Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic ...Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic management,DFUs,foot lesions,proper care for injuries,diet,and surgery.Certain reasonably priced treatments,such as hyperbaric oxygen and vacuum-assisted closure therapy,are also available for DFUs,along with modern wound care products and techniques.Nonetheless,DF care(cleaning,applying antimicrobial cream when wounded,and foot reflexology),blood glucose monitoring to control diabetes,and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs.Between 50%and 80%of DF infections are preventable.Regardless of the intensity of the lesion,it needs to be treated carefully and checked daily during infection.Tissue regeneration can be aided by cleaning,dressing,and application of topical medicines.The choice of shoes is also important because it affects blood circulation and nerve impulses.In general,regular check-ups,monitoring of the patient’s condition,measuring blood glucose levels,and providing frequent guidance regarding DFU care are crucial.Finally,this important clinical problem requires involvement of multiple professionals to properly manage it.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therape...BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.展开更多
BACKGROUND Pain often predisposes patients with diabetic foot ulcers(DFUs)to negative emotional states,such as anxiety and depression,which can significantly impair treatment outcomes and recovery.However,very few stu...BACKGROUND Pain often predisposes patients with diabetic foot ulcers(DFUs)to negative emotional states,such as anxiety and depression,which can significantly impair treatment outcomes and recovery.However,very few studies have explored the relationship between anxiety,depression,and pain in DFUs,as well as the associated risk factors.AIM To analyze the correlation between anxiety,depression,and pain in patients with DFUs and to identify the associated risk factors.METHODS This study included 106 patients diagnosed with DFUs who were admitted to Tiantai County People’s Hospital between March 2022 and March 2024.The patients’anxiety levels were evaluated using Zung’s self-rating anxiety scale(SAS),depression status was assessed using Zung’s self-rating depression scale(SDS),and pain intensity was assessed using the visual analog scale(VAS).Subsequently,correlations between SAS,SDS,and VAS scores were analyzed.Univariate and multivariate analyses were conducted to explore the risk factors that contributed to anxiety and depression in patients with DFUs.RESULTS Among the 106 patients,39.62%exhibited anxiety and 43.40%presented with depression.Most patients experiencing anxiety or depression exhibited mild symptoms,with no severe cases observed.Compared with asymptomatic patients,those with anxiety or depression had significantly higher VAS scores.Correlation analysis indicated a significant positive relationship between both SAS and SDS scores and the VAS score.Univariate analysis identified sex,age,Wagner’s grade,presence of other complications,and smoking history as factors significantly associated with anxiety and depression.Multivariate analysis further confirmed that younger age,higher Wagner’s grade,and higher VAS scores were independent predictors of anxiety and depression.CONCLUSION This study reveals a significant positive correlation between anxiety,depression,and pain in patients with DFUs.This finding suggests that timely and effective pain intervention may be beneficial in alleviating negative emotions such as anxiety and depression.In addition,younger age(<50 years),higher Wagner’s grade,and higher VAS scores increase the risk of developing anxiety and depression in this patient population.展开更多
Diabetic foot ulcers are among the most severe complications of the lower limb in patients with diabetes.As the immune resistance decreases due to the long-term exposure to hyperglycemic microenvironment,the wound oft...Diabetic foot ulcers are among the most severe complications of the lower limb in patients with diabetes.As the immune resistance decreases due to the long-term exposure to hyperglycemic microenvironment,the wound often fails to heal,leading to a poor prognosis.Foot ulcers have a high risk of amputation and mortality rates making it a growing health concern.Recently,exosomes derived from adipose mesenchymal stem cells have been shown to promote tissue healing,making them a popular topic in cell-free therapies.This article focuses on the risk factors leading to the development of diabetic foot ulcers and the mechanisms of non-healing with the hope to provide new directions or targets for future diabetic foot ulcer treatment.Additionally,this article clarifies the potential mechanisms of action of exosomes from adipose-derived stem cells in promoting the healing of diabetic foot ulcers and discusses its clinical application and limitations.This review aims to provide effective scientific evidence for research on the mechanism and clinical application of exosomes from adipose-derived stem cells for the treatment of diabetic foot ulcers.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)represent a common and serious complication of diabetes,characterized by impaired wound healing and an increased risk of infection.These infections severely impact patient health,n...BACKGROUND Diabetic foot ulcers(DFUs)represent a common and serious complication of diabetes,characterized by impaired wound healing and an increased risk of infection.These infections severely impact patient health,necessitating extensive medical intervention,and increasing the risk of amputation.Vitamin D(VD)plays a critical role in immune regulation and tissue repair.AIM To investigate the effects of VD supplementation on infection rates,wound healing,and immune function in patients with DFUs.METHODS A randomized controlled trial was conducted involving 120 patients with DFUs.Participants were randomly assigned to either a control group(n=60),which received standard care without VD supplementation,or an intervention group(n=60),which received 2000 IU of oral VD3(cholecalciferol)daily for 12 weeks.The primary outcomes included the incidence and severity of infections,whereas the secondary outcomes included wound healing rate,serum 25-hydroxyvitamin D level,levels of immune markers(cathelicidin,interleukin-6 and tumor necrosis factor-α),and adverse events,such as hypercalcemia.RESULTS The incidence of infection was significantly lower in the VD supplementation group(25%)compared with the control group(45%)(P=0.01).Severe infections requiring systemic antibiotics or hospitalization were also less frequent in the VD supplementation group.Wound healing was notably enhanced in the VD supplementation group,with a 60%reduction in ulcer size compared with a 35%reduction in the control group(P<0.01).Serum 25(OH)D level significantly increased in the VD supplementation group(from 16.5 ng/mL to 35.2 ng/mL),confirming the efficacy of VD supplementation.Immune function improved,as demonstrated by a 30%rise in cathelicidin level and a 20%decline in levels of pro-inflammatory cytokines.No adverse effects,including hypercalcemia,were reported.CONCLUSION The VD supplementation effectively reduced infection rate,promoted wound healing,and strengthened immune responses in patients with DFUs.These findings support the incorporation of VD as a safe and effective adjunctive therapy in the clinical management of DFUs.展开更多
