Stem cell therapy in diabetic foot ulcer has emerged as a promising treatment option to promote ulcer healing. This network meta-analysis was undertaken to evaluate how they compete with each other and their ranking with respect to chances of ulcer healing. A systematic search strategy to retrieve data from five databases, were used to identify potential studies. Randomized controlled trial or clinical controlled trial, published in English, using any type of stem cells as intervention in individuals aged over 18 years diagnosed with diabetic foot ulcers were included. This network meta-analysis was performed using frequentist method using R version 4.2.1. Eighteen clinical trials were included in the study which included 13 interventions. The study found that most of the stem cells were significantly promoting ulcer healing chances with human viable wound matrix (hVWM) [RR 2.91; CI: 1.28, 6.64], peripheral blood mononuclear cells (PBMNC) [RR 2.35; CI: 1.21, 4.55], bone marrow mesenchymal stem cells (BMMSCs) [RR 2.20; CI: 1.34, 3.60], were top three stem cell options among all. P score also suggested the same. Risk of bias study suggested that there was "some concern or "high risk'' among majority of studies. It is evident from this study that bone marrow mononuclear cells were found to be most effective in wound healing in cases of diabetic foot ulcer in that order. Though there was no significant difference between these and more studies were required to ascertain whether they differ in term of efficacy for the clinical outcome of ulcer healing.
干细胞治疗糖尿病足溃疡已成为促进溃疡愈合的一种很有前景的治疗方法。本网络荟萃分析旨在评估干细胞疗法与溃疡愈合几率之间的相互影响和排名。我们采用了系统性检索策略,从五个数据库中检索数据,以确定潜在的研究。研究对象包括用任何类型的干细胞对18岁以上被诊断患有糖尿病足溃疡的患者进行干预的随机对照试验或临床对照试验。该网络荟萃分析采用频数主义方法,使用 R 4.2.1 版本。研究共纳入18项临床试验,其中包括13项干预措施。研究发现,大多数干细胞都能显著促进溃疡愈合,其中人类存活伤口基质(hVWM)[RR 2.91;CI:1.28,6.64]、外周血单核细胞(PBMNC)[RR 2.35;CI:1.21,4.55]、骨髓间充质干细胞(BMMSCs)[RR 2.20;CI:1.34,3.60]是所有干细胞选择中的前三名。P评分也表明了这一点。偏倚风险研究表明,大多数研究存在 "一定程度的担忧 "或 "高风险"。这项研究表明,骨髓单核细胞对糖尿病足溃疡患者的伤口愈合最有效。虽然它们之间没有明显的差异,但还需要更多的研究来确定它们对溃疡愈合的临床结果是否有不同的疗效。
{"title":"A Network Meta-Analysis of Randomized Controlled Trials on the Comparative Efficacy of Stem Cells Therapy for Diabetic Foot Ulcer Healing.","authors":"Shiv Kumar Mudgal, Subodh Kumar, Suresh K Sharma, Rakhi Gaur, Dibyajyoti Saikia, Harminder Singh, Saurabh Varshney, Ashoo Grover, Seshadri Reddy Varikasuvu","doi":"10.1177/15347346241286216","DOIUrl":"https://doi.org/10.1177/15347346241286216","url":null,"abstract":"<p><p>Stem cell therapy in diabetic foot ulcer has emerged as a promising treatment option to promote ulcer healing. This network meta-analysis was undertaken to evaluate how they compete with each other and their ranking with respect to chances of ulcer healing. A systematic search strategy to retrieve data from five databases, were used to identify potential studies. Randomized controlled trial or clinical controlled trial, published in English, using any type of stem cells as intervention in individuals aged over 18 years diagnosed with diabetic foot ulcers were included. This network meta-analysis was performed using frequentist method using R version 4.2.1. Eighteen clinical trials were included in the study which included 13 interventions. The study found that most of the stem cells were significantly promoting ulcer healing chances with human viable wound matrix (hVWM) [RR 2.91; CI: 1.28, 6.64], peripheral blood mononuclear cells (PBMNC) [RR 2.35; CI: 1.21, 4.55], bone marrow mesenchymal stem cells (BMMSCs) [RR 2.20; CI: 1.34, 3.60], were top three stem cell options among all. P score also suggested the same. Risk of bias study suggested that there was \"some concern or \"high risk'' among majority of studies. It is evident from this study that bone marrow mononuclear cells were found to be most effective in wound healing in cases of diabetic foot ulcer in that order. Though there was no significant difference between these and more studies were required to ascertain whether they differ in term of efficacy for the clinical outcome of ulcer healing.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305245","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1177/15347346241283260
Sichao Jiang, Shouyu Wang
Background: Charcot foot or Charcot neuropathic joint disease (CN) is a rare and complex foot disease with unknown pathogenesis, hindering early identification and intervention. The study aimed to clarify the causal association between all predominant risk factors and CN.
