The international journal of lower extremity wounds最新文献

Background: Multiple studies have shown metabolites may have potential effects on Charcot foot. However, the Mendelian randomization method has not yet explored the relationship between metabolites and Charcot foot.

Methods: We selected genetic variants from the publicly available Genome-wide Association Studies (GWAS) summary database to represent 1400 metabolites described in recent research. Mendelian randomization (MR) analysis was carried out to examine the relationships between these metabolites and Charcot foot. Significant single nucleotide polymorphism (SNP) data associated with exposure were screened out through association analysis. Valid instrumental variables (IVs) were then selected, excluding SNPs with F-statistic values below 10. The MR analyses primarily employed the inverse variance weighted (IVW) method. Bayesian weighted Mendelian randomization (BWMR), constrained maximum likelihood(cML), contamination mixture(Conmix), robust adjusted profile score(RAPS), and debiased inverse-variance weighted(deIVW) method were used to enhance the results. Colocalization analysis was performed to identify shared causal genetic variants associated with the resulting phenotypes. Sensitivity analyses, including assessments of Cochrane's Q test, egger intercept, and MR PRESSO test were conducted to confirm the robustness of the results.

Results: After preliminary MR exploration, the IVW results exhibited positive causal relationships between hexadecenedioate (C16:1-DC) levels (OR = 0.698, 95%CI: 0.586 to 0.831, P_FDR= 0.040), octadecadienedioate (C18:2-DC) levels (OR = 0.665, 95%CI: 0.552 to 0.800, P_FDR= 0.021), octadecanedioylcarnitine (C18-DC) levels (OR = 0.676, 95%CI: 0.553 to 0.827, P_FDR= 0.067) and Charcot foot. Colocalization analysis indicated that the above three metabolites share a common causal variant at the same genomic location with Charcot foot. Sixty-four metabolites with suggestive causal relationships with Charcot foot were also identified, among which 25 kinds of metabolites were positively correlated with Charcot foot, and 33 metabolites were negatively associated with Charcot foot. The BWMR, cML, Conmix, RAPS, and deIVW results supported our preliminary MR results. In several results, sensitivity analyses showed heterogeneity and horizontal pleiotropy, while the causal relationships obtained through FDR correction did not show any significant heterogeneity and horizontal pleiotropy. No reverse causal association was detected.

Conclusion: We detected protective and risk metabolites in Charcot foot. Controlling metabolites may decrease Charcot foot risk and serve as a novel therapeutic biomarker for the therapy.

This study aimed to evaluate the impact of diabetic foot care training delivered using the Pecha Kucha (20*20) presentation method on the knowledge, self-efficacy, and behavior levels of patients with Type 2 diabetes. Conducted between December 10, 2023, and October 7, 2024, this randomized controlled experimental study included 125 diabetic individuals, with 62 in the experimental group and 63 in the control group. The experimental group received diabetic foot care education using the Pecha Kucha method, while the control group received conventional education. Data were collected using the Patient Assessment Form, Diabetes Foot Knowledge Questionnaire, Diabetic Foot Care Self-Efficacy Scale, and Foot Self-Care Behavior Scale. Statistical analyses revealed that the experimental group demonstrated significantly higher scores in knowledge and self-efficacy compared to the control group (p < 0.001), while no significant difference was found in self-care behavior scores (p > 0.05). The results suggest that the Pecha Kucha method effectively enhances diabetic individuals' knowledge and self-efficacy regarding foot care. However, further research is needed to explore its long-term impact on behavior changes. The study was registered in Clinical Trials (https://clinicaltrials.gov/study/NCT06768645) with the registration number of "NCT06768645".