Oral ulcers may greatly diminish patient life quality and potentially result in malignant transformations.Using gels or films as pseudomembrane barriers is an effective method for promoting ulcer healing.However,these...Oral ulcers may greatly diminish patient life quality and potentially result in malignant transformations.Using gels or films as pseudomembrane barriers is an effective method for promoting ulcer healing.However,these pseudomembranes face challenges such as saliva flushing,dynamic changes,and the presence of abundant microorganisms in the complex oral environment.Herein,we developed an injectable,photoinduction,in situ-enhanceable oral ulcer repair hydrogel(named as GIL2)by incorporating dynamic phenylboronic acid ester bonds and imidazole ions into a methacrylated gelatin matrix.GIL2 exhibited rapid gelation(3 s),low swelling properties(1.07 g/g),robust tensile strength(56.83 kPa)and high adhesive strength(63.38 kPa),allowing it to adhere effectively to the ulcer surface.Moreover,the GIL2 demonstrated intrinsic antibacterial and antioxidant qualities.Within a diabetic rat model for oral ulcers,GIL2 effectively eased oxidative stress and decreased the inflammation present in ulcerated wounds,thereby greatly hastening the healing process of these ulcers.Together,GIL2 hydrogel demonstrates remarkable adaptability within the oral milieu,revitalizing clinical strategy advancements for treating bacterialinfected oral ulcers.展开更多
Oral ulcers are a common ulcerative injury that occurs in the oral mucosa.When occurring,they can cause mucosal pain and affect eating and communication.The oral cavity,characterized by its moist environment and const...Oral ulcers are a common ulcerative injury that occurs in the oral mucosa.When occurring,they can cause mucosal pain and affect eating and communication.The oral cavity,characterized by its moist environment and constant movement of the lips and tongue,presents challenges for conventional drug delivery systems due to its suboptimal adhesion.Therefore,there is a need for the development of adhesive materials specifically designed for use within the oral cavity.In this research,a sticky coacervate incorporating tea polyphenols(TP)was formulated based on the adhesive properties observed in sandcastle worms.The coacervate is composed of Pluronic F68(F68)and TP,synthesized through the coacervation reaction.The F68-TP coacervates are attached to porcine skin easily.It also reduces bacterial viability and has the ability to clear reactive oxygen species.In animal ulcer models,these coacervates demonstrate anti-inflammatory effects and enhance collagen and muscle fiber synthesis.Overall,these adhesive coacervates with antioxidative and antibacterial properties hold potential as a therapeutic option for oral ulcers in the oral cavity.展开更多
BACKGROUND Clostridium difficile(C.difficile)infection(CDI)is a common healthcare-associated infection.Older adult hospitalized patients with pressure ulcers are more sus-ceptible because of low immunity and disordere...BACKGROUND Clostridium difficile(C.difficile)infection(CDI)is a common healthcare-associated infection.Older adult hospitalized patients with pressure ulcers are more sus-ceptible because of low immunity and disordered flora,but their specific risk factors are unknown.This study hypothesizes that the use of antibiotics for more than 2 weeks,the use of proton pump inhibitors(PPIs),and the use ofβ-lactam antibiotics are independent risk factors for CDI in this population.METHODS A total of 120 older adults hospitalized with pressure ulcers from 2020 to 2023 were enrolled in the wound repair ward of the hospital.Stool samples were collected for anaerobic culture,C.difficile glutamate dehydrogenase(GDH)anti-gen and toxin detection,and multivariate logistic regression was used to analyze risk factors.RESULTS Among 120 older adults hospitalized patients with pressure ulcers,39 tested po-sitive for C.difficile,with an incidence rate of 32.5%.Thirty-nine patients(32.5%)were positive for GDH antigen.Twelve patients(10.0%)were positive for toxin A/B.Multivariate analysis shows that the use of antibiotics for more than 2 weeks,the use of proton pump inhibitors,and the use ofβ-lactam antibiotics are independent risk factors for CDI(all P values<0.05).CONCLUSION From 2020 to 2023,the incidence of CDI in 120 hospitalized older adult patients with pressure ulcers was 32.5%,and three independent risk factors were identified.展开更多
BACKGROUND Stress ulcers are common complications in critically ill patients,with a higher incidence observed in older patients following gastrointestinal surgery.This study aimed to develop and evaluate the effective...BACKGROUND Stress ulcers are common complications in critically ill patients,with a higher incidence observed in older patients following gastrointestinal surgery.This study aimed to develop and evaluate the effectiveness of a multi-modal intervention protocol to prevent stress ulcers in this high-risk population.AIM To assess the impact of a multi-modal intervention on preventing stress ulcers in older intensive care unit(ICU)patients postoperatively.METHODS A randomized controlled trial involving critically ill patients(aged≥65 years)admitted to the ICU after gastrointestinal surgery was conducted.Patients were randomly assigned to either the intervention group,which received a multimodal stress ulcer prevention protocol,or the control group,which received standard care.The primary outcome measure was the incidence of stress ulcers.The secondary outcomes included ulcer healing time,complication rates,and length of hospital stay.RESULTS A total of 200 patients(100 in each group)were included in this study.The intervention group exhibited a significantly lower incidence of stress ulcers than the control group(15%vs 30%,P<0.01).Additionally,the intervention group demonstrated shorter ulcer healing times(mean 5.2 vs 7.8 days,P<0.05),lower complication rates(10%vs 22%,P<0.05),and reduced length of hospital stay(mean 12.3 vs 15.7 days,P<0.05).CONCLUSION This multi-modal intervention protocol significantly reduced the incidence of stress ulcers and improved clinical outcomes in critically ill older patients after gastrointestinal surgery.This comprehensive approach may provide a valuable strategy for managing high-risk populations in intensive care settings.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free ant...BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free anterolateral thigh(ALT)perforator flap is a promising reconstructive method;however,diabetic vasculopathy challenges optimal perfusion.This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.AIM To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs,thereby providing insights to improve surgical outcomes.METHODS This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024.Patients were categorized into normal(n=50)and abnormal(n=50)blood perfusion groups based on intraoperative perfusion assessments.Data on demographics,clinical characteristics,vascular status,metabolic control,and preoperative laboratory parameters were collected.Statistical analyses,including univariate and multivariate logistic regression,were conducted to identify significant predictive factors for perfusion outcomes.RESULTS Old age,high body mass index,long diabetes duration,and presence of diabetic peripheral neuropathy were associated with impaired perfusion.Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin(HbA1c),creatinine,triglycerides,and partial pressure of carbon dioxide.Conversely,high hemoglobin,albumin,and prealbumin levels and partial pressure of oxygen(PaO_(2))were protective.Multivariate analysis identified diabetes duration,HbA1c,PaCO_(2),PaO_(2),and albumin as independent predictors of perfusion,underscoring the roles of metabolic control and vascular health.CONCLUSION Optimizing metabolic control,vascular health,and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.展开更多
