Advances in wound care最新文献

{"title":"Alpha-1-Antitrypsin Enhances Fat Graft Survival in a Murine Model.","authors":"Dor Halpern, Idan Farber, Yuval Anav, Alexandra Tsitrina, Eli C Lewis, Eldad Silberstein","doi":"10.1089/wound.2024.0176","DOIUrl":"10.1089/wound.2024.0176","url":null,"abstract":"<p><strong>Objective: </strong>Fat grafting is widely applied for various purposes, including volume restoration, improving tissue quality, and promoting wound healing, but it has poor long-term graft survival predictability. Alpha-1-antitrypsin (AAT) administration is hypothesized to improve fat graft outcomes by expediting inflammatory resolution and graft vascularity and reducing necrosis.</p><p><strong>Approach: </strong>Mice heterozygote to human AAT was grafted fat under the scalp alongside 400 µg/graft AAT or albumin (ALB) on days 0 and 3. Graft volume was determined by micro-magnetic resonance imaging, and explants were assessed for viability, histology, immunohistochemistry, and expression of selected genes. AAT expression was examined in hypoxia-exposed adipose-derived stem cells (ADSCs).</p><p><strong>Results: </strong>After 90 days, AAT-treated grafts maintained higher volumes (70.06% vs. 34.54%, <i>n</i> = 8, <i>p</i> = 0.02) and displayed improved tissue quality. On day 10 after grafting, grafts exhibited more blood vessels (mean 1.94/mm² vs. 0.33/mm²) and 6.25-fold more adiponectin transcript levels (<i>n</i> = 12, <i>p</i> = 0.02). Although day-3 interleukin (IL)-1β expression was 5-fold greater in AAT-treated grafts (<i>n</i> = 6, <i>p</i> = 0.4), day-10 IL-1β expression was 2-fold lower compared to ALB-treated grafts (<i>n</i> = 22, <i>p</i> = 0.01). In the Methoxynitrosulfophenyl-tetrazolium carboxanilide (XTT) assay, day-3 AAT-treated grafts were 1.56-fold more metabolically functional (<i>n</i> = 6, <i>p</i> = 0.04) and exhibited greater perilipin-positive regions (18.5% versus 3.1%). Hypoxia-exposed ADSC expressed 9-fold higher AAT transcript levels (<i>p</i> = 0.04).</p><p><strong>Innovation: </strong>Fat grafting outcomes improved by early AAT treatment, probably by accelerating inflammatory resolution. Due to its marked safety profile, the study's findings are for adjunct clinical-grade AAT therapy.</p><p><strong>Conclusion: </strong>AAT has a promising potential to be utilized as a fat graft outcome enhancer in terms of volume retention predictability and tissue quality.[Figure: see text].</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"299-309"},"PeriodicalIF":5.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-Powered Image-Based Assessment of Pressure Injuries Using You Only Look Once Version 8 (YOLOv8) Models.","authors":"Mehedi Hasan Tusar, Fateme Fayyazbakhsh, Niloofar Zendehdel, Eduard Mochalin, Igor Melnychuk, Lisa Gould, Ming C Leu","doi":"10.1089/wound.2024.0245","DOIUrl":"10.1089/wound.2024.0245","url":null,"abstract":"<p><strong>Objective: </strong>The primary objective of this study is to enhance the detection and staging of pressure injuries using machine learning capabilities for precise image analysis. This study explores the application of the You Only Look Once version 8 (YOLOv8) deep learning model for pressure injury staging.</p><p><strong>Approach: </strong>We prepared a high-quality, publicly available dataset to evaluate different variants of YOLOv8 (YOLOv8n, YOLOv8s, YOLOv8m, YOLOv8l, and YOLOv8x) and five optimizers (Adam, AdamW, NAdam, RAdam, and stochastic gradient descent) to determine the most effective configuration. We followed a simulation-based research approach, which is an extension of the Consolidated Standards of Reporting Trials (CONSORT) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for dataset preparation and algorithm evaluation.</p><p><strong>Results: </strong>YOLOv8s, with the AdamW optimizer and hyperparameter tuning, achieved the best performance metrics, including a mean average precision at intersection over union ≥0.5 of 84.16% and a recall of 82.31%, surpassing previous YOLO-based models in accuracy. The ensemble model incorporating all YOLOv8 variants showed strong performance when applied to unseen images.</p><p><strong>Innovation: </strong>Notably, the YOLOv8s model significantly improved detection for challenging stages such as Stage 2 and achieved accuracy rates of 0.90 for deep tissue injury, 0.91 for Unstageable, and 0.74, 0.76, 0.70, and 0.77 for Stages 1, 2, 3, and 4, respectively.