The international journal of lower extremity wounds最新文献

{"title":"Bone Biopsy Microbiology Does Not Explain Clinical Severity in Diabetic Foot Osteomyelitis.","authors":"Javier Aragón-Sánchez, Gerardo Víquez-Molina, José María Rojas-Bonilla","doi":"10.1177/15347346251353684","DOIUrl":"https://doi.org/10.1177/15347346251353684","url":null,"abstract":"<p><p>Diabetic foot osteomyelitis is the most frequent infection in diabetes-related foot ulcers, often associated with delayed healing, prolonged hospitalization, and increased risk of amputation. The contribution of microbiological factors to its clinical severity remains uncertain. While severe cases are often associated with soft tissue complications such as abscesses or necrotizing infections, it is unclear whether the bacterial profile influences infection severity. This study aimed to determine whether severe presentations are associated with a higher frequency of polymicrobial infections, multidrug-resistant organisms, or specific bacterial species. We conducted a secondary analysis of a prospective cohort of patients with moderate or severe diabetic foot infections confirmed to involve osteomyelitis through histopathological evaluation. Bacterial species isolated from bone biopsy cultures were compared between moderate and severe cases. Among 114 patients included, 73 were classified as moderate and 41 as severe. Bone cultures were positive in 101 cases, yielding 173 isolates. <i>Staphylococcus aureus</i> was the most frequently isolated species, followed by <i>Enterococcus faecalis</i> and <i>Streptococcus agalactiae</i>. No significant differences were found between severity groups in the distribution of individual species, polymicrobial cultures (46.6% in moderate vs 56.1% in severe; p = 0.435), or multidrug-resistant organisms (12.3% vs 12.2%; p = 1.000). A global comparison of species distribution also showed no statistical association with severity (p = 0.941). These findings suggest that severity is not explained by the microbiological profile identified through conventional aerobic cultures. Instead, host-related or anatomical factors may be more relevant, although the lack of anaerobic cultures may have underestimated microbial diversity.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251353684"},"PeriodicalIF":0.0,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144510180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authorship Issues Further Plagued by Traded and Commercialized Authorship Slots, and <i>Faux</i> Authorship Resulting from the Use of Generative AI.","authors":"Jaime A Teixeira da Silva","doi":"10.1177/15347346251352725","DOIUrl":"https://doi.org/10.1177/15347346251352725","url":null,"abstract":"","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251352725"},"PeriodicalIF":0.0,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144499989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Mesenchymal Stem Cells in the Treatment of Diabetic Foot Ulcers: A Meta-Analysis of Randomized Controlled Trials.","authors":"Xiang-Hui Mei, Tong Zhang, Yan Yang, Li Sun, Rui-Min Han, Na Wu, Ye Tian, Bai-Chao Li, Min Ge, De-Feng Wang","doi":"10.1177/15347346251348797","DOIUrl":"https://doi.org/10.1177/15347346251348797","url":null,"abstract":"<p><p>BackgroundDiabetic foot ulcers (DFUs), a severe chronic complication of diabetes, are characterized by refractory wounds and high risks of amputation/mortality, posing substantial public health challenges. Mesenchymal stem cells (MSCs) demonstrate therapeutic potential through synergistic mechanisms including paracrine signaling, immunomodulation, neovascularization, and tissue regeneration. This study conducts a systematic review and meta-analysis of randomized controlled trials (RCTs) to comprehensively evaluate the clinical efficacy of MSC-based therapy for DFUs, aiming to optimize treatment strategies with evidence-based insights.MethodWe systematically searched PubMed, Embase, Cochrane Library, and Web of Science for RCTs investigating MSC therapy in DFUs. Following PRISMA guidelines, studies were selected with pre-defined criteria. Meta-analyses employed random-/fixed-effects models based on I² statistics. Primary endpoints encompassed complete healing rate (100% epithelialization), amputation incidence, serious adverse events (SAEs) risk, and recurrence rate. Furthermore, sensitivity analyses were conducted to evaluate the robustness of the findings. A comprehensive assessment of potential publication bias in the current meta-analysis was performed using Egger's linear regression test, Begg's rank correlation test, and funnel plot visualization.ResultsSix RCTs were included. MSC therapy significantly improved overall complete healing rates (RR = 1.63, 95% CI: 