Tacrolimus(Tac)is a cornerstone immunosuppressant in the treatment regimens for organ transplant recipients.However,its extensive clinical use has brought attention to its associated drug safety concerns.Recent case r...Tacrolimus(Tac)is a cornerstone immunosuppressant in the treatment regimens for organ transplant recipients.However,its extensive clinical use has brought attention to its associated drug safety concerns.Recent case reports highlighting Tac-induced gastrointestinal ulcers have prompted further investigation.In the present study,we analyzed Tac-associated adverse events using data from the U.S.Food and Drug Administration Adverse Event Reporting System(FAERS)to identify potential adverse event signals.Adverse event reports were collected up to the third quarter(Q3)of 2023,revealing 339 cases of Tac-related gastrointestinal ulcers.A disproportionality analysis was conducted utilizing the Bayesian confidence propagation neural network of information component(IC)and reporting odds ratio(ROR)methods.All statistical analyses were performed using R version 3.6.1.The findings demonstrated a significant signal for gastrointestinal ulcers associated with Tac use,with a ROR1 of 1.87(95%CI:1.68-2.08)and an IC1 of 0.89(95%CI:0.73-1.05)when compared to all other drugs.When compared specifically to cyclosporine,Tac also showed a significant signal(ROR2=1.55,95%CI:1.28-1.86;IC2=0.24,95%CI:0.04-0.44).Further analysis identified age,male gender,and European descent as risk factors for mortality outcomes in patients with Tac-associated gastrointestinal ulcers.These findings highlighted the critical need for clinicians to strengthen the monitoring and early detection of gastrointestinal ulcers in patients undergoing Tac therapy.Enhanced vigilance in this regard is essential to optimize the management and care of transplant patients.展开更多
Microneedle(MN)patches could be a promising treatment for diabetic foot ulcers that plague thousands of people worldwide.While reducing skin resistance or increasing driving force can accelerate the efficiency of tran...Microneedle(MN)patches could be a promising treatment for diabetic foot ulcers that plague thousands of people worldwide.While reducing skin resistance or increasing driving force can accelerate the efficiency of transdermal drug delivery with conventional MN patches,it can create toxic chemical residues or require the help of additional devices.Herein,a thermo-responsive microneedles patch(TMN)with high biocompatibility without additional equipment is proposed.The TMN consisted of a bilayer microneedles composed of sodium alginate(SA)-g-poly(N-isopropylacrylamide)layer(SA-g-PNIPAM)loaded with sucrose octasulfate sodium salt(SOS)and hyaluronic acid layer and a polycaprolactone/chitosan nanofiber membrane loading with tetracycline hydrochloride(TH)and SOS.PNIPAM accelerates drug release by extruding the drug through a volumetric phase transition in response to temperature changes,and TH and SOS promote wound healing by inhibiting bacterial growth and promoting vascular regeneration and epithelial formation.The results showed that the drug release of TMN was significantly faster,with the drug release rate of more than 80% in the 10th h,and the antibacterial rate of TMN could reach 800%.In addition,TMN had good biocompatibility and good healing effects in vivo,which may be helpful for the design of multifunctional dressings in the future.展开更多
BACKGROUND Negative pressure wound therapy(NPWT)is a potential treatment for diabetic foot ulcers(DFUs),although the mechanisms underlying its effectiveness remain unclear.This study posits that NPWT may improve wound...BACKGROUND Negative pressure wound therapy(NPWT)is a potential treatment for diabetic foot ulcers(DFUs),although the mechanisms underlying its effectiveness remain unclear.This study posits that NPWT may improve wound healing by promoting angiogenesis and activating the nuclear factor erythroid 2-related factor 2(Nrf2)/Kelch-like epichlorohydrin-associated protein 1(Keap1)signaling pathway,which is crucial for the body’s defense against oxidative stress.The hypothesis indicates that enhancing antioxidant defenses through NPWT may positively affect the healing process.There are still limited data on the roles of Nrf2,its downstream signaling molecules,and angiogenesis markers in patients undergoing NPWT.AIM To study the mechanism of NPWT in DFUs.METHODS This study included a total of 40 hospitalized patients with DFUs from Xuzhou Central Hospital,who were divided into Control group(n=21)and NPWT group(n=19).The levels of Nrf2 and Keap1 were analyzed in the granulation tissue 7 days after treatment.The wound condition,erythrocyte sedimentation rate(ESR),procalcitonin(PCT),interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),vascular endothelial growth factor(VEGF),basic fibroblast growth factor(b-FGF),cluster of differentiation 31(CD31),and levels of oxidative stress[malondialdehyde(MDA),superoxide dismutase(SOD),catalase(CAT),and total antioxidant capacity(T-AOC)]were analyzed before and 7 days after treatment by the Mann-Whitney U test.RESULTS The NPWT group demonstrated significant improvements in wound healing compared to the control group after 7 days of treatment.The levels of ESR,PCT,IL-6,and TNF-αwere significantly reduced in the NPWT group compared to the control group(P<0.05),while the levels of CD31,VEGF,and b-FGF showed significant increases(P<0.05).The NPWT group exhibited notable elevations in the levels of Nrf2 and its downstream targets(SOD,CAT,and T-AOC),accompanied by decreases in the levels of Keap1 and MDA(P<0.05).CONCLUSION NPWT may contribute to the healing of DFUs by potentially reducing levels of oxidative stress.Its effects could possibly be enhanced through the action of Nrf2.展开更多
BACKGROUND Hydroxyurea,an antimetabolite,is frequently prescribed for various hemato-logical disorders,and its common side effects include gastrointestinal problems,cutaneous or mucosal lesions and pyrexia/fever.CASE ...BACKGROUND Hydroxyurea,an antimetabolite,is frequently prescribed for various hemato-logical disorders,and its common side effects include gastrointestinal problems,cutaneous or mucosal lesions and pyrexia/fever.CASE SUMMARY This study reports the case of a 67-year-old woman who developed recurrent abdominal pain after 10 years of continuous hydroxyurea therapy for primary thrombocythemia.Colonoscopy revealed an ileocecal ulcer.After discontinuing hydroxyurea therapy for 6 months,follow-up colonoscopy showed a significant reduction in the ulceration.CONCLUSION We consider cecal ulcers as a rare complication of hydroxyurea therapy which typically resolves upon stopping the drug.展开更多
The aim of this study was to evaluate the cost and effectiveness of soft silicone foam dressings （SSFD, Mepilex） on the treatment of pressure ulcers. We searched electronic databases and retrieved articles to make a...The aim of this study was to evaluate the cost and effectiveness of soft silicone foam dressings （SSFD, Mepilex） on the treatment of pressure ulcers. We searched electronic databases and retrieved articles to make a systematic evaluation, and then make a cost-effectiveness analysis by decision tree model combined with data from clinical treatments. The result shows that compared with the common sterile gauze, SSFD possesses an apparent advantage. The effective ratio is 96.3% versus 77.3%, although the cost of SSFD is much higher than that of sterile gauze, Mepilex appears to be more cost-effectiveness for preventive use.展开更多
BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenou...BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenous PPIs and oral potassium competitive acid blockers(PCABs)administered prior to endoscopic treatment of bleeding peptic ulcers.METHODS This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding(treated August 2023 to February 2024).Prior to emergency endoscopy,patients received either intravenous PPI(pantoprazole 80 mg bolus)or oral PCAB(tegoprazan 50 mg single-dose).Severity of bleeding was assessed using the Glasgow-Blatchford,Rockall,and AIMS65 scoring systems.Patients with severe comorbidities were excluded.Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding.Multivariate logistic regression was performed to adjust for potential confounding factors.RESULTS Total of the 105 patients,61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy.To minimize selection bias,bleeding severity was assessed using the Glasgow-Blatchford,Rockall and AIMS65 scores,with no statistically significant differences observed between the two groups.During emergency endoscopy performed within 48 hours,ulcer bed status was classified according to the Forrest classification.The proportion of lesions graded IIa or higher was significantly lower in the PCAB group(P<0.001),as was the frequency of therapeutic endoscopy intervention(odds ratio=0.272,95%confidence interval:0.111-0.665,P=0.004).The frequency of re-bleeding events was statistically significantly higher in the PPI group(odds ratio=0.141,95%confidence interval:0.024-0.844,P=0.032).CONCLUSION Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.展开更多
