ObjectiveTo evaluate the effects of knee compression using elastic bandages on pain intensity and physical function in individuals with knee osteoarthritis in the short term.DesignThree-arm, randomised controlled trial.SettingIndividuals with knee osteoarthritis received compression, sham compression, or no bandaging.Main measuresNinety participants were assessed at baseline (Day 1), Day 6 after intervention, and 12 and 24 weeks post-intervention. The primary outcomes were pain intensity assessed using the Visual Analogue Scale and the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index, physical function tests, and global rating of change.InterventionsThe experimental group received knee compression with elastic bandages for 20 min per day over four consecutive days; sham group used elastic bandages without compression; and the control group received no bandaging.ResultsNo between-group differences reached the minimal clinically important difference for pain measured by the Visual Analogue Scale or Western Ontario and McMaster Universities Osteoarthritis Index pain subscale at any follow-up. Likewise, not clinically important between-group differences were found for Western Ontario and McMaster Universities Osteoarthritis Index or physical function tests. On Day 6, global rating of change favored the experimental versus sham group (-1.5; 95% confidence interval -2.6 to -0.3) and the sham versus control group (-1.4; 95% confidence interval -2.5 to -0.3).ConclusionKnee compression using elastic bandages was not superior to sham or control conditions in reducing pain or improving physical function in individuals with knee osteoarthritis.Level of evidence1b.Trial registration: NCT04724902.

An ulcer cruris is a leg wound that can have various causes, with venous ulcers from chronic venous insufficiency being most common. First-line treatment includes ambulatory compression therapy and wound care. Compression reduces the underlying cause, increased venous pressure. Patient education about the pathogenesis, treatment, and prognosis is important. Factors that delay healing include, among others, hypergranulation, edema, contact allergy, comorbidity, and pain. Monitoring progress is essential to ensure timely referral when healing stagnates. A dermatologist or vascular surgeon can provide outpatient treatment in cases of insufficient superficial venous system, which potentially can lead to faster healing and reducing recurrence.

The aim of this study was to evaluate the cost-effectiveness of treating patients with Venous Leg Ulcers (VLUs) with the Muscle Pump Activation device (MPA, geko) in Canada. This is a cost-effectiveness analysis of the treatment of patients with VLUs, using MPA for 4 weeks in addition to standard of care compression therapy (SOC), compared to SOC alone using Canadian costs of VLU treatment. The authors determined the Canadian costs for each visit for a patient with a VLU to have their dressings performed at a nursing clinic. The total costs of treatment were determined based on healing rates from a randomized controlled trial from Wales that demonstrated a significant improvement in the healing of VLUs when MPA was used for 4 weeks in addition to SOC, compared to SOC alone. The cost per visit to a nursing clinic for the treatment of a VLU was estimated to be $109.71 CAD and dressing frequency was estimated to be an average of every 2.5 days. Using projected healing rates over a 12-month period based on the UK paper, the model indicated that treatment with MPA resulted in a cost savings of $983.61 CAD per patient. The average increase in ulcer free days was 56.6 days per patient. The Incremental Cost Effectiveness Ratio (ICER) identified a saving of $17.38 per ulcer free day. This model based on Canadian costs resulted in faster healing of VLUs and a reduced average Direct Wound Care Cost of $983.61 per patient for the whole of their ulcer treatment when the MPA is used for 4 weeks in addition to SOC. This treatment has the potential for patient benefit as well as significant cost savings for the Canadian Health Care system.

Inpatient care for venous leg ulcers is often inconsistent, with delays in vascular assessment and compression therapy contributing to prolonged healing and fragmented treatment. This evaluation examined a front-door Tissue Viability Nurse-led service providing specialist assessment at hospital admission. A descriptive service improvement evaluation was conducted. From 2022, patients in the Assessment Ward admitted with leg wounds received Tissue Viability assessment within one working day, including Doppler-based vascular evaluation, wound bed preparation, peri-wound skin optimisation and early initiation of compression therapy. Compression bandaging became a core clinical skill for registered nurses, supported by a rationalised product formulary. This observational evaluation and qualitative review suggested that early specialist involvement supported the timely initiation of compression therapy, reduced variation in inpatient wound care and minimised duplicate referrals through clear Tissue Viability-led care plans. Staff confidence in applying compression was perceived to improve, collaboration with vascular, dermatology and community services strengthened and patients informally reported clearer information and greater continuity of care, supporting a timelier approach to care delivery. Positioning Tissue Viability expertise at the Assessment Ward appeared to support improvements in the consistency and safety of care processes in leg ulcer management. This front-door specialist model, rarely described in acute care literature, enhanced timeliness and coordination and provides a scalable approach to addressing international gaps in acute wound care pathways.