Objective: To investigate the risk factors for diabetic foot ulcers (DFU) in patients with type 2 diabetes (T2DM), to create a nomogram prediction model, and to further validate the nomogram model. 500 T2DM patients treated at Shanghai Integrated Traditional Chinese and Western Medicine Hospital were retrospectively analyzed from April 2023 to November 2023. Patients were categorized into groups based on the presence of DFU (n = 64) and T2DM (n = 436). Clinical data were analyzed, and relevant parameters were assessed using a receiver operating curve (ROC) analysis. A risk prediction model was created using the R language software 4.0 "rms" and validated using calibration and decision curves. Age, diabetes duration, coronary heart disease, cerebrovascular disease, diabetic nephropathy, HbA1c, and fasting blood glucose were significantly higher in the DFU group (OR = 1.598,1.444,1.101,1.210,1.414,2.132,1.935，all P＜0.001). Gender, family history of diabetes, hypertension, peripheral neuropathy, drug regimen, and lipid levels showed no significant differences (P > 0.05). Logistic regression analysis identified age, diabetes duration, athlete's foot infection, HbA1c, and fasting blood glucose as independent risk factors for DFU in T2DM. The nomogram model yielded a C-index of 0.822 (95% CI: 0.813-0.882), indicating a net clinical benefit. The constructed nomogram prediction model based on age, diabetes duration, athlete's foot infection, HbA1c, and fasting blood glucose provides a simple assessment method for DFU in T2DM patients. Further validation of this model is warranted.

Muscle strength, balance, performance, and gait speed of individuals diagnosed with diabetic foot wound are negatively affected. This study aimed to investigate the effects of wound localisation on balance, performance, muscle strength, and gait speed in individuals with diabetic foot wounds. Individuals (n = 48) with a mean age of 59.35 ± 11.28 years and were divided into two groups according to wound localisation as group 1 (n = 24) with forefoot wounds and group 2 (n = 24) with hindfoot wounds. Four Step Square Test was used for dynamic balance assessment, Timed Up and Go Test for performance, Manual Muscle Tests for muscle strength, and 10 Meter Walk Test for gait speed assessment. When compared in terms of muscle strength, there was a difference only between the injured side Gluteus Medius (p = 0.02), Gastrosoleus (p = 0.00), and Tibialis Anterior (p = 0.03) muscles. Other muscle groups strength, balance, performance, and gait speed were similar (p > 0.05). Loss of muscle strength can lead to serious negative consequences such as deformity and new wound formation if not intervened in time. The effects on balance and performance are similar in different wound localizations.

Charcot neuropathic arthropathy (CN) impacts peripheral lower extremity nerves, leading to joint destruction, and has a significant economic burden on the healthcare system. This economic burden is further exacerbated by the projected increase in diabetes mellitus cases over the coming decades, with a corresponding anticipated rise in CN. This study assesses CN management costs through a single institution retrospective chart review and cost-effectiveness through economic modeling by utilizing a well-established equation to determine the cost-effectiveness of conservative management. This retrospective chart review from a single academic center analyzed costs and outcomes for CN patients undergoing exostectomy, arthrodesis, major amputation, minor amputation, or casting from 2000-2022. This retrospective review analyzed 216 CN patients (average age 58, 54% male). Costs were $57 949 for exostectomy, $149 009 for arthrodesis, $40 313 for major amputation, $55 035 for minor amputation, $125 851 for failed casting, and $8233 for casting. We conducted a break-even analysis that determined that intervention with casting was cost-effective compared to failed casting. Total contact casting is a cost-effective first-line treatment for CN, capable of managing non-advanced cases effectively and reducing the economic burden of surgical intervention. This study provides a critical framework for practitioners to assess cost-effectiveness in various institutional contexts.

This retrospective study aimed to evaluate diabetic foot ulcer (DFU) recurrence rates and associated risk factors, focusing on hemodialysis and specific amputation levels. Patients with diabetes treated for DFU between 2003 and 2019 at a wound-care center in Japan were studied. The primary outcome was DFU recurrence, and the factors evaluated included age, sex, hemodialysis treatment, revascularization type, and amputation level. Among 236 participants (mean age: 65 years; male: 73%; 33% on hemodialysis), DFU recurrence rates were 40.3% and 77.1% at 1 and 5 years, respectively. Hemodialysis was significantly associated with an increased DFU recurrence risk (hazard ratio: 1.92; 95% confidence interval: 1.40-2.64, P < .001). Revascularization did not significantly impact DFU recurrence rates after ulcer healing. Contralateral DFU recurrence was the most frequent, occurring in 45% of cases. Higher DFU recurrence rates were observed at adjacent toes on the same side in patients who underwent great toe amputation and at the treated site in patients who underwent transmetatarsal, Lisfranc, or Chopart amputations. These findings indicate that DFU recurrence poses a higher risk in patients undergoing hemodialysis. Tailored postoperative management focusing on both contralateral and ipsilateral recurrences is essential to minimize recurrence and improve long-term outcomes.