Objective: To identify the principal factors associated with the occurrence and development of medical device-related pressure injuries (MDRPI) in adults admitted to hospitals. MDRPI, a peculiar subtype of pressure in...Objective: To identify the principal factors associated with the occurrence and development of medical device-related pressure injuries (MDRPI) in adults admitted to hospitals. MDRPI, a peculiar subtype of pressure injuries (PI), result from the pression exerted by devices (or their fixation systems) applied for diagnostic and therapeutic purposes. MDRPI represent a serious problem for patients and healthcare systems. Understanding potential risk factors is an important step in implementing effective interventions. Methods: In this study, we will perform a systematic review;if possible, also a meta-analysis will be performed. The review will follow the preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting guidelines for systematic reviews. A rigorous literature search will be conducted both in electronic databases (Medline/PubMed, Embase, CINAHL, Web of Science, Scopus, Cochrane Library) to identify studies published since 2000 and in gray literature for unpublished studies. Pairs of researchers will identify relevant evidence, extract data, and assess risk of bias independently in each eligible study. Factors associated with the occurrence of MDRPI are considered the primary outcome. Secondary outcomes are prevalence and incidence of MDRPI, length of hospital stay, infections, and death. The evidence will be synthesized using the GRADE methodology. Results: Results are not currently available as this is a protocol for a systematic review. Conclusions: This systematic review will identify evidence on risk factors for developing MDRPI. We are confident that the results of this review will help to improve clinical practice and guide future research.展开更多
BACKGROUND Corneal ulcers are a major cause of visual impairment in developing countries.In Indonesia,severe infective ulcers often require keratoplasty(KP)to preserve ocular integrity and improve outcomes.AIM To dete...BACKGROUND Corneal ulcers are a major cause of visual impairment in developing countries.In Indonesia,severe infective ulcers often require keratoplasty(KP)to preserve ocular integrity and improve outcomes.AIM To determine demographic,clinical and microbiological characteristics,complications,and KP outcomes in patients with moderate to severe infective corneal ulcers.METHODS A retrospective review was conducted on patients with moderate to severe infective corneal ulcers who underwent KP between January 1,2018 and December 31,2020,with a minimum follow-up period of 3 weeks at the Ocular Infection and Immunology clinic of a tertiary referral hospital in Jakarta.Data were extracted from medical records.RESULTS A total of 99 eyes from 99 patients with a mean age of 41.7±16.2 years were included.Eight-nine eyes of corneal cases were located at the central cornea with>6 mm lesion size(forty-one eyes).The culture positivity rate was 33%,primarily composed of Staphylococcus epidermidis.Eyeball integrity was maintained in all patients.Mean uncorrected visual acuity(VA)before KP was 2.50 and improved to 2.04 after 3 months of follow-up.Twenty patients with a cornea that was kept transparent achieved a VA of 0.40.Complications after KP appeared in 60 eyes,while secondary glaucoma was the most common complication(28 eyes),followed by graft failure(24 eyes)and graft rejection(14 eyes).CONCLUSION Corneal ulcers are a common problem in Indonesia following eye trauma.Therapeutic and tectonic KP can preserve the integrity of the eyeball in moderate to severe cases,although complications are common.展开更多
Objective:To evaluate the efficacy rate of rebamipide combined with triple therapy in the treatment of senile peptic gastric ulcers.Methods:A cohort of 68 elderly patients diagnosed with peptic gastric ulcers was enro...Objective:To evaluate the efficacy rate of rebamipide combined with triple therapy in the treatment of senile peptic gastric ulcers.Methods:A cohort of 68 elderly patients diagnosed with peptic gastric ulcers was enrolled in this study between January 2022 and December 2024.Using the envelope method for randomization,the patients were divided into two equal groups:a control group administered standard triple therapy and an observation group that received the same triple therapy supplemented with rebamipide.The clinical efficacy,gastric mucosal morphology(mucosal thickness,gland density,active inflammatory cell infiltration,chronic inflammatory cell infiltration),and pepsinogen I/II were compared between the two groups.Results:The total effective rate in the observation group was significantly higher than that in the control group,with a statistically significant difference(p<0.05).After treatment,the scores of all items in both groups were significantly lower than those before treatment,and the scores in the observation group were significantly lower than those in the control group,with statistically significant differences(p<0.05).After treatment,the ratios in both groups were significantly higher than those before treatment,and the ratio in the observation group was significantly higher than that in the control group,with statistically significant differences(p<0.05).Conclusion:Rebamipide combined with triple therapy can significantly improve the treatment efficacy of senile peptic gastric ulcers,effectively improve the histological status of the gastric mucosa,and promote the recovery of gastric mucosal function,with superior efficacy compared to triple therapy alone.展开更多
Acquired hemophilia A(AHA)is a rare blood disorder that can cause life-threatening severe bleeding because of the development of autoantibodies(inhibitors)against factor VIII.AHA is common in elderly patients,and alth...Acquired hemophilia A(AHA)is a rare blood disorder that can cause life-threatening severe bleeding because of the development of autoantibodies(inhibitors)against factor VIII.AHA is common in elderly patients,and although most cases are characterized by subcutaneous or intramuscular bleeding,rare cases of gastrointestinal bleeding have been reported.Controlling gastrointestinal bleeding in patients with AHA is difficult even after multiple endoscopic hemostasis or transcatheter arterial embolization procedures,and these patients are prone to rebleeding.CASE SUMMARY We report the case of a 76-year-old Japanese woman with AHA who presented with repeated bleeding from an esophageal ulcer as the initial symptom.A hemorrhagic ulcer was detected in the lower esophagus,and endoscopic hemostasis using radiofrequency ablation was performed seven times over a month.However,this procedure was unsuccessful,and the patient was transferred to our department.Hypertonic saline-epinephrine injection plus clipping was administered for endoscopic hemostasis,but the treatment response of the patient was poor.After the AHA diagnosis was confirmed,a single dose of a mixture of factors VIIa and X was administered as a bypass hemostatic agent,and the bleeding was successfully controlled.In addition,emicizumab,a bispecific monoclonal antibody that is a substitute for activated factor VIII,was administered,and no further rebleeding was observed.CONCLUSION Multidisciplinary interventions between endoscopists and hematologists are essential to manage rare gastrointestinal bleeding caused by coagulation disorders,such as AHA.展开更多
基金Supported by the King Salman Center for Disability Research,No.KSRG-2023-407.
