The international journal of lower extremity wounds最新文献

The aim of the current study was to evaluate the rate of readmission in patients affected by diabetes and foot ulcers (DFUs), and causes and outcomes of patients requiring a new hospitalization. The current study is a retrospective observational study including patients who have required hospitalization since January 2019 to September 2022 due to a DFU. Once patients were discharged, they were regularly followed as outpatients. Within 6 months of follow-up, the rate of hospital readmission for a diabetic foot problem was recorded. According to the readmission or not, patients were divided into 2 groups, readmitted and not readmitted patients, respectively. Hence, all patients were followed for 6 months more and outcomes of the 2 groups were analyzed and compared. Overall, 310 patients were included. The mean age was 68  ±  12 years, the majority of patients reported type 2 diabetes (>90%), and the mean diabetes duration was approximately 20 years. Sixty-eight (21.9%) patients were readmitted. The main reason for hospital readmission was the presence of critical limb ischemia (CLI) in the contralateral limb (6.1%), the recurrence of CLI in the previous treated limb (4.5%), and the onset of new infected DFU in the contralateral foot (4.5%). Readmitted patients reported lower rate of healing (51.5% vs 89.2%, P < .0001) and higher rate of major amputation (10.3% vs 4.5%, P  =  .2) in comparison to not readmitted patients. Critical limb ischemia resulted in the only independent predictor of hospital readmission. Hospital readmission is a frequent issue among patients with DFUs, and readmitted patients showed a lower chance of wound healing. Critical limb ischemia resulted in the main cause of new hospitalization.

Bacterial proliferation plays a well-known role in delayed tissue healing. To date, the presence of microorganisms on the wound bed can be detected by skin swabs or skin biopsies. A novel noninvasive fluorescence imaging device has recently allowed real-time detection of bacteria in different types of wounds through endogenous autofluorescence. The fluorescence signals detected by the device provide health workers with a visual indication of the presence, load, and distribution of bacteria. The aim of our study was to evaluate the level of bacterial colonization in perilesional skin of patients affected by venous leg ulcers treated with 2 different types of bandages: short stretch bandage and zinc oxide bandage. We conducted a monocentric prospective study, enrolling 30 patients with venous leg ulcers, divided into 2 groups: group A was treated with short stretch bandage and group B with zinc oxide bandage. A complete patient's assessment was performed once a week for 3 weeks. Levels of potentially harmful bacteria in perilesional skin were detected using a fluorescent device by 2 experienced operators on the frames taken at individual injuries, while pain was evaluated with the Numerical Rating Scale. After 3 weeks, we observed a reduction in the bacterial colonization levels of the perilesional skin by 68.67% for group A and 85.54% for group B. All the patients had a statistically significant reduction in bacterial load (P < .001), and a statistically significant difference was identified between the 2 groups (P = .043). No statistically significant differences were found between the 2 groups in terms of pain relief (P = .114). Our study demonstrated that the application of zinc oxide bandage provides a higher reduction in bacterial load perilesional skin. On the other hand, we found no difference between the 2 bandages in terms of pain symptom reduction.

Aims: Wound is believed to be a major disorder in certain organs and/or tissues, which could be transmitted to other tissues. Skin is constantly exposed to infections, injuries, scratches, and burns. Wound dressings are commonly utilized for the treatment of wound site and protect it from external contamination. The biological importance of natural agents, such as herbal medicines and their derivations including extracts, essential oils and active compounds in the wound healing process has attracted the attention of researchers and also some manufacturers of wound dressings. Such natural agents improve wound healing by their antioxidant and antibacterial properties. This novel review article was conducted to evaluate the effects of medicinal plants and their derivations on inflammatory responses in surgical wound infection. Methods: The data were collected from various databases using specific keywords. Results: The results revealed that different medicinal plants and their derivations decrease the inflammation in the wound healing process by modulating in gene expression of inflammatory cytokines and immune cells. Conclusion: Active compounds of medicinal plants can alleviate inflammation in the wound healing process, which must be taken into consideration in pharmaceutical industries.