1.23-2.16; <i>P</i> = .0007), particularly in small ulcers (<5 cm²; RR = 1.71, 1.11-2.63, <i>P</i> = .02), but showed no efficacy for large ulcers (≥5 cm²; RR = 1.18, 0.75-1.86, <i>P</i> = .46). No significant differences emerged in amputation risk (<i>P</i> = .16), serious adverse events (<i>P</i> = .38), and recurrence (<i>P</i> = .33). Low heterogeneity and no publication bias were observed.ConclusionThis meta-analysis demonstrates MSCs therapy significantly enhances wound closure in diabetic foot ulcers, particularly achieving in small ulcers. However, no stable therapeutic benefits were observed for large ulcers, amputation prevention, recurrence reduction, and SAEs. Future multicenter phase III trials with standardized protocols are warranted to establish ulcer stage/size-specific treatments.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251348797"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144319099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reliability of Microwave Radiometry for the Assessment of Charcot Foot.","authors":"Ioanna Eleftheriadou, Anastasios Tentolouris, Ourania Kosta, Paraskevi Kontrafouri, Maria Tektonidou, Petros P Sfikakis, Nikolaos Tentolouris","doi":"10.1177/15347346251329733","DOIUrl":"https://doi.org/10.1177/15347346251329733","url":null,"abstract":"<p><p>Applying infrared thermometry for temperature measurement is recommended for Charcot neuro-osteoarthropathy (CNO) diagnosis and monitoring of its course. Microwave radiometry (MWR) is used for the detection of temperature changes in human tissues. This study evaluates the agreement between these two methods in CNO assessment. Individuals with diabetes mellitus (DM) with and without active CNO were included. MWR measurements were performed by a microwave computer-based system that detects microwave radiation from the area under investigation and temperatures of the internal tissues. Sensors with diameters of 0.8 cm (MWR 0.8), 2 cm (MWR 2), and 5 cm (MWR 5) were used, with larger diameters enabling deeper tissue assessment. Nine individuals (mean age: 54.6 ± 15.7, 2 females) with active CNO and 5 people with DM without CNO were included in the study. The agreement between temperatures measured by infrared thermometry and by MWR 0.8 was high and the average temperature discrepancy between the two methods was 0.034 °C (<i>P</i> = .676). The average temperature discrepancy between infrared thermometry and MWR 2 was -0.323 °C (<i>P</i> < .001) and between infrared thermometry and MWR 5 was -0.315 °C (<i>P</i> = .002). Participants with active CNO were followed-up for a median period of 67 [39, 79] weeks. During follow up, the difference in skin temperature between the affected and the contralateral foot was lower than 2 °C in 7 (77.8%) participants. Three out of 5 individuals had re-activation of CNO in 21, 22 and 65 weeks after the removal of the offloading device, respectively. The decision to gradually start loading would be different only for one person if we had used MWR instead of infrared thermometry for the measurement of temperature difference between the affected and the contralateral foot. In conclusion, infrared thermometry showed high agreement with MWR 0.8 but not with MWR 2 or MWR 5.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251329733"},"PeriodicalIF":0.0,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144287698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pig's Toenail Egg Yolk Ointment Promotes Pressure Ulcer Healing via the PI3K-Akt Pathway: A Randomized Controlled Trial.","authors":"Jiansheng Shao, Hui Zhang, Xiamei Zhang, Ying Xu, Jianhua Gu, Li Su","doi":"10.1177/15347346251348798","DOIUrl":"https://doi.org/10.1177/15347346251348798","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the efficacy and mechanism of pig's toenail egg yolk ointment in treating pressure ulcers. <b>Methods:</b> Eighty patients with Stage III-IV pressure ulcers were randomized into an experimental group (n = 50) receiving pig's toenail egg yolk ointment and a control group (n = 30) receiving conventional dressing. Clinical outcomes included Pressure Ulcer Scale for Healing(PUSH) score, wound healing rate, healing rate, and dressing costs. Additionally, a rat pressure ulcer model was used to assess healing rates, histopathology, and expression of VEGF, TNF-α, IL-1β, PI3 K, p-PI3 K, AKT, and p-AKT. <b>Results:</b> Clinical research: The experimental group showed significantly lower PUSH scores, higher wound healing rates, and reduced dressing costs compared to the control group (<i>P</i> < 0.05). Animal experiments: In rats, the ointment group demonstrated faster wound healing, neovascularization, and reduced inflammatory cell infiltration. ELISA results showed increased VEGF and decreased TNF-α and IL-1β levels. Western blot analysis indicated elevated p-PI3 K and p-AKT expression in the ointment group (<i>P</i> < 0.05). <b>Conclusion:</b> Pig's toenail egg yolk ointment promotes pressure ulcer healing by enhancing angiogenesis and modulating inflammatory factors through activation of the PI3K-Akt pathway.