</p><p><strong>Conclusion: </strong>These results demonstrate the effectiveness of YOLOv8s and ensemble models in improving the accuracy and robustness of pressure injury staging, offering a reliable tool for clinical decision-making.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"271-288"},"PeriodicalIF":5.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143623193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence Mapping of Clinical Practice Guideline Recommendations for Self-Management Strategies of Diabetic Foot Ulcers.","authors":"Shupeng Shi, Piaoyu Yang, Xingzhou Liu, Yongjie Li, Chuan Yang","doi":"10.1089/wound.2024.0276","DOIUrl":"10.1089/wound.2024.0276","url":null,"abstract":"<p><strong>Significance: </strong>Diabetic foot ulcer (DFU) is a common complication of diabetes, characterized by chronic, hard-to-heal wounds that can lead to serious infections and amputations. Effective self-management is crucial for treatment and prevention.</p><p><strong>Recent advances: </strong>A comprehensive literature search was conducted across academic databases, clinical practice guideline (CPG) databases, and the websites of diabetes societies. The characteristics, recommendations, and evaluation criteria of the CPGs were extracted and organized using Excel. Four researchers independently assessed the methodological and reporting quality of the CPGs using the Appraisal of Guidelines Research and Evaluation II instrument and the Reporting Items for practice Guidelines in HealThcare checklist. Data were synthesized and visualized through evidence mapping to provide an overview of current guideline coverage and key recommendations.</p><p><strong>Critical issues: </strong>This study included 13 CPGs and synthesized 46 recommendations. Self-management strategies for patients with DFU mainly involve health education, foot self-care, lifestyle change, comorbidity/symptom management, as well as follow-up and medical help-seeking. The identified CPGs were of mixed quality, with four classified as high quality. With respect to methodology, the CPGs performed well in scope and purpose (82.6%±10.9%) and clarity (80.77%±9.19%), but showed deficiencies in stakeholder involvement (52.8%; interquartile range [IQR]: 17.3%) and editorial independence (58.3%; IQR: 82.3%). For reporting quality, limitations were noted in transparency regarding review and quality assurance (18.75%; IQR: 100%), as well as funding and declaration of interests (12.5%; IQR: 32.82%).</p><p><strong>Future directions: </strong>The evidence provided by CPGs for DFU self-management varied in strength, and some recommendations were inconsistent. The results adds to our knowledge and promotes the development of trustworthy CPGs on DFU. Further research is necessary to propose more evidence-based and high-quality recommendations.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"310-324"},"PeriodicalIF":5.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143661907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal Foot in Diabetes: Implications for Wound Healing and Solutions.","authors":"Ashu Rastogi, Rahul Gupta, Jayaditya Ghosh, Edward B Jude","doi":"10.1089/wound.2025.0074","DOIUrl":"10.1089/wound.2025.0074","url":null,"abstract":"<p><strong>Significance: </strong>The prevalence of diabetes is increasing and so is diabetic foot disease (DFD). DFD encompasses diabetic foot ulcer (DFU), which is a major global health problem. DFD contributes to increased morbidity (reduced quality of life and lower limb amputation), a high rate of recurrence, and increased mortality. Patients with renal disease are at the highest risk of diabetes-related foot disease (renal foot).</p><p><strong>Recent advances: </strong>Research has been undertaken in the last decade to understand the underlying causes leading to DFD in chronic kidney disease (CKD). The mechanisms, pathophysiology, biochemical, and immunological changes that occur in renal foot are being investigated and have given some insights into renal foot disease.</p><p><strong>Critical issues: </strong>Patients with renal foot have multiple comorbidities, both systemic and local, that are peculiar to renal disease. Identification and treatment of existing comorbidities of anemia, hypoalbuminemia, immune dysfunction, vascular calcification, and limited life span are crucial to optimize outcomes in renal foot. Attention needs to be paid to nutrition deficiencies that can also adversely affect foot outcomes. Anticipated challenges in the management of infected DFU and endovascular interventions for peripheral arterial disease need to be studied. Compromised bone health in CKD complicates the management of Charcot foot in DFD. A better understanding of preulcer interventions that could be performed in patients with renal disease is lacking.