It has traditionally been considered that the larger the amount of knowledge, the greater the competency of a physician. However, the vertiginously fast accumulation of novel knowledge in modern medicine raises the risk that students and residents get lost in the chaos of information to which they are exposed. Thus, it becomes evident that redefining the model of medical education (and possibly rethinking what a "good" doctor means) becomes inevitable. Current challenges in medical training include early engagement of medical students in research activities and evidence-based medicine procedures, as well as adoption of new technologies, such as artificial intelligence. Gradually, the paradigm of the competent physician will transform from the "one who knows well" to "one who knows well where to search for knowledge." Given that person-centeredness remains an essential goal of medical education, supervision and assistance by academic staff are needed to ensure that the new training model has a positive impact on person-centered and doctor-patient relationships.

Thermal injury are the fourth most common type of trauma globally. This study aimed to examine the impact of ophiopogonin D (OPD) on thermal injury and elucidate its underlying molecular mechanisms of Skin epithelial cells C57BL/6 mice were anaesthetized with inhaled isoflurane, pre-heated in boiling water for 10 min, was lowered onto the skin and maintained under its own weight for 5 s. USP25 mRNA and protein expression in mice model of thermal injury were down-regulation. USP25 mRNA and protein expression was suppressed in vitro model of thermal injury.Sh-USP25 exacerbated toxicity in mice model of thermal injury. In contrast, USP25 was found to reduce inflammation and ROS-induced oxidative stress in an in vitro model. Furthermore, USP25 attenuated mitochondrial damage in vitro, and increased GPX4 protein expression, thereby reducing ferroptosis in Skin epithelial cells. Mechanistically, USP25 suppressed TAB2 expression in the thermal injury model. OPD was shown to reduce ferroptosis in skin epithelial cells following thermal injury via the USP25/ TAB2. Additionally, OPD alleviated thermal injury-induced toxicity in mitigating inflammation and ROS-induced oxidative stress. In conclusion, USP25 suppressed TAB2 expression to reduce ferroptosis in Skin epithelial cells, at least in part through the inhibition of Mitochondrial damage. OPD reduces ferroptosis and overall toxicity to thermal injury by targeting inflammation and ROS-induced oxidative stress via the USP25/ TAB2 axis. These findings suggest that OPD could be a potential therapeutic compound for treating thermal injury by modulating USP25.

The aim of this review was to examine the association between diabetic peripheral neuropathy (DPN) and deficiency of fat-soluble vitamins A, D, and E. Vitamins A, D, and E are involved in crucial neuroprotective mechanisms through the regulation of gene expression and antioxidant activity. Vitamin A appears to actively regulate the expression of nerve growth factor (NGF), essential for the development, survival, and regeneration of peripheral neurons. Vitamin D exhibits immunomodulatory effects, reduces the production of pro-inflammatory cytokines, and enhances neuroplasticity. Similarly, vitamin E, through its potent antioxidant action, minimises damage by reactive oxygen species (ROS), which are responsible for demyelinating lesions. Vitamin supplementation studies have shown a potential symptom improvement or reversal. These findings underline the necessity for early detection and correction of vitamin deficiencies as an integral component of a comprehensive strategy for the prevention and management of DPN.