文摘Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic management,DFUs,foot lesions,proper care for injuries,diet,and surgery.Certain reasonably priced treatments,such as hyperbaric oxygen and vacuum-assisted closure therapy,are also available for DFUs,along with modern wound care products and techniques.Nonetheless,DF care(cleaning,applying antimicrobial cream when wounded,and foot reflexology),blood glucose monitoring to control diabetes,and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs.Between 50%and 80%of DF infections are preventable.Regardless of the intensity of the lesion,it needs to be treated carefully and checked daily during infection.Tissue regeneration can be aided by cleaning,dressing,and application of topical medicines.The choice of shoes is also important because it affects blood circulation and nerve impulses.In general,regular check-ups,monitoring of the patient’s condition,measuring blood glucose levels,and providing frequent guidance regarding DFU care are crucial.Finally,this important clinical problem requires involvement of multiple professionals to properly manage it.
基金Hubei Province Top Medical Youth Talent Program,Wuhan Knowledge Innovation Special Basic Research Project,No.2023020201020558Clinical Research Project of Affiliated Hospital of Guangdong Medical University,No.LCYJ2021B004 and No.LCYJ2019B010Science and Technology Plan Project of Zhanjiang,No.2022A01191.
文摘BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.
文摘BACKGROUND Pain often predisposes patients with diabetic foot ulcers(DFUs)to negative emotional states,such as anxiety and depression,which can significantly impair treatment outcomes and recovery.However,very few studies have explored the relationship between anxiety,depression,and pain in DFUs,as well as the associated risk factors.AIM To analyze the correlation between anxiety,depression,and pain in patients with DFUs and to identify the associated risk factors.METHODS This study included 106 patients diagnosed with DFUs who were admitted to Tiantai County People’s Hospital between March 2022 and March 2024.The patients’anxiety levels were evaluated using Zung’s self-rating anxiety scale(SAS),depression status was assessed using Zung’s self-rating depression scale(SDS),and pain intensity was assessed using the visual analog scale(VAS).Subsequently,correlations between SAS,SDS,and VAS scores were analyzed.Univariate and multivariate analyses were conducted to explore the risk factors that contributed to anxiety and depression in patients with DFUs.RESULTS Among the 106 patients,39.62%exhibited anxiety and 43.40%presented with depression.Most patients experiencing anxiety or depression exhibited mild symptoms,with no severe cases observed.Compared with asymptomatic patients,those with anxiety or depression had significantly higher VAS scores.Correlation analysis indicated a significant positive relationship between both SAS and SDS scores and the VAS score.Univariate analysis identified sex,age,Wagner’s grade,presence of other complications,and smoking history as factors significantly associated with anxiety and depression.Multivariate analysis further confirmed that younger age,higher Wagner’s grade,and higher VAS scores were independent predictors of anxiety and depression.CONCLUSION This study reveals a significant positive correlation between anxiety,depression,and pain in patients with DFUs.This finding suggests that timely and effective pain intervention may be beneficial in alleviating negative emotions such as anxiety and depression.In addition,younger age(<50 years),higher Wagner’s grade,and higher VAS scores increase the risk of developing anxiety and depression in this patient population.
文摘Diabetic foot ulcers are among the most severe complications of the lower limb in patients with diabetes.As the immune resistance decreases due to the long-term exposure to hyperglycemic microenvironment,the wound often fails to heal,leading to a poor prognosis.Foot ulcers have a high risk of amputation and mortality rates making it a growing health concern.Recently,exosomes derived from adipose mesenchymal stem cells have been shown to promote tissue healing,making them a popular topic in cell-free therapies.This article focuses on the risk factors leading to the development of diabetic foot ulcers and the mechanisms of non-healing with the hope to provide new directions or targets for future diabetic foot ulcer treatment.Additionally,this article clarifies the potential mechanisms of action of exosomes from adipose-derived stem cells in promoting the healing of diabetic foot ulcers and discusses its clinical application and limitations.This review aims to provide effective scientific evidence for research on the mechanism and clinical application of exosomes from adipose-derived stem cells for the treatment of diabetic foot ulcers.
基金Supported by Natural Science Foundation of Henan Province,No.202300410396the Young Talents Promotion Project of Henan Province,No.2021HYTP043.
文摘BACKGROUND Diabetic foot ulcers(DFUs)represent a common and serious complication of diabetes,characterized by impaired wound healing and an increased risk of infection.These infections severely impact patient health,necessitating extensive medical intervention,and increasing the risk of amputation.Vitamin D(VD)plays a critical role in immune regulation and tissue repair.AIM To investigate the effects of VD supplementation on infection rates,wound healing,and immune function in patients with DFUs.METHODS A randomized controlled trial was conducted involving 120 patients with DFUs.Participants were randomly assigned to either a control group(n=60),which received standard care without VD supplementation,or an intervention group(n=60),which received 2000 IU of oral VD3(cholecalciferol)daily for 12 weeks.The primary outcomes included the incidence and severity of infections,whereas the secondary outcomes included wound healing rate,serum 25-hydroxyvitamin D level,levels of immune markers(cathelicidin,interleukin-6 and tumor necrosis factor-α),and adverse events,such as hypercalcemia.RESULTS The incidence of infection was significantly lower in the VD supplementation group(25%)compared with the control group(45%)(P=0.01).Severe infections requiring systemic antibiotics or hospitalization were also less frequent in the VD supplementation group.Wound healing was notably enhanced in the VD supplementation group,with a 60%reduction in ulcer size compared with a 35%reduction in the control group(P<0.01).Serum 25(OH)D level significantly increased in the VD supplementation group(from 16.5 ng/mL to 35.2 ng/mL),confirming the efficacy of VD supplementation.Immune function improved,as demonstrated by a 30%rise in cathelicidin level and a 20%decline in levels of pro-inflammatory cytokines.No adverse effects,including hypercalcemia,were reported.CONCLUSION The VD supplementation effectively reduced infection rate,promoted wound healing,and strengthened immune responses in patients with DFUs.These findings support the incorporation of VD as a safe and effective adjunctive therapy in the clinical management of DFUs.
基金funding from the National Natural Science Foundation of China(Nos.82071170 and 82371016)the Zhejiang Provincial Science and Technology Project for Public Welfare(No.LGF21H140004).
