Evaluating the effectiveness of a self-management exercise intervention on wound healing, functional ability and health-related quality of life outcomes in adults with venous leg ulcers: a randomised controlled trial

Exercise that targets ankle joint mobility may lead to improvement in calf muscle pump function and subsequent healing. The objectives of this research were to assess the impact of an exercise intervention in addition to routine evidence-based care on the healing rates, functional ability and health-related quality of life for adults with venous leg ulcers (VLUs). This study included 63 patients with VLUs. Patients were randomised to receive either a 12-week exercise intervention with a telephone coaching component or usual care plus telephone calls at the same timepoints. The primary outcome evaluated the effectiveness of the intervention in relation to wound healing. The secondary outcomes evaluated physical activity, functional ability and health-related quality of life measures between groups at the end of the 12 weeks. A per protocol analysis complemented the effectiveness (intention-to-treat) analysis to highlight the importance of adherence to an exercise intervention. Intention-to-treat analyses for the primary outcome showed 77% of those in the intervention group healed by 12 weeks compared to 53% of those in the usual care group. Although this difference was not statistically significant due to a smaller than expected sample size, a 24% difference in healing rates could be considered clinically significant. The per protocol analysis for wound healing, however, showed that those in the intervention group who adhered to the exercise protocol 75% or more of the time were significantly more likely to heal and showed higher rates for wound healing than the control group (P = 0·01), that is, 95% of those who adhered in the intervention group healed in 12 weeks. The secondary outcomes of physical activity, functional ability and health-related quality of life were not significantly altered by the intervention. Among the secondary outcomes (physical activity, functional ability and health-related quality of life), intention-to-treat analyses did not support the effectiveness of the intervention. However, per protocol analyses revealed encouraging results with those participants who adhered more than 75% of the time (n = 19) showing significantly improved Range of Ankle Motion from the self-management exercise programme (P = 0·045). This study has shown that those participants who adhere to the exercise programme as an adjunctive treatment to standard care are more likely to heal and have better functional outcomes than those who do not adhere to the exercises in conjunction with usual care.

Excimer laser refractive surgery : corneal wound healing and clinical results

Although the first procedure in a seeing human eye using excimer laser was reported in 1988 (McDonald et al. 1989, O'Connor et al. 2006) just three studies (Kymionis et al. 2007, O'Connor et al. 2006, Rajan et al. 2004) with a follow-up over ten years had been published when this thesis was started. The present thesis aims to investigate 1) the long-term outcomes of excimer laser refractive surgery performed for myopia and/or astigmatism by photorefractive keratectomy (PRK) and laser-in situ- keratomileusis (LASIK), 2) the possible differences in postoperative outcomes and complications when moderate-to-high astigmatism is treated with PRK or LASIK, 3) the presence of irregular astigmatism that depend exclusively on the corneal epithelium, and 4) the role of corneal nerve recovery in corneal wound healing in PRK enhancement. Our results revealed that in long-term the number of eyes that achieved uncorrected visual acuity (UCVA)≤0.0 and ≤0.5 (logMAR) was higher after PRK than after LASIK. Postoperative stability was slightly better after PRK than after LASIK. In LASIK treated eyes the incidence of myopic regression was more pronounced when the intended correction was over >6.0 D and in patients aged <30 years.Yet the intended corrections in our study were higher for LASIK than for PRK eyes. No differences were found in percentages of eyes with best corrected visual acuity (BCVA) or loss of two or more lines of visual acuity between PRK and LASIK in the long-term. The postoperative long-term outcomes of PRK with two different delivery systems broad beam and scanning laser were compared and revealed no differences. Postoperative outcomes of moderate-to-high astigmatism yielded better results in terms of UCVA and less compromise or loss of two more lines of BCVA after LASIK that after PRK.Similar stability for both procedures was revealed. Vector analysis showed that LASIK outcomes tended to be more accurate than PRK outcomes, yet no statistically differences were found. Irregular astigmatism secondary to recurrent corneal erosion due to map-dot-fingerprint was successfully treated with phototherapeutic keratectomy (PTK). Preoperative videokeratographies (VK) showed irregular astigmatism. However, postoperatively, all eyes showed a regular pattern. No correlation was found between pre- and postoperative VK patterns. Postoperative outcomes of late PRK in eyes originally subjected to LASIK showed that all (7/7) eyes achieved UCVA ≤0.5 at last follow-up (range 3 — 11 months), and no eye lost lines of BCVA. Postoperatively all eyes developed and initial mild haze (0.5 — 1) into the first month. Yet, at last follow-up 5/7 eyes showed a haze of 0.5 and this was no longer evident in 2/7 eyes. Based on these results, we demonstrated that the long-term outcomes after PRK and LASIK were safe and efficient, with similar stability for both procedures. The PRK outcomes were similar when treated by broad-beam or scanning slit laser. LASIK was better than PRK to correct moderate-to-high astigmatism, yet both procedures showed a tendency of undercorrection. Irregular astigmatism was proven to be able to depend exclusively from the corneal epithelium. If this kind of astigmatism is present in the cornea and a customized PRK/LASIK correction is done based on wavefront measurements an irregular astigmatism may be produced rather than treated. Corneal sensory nerve recovery should have an important role in the modulation of the corneal wound healing and post-operative anterior stromal scarring. PRK enhancement may be an option in eyes with previous LASIK after a sufficient time interval that in at least 2 years.