Methods: Two-sample Mendelian Randomization (MR), Multivariate MR, and Bidirectional MR analyses investigated the causal association between 36 modifiable risk factors and CN. The causal relationship between CN and Inflammatory cytokine and immune cells was also analyzed.
Results: Genetic factors associated with obesity and genetic susceptibility to various autoimmune diseases and non-cancerous thyroid diseases increased the risk of CN (P < .05), genetically associated high basal metabolic rate and high total cholesterol decreased the risk of CN (P < .05). In addition, we found a bi-directional causal relationship between CN and diabetes. In further immune cell analysis, we found 8 CN related immune cells, and in inflammatory cytokine analysis, we found 2 CN related inflammatory cytokines.
Conclusions: This comprehensive MR Study supports the causal role of Obesity-related factors, diabetes, autoimmune-related factors, and smoking in the development and progression of CN. This study identifies a potential cause of CN that has not been identified in previous studies and provides a new direction for further research.
{"title":"Analysis of Genetic Risk Factors Associated with Charcot Foot Based on the FinnGen Study R9 Data: A Wide-angle Mendelian Randomization Study.","authors":"Sichao Jiang, Shouyu Wang","doi":"10.1177/15347346241283260","DOIUrl":"https://doi.org/10.1177/15347346241283260","url":null,"abstract":"<p><strong>Background: </strong>Charcot foot or Charcot neuropathic joint disease (CN) is a rare and complex foot disease with unknown pathogenesis, hindering early identification and intervention. The study aimed to clarify the causal association between all predominant risk factors and CN.</p><p><strong>Methods: </strong>Two-sample Mendelian Randomization (MR), Multivariate MR, and Bidirectional MR analyses investigated the causal association between 36 modifiable risk factors and CN. The causal relationship between CN and Inflammatory cytokine and immune cells was also analyzed.</p><p><strong>Results: </strong>Genetic factors associated with obesity and genetic susceptibility to various autoimmune diseases and non-cancerous thyroid diseases increased the risk of CN (<i>P </i>< .05), genetically associated high basal metabolic rate and high total cholesterol decreased the risk of CN (<i>P </i>< .05). In addition, we found a bi-directional causal relationship between CN and diabetes. In further immune cell analysis, we found 8 CN related immune cells, and in inflammatory cytokine analysis, we found 2 CN related inflammatory cytokines.</p><p><strong>Conclusions: </strong>This comprehensive MR Study supports the causal role of Obesity-related factors, diabetes, autoimmune-related factors, and smoking in the development and progression of CN. This study identifies a potential cause of CN that has not been identified in previous studies and provides a new direction for further research.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-16DOI: 10.1177/15347346241284059
Kleoniki I Athanasiadou, Christothea A Tsiridis, Ioanna A Paschou, Stavroula A Paschou, Nikolaos Papanas
The aim of this narrative review was to discuss manifestations of endocrine disease other than diabetic foot in the lower extremities. Acromegaly, Addison's disease, Cushing's syndrome, hypo- and hyperthyroidism, hypo- and hyperparathyroidism, autoimmune polyglandular syndrome, hypopituitarism, and glucagonoma are among the endocrine diseases that may present with clinical manifestations in the lower extremities. Clinical signs vary depending on the underlying condition. Clinical suspicion is necessary for early diagnosis. Treatment of the underlying endocrine disease usually results in improvement of lower-extremity manifestations.