文摘Oral ulcers may greatly diminish patient life quality and potentially result in malignant transformations.Using gels or films as pseudomembrane barriers is an effective method for promoting ulcer healing.However,these pseudomembranes face challenges such as saliva flushing,dynamic changes,and the presence of abundant microorganisms in the complex oral environment.Herein,we developed an injectable,photoinduction,in situ-enhanceable oral ulcer repair hydrogel(named as GIL2)by incorporating dynamic phenylboronic acid ester bonds and imidazole ions into a methacrylated gelatin matrix.GIL2 exhibited rapid gelation(3 s),low swelling properties(1.07 g/g),robust tensile strength(56.83 kPa)and high adhesive strength(63.38 kPa),allowing it to adhere effectively to the ulcer surface.Moreover,the GIL2 demonstrated intrinsic antibacterial and antioxidant qualities.Within a diabetic rat model for oral ulcers,GIL2 effectively eased oxidative stress and decreased the inflammation present in ulcerated wounds,thereby greatly hastening the healing process of these ulcers.Together,GIL2 hydrogel demonstrates remarkable adaptability within the oral milieu,revitalizing clinical strategy advancements for treating bacterialinfected oral ulcers.
基金supported by the National Natural Science Foundation(No.32271468)Sichuan Science and Technology Program(No.2021JDTD0001)+2 种基金1·3·5 Project for disciplines of excellence,West China Hospital,Sichuan University(No.ZYYC23005)the Fundamental Research Funds for the Central Universities(No.2022SCU12046)Innovation Research Project of Sichuan University(No.2022SCUH0046).
文摘Oral ulcers are a common ulcerative injury that occurs in the oral mucosa.When occurring,they can cause mucosal pain and affect eating and communication.The oral cavity,characterized by its moist environment and constant movement of the lips and tongue,presents challenges for conventional drug delivery systems due to its suboptimal adhesion.Therefore,there is a need for the development of adhesive materials specifically designed for use within the oral cavity.In this research,a sticky coacervate incorporating tea polyphenols(TP)was formulated based on the adhesive properties observed in sandcastle worms.The coacervate is composed of Pluronic F68(F68)and TP,synthesized through the coacervation reaction.The F68-TP coacervates are attached to porcine skin easily.It also reduces bacterial viability and has the ability to clear reactive oxygen species.In animal ulcer models,these coacervates demonstrate anti-inflammatory effects and enhance collagen and muscle fiber synthesis.Overall,these adhesive coacervates with antioxidative and antibacterial properties hold potential as a therapeutic option for oral ulcers in the oral cavity.
基金Supported by the Zhejiang Province Medical and Health Science and Technology Plan Project,No.2018KY644 and No.2020KY234。
文摘BACKGROUND Clostridium difficile(C.difficile)infection(CDI)is a common healthcare-associated infection.Older adult hospitalized patients with pressure ulcers are more sus-ceptible because of low immunity and disordered flora,but their specific risk factors are unknown.This study hypothesizes that the use of antibiotics for more than 2 weeks,the use of proton pump inhibitors(PPIs),and the use ofβ-lactam antibiotics are independent risk factors for CDI in this population.METHODS A total of 120 older adults hospitalized with pressure ulcers from 2020 to 2023 were enrolled in the wound repair ward of the hospital.Stool samples were collected for anaerobic culture,C.difficile glutamate dehydrogenase(GDH)anti-gen and toxin detection,and multivariate logistic regression was used to analyze risk factors.RESULTS Among 120 older adults hospitalized patients with pressure ulcers,39 tested po-sitive for C.difficile,with an incidence rate of 32.5%.Thirty-nine patients(32.5%)were positive for GDH antigen.Twelve patients(10.0%)were positive for toxin A/B.Multivariate analysis shows that the use of antibiotics for more than 2 weeks,the use of proton pump inhibitors,and the use ofβ-lactam antibiotics are independent risk factors for CDI(all P values<0.05).CONCLUSION From 2020 to 2023,the incidence of CDI in 120 hospitalized older adult patients with pressure ulcers was 32.5%,and three independent risk factors were identified.
文摘BACKGROUND Stress ulcers are common complications in critically ill patients,with a higher incidence observed in older patients following gastrointestinal surgery.This study aimed to develop and evaluate the effectiveness of a multi-modal intervention protocol to prevent stress ulcers in this high-risk population.AIM To assess the impact of a multi-modal intervention on preventing stress ulcers in older intensive care unit(ICU)patients postoperatively.METHODS A randomized controlled trial involving critically ill patients(aged≥65 years)admitted to the ICU after gastrointestinal surgery was conducted.Patients were randomly assigned to either the intervention group,which received a multimodal stress ulcer prevention protocol,or the control group,which received standard care.The primary outcome measure was the incidence of stress ulcers.The secondary outcomes included ulcer healing time,complication rates,and length of hospital stay.RESULTS A total of 200 patients(100 in each group)were included in this study.The intervention group exhibited a significantly lower incidence of stress ulcers than the control group(15%vs 30%,P<0.01).Additionally,the intervention group demonstrated shorter ulcer healing times(mean 5.2 vs 7.8 days,P<0.05),lower complication rates(10%vs 22%,P<0.05),and reduced length of hospital stay(mean 12.3 vs 15.7 days,P<0.05).CONCLUSION This multi-modal intervention protocol significantly reduced the incidence of stress ulcers and improved clinical outcomes in critically ill older patients after gastrointestinal surgery.This comprehensive approach may provide a valuable strategy for managing high-risk populations in intensive care settings.
文摘BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free anterolateral thigh(ALT)perforator flap is a promising reconstructive method;however,diabetic vasculopathy challenges optimal perfusion.This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.AIM To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs,thereby providing insights to improve surgical outcomes.METHODS This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024.Patients were categorized into normal(n=50)and abnormal(n=50)blood perfusion groups based on intraoperative perfusion assessments.Data on demographics,clinical characteristics,vascular status,metabolic control,and preoperative laboratory parameters were collected.Statistical analyses,including univariate and multivariate logistic regression,were conducted to identify significant predictive factors for perfusion outcomes.RESULTS Old age,high body mass index,long diabetes duration,and presence of diabetic peripheral neuropathy were associated with impaired perfusion.Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin(HbA1c),creatinine,triglycerides,and partial pressure of carbon dioxide.Conversely,high hemoglobin,albumin,and prealbumin levels and partial pressure of oxygen(PaO_(2))were protective.Multivariate analysis identified diabetes duration,HbA1c,PaCO_(2),PaO_(2),and albumin as independent predictors of perfusion,underscoring the roles of metabolic control and vascular health.CONCLUSION Optimizing metabolic control,vascular health,and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.
