The international journal of lower extremity wounds最新文献

Charcot neuro-osteoarthropathy (CNO) is a complication of diabetes occurring in people with diabetic neuropathy with a prevalence of 0.5% to 1% that may culminate to foot deformity, amputation, and early mortality. However, it is not known why only certain patients with diabetic neuropathy develop CNO. Hence, early recognition of risk factors, timely diagnosis, and appropriate intervention of CNO is pertinent. Recent understanding of the pathophysiology of CNO has expanded to suggest the involvement of RANKL-OPG pathways. But pharmaco-therapeutic interventions targeting bone metabolism predominantly inhibiting RANKL were not found to be useful. Moreover, there are not enough markers to help identify patients with diabetes who are at a higher risk of developing CNO. Hence, we explored the literature in the present systematic review of mainly case-control studies to identify genetic factors that could help in understanding the pathophysiology and risk factors for the development of CNO. We could identify 7 relevant studies identifying single nucleotide polymorphism of OPG and RANK genes. There is an isolated study identifying alterations of micro RNA associated with RANKL-OPG pathway. Another study found epigenetic alterations by performing whole methylome sequencing in people with CNO compared to control. These genetic factors can be used as a diagnostic marker and their functional counterparts as targets for future therapeutic interventions. However, we found that literature is sparse on the genetic risk factors for CNO in people with diabetic neuropathy and there is still a lot of scope for future studies towards finding the molecular and genetic markers for CNO.

Charcot neuro-osteoarthropathy (CN) is a severe and often underrecognized complication of diabetes mellitus, primarily affecting individuals with diabetic neuropathy. Its clinical course is marked by progressive joint destruction and foot deformities. This review aims to summarize current evidence regarding the role of CN in the development and recurrence of diabetic foot ulcers (DFUs), the risk of amputation, and long-term survival outcomes, as well as to highlight key mechanisms contributing to these complications. Individuals with CN exhibit a significantly higher risk of DFUs, particularly in the midfoot region, due to structural deformities and increased plantar pressure. The risk of amputation is markedly elevated in individuals with CN, especially when DFUs are present. Mortality rates in CN are substantial, with five-year survival comparable to or worse than several malignancies. The development of foot ulcers and amputations in CN results from a complex interaction of neuropathy, structural deformity and chronic inflammation. Therefore, CN is a high-risk condition associated with serious foot complications and elevated mortality. Early recognition, multidisciplinary management, and further research into its independent prognostic impact are essential to improve long-term outcomes.

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.

Background and aimsCharcot neuroosteoarthropathy (CN) is considered a rare complication of diabetic neuropathy. Due to its insidious mode of presentation, CN may be difficult to diagnose timely and a high index of suspicion is required from both, the diabetic patient (especially those with neuropathy) and their physicians for the early diagnosis and treatment to prevent major complications.MethodsWe planned a narrative review and searched MEDLINE database to identify evidence regarding CN incidence, treatment options, and recent guidelines. As practitioners do not commonly treat CN, a characteristic clinical case is also presented.ResultsThe available evidence for diagnosis and treatment remains of low quality. On the one hand, there is an urgent need for action to increase awareness of the disease in both practitioners and people with diabetes. On the other hand, prospective nationwide registries of patients with diabetic neuropathy will help clarify the prognostic factors that may predispose to this complication, and more randomized clinical trials are needed to identify whether medical treatment may improve CN outcomes. For the time being, offloading of the foot to stop the perpetuation of trauma, and inflammation, and importantly to arrest the progression to a deformed nonfunctional foot is the cornerstone of medical therapy of CN. Multidisciplinary assessment between diabetologists and radiologists is fundamental for prompt diagnosis.ConclusionsTo avoid potentially deleterious delays in diagnosis and treatment, every physician should bear in mind that every patient with diabetic neuropathy presenting with a warm swollen foot should be treated as having CN until proven otherwise.

AimsThe goal was to gather and assess information about the features of patients suffering from Diabetic Foot Syndrome with active ulcers. This data was compared to findings gathered by a designated researcher for evaluation.Materials and MethodsThis cross-sectional observational study was designed using data from a validated survey.ResultsWe conducted 102 surveys, revealing positive data on the respondents' knowledge, awareness, attitudes, and practices. However, discrepancies appeared between the participants' self-assessments, the researcher's evaluations and the actual implementation of recommendations, such as wearing inappropriate footwear, not moisturizing the feet or avoiding walking more than an hour while there is an active ulcer.ConclusionDespite participants showing positive knowledge, awareness, attitudes, and practices, it is crucial to enhance educational measures in regular clinical practice. This would further reinforce patients' preventative actions against DFU in everyday life.Practice ImplicationsThis study highlights the need to enhance patient education and preventative measures in clinical practice, ensuring patients consistently apply knowledge to prevent diabetic foot ulcers daily.