{"title":"Manifestations of Endocrine Disease in the Lower Extremities: Beyond the Diabetic Foot.","authors":"Kleoniki I Athanasiadou, Christothea A Tsiridis, Ioanna A Paschou, Stavroula A Paschou, Nikolaos Papanas","doi":"10.1177/15347346241284059","DOIUrl":"https://doi.org/10.1177/15347346241284059","url":null,"abstract":"<p><p>The aim of this narrative review was to discuss manifestations of endocrine disease other than diabetic foot in the lower extremities. Acromegaly, Addison's disease, Cushing's syndrome, hypo- and hyperthyroidism, hypo- and hyperparathyroidism, autoimmune polyglandular syndrome, hypopituitarism, and glucagonoma are among the endocrine diseases that may present with clinical manifestations in the lower extremities. Clinical signs vary depending on the underlying condition. Clinical suspicion is necessary for early diagnosis. Treatment of the underlying endocrine disease usually results in improvement of lower-extremity manifestations.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142305247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Evolving Strategies in the Management of Venous Leg Ulcers.","authors":"Kittipan Rerkasem, Myo Zin Oo, Massimo Papi, Nikolaos Papanas","doi":"10.1177/15347346241283142","DOIUrl":"https://doi.org/10.1177/15347346241283142","url":null,"abstract":"","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142157080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-28DOI: 10.1177/15347346241279517
Xu Xu, Qiang Guo
No consensus or guideline has been established regarding the optimal timing of tissue resection after revascularization in patients with chronic limb-threatening ischemia (CLTI). This study aimed to compare early tissue resection and watchful waiting after revascularization regarding the outcomes of patients with CLTI. We searched PubMed, the Cochrane Library, and EMBASE for relevant randomized trials and observational studies published from their inception to May 1, 2024. In total, five articles were analyzed. The results showed that the early tissue resection group had a higher wound healing rate than the watchful waiting group (I2 = 26%, odds ratio [OR] = 2.80, 95% confidence interval [CI] 1.32 to 5.92, P = 0.007). However, the rate of major amputation was significantly higher in the early tissue resection group than in the watchful waiting group (I2 = 5%, OR = 1.48, 95% CI 1.18 to 1.86, P < 0.001), and wound recurrence rate in the early tissue resection group was relatively higher than that in the watchful waiting group (I2 = 0%, OR = 2.42, 95% CI: 0.99 to 5.93, P = 0.05). No statistical significance was found in the rate of postoperative mortality (I2 = 2%, OR = 0.99, 95% CI: 0.69 to 1.41, P = 0.94) and wound healing time (I2 = 97%, standardized mean difference = -105.92, 95% CI -232.96 to 21.13, P = 0.10) between the early tissue resection and watchful waiting groups. For patients without signs of infection, a watchful waiting strategy could reduce the risk of major amputation.
{"title":"Early Tissue Resection Versus Watchful Waiting After Revascularization for Chronic Limb-Threatening Ischemia: A Meta-Analysis.","authors":"Xu Xu, Qiang Guo","doi":"10.1177/15347346241279517","DOIUrl":"https://doi.org/10.1177/15347346241279517","url":null,"abstract":"<p><p>No consensus or guideline has been established regarding the optimal timing of tissue resection after revascularization in patients with chronic limb-threatening ischemia (CLTI). This study aimed to compare early tissue resection and watchful waiting after revascularization regarding the outcomes of patients with CLTI. We searched PubMed, the Cochrane Library, and EMBASE for relevant randomized trials and observational studies published from their inception to May 1, 2024. In total, five articles were analyzed. The results showed that the early tissue resection group had a higher wound healing rate than the watchful waiting group (I<sup>2 </sup>= 26%, odds ratio [OR] = 2.80, 95% confidence interval [CI] 1.32 to 5.92, <i>P </i>= 0.007). However, the rate of major amputation was significantly higher in the early tissue resection group than in the watchful waiting group (I<sup>2 </sup>= 5%, OR = 1.48, 95% CI 1.18 to 1.86, <i>P </i>< 0.001), and wound recurrence rate in the early tissue resection group was relatively higher than that in the watchful waiting group (I<sup>2 </sup>= 0%, OR = 2.42, 95% CI: 0.99 to 5.93, <i>P </i>= 0.05). No statistical significance was found in the rate of postoperative mortality (I<sup>2 </sup>= 2%, OR = 0.99, 95% CI: 0.69 to 1.41, <i>P </i>= 0.94) and wound healing time (I<sup>2 </sup>= 97%, standardized mean difference = -105.92, 95% CI -232.96 to 21.13, <i>P </i>= 0.10) between the early tissue resection and watchful waiting groups. For patients without signs of infection, a watchful waiting strategy could reduce the risk of major amputation.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-23DOI: 10.1177/15347346241275243
Zhenxue Zhao, Wenchao Xu, Suxia Wang, Dandan Zhang, Yuqi Wang
Objective: To explore the effect of information-motivation-behavioral skills model (IMB)-based continuous nursing model on the out-of-hospital rehabilitation of diabetic foot ulceration (DFU) patients, and to provide a theoretical basis for long-term disease management of DFU patients.