文摘Tacrolimus(Tac)is a cornerstone immunosuppressant in the treatment regimens for organ transplant recipients.However,its extensive clinical use has brought attention to its associated drug safety concerns.Recent case reports highlighting Tac-induced gastrointestinal ulcers have prompted further investigation.In the present study,we analyzed Tac-associated adverse events using data from the U.S.Food and Drug Administration Adverse Event Reporting System(FAERS)to identify potential adverse event signals.Adverse event reports were collected up to the third quarter(Q3)of 2023,revealing 339 cases of Tac-related gastrointestinal ulcers.A disproportionality analysis was conducted utilizing the Bayesian confidence propagation neural network of information component(IC)and reporting odds ratio(ROR)methods.All statistical analyses were performed using R version 3.6.1.The findings demonstrated a significant signal for gastrointestinal ulcers associated with Tac use,with a ROR1 of 1.87(95%CI:1.68-2.08)and an IC1 of 0.89(95%CI:0.73-1.05)when compared to all other drugs.When compared specifically to cyclosporine,Tac also showed a significant signal(ROR2=1.55,95%CI:1.28-1.86;IC2=0.24,95%CI:0.04-0.44).Further analysis identified age,male gender,and European descent as risk factors for mortality outcomes in patients with Tac-associated gastrointestinal ulcers.These findings highlighted the critical need for clinicians to strengthen the monitoring and early detection of gastrointestinal ulcers in patients undergoing Tac therapy.Enhanced vigilance in this regard is essential to optimize the management and care of transplant patients.
基金supported by the Joint Funds of National Natural Science Foundation of China(No.U22A20162)the Natural Science Foundation of Hebei Province of China(No.C2021202002)+1 种基金the National Natural Science Foundation of China(No.52271245),the Natural Science Foundation of Tianjin(No.21JCQNJC01280)the financial support from the Danish Council for Independent Research(9040-00219B),European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement ENSIGN(Project ID:101086226),L4DNANO(Project ID:101086227).
文摘Microneedle(MN)patches could be a promising treatment for diabetic foot ulcers that plague thousands of people worldwide.While reducing skin resistance or increasing driving force can accelerate the efficiency of transdermal drug delivery with conventional MN patches,it can create toxic chemical residues or require the help of additional devices.Herein,a thermo-responsive microneedles patch(TMN)with high biocompatibility without additional equipment is proposed.The TMN consisted of a bilayer microneedles composed of sodium alginate(SA)-g-poly(N-isopropylacrylamide)layer(SA-g-PNIPAM)loaded with sucrose octasulfate sodium salt(SOS)and hyaluronic acid layer and a polycaprolactone/chitosan nanofiber membrane loading with tetracycline hydrochloride(TH)and SOS.PNIPAM accelerates drug release by extruding the drug through a volumetric phase transition in response to temperature changes,and TH and SOS promote wound healing by inhibiting bacterial growth and promoting vascular regeneration and epithelial formation.The results showed that the drug release of TMN was significantly faster,with the drug release rate of more than 80% in the 10th h,and the antibacterial rate of TMN could reach 800%.In addition,TMN had good biocompatibility and good healing effects in vivo,which may be helpful for the design of multifunctional dressings in the future.
文摘BACKGROUND Negative pressure wound therapy(NPWT)is a potential treatment for diabetic foot ulcers(DFUs),although the mechanisms underlying its effectiveness remain unclear.This study posits that NPWT may improve wound healing by promoting angiogenesis and activating the nuclear factor erythroid 2-related factor 2(Nrf2)/Kelch-like epichlorohydrin-associated protein 1(Keap1)signaling pathway,which is crucial for the body’s defense against oxidative stress.The hypothesis indicates that enhancing antioxidant defenses through NPWT may positively affect the healing process.There are still limited data on the roles of Nrf2,its downstream signaling molecules,and angiogenesis markers in patients undergoing NPWT.AIM To study the mechanism of NPWT in DFUs.METHODS This study included a total of 40 hospitalized patients with DFUs from Xuzhou Central Hospital,who were divided into Control group(n=21)and NPWT group(n=19).The levels of Nrf2 and Keap1 were analyzed in the granulation tissue 7 days after treatment.The wound condition,erythrocyte sedimentation rate(ESR),procalcitonin(PCT),interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),vascular endothelial growth factor(VEGF),basic fibroblast growth factor(b-FGF),cluster of differentiation 31(CD31),and levels of oxidative stress[malondialdehyde(MDA),superoxide dismutase(SOD),catalase(CAT),and total antioxidant capacity(T-AOC)]were analyzed before and 7 days after treatment by the Mann-Whitney U test.RESULTS The NPWT group demonstrated significant improvements in wound healing compared to the control group after 7 days of treatment.The levels of ESR,PCT,IL-6,and TNF-αwere significantly reduced in the NPWT group compared to the control group(P<0.05),while the levels of CD31,VEGF,and b-FGF showed significant increases(P<0.05).The NPWT group exhibited notable elevations in the levels of Nrf2 and its downstream targets(SOD,CAT,and T-AOC),accompanied by decreases in the levels of Keap1 and MDA(P<0.05).CONCLUSION NPWT may contribute to the healing of DFUs by potentially reducing levels of oxidative stress.Its effects could possibly be enhanced through the action of Nrf2.
基金Supported by National Natural Science Foundation of China,No.82370604Major Science and Technology innovation Project of Fujian Province,No.2023Y9269Natural Science Foundation of Fujian Province,China,No.2023J01239.
文摘BACKGROUND Hydroxyurea,an antimetabolite,is frequently prescribed for various hemato-logical disorders,and its common side effects include gastrointestinal problems,cutaneous or mucosal lesions and pyrexia/fever.CASE SUMMARY This study reports the case of a 67-year-old woman who developed recurrent abdominal pain after 10 years of continuous hydroxyurea therapy for primary thrombocythemia.Colonoscopy revealed an ileocecal ulcer.After discontinuing hydroxyurea therapy for 6 months,follow-up colonoscopy showed a significant reduction in the ulceration.CONCLUSION We consider cecal ulcers as a rare complication of hydroxyurea therapy which typically resolves upon stopping the drug.
基金Mlnlycke Health Care for their assistance on this project
文摘The aim of this study was to evaluate the cost and effectiveness of soft silicone foam dressings （SSFD, Mepilex） on the treatment of pressure ulcers. We searched electronic databases and retrieved articles to make a systematic evaluation, and then make a cost-effectiveness analysis by decision tree model combined with data from clinical treatments. The result shows that compared with the common sterile gauze, SSFD possesses an apparent advantage. The effective ratio is 96.3% versus 77.3%, although the cost of SSFD is much higher than that of sterile gauze, Mepilex appears to be more cost-effectiveness for preventive use.
