Application of an infrared thermography-based model to detect pressure injuries: a prospective cohort study

Modulation of Macrophage ferroptosis under the guide of infrared thermography promotes the healing of pressure injuries

BACKGROUND

Accurately recognizing and regulating the transition time of macrophages to a pro- (M1-like) or anti-inflammatory (M2-like) state is essential for improving chronic inflammation in pressure injuries (PIs).

OBJECTIVE

This study aimed to evaluate the effectiveness of infrared thermography (IRT) in measuring wound temperature of PIs for the purpose of guiding treatment in regulating chronic inflammation.

METHODS

The healing process of 21 patients with PIs was monitored using IRT prospectively followed for 30 days. The wound temperature changing pattern of different healing outcomes were analyzed and calculated the optimal wound temperature range to guide the treatment time of anti-inflammation for 100 patients with PIs accurately. Additionally, the molecular mechanisms underlying the observed temperature changes in a mouse model of PI were investigated, and the effect of IRT-guided chronic inflammation targeting ferroptosis modulation on PIs was validated.

RESULTS

The application of IRT to monitor PIs temperatures outside the 36.23 °C to 37.37 °C range is indicative of a potential risk indicator, which allows for the timely guidance of treatment to markedly enhance the efficacy of PIs healing outcomes. This wound temperature change was also observed during the process of PIs healing in mice, as a result of the imbalance of M1-like/M2-like macrophages and the subsequent chronic inflammation. Mechanically, evidence indicates that ferroptosis is hyperactivated in PIs, and the enrichment of M1-like macrophages with iNOS/NO• can enhance their resistance to ferroptosis compared with M2-like macrophages, resulting in the imbalance of M1-like/M2-like macrophages and subsequent alteration of wound temperature.

CONCLUSIONS

The modulation of M2-like macrophage resistance to ferroptosis in PIs by NO• donors, suggesting by IRT-monitored temperature changes, has been demonstrated to significantly improve chronic inflammation. This establishes a foundation for the application of IRT to direct a therapeutic strategy for the precise promotion of PIs healing.

Evaluation methods of pressure injury stages: A systematic review and meta-analysis

BACKGROUND

Pressure injury is prevalent in clinical settings and demands precise staging for optimal care. Subjectivity and imprecision in traditional visual assessments have sparked the creation of advanced technology-based evaluation tools.

AIMS

To systematically assess pressure injury staging methods, analyze their evaluation results, and provide reference for clinical practice.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and manual searches of academic journals and conference proceedings were utilized.

METHODS

The study conducted a systematic search of databases in April 2024, utilizing Endnote X9 to document findings. Two reviewers independently extracted data and evaluated its quality using the QUADAS-2 tool. The meta-analysis, conducted in Meta-disc, focused on metrics such as AUC, sensitivity, and specificity. Heterogeneity among the studies was assessed using Cochran's Q and I2 tests.

RESULTS

This review screened 15312 articles and ultimately included 15 studies. These studies described methods for pressure injury staging, including visual assessment, 29 machine learning models, and human-model integrated evaluation. The accuracy of traditional visual assessment was relatively low and showed significant variability. Eight studies involving 24 machine learning models were included in the meta-analysis, demonstrating significantly high accuracy, with an AUC of 0.93, and the combined sensitivity, specificity, and diagnostic odds ratio were 0.81, 0.87, and 20.48, respectively.

CONCLUSION

The review underscores the advantages of machine learning in diagnosing pressure injuries, offering higher accuracy over traditional methods. Integrating clinical expertise with machine learning enhances medical service quality and efficiency.

PROSPERO REGISTRATION NUMBER

CRD42023462951. PROSPERO REGISTRATION LINK: crd.york.ac.uk/prospero/display_record.php?ID=CRD42023462951.

Bridging the gap: ICU nurses' experiences in detecting pressure injuries across diverse skin tones

BACKGROUND

Pressure Injury detection remains a challenge in patients with darker skin tones due to the absence of visible erythema, resulting in delayed diagnosis and poorer patient outcomes. Despite international guidelines, nurses face barriers in early recognition due to knowledge gaps and inadequate training in skin tone diversity. A timely assessment is critical for effective treatment. This necessitates that healthcare professionals recognise how early pressure ulcer signs may present in patients of all skin tone types.

AIM

To explore ICU nurses' experiences in assessing pressure areas in patients with dark skin tones and identify challenges and solutions.

METHODOLOGY

Following ethical approval, semi-structured interviews were conducted with 11 ICU Nurses. Interview data were analysed using thematic analysis using NVivo software.

FINDINGS

Three key themes emerged: (1) Gaps in education and training on diverse skin tones, (2) Challenges in early detection due to "white normativity" in assessment tools, and (3) The need for inclusive education and advanced diagnostic tools to mitigate disparities.

CONCLUSION

Urgent improvements in nursing curricula and clinical training are required to ensure equitable pressure injury detection for all skin tones. The study advocates for greater inclusivity in educational materials, continuous professional development, and the integration of advanced tools like infrared thermography and subepidermal moisture scanners.