Methods: A total of 88 patients with DFU admitted to our Hospital were included in this prospective study. The patients were divided into control and study groups using the random number table method, with 44 cases in each group. Patients in the study group received both routine care and IMB-based continuing care, and the control group received only routine care.
Results: At week 1, FBS, PBG (2 h) and HbA1c were significantly decreased in the study group compared with that in the control group (P < .05). At week 3 and 6, blood glucose indicators were significantly improved in both groups compared with week 1 (P < .05). In additional, the number of non-infected patients at week 1 and week 3 in the study group was significantly higher than that in the control group (P < .05). At week 3, the number of cured patients was significantly higher in the study group than that in the control group (P < .05). And the area of ulcer healing in the study group was significantly larger than that in the control group at week 1 and week 3 (P < .05).
Conclusion: In conclusion, the continuous nursing mode based on IMB can help DFU patients manage blood glucose level, reduce wound infection, and accelerate wound healing, which is worthy of wide clinical application and promotion.
{"title":"Application of Continuous Care Pattern Based on Information-Motivation-Behavioral Skills Model in out-of-Hospital Rehabilitation of Diabetic Foot Ulceration Patients: A Randomized Controlled Trial.","authors":"Zhenxue Zhao, Wenchao Xu, Suxia Wang, Dandan Zhang, Yuqi Wang","doi":"10.1177/15347346241275243","DOIUrl":"https://doi.org/10.1177/15347346241275243","url":null,"abstract":"<p><strong>Objective: </strong>To explore the effect of information-motivation-behavioral skills model (IMB)-based continuous nursing model on the out-of-hospital rehabilitation of diabetic foot ulceration (DFU) patients, and to provide a theoretical basis for long-term disease management of DFU patients.</p><p><strong>Methods: </strong>A total of 88 patients with DFU admitted to our Hospital were included in this prospective study. The patients were divided into control and study groups using the random number table method, with 44 cases in each group. Patients in the study group received both routine care and IMB-based continuing care, and the control group received only routine care.</p><p><strong>Results: </strong>At week 1, FBS, PBG (2 h) and HbA1c were significantly decreased in the study group compared with that in the control group (<i>P </i>< .05). At week 3 and 6, blood glucose indicators were significantly improved in both groups compared with week 1 (<i>P </i>< .05). In additional, the number of non-infected patients at week 1 and week 3 in the study group was significantly higher than that in the control group (<i>P </i>< .05). At week 3, the number of cured patients was significantly higher in the study group than that in the control group (<i>P </i>< .05). And the area of ulcer healing in the study group was significantly larger than that in the control group at week 1 and week 3 (<i>P </i>< .05).</p><p><strong>Conclusion: </strong>In conclusion, the continuous nursing mode based on IMB can help DFU patients manage blood glucose level, reduce wound infection, and accelerate wound healing, which is worthy of wide clinical application and promotion.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142038079","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-22DOI: 10.1177/15347346241273327
Wouter Brekelmans, Boudewijn L S Borger van der Burg, Bart Fischer, Maartje Hesseling-Kuijpers, Rigo Hoencamp, Harm Jaap Smit
Correct classification of wounds is of paramount importance for diagnostic and therapeutic pathways. The aim of this study was to provide insight in the incidence of different aetiology of wounds and the healing time in a primary care setting. All patients with a wound presented in Primary Care (PC) practice from January 2017 through 2020 were included. A retrospective analysis related to age, sex, duration of wound healing, healing-rates, aetiology and comorbidity of the patients was performed. The prevalence of wounds in primary care was is 3.9 per 1000. In more than 90% of the wounds heal within 37 days. The wound healing speed and duration to closure differ significantly (P = .002) between aetiology. This study shows that 90% of wounds that enter a Dutch GP practice heal within 37 days. This study provides unique data on wound healing rates differentiated by etiology.