Modeling and Field Oriented Control of Salient Pole Wound Field Synchronous Machine in Stator Flux Coordinates

This paper describes the field oriented control of a salient pole wound field synchronous machine in stator flux coordinates. The procedure for derivation of flux linkage equations along any general rotating axes including stator flux axes is given. The stator flux equations are used to identify the cross-coupling occurring between the axes due to saliency in the machine. The coupling terms are canceled as feedforward terms in the generation of references for current controllers to achieve good decoupling during transients. The design of current controller for stator-flux-oriented control is presented. This paper proposes the method of extending rotor flux closed loop observer for sensorless control of wound field synchronous machine. This paper also proposes a new sensorless control by using stator flux closed loop observer and estimation of torque angle using stator current components in stator flux coordinates. Detailed experimental results from a sensorless 15.8 hp salient pole wound field synchronous machine drive are presented to demonstrate the performance of the proposed control strategy from a low speed of 0.8 Hz to 50 Hz.

Starting scheme for load commutated inverter-fed wound field synchronous machine using an auxiliary low-power voltage source inverter

Conventional thyristor-based load commutated inverter (LCI)-fed wound field synchronous machine operates only above a minimum speed that is necessary to develop enough back emf to ensure commutation. The drive is started and brought up to a speed of around 10-15% by a complex `dc link current pulsing' technique. During this process, the drive have problems such as pulsating torque, insufficient average starting torque, longer starting time, etc. In this regard a simple starting and low-speed operation scheme, by employing an auxiliary low-power voltage source inverter (VSI) between the LCI and the machine terminals, is presented in this study. The drive is started and brought up to a low speed of around 15% using the VSI alone with field oriented control. The complete control is then smoothly and dynamically transferred to the conventional LCI control. After the control transfer, the VSI is turned off and physically disconnected from the main circuit. The advantages of this scheme are smooth starting, complete control of torque and flux at starting and low speeds, less starting time, stable operation, etc. The voltage rating of the required VSI is very low of the order of 10-15%, whereas the current rating is dependent on the starting torque requirement of the load. The experimental results from a 15.8 hp LCI-fed wound field synchronous machine are given to demonstrate the scheme.

Variable-speed wind power generation using doubly fed wound rotor induction machine - A comparison with alternative schemes

In this paper, a wind energy conversion system (WECS) using grid-connected wound rotor induction machine controlled from the rotor side is compared with both fixed speed and variable speed systems using cage rotor induction machine. The comparison is done on the basis of (I) major hardware components required, (II) operating region, and (III) energy output due to a defined wind function using the characteristics of a practical wind turbine. Although a fixed speed system is more simple and reliable, it severely limits the energy output of a wind turbine. In case of variable speed systems, comparison shows that using a wound rotor induction machine of similar rating can significantly enhance energy capture. This comes about due to the ability to operate with rated torque even at supersynchronous speeds; power is then generated out of the rotor as well as the stator. Moreover, with rotor side control, the voltage rating of the power devices and dc bus capacitor bank is reduced. The size of the line side inductor also decreasesd. Results are presented to show the substantial advantages of the doubly fed system.

