The development of nanoparticle-based wound dressings marks a significant advancement in the management of chronic and non-healing wounds. Silver-based dressings have been used in wound management due to their strong antimicrobial properties. However, their clinical effectiveness depends on formulation, concentration, and duration of use. Recently, copper oxide dressings (CODs) have emerged as a novel alternative, offering both antimicrobial and regenerative benefits. We reviewed clinical studies, meta-analyses, and cost-effectiveness analyses on silver nanoparticle (AgNP), ionic silver, nanocrystalline silver, and copper oxide dressings across various wound types, including diabetic foot ulcers, venous leg ulcers, pressure ulcers, surgical wounds, and burns. Emphasis was placed on dressing formulations, silver or copper concentrations, clinical efficacy, safety, and cost-effectiveness. Traditional silver formulations, such as silver sulfadiazine (1%) and silver nitrate (0.5%), demonstrate antimicrobial activity but are limited by cytotoxicity and lack of long-term healing benefits. Nanocrystalline silver and ionic silver hydrofiber dressings provide sustained release, proving most effective in infection-prone and early inflammatory phases. Enhanced formulations (Aquacel® Ag + Extra™) show promise in treating biofilm-related wounds but need more robust data. By contrast, CODs have demonstrated antimicrobial efficacy alongside stimulation of angiogenesis, fibroblast proliferation, and extracellular matrix remodeling. Early clinical evidence suggests that CODs may accelerate healing in refractory wounds and offer cost advantages over negative pressure therapy, though large-scale trials remain limited. Silver dressings, particularly nanocrystalline and ionic hydrofiber formulations, remain clinically useful for infection control and short-term wound management, while older silver salts are less favorable due to toxicity and limited efficacy. CODs represent a biologically attractive alternative with dual antimicrobial and regenerative properties. Nonetheless, the current body of evidence is insufficient to declare a paradigm shift in wound healing, and CODs should presently be regarded as promising adjuncts pending validation in high-quality randomized trials.

Background: Outcomes after critical illness vary markedly despite similar diagnoses and severity scores, underscoring the limitations of chronological age and conventional Intensive Care Unit (ICU) prognostic tools. Personalization of critical care is increasingly essential to improve not only short-term survival but also long-term post-discharge outcomes. Biological aging clocks provide a quantitative framework to capture physiological reserve, immune competence, and vulnerability to stress. Methods: We conducted a scoping review of original human studies published between January 2015 and October 2025 that evaluated biological aging biomarkers in adult ICU populations. PubMed/MEDLINE, Scopus, Web of Science, and Embase were searched, with backward citation screening. Results: Across epigenetic, telomere-based, cfDNA, proteomic, metabolomic, and phenotypic aging measures, accelerated biological aging was consistently associated with increased mortality, organ dysfunction, and post-ICU vulnerability. Despite substantial methodological heterogeneity, a convergent signal emerged linking inflammation-weighted and stress-responsive deep biological clocks to clinically meaningful outcomes in critically ill patients. Conclusions: Biological aging biomarkers represent a mechanistically grounded approach to personalized prognostication in critical care. From a translational perspective, deep biological clocks hold promise for personalized risk stratification, prognostication, and the identification of high-risk recovery phenotypes, although prospective validation and implementation studies are required.

Background and Clinical Significance: Shock in pediatric patients remains a leading cause of morbidity and mortality, with refractory cases posing significant challenges. While catecholamines like norepinephrine and epinephrine are standard vasopressors, vasopressin (AVP) has emerged as a potential adjunct therapy. However, its role in pediatric shock remains controversial due to concerns about efficacy, safety, and appropriate use. This review assesses the current evidence on AVP in pediatric shock. Methods and Results: A comprehensive literature search was conducted using PubMed, Scopus, Web of Science, and Google Scholar, focusing on studies published in the last five years to capture recent advancements. Articles on AVP’s mechanism of action, pharmacokinetics, clinical applications, and safety were included. For background information, studies were not limited by publication date. AVP increases mean arterial pressure (MAP) and systemic vascular resistance (SVR) yet does not significantly reduce mortality. While AVP may be useful in catecholamine-resistant vasoplegia, its advantage over conventional vasopressors remains uncertain. Concerns about ischemic complications, myocardial dysfunction, and thrombocytopenia further limit its routine use. Conclusions: AVP may serve as an adjunct therapy in catecholamine-resistant vasoplegia, but safety concerns and unclear benefits restrict its routine use. Further research is needed to determine the optimal dosing, patient selection, and long-term outcomes. Until then, AVP should remain a last-line therapy when conventional vasopressors fail.