{"title":"Real-Life Data on Wound Healing Speed and Duration to Wound Closure by Different Aetiology in a Primary Care Centre in the Netherlands.","authors":"Wouter Brekelmans, Boudewijn L S Borger van der Burg, Bart Fischer, Maartje Hesseling-Kuijpers, Rigo Hoencamp, Harm Jaap Smit","doi":"10.1177/15347346241273327","DOIUrl":"https://doi.org/10.1177/15347346241273327","url":null,"abstract":"<p><p>Correct classification of wounds is of paramount importance for diagnostic and therapeutic pathways. The aim of this study was to provide insight in the incidence of different aetiology of wounds and the healing time in a primary care setting. All patients with a wound presented in Primary Care (PC) practice from January 2017 through 2020 were included. A retrospective analysis related to age, sex, duration of wound healing, healing-rates, aetiology and comorbidity of the patients was performed. The prevalence of wounds in primary care was is 3.9 per 1000. In more than 90% of the wounds heal within 37 days. The wound healing speed and duration to closure differ significantly (<i>P</i> = .002) between aetiology. This study shows that 90% of wounds that enter a Dutch GP practice heal within 37 days. This study provides unique data on wound healing rates differentiated by etiology.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142020057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-14DOI: 10.1177/15347346241275186
Raúl J Molines-Barroso, Mateo López-Moral, Marta García-Madrid, Esther García-Morales, Yolanda García-Álvarez, José Luis Lázaro-Martínez
The objective of this study was to identify bone fractures and joint dislocations that have greater association with the severity of arch collapse in patients with Charcot foot involving the midfoot.A retrospective study in 28 (N = 29 feet) patients who had Charcot foot deformity of the midfoot. The study included stage III of Eichenholtz classification, and Schon classification types I to III. Talar-first metatarsal and calcaneal pitch angles and cuboid height were used to evaluate the severity of the midfoot deformity in a weightbearing lateral radiograph. Two investigators evaluated the bone fracture and joint dislocation involved in weightbearing antero-posterior and lateral radiographs.There were 13 (46%) feet that showed pattern 1, 9 (31%) feet with pattern 2, and 7 (25%) feet with pattern 3 according to the Schon classification. One foot had a combination of patterns 1 and 2. Midfoot ulceration occurred in 64% (n = 19) of feet. In the multivariate analysis, plantarflexion of talar-first metatarsal angle was predicted by navicular-medial cuneiform dislocation (p = .007 [-20.620-3.683]), an increase of the negative calcaneal pitch angle by fragmentation of the cuboid (p = .003 [-15.568-3.626]), and increment of the negative cuboid height by navicular-medial cuneiform and medial cuneiform-first metatarsal dislocations (p = .040 [-12.779-0.317], p = .002 [-13.437-3.267], respectively).Bone fractures and dislocations in the sagittal plane seem to contribute to midfoot collapse, but navicular-medial cuneiform dislocation/non-union and cuboid fragmentation predict severe rocker-bottom deformity in cases of Charcot foot.
