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Cold atmospheric plasma (CAP) is a group of various chemical active species, such as ozone and nitric oxide, generated by working gas. CAP was demonstrated to have an effect on tissue regeneration and wound healing. We conducted this study to evaluate the efficacy and safety of CAP as a novel therapy for diabetic wounds in vitro and in vivo. The plasma consists of ionised helium gas that is produced by a high-voltage and high-frequency power supply. Eight-week-old male db/db mice and C57BL mice were treated with helium gas (control group), 90s' CAP (low-dose group), and 180s' CAP (high-dose group). Mice were treated and observed for 2 weeks. Skin samples from around the wound and blood samples were collected. Our in vitro analysis included scratch wound-healing assays by using human HaCaT immortalised human epidermal cells. After 14 days of treatment, CAP could obviously promote diabetic wound healing. Wound closure rates were significantly higher in the low-dose group and high-dose groups compared with the control group. Meanwhile, compared with the control group, the protein expression of IL-6, tumour necrosis factor-α, inducible nitric oxide synthase, and superoxide dismutase in two CAP groups significantly decreased, while the protein expression of vascular endothelial growth factor and transforming growth factor-β in two CAP groups significantly increased (all P < .05); these data show good agreement with the change in mRNA level (all P < .05). In vitro, scratch wound-healing assays showed that plasma treatment could effectively ensure healing within 3 minutes of exposure (all P < .05). In addition, no difference was found in histological observations of normal skin and the level of serum alanine transaminase, aspartate aminotransferase, blood urea nitrogen, creatinine, and white blood cells among the CAP groups and control group. CAP treatment for 3 minutes every day improves wound healing in diabetic mice by suppressing inflammation, reducing oxidative stress, and enhancing angiogenesis, involving several proteins signalling, and it is safe for the liver and kidney., (© 2020 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

The majority of pressure ulcers (PUs) including deep tissue injuries (DTIs) are preventable, and even reversible if detected in their early phase. One of the greatest barriers in PU prevention is that clinicians traditionally depended on subjective and qualitative techniques, particularly routine visual skin assessments that would only document existing, macroscopic PUs/DTIs, rather than preventing them or detecting them at their microscopic phase. At the early phase of cell damage, when a forming PU is still microscopic, there is a local increase in extracellular fluid contents within affected tissues, which is called sub-epidermal moisture (SEM). This new understanding has led to an emerging technology, a SEM Scanner (BBI LLC, Bruin Biometrics) that has been designed to effectively examine the health status of tissues, by measuring local changes in the biophysical SEM marker. In the present work, the SEM Scanner was tested under controlled laboratory conditions to experimentally determine its sensitivity and precision in identifying small (1 mL) water content changes in phantoms of the human heel and skull/face, which simulated common PU development scenarios. In both phantom configurations, the locally increased water contents resulted in consistent, statistically significant elevated SEM readings, which confirms that the SEM Scanner is able to detect fluid content changes that are as small as 1 mL. In agreement with a simplified theoretical (mathematical) SEM model, which was also developed here, changes in water contents had a consistent trend of effect on SEM delta values, which increased with each 1 mL increment in intra-tissue-substitute water contents., (© 2019 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Detection of subcutaneous tissue damage before it is visible can trigger early intervention and decrease hospital-acquired pressure ulcer (HAPU) rates. The objective of this two-phase study was to evaluate the clinical utility of the Sub-Epidermal Moisture (SEM) Scanner (Bruin Biometrics (BBI), LLC), a hand-held device that assesses increases in interstitial fluid or subepidermal moisture, indicating early tissue damage. Phase 1: Patients were provided standard-of-care risk assessment and interventions and were scanned with the SEM Scanner, but the resulting SEM scores were not used to determine interventions. This gave a baseline pressure ulcer incidence rate. Phase 2: This phase is the same as Phase 1 except the resulting SEM scores were used in conjunction with risk assessment scores to determine appropriate interventions and care planning. In Phase 1, 12 of the 89 subjects or 13.5% developed visible pressure ulcers-4 Stage I's, 6 Stage II's, 1 Stage III, and 1 deep tissue injury. In Phase 2, 2 of the 195 subjects or 1.0% developed visible pressure ulcers-1 Stage I and 1 Stage II. Patients in Phase 2 were more incontinent, less mobile, and had longer lengths of stay than those in Phase 1. Use of the Scanner resulted in a 93% decrease in HAPU. No deep injuries developed in Phase 2., (© 2018 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)