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251348798"},"PeriodicalIF":0.0,"publicationDate":"2025-06-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144259799","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effectiveness of Pentoxifylline 10% Topical Gel on the Pressure Ulcer Healing: A Randomized Controlled Clinical Trial.","authors":"Atefeh Alsadat Tayyebi, Rasool Soltani, Morteza Pourahmad, Erfaneh Ghassami, Mehdi Shahbazi Azad, Mohammad Mehdi Ahmadi, Mohammadreza Tabatabaei","doi":"10.1177/15347346251345244","DOIUrl":"https://doi.org/10.1177/15347346251345244","url":null,"abstract":"<p><p>Background and aimsRecent studies have shown wound-healing properties of systemic pentoxifylline (PTX). This study aimed to investigate the effectiveness of PTX 10% topical gel in the healing of pressure ulcer (PU).MethodsThe patients with stages 2 or 3 PU were randomly divided to PTX and control groups (n = 35 in each). For the first group, 10% PTX gel was used topically, along with common treatments, once a day for two weeks, while for the control group, a novel dressing along with the common wound care were applied. At the end of the first and second weeks, the wound size change and healing rate were compared between the groups.ResultsThere was a significant decrease in wound size at the first and second weeks in PTX group compared to the control (<i>P</i> < 0.05). Furthermore, the number of cases showing complete wound healing in PTX group (n = 16; 45.71%) was more than control group (n = 9; 25.71%); however, the difference was not statistically significant (<i>P</i> = 0.081).ConclusionThis study demonstrated that PTX 10% topical gel can be a promising treatment option to accelerate wound healing in patients with PU.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251345244"},"PeriodicalIF":0.0,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comprehensive Management of Venous Leg Ulcers: Evidence-Based Strategies and Treatment Options.","authors":"Myo Zin Oo, Boonying Siribumrungwong, Saritphat Orrapin, Nuttawut Sermsathanasawadi, Nikolaos Papanas, Kittipan Rerkasem","doi":"10.1177/15347346251333202","DOIUrl":"10.1177/15347346251333202","url":null,"abstract":"","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"257-259"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144045620","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diabetic Foot Ulcer in Malaysia: Consensus on Treatment Patterns, Health Care Utilization and Cost.","authors":"Harikrishna K R Nair, P Norlizah, M N Mariam, Syed A L Alsagoff, Kam Ming Long, K R Anantha, Ngoh Chin Liew, Nizam Ali Husien","doi":"10.1177/15347346221090096","DOIUrl":"10.1177/15347346221090096","url":null,"abstract":"<p><p>Healthcare resource utilization for Diabetic foot ulcers (DFUs) in Malaysia needs to be clarified. This modified Delphi panel study aimed to describe the clinical pathways for diabetic foot ulcer in Malaysia and to define the healthcare resources used and their costs. A systematic review of the literature was carried out on the management of diabetic foot ulcer in Malaysia. A modified Delphi panel involving 7 local experts was organized to validate the statements, in order to arrive at a consensus on the resources used for the treatment of DFU patients in Malaysia and their costs. A Markov model was then used to estimate the financial burden of DFU patients in Malaysia.The total cost per patient per annum was MYR 5981 in public and MYR 8581 in private setting. In the public setting, outpatient visits costs represent 50% of the overall cost, followed by medical devices which represent 38% of total costs. In the private setting, as in the public, outpatient visits and devices contribute the most to overall costs with 51% and 21%, respectively. However, hospital inpatient costs are higher in private setting and represent 14% of the total costs versus 5% in public setting.These findings may prove useful for clinicians and decision makers in understanding the economic implications of managing DFUs in Malaysia and the need for innovative therapies to reduce the burden for patients but also for the society.