ObjectiveThe objective of this study was to ascertain the relationships between Vitamin D levels and ulcers, balance, and mobility in patients with diabetic foot disease.Material and MethodsThis study is a cross-sectional study based on the prospective examination of diabetic foot patients referred from the diabetic foot outpatient clinic of Gülhane Training and Research Hospital to the Physical Medicine and Rehabilitation Clinic. The present study was conducted with a total of 120 diabetic patients, including 60 with diabetic foot ulcers (DFU group) and 60 with non-DFU group comprises of diabetic peripheral neuropathy. The Functional Ambulation Scale (FAS) and the 10-Meter Walk Test were utilized to assess mobility. The evaluation of balance was conducted using the Tinetti balance test.ResultsThe study found no significant differences in vitamin D levels between the groups; however, calcium levels were found to be significant in DFU group. Patients with DFU group exhibited lower scores on the Tinetti balance test and the Functional Ambulation Scale (P < .05).ConclusionThe findings of this study suggest that diabetic foot ulcers are associated with the risk of falling and mobility limitations. Conversely, no substantial discrepancy in vitamin D levels was observed between the two groups, with and without ulcers. This finding indicates that the balance and mobility impairments observed in the DFU group may have developed independently of vitamin D levels.

The study aimed to assess the outcomes of patients with diabetic foot osteomyelitis (DFO) and concomitant soft tissue infection (STI). It is a retrospective observational study including consecutive patients affected by DFO located in the forefoot (toes and/or rays) who referred to a specialized diabetic foot service from 2019 to 2022. Patients were categorized in two groups: those with DFO and STI and those with DFO without STI. All patients were managed by a conservative surgical approach aiming to remove only the infected bone in association with antibiotic therapy. After 1-year of follow-up, the following outcomes were evaluated and compared between groups: healing, healing time, minor amputation, major amputation, and hospitalization. Overall, 166 patients were included. The mean age was 68.5 ± 13.2 years, 94.9% of them were affected by type 2 diabetes with a mean duration of 19.3 ± 7.1 years. One hundred fourteen patients (68.7%) had DFO complicated by STI, while 52 (31.3%) had DFO without STI. The outcomes for DFO with and without STI were: healing (52.3 vs 94.2%, p = 0.005), healing time (7.8 ± 5.8 vs 4.6 ± 2.7 weeks, p = 0.0002), minor amputation (13.1 vs 3.8%, p = 0.04), major amputation (0 vs 0%, ns), and hospitalization (66.7 vs 48.1%, p < 0.002) respectively. In addition, STI resulted an independent predictor of non-healing [OR 3.1, CI 95% (1.7-9.3), p = 0.002]. Patients with DFO complicated by STI showed higher rate of non-healing, delayed healing time, and more case of minor amputation and hospitalization in comparison to those without STI. STI was independently associated to the risk of non-healing, while any association was found for amputation and hospitalization.

PurposeDiabetic foot ulcer (DFU) and diabetic retinopathy (DR) are severe complications of diabetes mellitus reflecting advanced vascular injury. While DR has been extensively studied as a predictor of DFU, data on the burden and determinants of DR among individuals with DFUs remain limited. This study aimed to evaluate the prevalence, severity, and clinical correlates of DR in individuals with DFUs.MethodsThis observational study included 85 individuals with DFUs and 81 individuals with type 2 diabetes mellitus without DFUs. All participants underwent comprehensive ophthalmologic examination for DR classification. Demographic characteristics, comorbidities, and laboratory parameters were recorded. Unadjusted and adjusted odds ratios (UORs and AORs) with 95% confidence intervals were calculated.ResultsDR was significantly more prevalent in individuals with DFUs than in controls (85.9% vs 51.9%; UOR 5.65, 95% CI 2.67-11.96; p < .001). Proliferative DR was approximately threefold more frequent in the DFU group (33.0% vs 11.1%; UOR 3.93, 95% CI 1.72-8.99; p = .002). Higher Wagner ulcer grades were associated with increased DR prevalence (p = .005). In multivariate analysis, longer duration of diabetes and proteinuria remained independently associated with DR, while HbA1c showed a modest independent association. Among DFU patients, DR was also associated with hypertension, proteinuria, and coronary artery disease.ConclusionIndividuals with DFUs carry a markedly increased burden of DR, particularly proliferative disease, indicating advanced systemic microvascular involvement. DFU should be regarded as a clinical red flag for severe retinopathy, warranting prompt and comprehensive ophthalmologic screening alongside integrated renal and cardiovascular assessment.