Hybrid LCI/VSI Power Circuit-A Universal High-Power Converter Solution for Wound Field Synchronous Motor Drives

Load commutated inverter (LCI)-fed wound field synchronous motor drives are used for medium-voltage high-power drive applications. This drive suffers from drawbacks such as complex starting procedure, sixth harmonic torque pulsations, quasi square wave motor current, notches in the terminal voltages, etc. In this paper, a hybrid converter circuit, consisting of an LCI and a voltage source inverter (VSI), is proposed, which can be a universal high-power converter solution for wound field synchronous motor drives. The proposed circuit, with the addition of a current-controlled VSI, overcomes nearly all of the shortcomings present in the conventional LCI-based system besides providing many additional advantages. In the proposed drive, the motor voltage and current are always sinusoidal even with the LCI switching at the fundamental frequency. The performance of the drive is demonstrated with detailed experimental waveforms from a 15.8-hp salient pole wound field synchronous machine. Finally, a brief description of the control scheme used for the proposed circuit is given.

A Brushless Wound Rotor Induction Generator for Variable Speed Microhydel Plants Without Ballast Load

A new generator topology for microhydel power plants, capable of unsupervised operation, is proposed. While conventional microhydel plants operate at constant speed with switched ballast loads, the proposed generator, based on the wound rotor induction machine, operates at variable speed and does away with the need for ballast loads. This increases reliability and substantially decreases system costs and setup times. The proposed generator has a simplified decoupled control structure with stator-referenced voltage control similar to a conventional synchronous generator, and rotor-side frequency control that is facilitated by rotating electronics mounted on the rotor. While this paper describes an isolated plant, the topology can also be tailored for distributed generation enabling conversion of the available hydraulic power into useful electrical power when the grid is present, and supplying local loads in the event of grid outage.

Remotely triggered micro-shock wave responsive drug delivery system for resolving diabetic wound infection and controlling blood sugar levels

A novel, micro-shock wave responsive spermidine and dextran sulfate microparticle was developed. Almost 90% of the drug release was observed when the particles were exposed to micro-shock waves 5 times. Micro-shock waves served two purposes; of releasing the antibiotic from the system and perhaps disrupting the S. aureus biofilm in the skin infection model. A combination of shock waves with ciprofloxacin loaded microparticles could completely cure the S. aureus infection lesion in a diabetic mouse model. As a proof of concept insulin release was triggered using micro-shock waves in diabetic mice to reduce the blood glucose level. Insulin release could be triggered for at least 3 days by exposing subcutaneously injected insulin loaded particles.

Mitigating Scarring and Inflammation during Corneal Wound Healing using Nanofiber-Hydrogel Scaffolds

Due to the universal lack of donor tissue, there has been emerging interest in engineering materials to stimulate living cells to restore the features and functions of injured organs. We are particularly interested in developing materials for corneal use, where the necessity to maintain the tissue’s transparency presents an additional challenge. Every year, there are 1.5 – 2 million new cases of monocular blindness due to irregular healing of corneal injuries, dwarfing the approximately 150,000 corneal transplants performed. The large gap between the need and availability of cornea transplantation motivates us to develop a wound-healing scaffold that can prevent corneal blindness.

To develop such a scaffold, it is necessary to regulate the cells responsible for repairing the damaged cornea, namely myofibroblasts, which are responsible for the disordered and non-refractive index matched scar that leads to corneal blindness. Using in vitro assays, we identified that protein nanofibers of certain orientation can promote cell migration and modulate the myofibroblast phenotype. The nanofibers are also transparent, easy to handle and non-cytotoxic. To adhere the nanofibers to a wound bed, we examined the use of two different in situ forming hydrogels: an artificial extracellular matrix protein (aECM)-based gel and a photo-crosslinkable heparin-based gel. Both hydrogels can be formed within minutes, are transparent upon gelation and are easily tunable.

Using an in vivo mouse model for epithelial defects, we show that our corneal scaffolds (nanofibers together with hydrogel) are well-tolerated (no inflammatory response or turbidity) and support epithelium regrowth. We developed an ex vivo corneal tissue culture model where corneas that are wounded and treated with our scaffold can be cultured while retaining their ability to repair wounds for up to 21 days. Using this technique, we found that the aECM-based treatment induced a more favorable wound response than the heparin-based treatment, prompting us to further examine the efficacy of the aECM-based treatment in vivo using a rabbit model for stromal wounds. Results show that treated corneas have fewer myofibroblasts and immune cells than untreated ones, indicating that our corneal scaffold shows promise in promoting a calmer wound response and preventing corneal haze formation.

Pattern of cutaneous wound healing in a live fish Clarias batrachus (L.)(Clariidae, Pisces.)