文摘BACKGROUND The use of proton pump inhibitors(PPIs)with the intent of reducing gastric acidity to the desired therapeutic level for treating bleeding peptic ulcer still has several limitations.AIM To compare intravenous PPIs and oral potassium competitive acid blockers(PCABs)administered prior to endoscopic treatment of bleeding peptic ulcers.METHODS This retrospective study involved 105 consecutive patients with non-variceal upper gastrointestinal bleeding(treated August 2023 to February 2024).Prior to emergency endoscopy,patients received either intravenous PPI(pantoprazole 80 mg bolus)or oral PCAB(tegoprazan 50 mg single-dose).Severity of bleeding was assessed using the Glasgow-Blatchford,Rockall,and AIMS65 scoring systems.Patients with severe comorbidities were excluded.Primary outcomes included need for therapeutic endoscopic intervention and occurrence of re-bleeding.Multivariate logistic regression was performed to adjust for potential confounding factors.RESULTS Total of the 105 patients,61 received intravenous PPI injection and 44 received oral PCAB prior to emergency endoscopy.To minimize selection bias,bleeding severity was assessed using the Glasgow-Blatchford,Rockall and AIMS65 scores,with no statistically significant differences observed between the two groups.During emergency endoscopy performed within 48 hours,ulcer bed status was classified according to the Forrest classification.The proportion of lesions graded IIa or higher was significantly lower in the PCAB group(P<0.001),as was the frequency of therapeutic endoscopy intervention(odds ratio=0.272,95%confidence interval:0.111-0.665,P=0.004).The frequency of re-bleeding events was statistically significantly higher in the PPI group(odds ratio=0.141,95%confidence interval:0.024-0.844,P=0.032).CONCLUSION Pre-endoscopic PCAB administration is more effective than PPI injection for upper gastrointestinal bleeding and may reduce ulcer bleeding mortality.
文摘Objective: To identify the principal factors associated with the occurrence and development of medical device-related pressure injuries (MDRPI) in adults admitted to hospitals. MDRPI, a peculiar subtype of pressure injuries (PI), result from the pression exerted by devices (or their fixation systems) applied for diagnostic and therapeutic purposes. MDRPI represent a serious problem for patients and healthcare systems. Understanding potential risk factors is an important step in implementing effective interventions. Methods: In this study, we will perform a systematic review;if possible, also a meta-analysis will be performed. The review will follow the preferred reporting items for systematic reviews and meta-analyses (PRISMA) reporting guidelines for systematic reviews. A rigorous literature search will be conducted both in electronic databases (Medline/PubMed, Embase, CINAHL, Web of Science, Scopus, Cochrane Library) to identify studies published since 2000 and in gray literature for unpublished studies. Pairs of researchers will identify relevant evidence, extract data, and assess risk of bias independently in each eligible study. Factors associated with the occurrence of MDRPI are considered the primary outcome. Secondary outcomes are prevalence and incidence of MDRPI, length of hospital stay, infections, and death. The evidence will be synthesized using the GRADE methodology. Results: Results are not currently available as this is a protocol for a systematic review. Conclusions: This systematic review will identify evidence on risk factors for developing MDRPI. We are confident that the results of this review will help to improve clinical practice and guide future research.
文摘BACKGROUND Corneal ulcers are a major cause of visual impairment in developing countries.In Indonesia,severe infective ulcers often require keratoplasty(KP)to preserve ocular integrity and improve outcomes.AIM To determine demographic,clinical and microbiological characteristics,complications,and KP outcomes in patients with moderate to severe infective corneal ulcers.METHODS A retrospective review was conducted on patients with moderate to severe infective corneal ulcers who underwent KP between January 1,2018 and December 31,2020,with a minimum follow-up period of 3 weeks at the Ocular Infection and Immunology clinic of a tertiary referral hospital in Jakarta.Data were extracted from medical records.RESULTS A total of 99 eyes from 99 patients with a mean age of 41.7±16.2 years were included.Eight-nine eyes of corneal cases were located at the central cornea with>6 mm lesion size(forty-one eyes).The culture positivity rate was 33%,primarily composed of Staphylococcus epidermidis.Eyeball integrity was maintained in all patients.Mean uncorrected visual acuity(VA)before KP was 2.50 and improved to 2.04 after 3 months of follow-up.Twenty patients with a cornea that was kept transparent achieved a VA of 0.40.Complications after KP appeared in 60 eyes,while secondary glaucoma was the most common complication(28 eyes),followed by graft failure(24 eyes)and graft rejection(14 eyes).CONCLUSION Corneal ulcers are a common problem in Indonesia following eye trauma.Therapeutic and tectonic KP can preserve the integrity of the eyeball in moderate to severe cases,although complications are common.
文摘Objective:To evaluate the efficacy rate of rebamipide combined with triple therapy in the treatment of senile peptic gastric ulcers.Methods:A cohort of 68 elderly patients diagnosed with peptic gastric ulcers was enrolled in this study between January 2022 and December 2024.Using the envelope method for randomization,the patients were divided into two equal groups:a control group administered standard triple therapy and an observation group that received the same triple therapy supplemented with rebamipide.The clinical efficacy,gastric mucosal morphology(mucosal thickness,gland density,active inflammatory cell infiltration,chronic inflammatory cell infiltration),and pepsinogen I/II were compared between the two groups.Results:The total effective rate in the observation group was significantly higher than that in the control group,with a statistically significant difference(p<0.05).After treatment,the scores of all items in both groups were significantly lower than those before treatment,and the scores in the observation group were significantly lower than those in the control group,with statistically significant differences(p<0.05).After treatment,the ratios in both groups were significantly higher than those before treatment,and the ratio in the observation group was significantly higher than that in the control group,with statistically significant differences(p<0.05).Conclusion:Rebamipide combined with triple therapy can significantly improve the treatment efficacy of senile peptic gastric ulcers,effectively improve the histological status of the gastric mucosa,and promote the recovery of gastric mucosal function,with superior efficacy compared to triple therapy alone.
文摘Acquired hemophilia A(AHA)is a rare blood disorder that can cause life-threatening severe bleeding because of the development of autoantibodies(inhibitors)against factor VIII.AHA is common in elderly patients,and although most cases are characterized by subcutaneous or intramuscular bleeding,rare cases of gastrointestinal bleeding have been reported.Controlling gastrointestinal bleeding in patients with AHA is difficult even after multiple endoscopic hemostasis or transcatheter arterial embolization procedures,and these patients are prone to rebleeding.CASE SUMMARY We report the case of a 76-year-old Japanese woman with AHA who presented with repeated bleeding from an esophageal ulcer as the initial symptom.A hemorrhagic ulcer was detected in the lower esophagus,and endoscopic hemostasis using radiofrequency ablation was performed seven times over a month.However,this procedure was unsuccessful,and the patient was transferred to our department.Hypertonic saline-epinephrine injection plus clipping was administered for endoscopic hemostasis,but the treatment response of the patient was poor.After the AHA diagnosis was confirmed,a single dose of a mixture of factors VIIa and X was administered as a bypass hemostatic agent,and the bleeding was successfully controlled.In addition,emicizumab,a bispecific monoclonal antibody that is a substitute for activated factor VIII,was administered,and no further rebleeding was observed.CONCLUSION Multidisciplinary interventions between endoscopists and hematologists are essential to manage rare gastrointestinal bleeding caused by coagulation disorders,such as AHA.