{"title":"Influence of Fractures and Dislocations in Severity of Rocker-Bottom Deformity in Patients with Charcot Foot.","authors":"Raúl J Molines-Barroso, Mateo López-Moral, Marta García-Madrid, Esther García-Morales, Yolanda García-Álvarez, José Luis Lázaro-Martínez","doi":"10.1177/15347346241275186","DOIUrl":"https://doi.org/10.1177/15347346241275186","url":null,"abstract":"<p><p>The objective of this study was to identify bone fractures and joint dislocations that have greater association with the severity of arch collapse in patients with Charcot foot involving the midfoot.A retrospective study in 28 (N = 29 feet) patients who had Charcot foot deformity of the midfoot. The study included stage III of Eichenholtz classification, and Schon classification types I to III. Talar-first metatarsal and calcaneal pitch angles and cuboid height were used to evaluate the severity of the midfoot deformity in a weightbearing lateral radiograph. Two investigators evaluated the bone fracture and joint dislocation involved in weightbearing antero-posterior and lateral radiographs.There were 13 (46%) feet that showed pattern 1, 9 (31%) feet with pattern 2, and 7 (25%) feet with pattern 3 according to the Schon classification. One foot had a combination of patterns 1 and 2. Midfoot ulceration occurred in 64% (n = 19) of feet. In the multivariate analysis, plantarflexion of talar-first metatarsal angle was predicted by navicular-medial cuneiform dislocation (p = .007 [-20.620-3.683]), an increase of the negative calcaneal pitch angle by fragmentation of the cuboid (p = .003 [-15.568-3.626]), and increment of the negative cuboid height by navicular-medial cuneiform and medial cuneiform-first metatarsal dislocations (p = .040 [-12.779-0.317], p = .002 [-13.437-3.267], respectively).Bone fractures and dislocations in the sagittal plane seem to contribute to midfoot collapse, but navicular-medial cuneiform dislocation/non-union and cuboid fragmentation predict severe rocker-bottom deformity in cases of Charcot foot.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-09DOI: 10.1177/15347346241273112
Adam Astrada, Gojiro Nakagami, Hiromi Sanada
Foot ulcerations are one of the most common complications of diabetes and one of the major initial causes of amputations. The formation of biofilms on wounds significantly contributes to infections and delayed healing. While existing methods for identifying these biofilms have limitations, there is a need for a convenient tool for its clinical application. This literature review aimed to address the problem with current clinical biofilm identification in wound care and a proposal for biofilm-detection-based wound care in diabetic foot ulcer patients. Identifying biofilms is particularly vital due to the absence of typical signs of infection in DFUs. However, current approaches, although effective, often prove invasive and technically intricate. The wound blotting technique, involving attaching a nitrocellulose membrane and subsequent staining, presents an alternative that is swift and non-invasive. Research highlights the applicability of wound blotting with alcian blue staining in clinical scenarios, consistently producing sensitive outcomes. By addressing the critical need for early biofilm detection, wound blotting holds promise for enhancing DFU management and contributing to strategies aimed at preventing amputations.
{"title":"Challenges in Biofilm Identification in Diabetic Foot Infections: Review of Literature.","authors":"Adam Astrada, Gojiro Nakagami, Hiromi Sanada","doi":"10.1177/15347346241273112","DOIUrl":"https://doi.org/10.1177/15347346241273112","url":null,"abstract":"<p><p>Foot ulcerations are one of the most common complications of diabetes and one of the major initial causes of amputations. The formation of biofilms on wounds significantly contributes to infections and delayed healing. While existing methods for identifying these biofilms have limitations, there is a need for a convenient tool for its clinical application. This literature review aimed to address the problem with current clinical biofilm identification in wound care and a proposal for biofilm-detection-based wound care in diabetic foot ulcer patients. Identifying biofilms is particularly vital due to the absence of typical signs of infection in DFUs. However, current approaches, although effective, often prove invasive and technically intricate. The wound blotting technique, involving attaching a nitrocellulose membrane and subsequent staining, presents an alternative that is swift and non-invasive. Research highlights the applicability of wound blotting with alcian blue staining in clinical scenarios, consistently producing sensitive outcomes. By addressing the critical need for early biofilm detection, wound blotting holds promise for enhancing DFU management and contributing to strategies aimed at preventing amputations.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908789","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-08DOI: 10.1177/15347346241273156
Dali Huang, Kang Wang, Ting Deng, Ting Yang, Jinmin Cao
Objective: Diabetic foot ulcers are common chronic complications of diabetes mellitus that can lead to amputation and death in severe cases. There is limited research on the relationship between the red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The few studies that have been conducted have been in single-center inpatient settings and there is limited research in outpatient settings. This study investigated this relationship in adult outpatient clinics in the United States.
Methods: A retrospective cross-sectional study was conducted with 1624 participants of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Three logistic regression models were developed to assess the association between red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The ratio was analyzed as a continuous and categorical variable. Stratified analyses were performed based on age, sex, HbA1c level, and body mass index.
Results: The study included 1624 adults, with a mean age of 65.0 ± 12.0 years, of whom 58.8% were male. The prevalence of diabetic lower-extremity ulcers was 8.0% (n = 131). Compared with individuals with a lower red cell distribution width/albumin ratio in T1(2.32,2.93), the adjusted OR values for the ratio and ulcers in T2(2.94,3.26), T3(3.27,7.42), and 2.07 (95% CI = 1.19∼3.61), 2.92 (95% CI = 1.63∼5.23). The association between the ratio and ulcers exhibited a non-linear relationship (nonlinear, P = .028).