</p><p><strong>Future directions: </strong>Research focus on renal foot is required for delineating treatments that can be instituted to prevent DFD and disease progression in CKD. Intervention studies specifically targeting comorbidities in renal foot, such as peripheral vascular disease and cardiovascular disease, are required. Educating physicians and surgeons about the heightened risk of adverse consequences in renal foot is paramount. Multidisciplinary teams and one-stop foot/renal clinics shall ensure comprehensive care to improve outcomes in patients with renal foot.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"325-347"},"PeriodicalIF":5.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144658121","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Shizuoka Study of a Population-Based Retrospective Cohort for the Evaluation of Risk of Pressure Injury in the Elderly.","authors":"Hideo Hashizume, Ammi Matsuura, Yoshiki Miyachi","doi":"10.1089/wound.2024.0256","DOIUrl":"10.1089/wound.2024.0256","url":null,"abstract":"<p><strong>Objective: </strong>The risk of pressure injuries (PIs) is increasing in Japan, where an aging population imposes substantial health care burdens.</p><p><strong>Approach: </strong>This retrospective cohort study utilizing the Shizuoka Kokuho Database evaluated factors associated with PI development in hospitalized patients.</p><p><strong>Results: </strong>An analysis of over 546,000 patients aged ≥65 years from 2012 to 2022 identified 6,372 PI cases. Cox regression analyses revealed that male sex (hazard ratio [HR] 1.32, 95% confidence interval [CI]: 1.25-1.39), advanced age (HR 8.54, 95% CI: 7.40-9.87 for ≥95 years vs. 65-69 years) and comorbidities such as neurological disorders (HR 1.87, 95% CI: 1.72-2.04), dementia (HR 1.69, 95% CI: 1.59-1.80), and congestive heart failure (HR 1.19, 95% CI: 1.12-1.27) were associated with increased PI risks. Conversely, antihyperlipidemic drugs may be associated with a lower PI risk (HR 0.69, 95% CI: 0.65-0.74). Due to data limitations, factors such as nutritional status, mobility, and caregiver support could not be evaluated.</p><p><strong>Innovation: </strong>This study is the first in Japan to leverage big data to identify high-risk groups for PIs, particularly among elderly individuals with specific comorbidities. This approach offers actionable insights into PI management, potentially enhancing care strategies and preventive guidelines.</p><p><strong>Conclusion: </strong>Male sex, advanced age, and comorbidities, including neurological disorders, dementia, psychosis, and congestive heart failure, were identified as primary PI risk factors. Conversely, antihyperlipidemic drug use may be associated with a lower PI risk. These findings highlight the need for comprehensive, targeted prevention strategies to reduce the risk of PI in elderly hospitalized patients.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"289-298"},"PeriodicalIF":5.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143646804","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pressure Injury Incidence and Quality of Care Index (1990-2021): An Analysis of Trends and Health Inequalities Based on the Study of Global Burden of Disease 2021.","authors":"Zhi-Qin Xie, Xue-Mei Tao, Ze-Quan Wang, Yun-Yu Du, Lin-Xia Yi, Chao Xie, Han-Xiao Yi, Min Zhang, Wan-Yin Xiong, Shi-Han Chen, Chao-Zhu He, Rui Liu, Li Zhou, Zhen Yang","doi":"10.1089/wound.2024.0241","DOIUrl":"10.1089/wound.2024.0241","url":null,"abstract":"<p><strong>Objectives: </strong>To elucidate the global disease burden and care quality associated with pressure injury (PI).</p><p><strong>Approach: </strong>This study examined temporal trends in PI incidence over the past 32 years. Decomposition analysis attributed these trends to demographic and epidemiological shifts, and cross-national health inequities were quantified. The Quality of Care Index (QCI) was constructed using principal component analysis to assess spatiotemporal variations in global PI care quality. A log-linear age-period-cohort model was employed to forecast trends over the next 15 years.