. 14.0%; p = 0.0226). The reduction was particularly evident in procedures lasting more than 180 min (9.5% vs. 17.1%; p = 0.0199), while no significant difference was observed in shorter procedures. Cost analysis demonstrated a net saving of approximately EUR 451 per procedure in the chlorhexidine group, driven by reduced infection-related costs and improved operating room efficiency. Conclusions : Baseline clinicopathological characteristics were comparable between groups. The overall surgical site infection rate was significantly lower in the chlorhexidine-alcohol group compared with the povidone-iodine group (8.3% vs. 14.0%; p = 0.0226). The reduction was particularly evident in procedures lasting more than 180 min (9.5% vs. 17.1%; p = 0.0199), while no significant difference was observed in shorter procedures. Cost analysis demonstrated a net savings of approximately EUR 451 per procedure in the chlorhexidine group, driven by reduced infection-related costs and improved operating room efficiency.

Xylazine-adulterated fentanyl use is associated with manifold negative health outcomes, including skin and soft tissue infections, intensified opioid withdrawal, and can complicate medication for opioid use disorder (MOUD) induction. This qualitative research aimed to explore how healthcare providers test for and treat xylazine-related health harms among people who use drugs (PWUD). From February-April 2025, twelve healthcare providers with expertise in managing the health harms of xylazine from three Northeastern states completed an approximately 45-min semi-structured interview to explore organizational capacity for xylazine toxicology screening and clinical management of xylazine-associated health harms. Rapid qualitative analysis was used to analyze transcripts and produce themes. Participants worked in academic institutions (n = 7), free-standing clinics (n = 5), harm reduction organizations (n = 4), substance use treatment programs (n = 4), hospitals (n = 2), and a federally qualified health center (n = 1). Providers infer xylazine exposure based on clinical presentation and rarely order toxicology, which is often unavailable at some institutions. Providers noted three core clinical effects of xylazine use including overdose, xylazine-associated skin wounds, and withdrawal. Respiratory support and monitoring are essential when responding to xylazine-involved overdose. Additionally, wound chronicity, limited treatment guidelines, homelessness, and stigma complicate xylazine-associated skin wound healing. Withdrawal from xylazine typically co-occurs with opioid withdrawal and is worse than opioid-only withdrawal. Xylazine may be worsening experiences of precipitated withdrawal when inducting patients onto buprenorphine. Some physicians noted that medetomidine, a sedative more potent than xylazine, is associated with withdrawal worse than xylazine withdrawal, weakening the efficacy of recently developed xylazine withdrawal protocols and underscoring the volatility of the drug supply. The clinical effects of xylazine do not occur in isolation from the effects of other substances and often compound one another. Findings demonstrate the complexities of care coordination and management of xylazine-associated health harms. The high level of care coordination needed for xylazine-exposed PWUD is a result of the volatile drug supply, which is likely to become increasingly harmful as new sedative type adulterants, like medetomidine, emerge.