Aims: To describe the nutritional status of people with diabetes-related foot complications and explore the association between nutrition and ulceration healing.

Methods: This retrospective cohort study included attendees of a diabetes foot service who completed a dietary questionnaire. Diet was compared to guideline recommendations and biochemical measures were recorded. Associations between dietary intake and biochemical measures were analysed using non-parametric tests, and their relationship with being ulcer-free at 12 weeks analysed by binary logistic regression.

Results: Of 102 participants, 83% were men, mean age 68 (SD 12), body mass index 28.6 (SD 6.1) kg/m², and 86% had type 2 diabetes. Complications included 154 ulcerations and 7 active Charcot feet. Recommended fruit, vegetable and protein intake was seldom attained. Common insufficiencies were 25-hydroxy-vitamin D (40%), zinc (27%), iron (23%) and vitamin C (21%). Vitamin C was higher in the upper (vs lower) tertile of fruit/vegetable intake (62 [95%CI 33-88] vs 30 [13-46] umol/L, p = 0.04), and zinc higher in those meeting protein requirements (12.3 [95%CI 11.1-12.8] vs 10.6 [9.8-11.5] umol/L, p = 0.04). Haemoglobin was the only predictor of becoming ulcer-free (OR 1.03 [95%CI 1.00-1.06], p = 0.03).

Conclusion: Nutritional inadequacies are common in people with diabetes-related foot complications; however, the benefit of assessing nutrition remains uncertain.

Burn lesions damage the skin's outermost defensive layer, allowing pathogenic microbes including Pseudomonas aeruginosa, Staphylococcus aureus and Escherichia coli to infiltrate. Silver sulfadiazine (SSD) is an effective antibacterial agent approved by U.S. Food and Drug Administration (US-FDA) and is considered as the gold standard for burn wound treatment. Despite the high degree of efficacy of SSD in burn wound management, it possesses some drawbacks, such as poor solubility, low topical bioavailability and skin irritations. The present study endeavors to develop nanosuspension based SSD nanogel for improving the deliverability of SSD and its therapeutic outcomes for the management of partial thickness burn. The SSD nanosuspension was formulated employing controlled nanoprecipitation approach using various surfactants. The formulation was optimized utilizing one-factor-at-a-time approach and to fetch the optimized formulation of 134.6 nm size. The optimized nanosuspension was incorporated into chitosan gel that offer superior drug release potential, and also offered better spreadability (5.21 ± 0.38 g) and extrudability (152.27 ± 0.22 gm) that represents the easy application over the skin and extrusion of gel from the tube. The formulation was well tolerated as shown by skin irritation study and offered a superior burn lesion healing characteristics vis-à-vis the marketed product, even at a lower concentration. Hence, the formulation offers a huge potential in enhancing the clinical outcomes of SSD, especially in the management of partial thickness burn. The developed system with the above mentioned outcomes could be a promising delivery system for partial thickness burn wound management.

Background: Patients with diabetes mellitus (DM) face a higher risk of developing chronic refractory wounds. Vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF) and epidermal growth factor receptor (EGFR) plays an important role in diabetes-related complications. This study aims to analyze the correlation between the 3 indicators and diabetic chronic refractory wounds, in order to establish the diagnostic value of these 3 indicators and provide reference for the treatment.

Material and methods: We selected 168 patients, with 84 in healing group and 84 in refractory group. The levels of serum VEGF, bFGF, and wound tissue EGFR were compared before treatment, and the correlation between the 3 indicators and the refractory wounds was analyzed. After the specific treatment in refractory group, the clinical efficacy and wound closure index was recorded, and the correlation between them and the 3 indicators were analyzed.

Results: The 3 indicators were all protective factors for diabetic chronic refractory wounds (p < .05). The serum VEGF and bFGF had relatively low diagnostic value for diabetic chronic refractory wounds, while wound tissue EGFR demonstrated higher diagnostic value (p < .05). The 3 indicators had a positive correlation with both the clinical efficacy and the wound closure index (p < .05).

Conclusion: Higher levels of serum VEGF, bFGF, and wound tissue EGFR are conducive to reducing the incidence of diabetic chronic refractory wounds. The combined measurement of these indicators holds high diagnostic value for the disease. Moreover, the higher the expression levels of these 3 indicators, the more favorable the clinical outcomes.