Retrospective analysis of thermographic imaging in early detection of pressure injuries

Pressure injuries in critically ill patients present a significant healthcare burden. Traditional methods, such as the Braden score, assess the risk of developing pressure injuries by evaluating factors like sensory perception, moisture and mobility. In contrast, thermographic imaging, which measures variations in skin temperature, offers a promising tool for not only assessing risk but also enabling earlier identification of pressure injuries. This study assessed thermographic imaging's ability to detect existing and evolving pressure injuries in surgical intensive care unit (SICU) patients and compared its accuracy with the Braden score. Among 465 patients, 76 underwent thermographic evaluations of the sacrum and/or heel. Of 25 patients with pressure injuries at admission, 23 had abnormal thermographic scores. Fifteen patient developed pressure injuries during SICU admission. Logistic regression showed that abnormal thermographic scores significantly increased the likelihood of detecting both existing and new injuries, while the Braden score was not a significant predictor. Thermographic imaging appears to be a superior predictor of pressure injuries, offering earlier detection and potentially improving patient outcomes while reducing healthcare costs.

Outcome Evaluation of Reconstructive Septorhinoplasty in Patients with a History of Nasal Skin Necrosis

Background: Nasal skin necrosis represents a severe rhinoplasty complication, potentially leading to nasal deformity and psychological distress. Objectives: To assess the safety, nasal function enhancement, and esthetic satisfaction in individuals with a history of nasal skin necrosis following reconstructive septorhinoplasty using patient-reported outcome measures. Methods: The case series included patients who underwent reconstructive septorhinoplasty 1 year after experiencing skin necrosis. Skeletal reconstruction was performed with an open approach using various autografts and techniques. The data collected encompassed demographics, medical history, operative reports, and postoperative events. The Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS) was administered preoperatively and 1 year postoperatively. Results: Most patients were female (35/38, 92%), with median age of 33.5 years (17-57) and 2 prior rhinoplasties (1-5) by 1 surgeon (1-2). The follow-up median was 23.78 months (11.83-54.23). Necrosis predominantly affected the nasal tip and soft tissue triangles. Septorhinoplasty utilized 11 V-shaped columellar base and 27 mid-columella incisions, lasting on average 274 min (175-405). Septal grafts were adequate for reconstruction in only three cases. Autografts for reconstruction encompassed auricular cartilage (31), rib cartilage (22), temporal fascia (14), and rectus fascia (6). SCHNOS scores improved significantly, with the obstruction domain decreasing from a preoperative mean of 75.92 (±22.83) to 34.08 (±27.87) and the cosmesis domain from 85.43 (±19.06) to 39.73 (±23.77). No postoperative severe vascular complication occurred. More previous surgeries linked to decreased patient satisfaction. Conclusion: Reconstructive septorhinoplasty can be successful in restoring relatively normal nasal contour following prior soft tissue necrosis, with limited risk for complications.

Apoptotic Bodies Derived from Fibroblast-Like Cells in Subcutaneous Connective Tissue Inhibit Ferroptosis in Ischaemic Flaps via the miR-339-5p/KEAP1/Nrf2 Axis

Preventing and treating avascular necrosis at the distal end of the flaps are critical to surgery success, but current treatments are not ideal. A recent study shows that apoptotic bodies (ABs) generated near the site of apoptosis can be taken up and promote cell proliferation. The study reveals that ABs derived from fibroblast-like cells in the subcutaneous connective tissue (FSCT cells) of skin flaps promoted ischaemic flap survival. It is also found that ABs inhibited cell death and oxidative stress and promoted M1-to-M2 polarization in macrophages. Transcriptome sequencing and protein level testing demonstrated that ABs promoted ischaemic flap survival in endothelial cells and macrophages by inhibiting ferroptosis via the KEAP1-Nrf2 axis. Furthermore, microRNA (miR) sequencing data and in vitro and in vivo experiments demonstrated that ABs inhibited KEAP1 by delivering miR-339-5p to exert therapeutic effects. In conclusion, FSCT cell-derived ABs inhibited ferroptosis, promoted the macrophage M1-to-M2 transition via the miR-339-5p/KEAP1/Nrf2 axis and promoted ischaemic flap survival. These results provide a potential therapeutic strategy to promote ischaemic flap survival by administering ABs.

A novel deep-learning based weighted feature fusion architecture for precise classification of pressure injury

Introduction: Precise classification has an important role in treatment of pressure injury (PI), while current machine-learning or deeplearning based methods of PI classification remain low accuracy. Methods: In this study, we developed a deeplearning based weighted feature fusion architecture for fine-grained classification, which combines a top-down and bottom-up pathway to fuse high-level semantic information and low-level detail representation. We validated it in our established database that consist of 1,519 images from multi-center clinical cohorts. ResNeXt was set as the backbone network. Results: We increased the accuracy of stage 3 PI from 60.3% to 76.2% by adding weighted feature pyramid network (wFPN). The accuracy for stage 1, 2, 4 PI were 0.870, 0.788, and 0.845 respectively. We found the overall accuracy, precision, recall, and F1-score of our network were 0.815, 0.808, 0.816, and 0.811 respectively. The area under the receiver operating characteristic curve was 0.940. Conclusions: Compared with current reported study, our network significantly increased the overall accuracy from 75% to 81.5% and showed great performance in predicting each stage. Upon further validation, our study will pave the path to the clinical application of our network in PI management.

Can technology change the status quo for pressure injury prevention?

Linked Article:  Jiang et al. Br J Dermatol 2022; 187:571–579.