Digital Health Interventions for Chronic Wound Management: A Systematic Review and Meta-Analysis.

BACKGROUND: Digital health interventions (DHIs) have shown promising results for the management of chronic wounds. However, its effectiveness compared to usual care and whether variability in the type of intervention affects wound outcomes are unclear. OBJECTIVE: The main objective was to determine the effectiveness of DHIs on wound healing outcomes in adult patients with chronic wounds. The secondary objectives were to assess if there was any variation in wound healing outcomes across the various types of DHIs. METHODS: In total, 9 databases were searched for the literature up to August 1, 2023. Randomized controlled trials (RCTs), cohort studies, and quasi-experimental studies comparing the efficacy of DHIs with controls in improving wound outcomes in adult patients with chronic wounds were included. Study selection, data extraction, and risk of bias assessment were conducted independently by 2 reviewers. We assessed the quality of each RCT, cohort study, and quasi-experimental study separately using the Cochrane risk of bias tool, ROBINS-I, and the Joanna Briggs Institute Critical Appraisal tools checklists. Relative risks (RRs) and 95% CIs were pooled using the random effects model, and heterogeneity was assessed by the I2 statistic. Subgroup analysis and sensitivity analysis were also performed. RESULTS: A total of 25 studies with 8125 patients were included in this systematic review, while only 20 studies with 6535 patients were included in the meta-analysis. Efficacy outcomes in RCTs showed no significant differences between the DHIs and control groups in terms of wound healing (RR 1.02, 95% CI 0.93-1.12; P=.67) and all-cause mortality around 1 year (RR 1.08, 95% CI 0.55-2.12; P=.83). Compared with the control group, the use of DHIs was associated with significant changes in adverse events (RR 0.44, 95% CI 0.22-0.89; P=.02). Subgroup analysis suggested a positive effect of the digital platforms in improving wound healing (RR 2.19, 95% CI 1.35-3.56; P=.002). Although meta-analysis was not possible in terms of wound size, cost analysis, patient satisfaction, and wound reporting rates, most studies still demonstrated that DHIs were not inferior to usual care in managing chronic wounds. CONCLUSIONS: The findings of our study demonstrate the viability of adopting DHIs to manage chronic wounds. However, more prominent, high-quality RCTs are needed to strengthen the evidence, and more detailed clinical efficacy research is required. TRIAL REGISTRATION: PROSPERO CRD42023392415; https://tinyurl.com/4ybz6bs9.

Antibiotic-free production of sucrose isomerase in Bacillus subtilis by genome integration.

Sucrose isomerase (SIase) catalyzes the hydrolysis and isomerization of sucrose to form isomaltulose, a valuable functional sugar widely used in the food industry. However, the lack of safe and efficient heterologous expression systems hinders SIase production and application. In this study, we achieved antibiotic-free SIase expression in Bacillus subtilis through genome integration. Using CRISPR/Cas9 system, SIase expression cassettes were integrated into various genomic loci, including amyE and ctc, both individually and in combination, resulting in single-copy and muti-copy integration strains. Engineered strains with a maltose-inducible promoter effectively expressed and secreted SIase. Notably, multi-copy strain exhibited enhanced SIase production, achieving 4.4 U/mL extracellular activity in shake flask cultivations. Furthermore, crude enzyme solution from engineered strain transformed high concentrations sucrose into high yields of isomaltulose, reaching a maximum yield of 94.6%. These findings demonstrate antibiotic-free SIase production in B. subtilis via genome integration, laying the foundation for its industrial production and application.

Genetic variation and population structure of a widely distributed damselfly (Ischnura senegalensis).

Ischnura senegalensis Rambur, 1842 is among the most widespread damselfly species in the world. Unlike dragonflies with strong migration abilities, I. senegalensis have limited dispersing abilities. Gene flow among I. senegalensis populations may be greatly influenced by anthropogenic disturbance, fragmented suitable habitats, sea straits, or even global warming. In this study, to investigate the genetic diversity of I. senegalensis populations, we sequenced and collected 498 cytochrome oxidase I sequences across the Old World. Haplotype network analysis showed 51 haplotypes and I. senegalensis could be grouped into four regions (Afrotropical region, Oriental region, main Islands of Japan, and the Ryukyu Islands), each of which contains different dominant haplotypes. Based on molecular variance analysis, we found that populations from the Afrotropical region have quite a low gene flow with the Asian populations (except Yemen). Furthermore, rice cultivation may aid the dispersion of I. senegalensis in the oriental region. Populations from the Ryukyu Islands show the highest genetic diversity, which may be due to the geological separation among islands. Our results prove that I. senegalensis has great genetic diversity among different populations across the world.

Study on the mechanism of synthetic (Ce,La)CO3F sulfuric acid acidification and NH3-SCR loaded with Mn and Fe.

A hydrothermal method was used to synthesise (Ce,La)CO3F grain simulated minerals, in accordance with the Ce-La ratio of bastnaesite in the mineralogy of the Bayan Ebo process. The NH3-SCR catalytic activity of the synthesised (Ce,La)CO3F was improved by loading transition metals Mn and Fe and sulphuric acid acidification treatments. The activity test results showed that the catalysts which were simultaneously acidified with sulphuric acid and loaded with transition metals Mn and Fe had a NO x conversion of 92% at 250 °C. XRD, SEM, XPS and in situ Fourier transform infrared spectroscopy (FTIR) were used to investigate the physical phase structure, surface morphology, reaction performance and mechanism of the catalysts, to provide theoretical guidance for the specific reaction path of cerium fluorocarbon ore in the NH3-SCR reaction. The results showed that the introduction of transition metals and sulphuric acid greatly increases the proportion of adsorbed oxygen (Oα) and facilitates the adsorption of NH3 and NO. The catalyst surface metal sulphate and metal oxide species act as the main active components on the catalyst surface to promoted the reaction, and cracks and pores appear on the surface to facilitate the adsorption of reactive gases. The reaction mechanism of the SO4 2--Mn-Fe/(Ce,La)CO3F catalyst, and characterisation of the adsorption and conversion behaviour of the reactive species on the catalyst surface, were investigated by Fourier transform infrared spectroscopy (FTIR). The results showed that the catalyst follows the E-R and L-H mechanisms throughout the reaction, with the E-R mechanism being the main reaction. The reaction species were NH4 +/NH3 species in the adsorbed state and NO. The NH3(ad) species on the Lewis acidic site is the main NH3(g) adsorbed species for the reaction, bonded to Ce4+ in the carrier (Ce,La)CO3F to participate in the acid cycle reaction, and undergo a redox reaction on the catalyst surface to produce N2 and H2O. The SO4 2- present on the catalyst surface can also act as an acidic site for the adsorption of NH3. The above results indicated the excellent performance of the SO4 2--Mn-Fe/(Ce,La)CO3F catalyst, which provided a theoretical basis for the high value utilization of bastnaesite.