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":"1 1","pages":"312-319"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84960267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Studying Microbial Ecology of Diabetic Foot Infections: Significance of PCR Analysis for Prudent Antimicrobial Stewardship.","authors":"Deema Jaber, Nidal Younes, Enam Khalil, Abla Albsoul-Younes, Mohammed Zawiah, Amal G Al-Bakri","doi":"10.1177/15347346241230288","DOIUrl":"10.1177/15347346241230288","url":null,"abstract":"<p><p>This study presents a comprehensive investigation into the microbial ecology of diabetic foot infections (DFIs), using molecular-polymerase chain reaction (PCR) analysis to accurately identify the causative agents. One hundred DFI patients were recruited and classified using the Depth Extent Phase and Associated Etiology (DEPA) score according to their severity. Results revealed polymicrobial infections in 75% of cases, predominantly featuring <i>Staphylococcus epidermidis</i> (83%) and <i>Staphylococcus aureus</i> (63%). Importantly, 20% of samples exhibited facultative anaerobes <i>Bacteroides fragilis</i> or <i>Clostridium perfringens</i>, exclusively in high DEPA score ulcers. <i>Candida albicans</i> coinfection was identified in 19.2% of cases, underscoring the need for mycological evaluation. Empirical antimicrobial therapy regimens were tailored to DEPA severity, yet our findings highlighted a potential gap in methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) coverage. Despite an 88% prevalence of methicillin-resistant <i>Staphylococci</i>, vancomycin usage was suboptimal. This raises concerns about the underestimation of MRSA risk and the need for tailored antibiotic guidelines. Our study demonstrates the efficacy of molecular-PCR analysis in identifying diverse microbial communities in DFIs, influencing targeted antibiotic choices. The results advocate for refined antimicrobial guidelines, considering regional variations in microbial patterns and judiciously addressing multidrug-resistant strains. This research contributes crucial insights for optimizing DFIs management and helps the physicians to have a fast decision in selection the suitable antibiotic for each patient and to decrease the risk of bacterial resistance from the improper use of broad-spectrum empirical therapies.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"497-505"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139907188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antimicrobial Peptide Buforin-I Facilitates the Healing of Foot Wounds in Diabetic Mice.","authors":"Huang Hu, Hong Zhang, Meixian He, Jingjing Tai","doi":"10.1177/15347346251336569","DOIUrl":"https://doi.org/10.1177/15347346251336569","url":null,"abstract":"<p><p>BackgroundDiabetic wounds are difficult to heal due to long-term chronic ulcers, thus lacking effective treatment methods. Some antimicrobial peptides are known to have biological functions that promote wound healing, but the effects of the antimicrobial peptide Buforin-I on diabetic wound healing and the mechanisms underlying these effects are not yet elucidated.MethodsThis project investigated the effects of Buforin-I on the healing rate of foot wounds in streptozotocin (STZ)-induced diabetic mice and the antioxidant reactions in wound tissues. Histological staining with HE and Masson, as well as biochemical assays with immunohistochemistry (IHC), were applied to assess tissue chemistry markers. The activity levels of SOD, GSH, and reactive oxygen species (ROS) were measured to evaluate oxidative stress levels. TUNEL analysis was carried out to detect the apoptosis rate. The levels of VEGF, TGF-β1, and Nrf2 were measured by enzyme-linked immunosorbent assay (ELISA) and western blot (WB). In addition, the <i>in vitro</i> effects of Buforin-I on cell proliferation, apoptosis, migration, and oxidative stress levels under high glucose conditions were analyzed on HaCaT cells. Cell viability was measured using an MTT assay, and cell migration was assessed through the wound healing experiment.ResultsBuforin-I treatment accelerated the healing of foot wounds in STZ-induced diabetic mice, with increased fibroblast proliferation and collagen deposition in the wound tissue and decreased Nrf2-mediated oxidative stress levels. Furthermore, Buforin-I facilitated the proliferation and migration as well as reduced apoptosis of HaCaT cells under high glucose conditions, thus enhancing the antioxidant capacity of HaCaT cells.ConclusionIn conclusion, this study confirmed the promoting effect of Buforin-I on diabetic wound healing through the regulation of oxidative stress, highlighting the potential application of Buforin-I in diabetic wound healing.</p>","PeriodicalId":94229,"journal":{"name":"The international journal of lower extremity wounds","volume":" ","pages":"15347346251336569"},"PeriodicalIF":0.0,"publicationDate":"2025-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144192633","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}