Chronic,non-healing wounds represent a significant challenge for healthcare systems worldwide,often requiring significant human and financial resources.Chronic wounds arise from the complex interplay of underlying com...Chronic,non-healing wounds represent a significant challenge for healthcare systems worldwide,often requiring significant human and financial resources.Chronic wounds arise from the complex interplay of underlying comorbidities,such as diabetes or vascular diseases,lifestyle factors,and genetic risk profiles which may predispose extremities to local ischemia.Injuries are further exacerbated by bacterial colonization and the formation of biofilms.Infection,consequently,perpetuates a chronic inflammatory microenvironment,preventing the progression and completion of normal wound healing.The current standard of care(SOC)for chronic wounds involves surgical debridement along with localized wound irrigation,which requires inpatient care under general anesthesia.This could be followed by,if necessary,defect coverage via a reconstructive ladder utilizing wound debridement along with skin graft,local,or free flap techniques once the wound conditions are stabilized and adequate blood supply is restored.To promote physiological wound healing,a variety of approaches have been subjected to translational research.Beyond conventional wound healing drugs and devices that currently supplement treatments,cellular and immunotherapies have emerged as promising therapeutics that can behave as tailored therapies with cell-or molecule-specific wound healing properties.However,in contrast to the clinical omnipresence of chronic wound healing disorders,there remains a shortage of studies condensing the current body of evidence on cellular therapies and immunotherapies for chronic wounds.This review provides a comprehensive exploration of current therapies,experimental approaches,and translational studies,offering insights into their efficacy and limitations.Ultimately,we hope this line of research may serve as an evidence-based foundation to guide further experimental and translational approaches and optimize patient care long-term.展开更多
目的探究神经重症患者压力性损伤的临床特征、影响因素及预测模型的构建与评价。方法采用回顾性的研究方法,采集温州医科大学附属第一医院2020年4月–2024年4月的250例神经重症患者,分别收集其临床特征。依据患者治疗后是否发生压力性损...目的探究神经重症患者压力性损伤的临床特征、影响因素及预测模型的构建与评价。方法采用回顾性的研究方法,采集温州医科大学附属第一医院2020年4月–2024年4月的250例神经重症患者,分别收集其临床特征。依据患者治疗后是否发生压力性损伤,将250例神经重症患者分为损伤组和未损伤组,采集其是否昏迷或嗜睡、入住神经重症原发病以及急性生理与慢性健康评分系统(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评分等基线资料,比较急性脑血管病、昏迷或嗜睡以及APACHEⅡ评分受试者工作特征(receiver operating characteristics,ROC)曲线下面积(area under the curve,AUC)。结果接受治疗的250例神经重症患者中,发生压力性损伤的患者共有58例。其中35例(60.34%)为黏膜压力性损伤,23例(39.66%)为器械相关压力性损伤。按照压力性损伤分期标准1期46例(79.31%)、2期8例(13.97%)、3期4例(6.90%),无4期病例;logistic多因素回归分析显示,入住神经重症原发病(OR=3.102,95%CI:1.013~9.499)、昏迷或嗜睡(OR=3.769,95%CI:1.237~11.478)、APACHEⅡ评分(OR=0.201,95%CI:0.124~0.328)是神经重症患者发生压力性损伤的影响因素;ROC结果显示,三者联合预测的AUC为0.974,95%CI:0.957~0.992,灵敏度和特异度分别为91.40%和93.70%。联合预测模型的预测质量为0.96,显著单独构建的预测模型(P<0.05),Hosmer-Lemeshow检验显示模型拟合度良好(χ^(2)=4.779,P=0.062),说明该模型具有较高的精确度。结论急性脑血管病、昏迷或嗜睡以及APACHEⅡ评分均对神经重症患者发生压力性损伤具有不同程度的预测价值,其中急性脑血管病和昏迷或嗜睡预测值相同,但三者联合预测的准确性更高,具有广阔的应用前景和临床推广价值。展开更多
基金supported by grants from the German Research Foundation (DFG)
文摘Chronic,non-healing wounds represent a significant challenge for healthcare systems worldwide,often requiring significant human and financial resources.Chronic wounds arise from the complex interplay of underlying comorbidities,such as diabetes or vascular diseases,lifestyle factors,and genetic risk profiles which may predispose extremities to local ischemia.Injuries are further exacerbated by bacterial colonization and the formation of biofilms.Infection,consequently,perpetuates a chronic inflammatory microenvironment,preventing the progression and completion of normal wound healing.The current standard of care(SOC)for chronic wounds involves surgical debridement along with localized wound irrigation,which requires inpatient care under general anesthesia.This could be followed by,if necessary,defect coverage via a reconstructive ladder utilizing wound debridement along with skin graft,local,or free flap techniques once the wound conditions are stabilized and adequate blood supply is restored.To promote physiological wound healing,a variety of approaches have been subjected to translational research.Beyond conventional wound healing drugs and devices that currently supplement treatments,cellular and immunotherapies have emerged as promising therapeutics that can behave as tailored therapies with cell-or molecule-specific wound healing properties.However,in contrast to the clinical omnipresence of chronic wound healing disorders,there remains a shortage of studies condensing the current body of evidence on cellular therapies and immunotherapies for chronic wounds.This review provides a comprehensive exploration of current therapies,experimental approaches,and translational studies,offering insights into their efficacy and limitations.Ultimately,we hope this line of research may serve as an evidence-based foundation to guide further experimental and translational approaches and optimize patient care long-term.
文摘目的探究神经重症患者压力性损伤的临床特征、影响因素及预测模型的构建与评价。方法采用回顾性的研究方法,采集温州医科大学附属第一医院2020年4月–2024年4月的250例神经重症患者,分别收集其临床特征。依据患者治疗后是否发生压力性损伤,将250例神经重症患者分为损伤组和未损伤组,采集其是否昏迷或嗜睡、入住神经重症原发病以及急性生理与慢性健康评分系统(Acute Physiology and Chronic Health EvaluationⅡ,APACHEⅡ)评分等基线资料,比较急性脑血管病、昏迷或嗜睡以及APACHEⅡ评分受试者工作特征(receiver operating characteristics,ROC)曲线下面积(area under the curve,AUC)。结果接受治疗的250例神经重症患者中,发生压力性损伤的患者共有58例。其中35例(60.34%)为黏膜压力性损伤,23例(39.66%)为器械相关压力性损伤。按照压力性损伤分期标准1期46例(79.31%)、2期8例(13.97%)、3期4例(6.90%),无4期病例;logistic多因素回归分析显示,入住神经重症原发病(OR=3.102,95%CI:1.013~9.499)、昏迷或嗜睡(OR=3.769,95%CI:1.237~11.478)、APACHEⅡ评分(OR=0.201,95%CI:0.124~0.328)是神经重症患者发生压力性损伤的影响因素;ROC结果显示,三者联合预测的AUC为0.974,95%CI:0.957~0.992,灵敏度和特异度分别为91.40%和93.70%。联合预测模型的预测质量为0.96,显著单独构建的预测模型(P<0.05),Hosmer-Lemeshow检验显示模型拟合度良好(χ^(2)=4.779,P=0.062),说明该模型具有较高的精确度。结论急性脑血管病、昏迷或嗜睡以及APACHEⅡ评分均对神经重症患者发生压力性损伤具有不同程度的预测价值,其中急性脑血管病和昏迷或嗜睡预测值相同,但三者联合预测的准确性更高,具有广阔的应用前景和临床推广价值。