Incisional wounds of the same length and depth were made on skin between dorsal fin and the lateral line canal of Clarias batrachus and the pattern of wound closure has been studied histologically. Following infliction, a marked change in the colour of the skin surrounding the wound was observed which lasted for about 30 h and restored thereafter. Mucus and blood cells plugged the wound gap shortly after infliction. The epidermis surrounding the wound was found to be detached from the basement membrane. Mass movement of epidermal cells was observed from both side of the wound gap. The epidermal cells at the margin of the wound became hypertrophied. The epidermis became normal by 32 days. The dealing of sub-epidermal tissue indicated degenerative and regenerative changes of muscle fibres. The mucus and blood cells were accumulated in the wound gap and later fine blood vessels were formed. Gradually granulation tissue was formed and fibroblasts and myoblasts appeared. Myoblast differentiated into muscle bundles. The epidermal repair was completed within 35 days.

Electrospinning of multicomponent ultrathin fibrous nonwovens for semi-occlusive wound dressings

This work describes the design and assembly of multifunctional and cost-efficient composite fiber nonwovens as semi-occlusive wound dressings using a simple electrospinning process to incorporate a variety Of functional components into an Ultrathin fiber. These components include non-hydrophilic poly(L-lactide) (PLLA) as fibrous backbone, hydrophilic poly(vinyl pyrrolidone)iodine (PVP-I), TiO2 nanoparticles, zinc chloride as antimicrobial, odor-controlling, and antiphlogistic agents, respectively. The process of synthesis starts with a multicomponent solution Of PLLA, PVP, TiO2 nanoparticles plus zinc chloride, in which TiO2 nanoparticles are synthesized by in situ hydrolysis of TiO2 precursors in a PVP Solution for the sake of obtaining the particle-uniformly dispersive solution. Subsequent electrospinning generates the corresponding composite fibers. A further iodine vapor treatment to the composite fibers combines iodine with PVP to produce the PVP-I complexes. Experiments indicate that the assembled composite fibers (300-400 nm) possess the ointment-releasing characteristic and the phase-separate, core-sheath structures in which PVP-I residing in fiber Surface layer becomes the sheath, and PLLA distributing inside the fiber acts as the core.

Medicated wound dressings based on poly(vinyl alcohol)/poly(N-vinyl pyrrolidone)/chitosan hydrogels

Poly(vinyl alcohol) /poly(N-vinyl pyrrolidone) (PVP)/chitosan hydrogels were prepared by a low-temperature treatment and subsequent Co-60 -gamma-ray irradiation and then were medicated with ciprofloxacin lactate (an antibiotic) and chitosan oligomer (molecular weight = 3000 g/mol). The gel content, swelling ratio, tensile strength, and crystallinity of the hydrogels were determined. The effects of the chitosan molecular weight, the low-temperature treatment procedure, and the radiation dosage on the hydrogel properties were examined. The molecular weight of chitosan was lowered by the irradiation, but its basic polysaccharide structure was not destroyed. Repeating the low-temperature treatment and gamma-ray irradiation caused effective physical crosslinking and chemical crosslinking, respectively, and contributed to the mechanical strength of the final hydrogels. The incorporation of PVP and chitosan resulted in a significant improvement in the equilibrium swelling ratio. and elongation ratio of the prepared hydrogels. The ciprofloxacin lactate and chitosan oligomer were soaked into the hydrogels. Their in vitro release behaviors were examined, and they were found to follow diffusion-controlled kinetics.

A WOUND-TYPE LITHIUM POLYANILINE SECONDARY CELL

A wound-type cell with a polyaniline (PAn) positive electrode, a LiClO4-propylene carbonate (PC) electrolyte, and a lithium foil negative electrode has been constructed. The two electrodes are separated by a polypropylene separator. The PAn is deposited on carbon felt from a HClO4 solution containing aniline by galvanostatic or potentiostatic electrolysis. Using cyclic voltammetry charge/discharge cycles and charge/retention tests, the following results have been obtained: (i) reversibility of the charge/discharge reaction of the PAn electrode is very good; (ii) more than 50 charge/discharge cycles at 80% charge/discharge efficiency and 260 W h kg-1 discharge energy density can be achieved at 50 mA between 2 and 4 V; (iii) the open-circuit voltage and the capacity retention of the battery after storage at open-circuit for 60 days are 3.4 V and 33%, respectively.