Conclusion: These results support the hypothesis of an S-shaped relationship between red cell distribution width/albumin and diabetic lower-extremity ulcers. Monitoring the RDW/Albumin ratio could be crucial for preventing diabetic lower-extremity ulcers in outpatient settings. Regular assessments may help identify high-risk patients early, enabling timely interventions. Future studies should further assess these two factors and their underlying mechanisms.
目的:糖尿病足溃疡是糖尿病常见的慢性并发症,严重时可导致截肢和死亡。有关红细胞分布宽度/白蛋白比率与糖尿病下肢溃疡之间关系的研究十分有限。为数不多的研究都是在单中心住院环境中进行的,在门诊环境中的研究也很有限。本研究调查了美国成人门诊中的这种关系:方法:本研究对 1999 年至 2004 年参加美国国家健康与营养调查(NHANES)的 1624 名参与者进行了回顾性横断面研究。建立了三个逻辑回归模型来评估红细胞分布宽度/白蛋白比值与糖尿病下肢溃疡之间的关系。该比率作为连续变量和分类变量进行分析。根据年龄、性别、HbA1c水平和体重指数进行了分层分析:研究纳入了1624名成年人,平均年龄为(65.0 ± 12.0)岁,其中58.8%为男性。糖尿病下肢溃疡的发病率为 8.0%(n = 131)。与 T1(2.32,2.93)红细胞分布宽度/白蛋白比值较低的个体相比,T2(2.94,3.26)、T3(3.27,7.42)比值与溃疡的调整 OR 值分别为 2.07(95% CI = 1.19∼3.61)、2.92(95% CI = 1.63∼5.23)。该比率与溃疡之间呈现非线性关系(非线性,P = .028):这些结果支持了红细胞分布宽度/白蛋白与糖尿病下肢溃疡之间存在 S 型关系的假设。在门诊环境中,监测红细胞分布宽度/白蛋白比率对预防糖尿病下肢溃疡至关重要。定期评估有助于及早发现高危患者,及时采取干预措施。未来的研究应进一步评估这两个因素及其内在机制。
{"title":"Association Between red Cell Distribution Width/Albumin Ratio and Diabetic Lower Extremity Ulcers (DLEU) among US Outpatients in the NHANES: A Retrospective Cross-Sectional Study.","authors":"Dali Huang, Kang Wang, Ting Deng, Ting Yang, Jinmin Cao","doi":"10.1177/15347346241273156","DOIUrl":"https://doi.org/10.1177/15347346241273156","url":null,"abstract":"<p><strong>Objective: </strong>Diabetic foot ulcers are common chronic complications of diabetes mellitus that can lead to amputation and death in severe cases. There is limited research on the relationship between the red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The few studies that have been conducted have been in single-center inpatient settings and there is limited research in outpatient settings. This study investigated this relationship in adult outpatient clinics in the United States.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted with 1624 participants of the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Three logistic regression models were developed to assess the association between red cell distribution width/albumin ratio and diabetic lower-extremity ulcers. The ratio was analyzed as a continuous and categorical variable. Stratified analyses were performed based on age, sex, HbA1c level, and body mass index.</p><p><strong>Results: </strong>The study included 1624 adults, with a mean age of 65.0 ± 12.0 years, of whom 58.8% were male. The prevalence of diabetic lower-extremity ulcers was 8.0% (<i>n</i> = 131). Compared with individuals with a lower red cell distribution width/albumin ratio in T1(2.32,2.93), the adjusted OR values for the ratio and ulcers in T2(2.94,3.26), T3(3.27,7.42), and 2.07 (95% CI = 1.19∼3.61), 2.92 (95% CI = 1.63∼5.23). The association between the ratio and ulcers exhibited a non-linear relationship (nonlinear, <i>P</i> = .028).</p><p><strong>Conclusion: </strong>These results support the hypothesis of an S-shaped relationship between red cell distribution width/albumin and diabetic lower-extremity ulcers. Monitoring the RDW/Albumin ratio could be crucial for preventing diabetic lower-extremity ulcers in outpatient settings. Regular assessments may help identify high-risk patients early, enabling timely interventions. Future studies should further assess these two factors and their underlying mechanisms.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141904103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}