</p><p><strong>Results: </strong>In 2021, there were nearly 2.47 million PI cases globally, a 115.92% increase from 1.14 million in 1990. Decomposition analysis revealed that population aging and demographic growth were the primary drivers of increasing PI incidence. Lower QCI was concentrated in African countries and those with low sociodemographic index (SDI). Incidence rates increased gradually with improving SDI. Significant health inequalities existed among 204 countries and regions, with minimal changes in inequality slope indices over time. Projections indicate a gradual increase to 3.5 million PI cases globally by 2035.</p><p><strong>Innovation: </strong>This study developed a novel comprehensive indicator, the QCI, and for the first time, shed light on health inequalities in PI across 204 countries and territories.</p><p><strong>Conclusion: </strong>Over the past 32 years, the global disease burden of PI has been significant, accompanied by health inequalities across countries and regions. For nations with low SDI, there remains considerable room for improvement in the quality of care for PI, necessitating more effective strategies to address health care disparities.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"wound20240241"},"PeriodicalIF":5.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144245727","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Moisturizers, Emollients, or Barrier Preparations for the Prevention of Pressure Injury: A Systematic Review and Meta-Analysis.","authors":"Hayley Ryan, Brett G Mitchell, Oya Gumuskaya, Alison Hutton, Peta Tehan","doi":"10.1089/wound.2023.0002","DOIUrl":"10.1089/wound.2023.0002","url":null,"abstract":"<p><strong>Significance: </strong>Pressure injuries are prevalent, yet preventable global health care problem estimated to affect 14% of hospital patients and up to 46% of aged care residents. One common prevention strategy is improving skin integrity through emollient therapy to optimize hydration and avoid skin breakdown. Therefore, this study aimed to review the literature and determine effectiveness of inert emollients, moisturizers, and barrier preparations compared with standard care, to prevent pressure injury in aged care or hospital settings.</p><p><strong>Recent advances: </strong>Search terms were derived with database searches, including ProQuest, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medline, Science Direct, Scopus, and the Cochrane library. The Robins1 and Risk of Bias 2 (Rob2) quality appraisal tools were used. A meta-analysis of the effects of interventions was conducted (random effects). Four studies met the inclusion criteria, with heterogeneous quality. Pooling of nonrandomized studies found that the application of emollients, moisturizers or barrier preparations did not significantly reduce incidence of pressure injury compared with standard care (relative risk 0.50, 95% confidence interval: 0.15-1.63, <i>Z</i> = 1.15, <i>p</i> = 0.25).</p><p><strong>Critical issues: </strong>This review suggests that the use of inert moisturizers, emollients, or barrier preparations for preventing pressure injuries was not effective to prevent pressure injury in aged care or hospital settings. However, there was a distinct lack of randomized controlled trials (RCTs), with only one meeting the inclusion criteria. Furthermore, most of the included studies did not report on the frequency of application of the product, making it difficult to determine if application was in line with current international guidelines. One included study, which utilized a combination of neutral body wash and emollient demonstrated a significant reduction in the development of stage one and two pressure injuries. This combination of care may further support skin integrity and should be further examined in future trials.</p><p><strong>Future directions: </strong>Future studies should ideally be RCTs, which control for skin cleansing, and implement an inert moisturizer emollient or barrier preparation as part of a pressure injury reduction bundle of care. Standardization of the application of the product, the volume of product applied at each application, and the quality of the product should also be considered.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"wound20230002"},"PeriodicalIF":5.