Objective: The effectiveness of available wound debridement strategies, including endogenous autolysis, enzymatic, larval, and surgical approaches, is often limited by poor wound-bed biology, cost, and invasiveness. Although copper oxide–containing dressings (COD) have demonstrated broad wound-healing activity in basic science and clinical studies, their potential to modulate debridement has not been specifically characterized. Methods: We retrospectively analyzed five extreme clinical cases involving six limbs with diverse etiologies, extensive necrosis, impaired perfusion, and frequently compromised systemic conditions. Sequential clinical imaging and detailed follow-up were used to assess wound-bed dynamics. Observations were interpreted in the context of relevant published basic science. Results: In five of six limbs, major amputation or revision to a higher level had been indicated prior to COD initiation. In all cases, application of COD was associated with rapid and extensive clearance of devitalized tissue, suggesting augmentation of endogenous autolytic mechanisms. Review of the literature supports copper-dependent pathways (CDPs), including the MMP–TIMP axis, inflammatory signaling via NF-κB, and macrophage polarization. Analysis of serial photographs demonstrated concurrent emergence of granulation tissue and vascularization, supporting synergism between angiogenesis, granulation tissue formation, and debridement, all induced by COD. Conclusions: The findings support the hypothesis that copper ions and COD may amplify autolytic tissue clearance through CDPs, with concurrent synergistic interaction between angiogenesis and debridement.

Context and objective: Post-amputation pain (PAP) is an umbrella term that includes residual limb pain (RLP) and phantom limb pain (PLP), posing a significant challenge to recovery and quality of life after limb loss. Ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has gained interest for its potential to manage PAP, particularly in refractory cases. This narrative review explores the efficacy of ketamine for PAP and the emerging role of pharmacogenomics in guiding its use. Methods: A literature review of PubMed, Embase, and Cochrane databases was conducted, focusing on clinical trials, systematic reviews, and genetic influences on ketamine metabolism and response. Studies suggest that perioperative ketamine can reduce PAP severity and opioid use. However, outcomes vary, with some patients experiencing transient relief and others achieving prolonged benefit. Results: This variability may be linked to genetic differences in CYP2B6, CYP3A4/5, COMT Val158Met, SLC6A2, and KCNS1, which affect ketamine’s metabolism, efficacy and side effect profile. Understanding these pharmacogenomic factors could enable more personalized and effective ketamine therapy. Conclusion: Despite its promise, inconsistent dosing regimens and limited integration of genetic data hinder standardization. Further research into genotype-guided ketamine protocols may improve treatment outcomes and support precision analgesia in amputee care.

Background and Clinical Significance: Neonatal hemochromatosis is a rare iron overload disorder that causes severe liver injury in newborns, typically with extrahepatic siderosis. Diagnosis of neonatal hemochromatosis is usually confirmed through a biopsy and MRI, demonstrating deposition of iron and liver failure. However, in severe patients who are not able to undergo biopsy, the diagnostic and management method remains unknown. Case Presentation: We present an unusual case of neonatal hemochromatosis without extrahepatic iron deposition in a 9-day-old male who showed signs of liver failure and respiratory distress. This case suggests that when the risks of biopsy outweigh its benefits, a diagnosis may be reached based on clinical evaluation and MRI findings. Early high-dose intravenous immunoglobulin therapy improved liver function and led to recovery, highlighting the need for early therapeutic intervention in neonatal hemochromatosis. Conclusions: This case highlights that the absence of extrahepatic siderosis cannot exclude a diagnosis of neonatal hemochromatosis, and high doses of IVIG should be administered promptly when neonatal hemochromatosis is suspected to maximize therapeutic effectiveness.