Whilst strong compression is effective in treating venous leg ulcers, compression systems vary in their effects on ulcer healing and wider outcomes. Four-layer bandage systems (4LB) and two-layer hosiery (2LH) are recognised effective compression systems in practice. The relative effectiveness and cost-effectiveness of two-layer bandage systems (2LB, a commonly used system), compression wraps (CW, a newer option), and short-stretch bandages (SSB) were uncertain. This paper aims to compare the effectiveness on time to venous ulcer healing and cost-effectiveness of 4LB and 2LH (or a choice of these), with 2LB, SSB, and CW.

This study aimed to develop a novel hemostatic dressing capable of exerting pressure-assisted hemostasis, promoting platelet aggregation, and enhancing the absorption of blood and tissue exudates. The Alginate/calcium chloride (Alg/CaCl2) dressing was fabricated by crosslinking sodium alginate with calcium chloride, resulting in the formation of a stable gel network, which was subsequently freeze-dried to obtain a porous structure. In vitro evaluations were performed using L929 mouse fibroblasts to assess cytotoxicity, platelet aggregation, and platelet activation. The biosafety of the dressing was further examined using a rabbit skin irritation model following both topical application and subcutaneous injection. In addition, the pressure-assisted hemostatic effect of the dressing was evaluated using a customized compression device incorporating the Alg/CaCl2 dressing.The results demonstrated that the Alg/CaCl2 dressing promoted platelet aggregation and activation while exhibiting minimal cytotoxicity at most tested concentrations, indicating favorable biocompatibility. The dressing possessed a highly porous structure and excellent fluid absorption capacity. Furthermore, the sustained release of physiologically active calcium ions may facilitate platelet activation and fibrin formation, thereby accelerating the hemostatic process. In vivo assessments revealed no significant skin irritation or adverse tissue reactions following either topical application or subcutaneous injection, supporting its safety for biomedical applications. Moreover, compression testing in the animal model demonstrated that the Alg/CaCl2 dressing generated greater compressive force than commercially available hemostatic products, contributing to enhanced pressure-assisted hemostasis.

Osteocyte lacunae are ubiquitous microstructural cavities in bone that perturb local stress and strain fields, shaping the mechanical microenvironment relevant to mechanotransduction and microdamage initiation. Yet lacunar-scale mechanical fields are not directly measurable in situ, and existing numerical studies are often limited by idealized geometries, incomplete verification, generic material properties, and a lack of specimen-matched experimental validation. Here, we present an image-guided multiscale framework integrating synchrotron radiation µCT in situ compression, convolutional neural network (CNN)-based lacunar segmentation and morphometrics, inverse identification of tissue elastic properties, and µCT-driven finite element simulation with lacuna-resolved submodeling. In a human trabecular bone case study, CNN-based analysis identified 219,931 lacunae and equivalent-ellipsoid reconstruction reproduced segmented lacunar volumes with high fidelity (R[2] = 0.97), enabling robust population-scale shape and orientation assessment and revealing preferential alignment with the local trabecular axis. Numerical verification supported a loose-wrap hexahedral discretization and mesh convergence at h = 0.04 mm (relative discretization error of 0.35%). Specimen-specific inverse calibration reproduced the experimental linear force-displacement response (RMSE = 0.82 N). Lacuna-resolved analyses across three submodels showed localized equatorial tensile amplification (Kt=1.38-1.99) governed primarily by lacunar elongation, orientation, and local stress triaxiality. These effects were captured by a compact multivariate power-law relation (R[2]=0.81; RLOOCV[2]=0.72). Inter-lacunar interactions decayed rapidly with distance and became negligible beyond ∼8-9 effective radii (∼23 µm), providing a scale-free isolation criterion. This experimentally calibrated and numerically verified workflow bridges specimen-scale mechanics and peri-lacunar stress fields and enables quantitative, population-scale assessment of how lacunae modulate local mechanical stimuli. STATEMENT OF SIGNIFICANCE: Osteocytes sense mechanical loading through microscopic cavities (lacunae) embedded in bone, yet the local mechanical environment around these cavities cannot be measured directly and is often oversimplified in computational studies. This work introduces a validated, image-guided multiscale framework that combines synchrotron imaging, deep-learning-based lacunar mapping, in situ mechanical testing, and specimen-calibrated finite element modeling to quantify how real lacunar shape, orientation, and spacing affect local stress amplification. Unlike previous idealized or unvalidated approaches, the method provides transferable, quantitative descriptors of lacuna-driven mechanical perturbations and defines a scale-free criterion for lacunar interaction. The framework enables population-scale assessment of osteocyte-level mechanics and offers new tools for studying bone quality, adaptation, and fragility beyond bone mass alone.