Aims/hypothesisDiabetic foot ulcers are a common and serious complication of diabetes, frequently resulting in infection, amputation, and increased mortality. Cold atmospheric plasma (CAP) is a new treatment modality that combines antimicrobial activity with promotion of tissue regeneration. We aimed to systematically review and meta-analyse randomized controlled trials to determine whether cold atmospheric plasma therapy, when added to standard wound care, improves healing outcomes and safety in patients with diabetic foot ulcers (DFUs).MethodsFollowing PRISMA 2020 guidelines, we included randomized controlled trials in adults with DFUs comparing adjunctive CAP plus standard care versus standard care. Non-RCTs, non-CAP energy modalities, CAP without concomitant standard care, and studies without a concurrent control were excluded. The primary outcome was final fractional wound area (final/baseline; unitless proportion, 0-1). Secondary outcomes were ≥50% wound-size reduction by week 3, bacterial load, and adverse events.ResultsThree RCTs (107 participants; 126 ulcers) showed that CAP reduced final fractional wound area (mean difference -0.29 proportion units, 95% CI -0.47 to -0.11; p = 0.002; I² = 22%). The proportion achieving ≥50% wound-size reduction by week 3 was higher with CAP (RR 2.39, 95% CI 1.46-3.91; p < 0.001; I² = 0%). Bacterial load declined over time in both groups with no sustained between-group difference; immediate post-application reductions were observed with CAP within sessions. No serious treatment-related adverse events were reported.Conclusions/interpretationAdjunctive cold atmospheric plasma improved early healing of diabetic foot ulcers and showed a favourable short-term safety profile, with no sustained advantage in infection control over standard care. Larger, longer randomized trials are warranted to assess complete closure and recurrence outcomes and to define optimal treatment parameters.RegistrationPROSPERO registration ID CRD4201113940.

ObjectiveTo investigate the association between frailty and diabetic foot ulcer (DFU) risk among patients with diabetes and to evaluate the frailty index as a potential predictive tool.MethodsThis cross-sectional study analyzed data from the National Health and Nutrition Examination Survey (NHANES). Participants were categorized into frailty Z-score quartiles. Survey-weighted generalized linear models (SWGLMs) were used to evaluate the association between Frailty and DFU, with restricted cubic spline (RCS) analysis to examine non-linear relationships. Subgroup and interaction analyses were also conducted.ResultsAmong 831 adults with diabetes (mean age 59.2 years; 49.6% female), higher frailty scores were significantly associated with increased DFU risk. After multivariate adjustment, each standard deviation increase in frailty Z-score was linked to a 92% higher DFU risk (OR = 1.92, 95% CI: 1.34-2.73, P < 0.001). Participants in the highest frailty quartile had a nearly 5-fold increased risk compared to the lowest (OR = 5.95, 95% CI: 0.44-30.0, P = 0.033), with a significant dose-response trend (P for trend=0.023). RCS analysis supported a significant overall association (P < 0.001), showing a primarily linear relationship (P for nonlinearity=0.207). Subgroup analyses revealed consistent associations without significant interactions.ConclusionsFrailty is independently associated with elevated DFU risk among patients with diabetes. The frailty index may serve as a useful adjunct to conventional risk factors for early identification of high-risk individuals.

BackgroundChronic wounds represent a pathological state characterized by failure to heal within the normal timeframe, often accompanied by infection, high recurrence rates, and treatment challenges. Nicotine, the primary component of both electronic cigarettes and traditional tobacco, is known not only for its addictive properties but also for its potential to interfere with wound healing through multiple mechanisms. However, its toxicological mechanisms at the multi-target and multi-pathway levels remain unclear.MethodsThis study employed network toxicology and molecular docking techniques. Targets of nicotine and chronic wound-related genes were obtained from databases such as PubChem, GeneCards, and OMIM. Common targets were screened, and a protein-protein interaction (PPI) network was constructed. The CytoHubba plugin was used to identify core targets, while GO and KEGG enrichment analyses were performed to elucidate their biological functions and pathways. Molecular docking was subsequently conducted to validate the binding affinity between nicotine and the core targets.ResultsNicotine exhibited significant skin sensitization, neurotoxicity, and respiratory toxicity. A total of 160 common targets of nicotine and chronic wounds were identified, with TNF, IL6, and IL1B recognized as core targets. Enrichment analysis revealed significant involvement in inflammatory responses, the PI3K-AKT signaling pathway, the AGE-RAGE signaling pathway, and others. Molecular docking demonstrated strong binding affinity between nicotine and TNF (-5.6 kcal/mol) as well as IL6 (-5.0 kcal/mol).ConclusionNicotine disrupts the homeostasis of the wound microenvironment by regulating core inflammatory factors such as TNF and IL6, inhibiting the PI3K-AKT repair pathway, and activating the AGE-RAGE metabolic toxicity pathway, thereby impeding the healing of chronic wounds. This study provides a multi-target network perspective on the toxic mechanisms of nicotine in wound healing and offers a theoretical foundation for clinical smoking cessation to promote wound recovery.

Diabetic foot ulcers (DFUs) and diabetic peripheral neuropathy (DPN) are severe complications in type 2 diabetes mellitus (T2DM). Selenium (Se) is an important element with antioxidant properties, which is crucial for human homeostasis. In this narrative mini review, we summarise the evidence on the potential association of Se with DPN and DFUs. Generally, in most of the limited number of studies, serum Se levels were significantly lower in subjects with DPN or DFUs. In addition, one study demonstrated that urinary Se levels were lower in the DPN group. Nevertheless, further investigations are needed to confirm these preliminary findings.