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9777781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Risk-Adjusted Wound Healing Rates and Long-Term Outcomes in a Network of U.S. Wound Care Clinics.","authors":"Grigory Franguridi, Andrew Becker, Soeren Mattke, Mary Sheridan, Jack Knott, William Ennis","doi":"10.1089/wound.2024.0263","DOIUrl":"10.1089/wound.2024.0263","url":null,"abstract":"<p><strong>Objective: </strong>Chronic wounds have a high prevalence and poor outcomes in a geriatric population. It is unknown whether higher rates of successful wound healing are associated with better long-term outcomes. We sought to determine the association of risk-adjusted healing rates in wound care clinics with postdischarge outcomes.</p><p><strong>Approach: </strong>This observational study compared outcomes of Medicare patients with chronic wounds who received care at clinics with the highest risk-adjusted wound healing rates (<i>n</i> = 91) to those with the lowest rates (<i>n</i> = 88) in a network of 510 specialized U.S. wound care clinics. All 12,703 patients with chronic wounds at the clinics that could be identified in Medicare data were included. The outcomes were incidences of wound recurrence, gangrene, sepsis, and amputation after discharge.</p><p><strong>Results: </strong>The study included 6,462 and 6,241 patients in top- and bottom-performing clinics, respectively. Being treated in a top-performing clinic was associated with a lower cumulative incidence of all four outcomes. The difference was statistically significantly lower for wound recurrence (adjusted hazard ratio [aHR] = 0.82, 95% confidence interval [CI] 0.76-0.87, <i>p</i> < 0.001) and gangrene (aHR = 0.62, 95% CI 0.52-0.76, <i>p</i> < 0.001) but not for sepsis (aHR = 0.88, 95% CI 0.76-1.001, <i>p</i> = 0.065) and amputation (aHR = 0.75, 95% CI 0.65-1.00, <i>p</i> = 0.055).</p><p><strong>Innovation: </strong>This study is the first to suggest that patients treated in clinics with better wound-healing outcomes also have better outcomes after discharge. This finding can inform analyses to understand differences in practice patterns that lead to better outcomes.</p><p><strong>Conclusion: </strong>Treatment of chronic wounds in wound care clinics with higher risk-adjusted healing rates is associated with a lower risk of wound-related adverse events during follow-up, particularly in the first year. More research is needed to understand the factors that contribute to this effect and to determine interventions to improve outcomes sustainably as well as assess the impact of changes in outcomes on resource utilization and patients' quality of life.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"wound20240263"},"PeriodicalIF":5.6,"publicationDate":"2026-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144223995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Functionality of High-Density Lipoproteins Is Impaired in People with Diabetes Who Require Minor Amputations.","authors":"Zahra Lotfollahi, Emma L Solly, Joanne T M Tan, Victoria A Nankivell, Lauren Sandeman, Liam Stretton, Mohsen Dorraki, Guilherme Pena, Johan Verjans, Zygmunt Szpak, Joseph Dawson, Neil McMillan, Peter J Psaltis, Robert Fitridge, Christina A Bursill","doi":"10.1177/21621918261441530","DOIUrl":"https://doi.org/10.1177/21621918261441530","url":null,"abstract":"<p><strong>Objective: </strong>High-density lipoprotein (HDL) functionality is emerging as a novel predictor of disease outcomes. The role of HDL functionality in patients with diabetes-related amputations is unexplored. We aimed to assess changes in HDL functionality in people with diabetes who had minor amputations and to determine the relationship between HDL functionality and wound closure (WC).</p><p><strong>Approach: </strong>Thirty patients with diabetes mellitus (DM) and 11 without (non-DM) undergoing minor amputations were recruited. Blood was collected at baseline (DM, <i>n</i> = 30; non-DM, <i>n</i> = 11), 1 month (DM, <i>n</i> = 22; non-DM, <i>n</i> = 5), and 6 months (DM, <i>n</i> = 14; non-DM, <i>n</i> = 3) postamputation and from 20 healthy gender- and age-matched control participants. HDL was isolated from plasma and functionality markers of macrophage cholesterol efflux, and anti-inflammatory and proangiogenic capacities in endothelial cells were assessed. The study adhered to Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.</p><p><strong>Results: </strong>HDL-cholesterol (HDL-c) levels positively correlated with WC (<i>r</i> = 0.44, <i>p</i> < 0.05). Cholesterol efflux capacity of DM HDL was reduced 1-month postamputation (-44% vs. non-DM HDL, <i>d</i> = -1.5, <i>p</i> < 0.05). Following inflammatory stimulation, DM HDL-treated cells had elevated levels of <i>C-X3-C motif chemokine ligand 1</i> (+92%, <i>d</i> = 0.9), <i>C-C motif chemokine ligand 2</i> (+49%, <i>d</i> = 0.8), <i>vascular cell adhesion molecule 1</i> (+67%, <i>d</i> = 0.9), and <i>intracellular adhesion molecule 1</i> (+58%, <i>d</i> = 0.9) (vs. non-DM HDL, <i>p</i> < 0.05). The capacity of endothelial cells to form tubules reduced linearly with time following DM HDL treatment (<i>p</i> < 0.05), concomitant with reduced <i>vascular endothelial growth factor A</i> (-47% vs. non-DM HDL, <i>d</i> = -1.2, <i>p</i> < 0.05). Endothelial cells treated with HDL from participants with delayed WC (<50%, 1-month postamputation) exhibited increased v-rel avian reticuloendotheliosis viral oncogene homolog A (<i>RELA)</i> expression (+52%, <i>d</i> = 1.2, <i>p</i> < 0.05). The impairment of HDL functionality in DM was concomitant with reduced apolipoprotein AI (-34%, <i>d</i> = 1.2) and paraoxonase 1 (-32%, <i>d</i> = -1.3, vs. non-DM, <i>p</i> < 0.05) protein in HDL 1-month postamputation.</p><p><strong>Innovation: </strong>An HDL panel, including HDL-c and HDL functionality and composition, could be used in early screening to identify patients who may benefit from early therapeutic intervention, guiding wound care management.</p><p><strong>Conclusion: </strong>Impaired HDL functionality, mediated through changes in HDL composition, may contribute to delayed wound healing.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"21621918261441530"},"PeriodicalIF":5.6,"publicationDate":"2026-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147759480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protein-Based Nutrition for Chronic Wounds: A Clinician's Guide to Patient Selection, Dosing, Monitoring, and Outcomes.","authors":"Zilong Tan, Yi Ru, Caiyun Zhang, Xinxin Wu, Qingkai Liu, Bin Li, Qilong Chen","doi":"10.1177/21621918261444178","DOIUrl":"https://doi.org/10.1177/21621918261444178","url":null,"abstract":"<p><strong>Significance: </strong>Chronic wounds remain a major global health burden and often stall despite guideline-based care because of persistent inflammation, oxidative stress, impaired perfusion, and dysregulated extracellular matrix remodeling. Protein-based nutrition is best positioned as an adjunct to, rather than a substitute for, standard wound care.</p><p><strong>Recent advances: </strong>Human studies, supported by mechanistic rationale, suggest that optimizing total protein intake (commonly ∼1.25 to 1.5 g/kg/day in appropriate patients) and, in selected settings, adding functional components such as arginine, glutamine, and β-hydroxy-β-methylbutyrate (HMB) may improve wound-area reduction and healing trajectories when integrated with standard care. Reported signals vary by etiology, including improved wound-area reduction and Pressure Ulcer Scale for Healing outcomes in pressure injuries, possible benefit in selected high-risk diabetic foot ulcer subgroups, and reduced venous ulcer area when supplementation is paired with consistent compression.</p><p><strong>Critical issues: </strong>Evidence remains heterogeneous across wound types and study designs, with inconsistent dosing, duration, endpoints, and patient-selection criteria that limit standardized implementation. Safety and feasibility are especially important in renal risk and diabetes, where renal function and glycemic control require monitoring. Clinical evidence was interpreted with attention to study design and reporting standards, including CONSORT, STROBE, or STARD, as applicable.</p><p><strong>Future directions: </strong>This review translates current evidence into a clinician-oriented framework for patient selection, prescribing, monitoring, and treatment adjustment, emphasizing initiation triggers in stalled wounds and trajectory-based reassessment every 2-4 weeks. Future work should prioritize pragmatic, well-controlled trials comparing formulations and dosing windows by wound etiology, together with biomarker-informed stratification to improve personalization, safety, and real-world uptake.</p>","PeriodicalId":7413,"journal":{"name":"Advances in wound care","volume":" ","pages":"21621918261444178"},"PeriodicalIF":5.6,"publicationDate":"2026-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147715728","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}