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Mirghani HO. Platelets indices clinical implications in diabetes mellitus: A broader insight. World J Diabetes 2025; 16:100467. [DOI: 10.4239/wjd.v16.i4.100467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2024] [Revised: 01/06/2025] [Accepted: 01/17/2025] [Indexed: 02/28/2025] Open
Abstract
Platelet indices (PIs) including high mean platelet volume (MPV), plateletcrit (PLC), and platelet distribution width (PLDW) are associated with poor glycemic control. In addition, they can indicate prothrombotic and procoagulation risk among patients with diabetes. PI measurement is cheap, quick and fits healthcare system needs in remote outreaching areas in low-income countries. However, a broader insight into their clinical implications in diabetes is lacking. To achieve a wider understanding, we reviewed PubMed/MEDLINE, Google Scholar and Cochrane Library for relevant articles investigating the role of PIs in diabetes mellitus. No limitation to the publication date was applied, which included all articles published up to August 17, 2024. The terms used were MPV, PLC, PLDW, platelet large cell ratio, glycated hemoglobin (HbA1c), PIs, platelet activity and diabetes mellitus. Out of the 790 articles retrieved, 187 full texts were reviewed, and 44 were included. PIs, when measurements are done promptly and within 2 h, could be short-term pointers to glycemic control in the life span of the platelets (2 wk). PIs are easy to perform, cheap and useful in remote outreaching areas with limited facilities where measurement of HbA1c is not available or cost-effective. However, PIs are not specific and are affected by demographic factors, such as pregnancy, renal failure, medications, hemoglobin and duration of diabetes. PIs could be implemented with daily blood glucose to inform doctors in low-income countries about their patients' glycemic control and cardiovascular risk. An important application might be when blood glucose control is needed quickly (before elective surgery).
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Ma F, Liu Y, Wang Y, Chirume WM, Yao D, Lan W, Zhao Z, Xu X, Zhang W, Guo C, Kong Q. A smart drug delivery microgel system with phased intervention capabilities and dual physical state of use promotes healing of diabetic infected wounds. J Mater Chem B 2025; 13:4138-4156. [PMID: 40045793 DOI: 10.1039/d4tb02474e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2025]
Abstract
Effectively managing infected diabetic wounds involves the elimination of bacteria, neutralization of reactive oxygen species (ROS), suppression of inflammation, and induction of angiogenesis. This study describes the development of a multifunctional hyaluronic acid (HA)-based microgel system capable of serving as either an injectable wet microgel or dry microspheres (MSs). After initially engineering Fe2+/tea polyphenol (TP) metal-polyphenol network (MPN)-functionalized HAMA MS, these particles were found to suppress inflammation and facilitate ROS scavenging. A deferoxamine (DFO)-loaded zinc-based metal-organic framework (ZIF-8@DFO) was then coated using phenylboronic acid (PBA)-functionalized ε-polylysine (PPL) to produce PPZD nanoparticles with antibacterial and pro-angiogenic properties. The dynamic loading of PPZD into MPN-functionalized MS (MMS) via boron ester bonds then yielded a pH/ROS-responsive microgel system (MMS@PPZD). PPL coating endowed the prepared materials with antimicrobial properties while mitigating cytotoxic effects resulting from the rapid release of Zn2+ and DFO in acidic micro-environments. This microgel system showed superior biocompatibility and phased intervention activities aligned with the various stages of the wound healing process in vitro and in vivo. Specifically, under acidic conditions, the system sequentially released TP, PL, Zn2+, and DFO, enabling effective ROS scavenging, suppressing inflammation, exhibiting antibacterial activity, and inducing angiogenesis. Overall, this environmentally-responsive, multifunctional, versatile microgel system offers significant promise for infected diabetic wound management.
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Affiliation(s)
- Fei Ma
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Yuheng Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Yu Wang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Walter Munesu Chirume
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Dengbo Yao
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Weiqiang Lan
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Zhen Zhao
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Xueyuan Xu
- Department of Urology and Institute of Urology (Laboratory of Reconstructive Urology), West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Weifei Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Chuan Guo
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
| | - Qingquan Kong
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
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Chang R, Wang P, Chen H, Chang SJ, Chen Q, Chang L, Qiu Y, Wang X, Lin X. Multifunctional Hydrogel Integrated Hemangioma Stem Cell-Derived Nanovesicle-Loaded Metal-Polyphenol Network Promotes Diabetic Flap Survival. Adv Healthc Mater 2025:e2404776. [PMID: 40108941 DOI: 10.1002/adhm.202404776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2024] [Revised: 02/11/2025] [Indexed: 03/22/2025]
Abstract
Diabetes-associated skin defects represent a significant global health challenge. While flap grafts have been a preferred treatment for soft-tissue injuries in diabetic patients, their survival is often compromised by impaired vascularization, infection, and the adverse diabetic pathological microenvironment. To address these limitations, a hybrid photo-crosslinkable hydrogel (HPC) integrated hemangioma stem cell-derived nanovesicle (HemV)-loaded dual-metal-polyphenol network (dMPN) (HemV@dMPN/HPC) is developed. HemVs, derived from highly vascularized infantile hemangioma tissues, play a key role in promoting cell proliferation and angiogenesis. The dMPN facilitates the gradual release of copper (Cu2+) and magnesium ions (Mg2+), stimulating angiogenesis and mitigating inflammation. The HPC further sustains ion release while preserving the therapeutic efficacy of HemVs. Moreover, both HPC and Cu2+ act to confer antibacterial properties, further accelerating wound healing. This multifunctional HemV@dMPN/HPC platform offers a promising therapeutic strategy for treating large diabetic skin defects and can potentially improve flap graft survival.
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Affiliation(s)
- Rui Chang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Pei Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Hongrui Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shih-Jen Chang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Qianyi Chen
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Lei Chang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yajing Qiu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xiansong Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Shanghai Key Laboratory of Tissue Engineering, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Xiaoxi Lin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
- Department of Laser and Aesthetic Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
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Yuan X, Meng L, Liu L, Zhang B, Xie S, Zhong W, Jia J, Zhang H, Jiang W, Xie Z. Hyperglycemia and type 2 diabetes mellitus associate with postoperative recurrence in chronic rhinosinusitis patients. Eur Arch Otorhinolaryngol 2025; 282:1289-1299. [PMID: 39613856 DOI: 10.1007/s00405-024-09109-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 11/20/2024] [Indexed: 12/01/2024]
Abstract
OBJECTIVE To investigate the associations between fasting blood glucose (FBG) and type 2 diabetes mellitus (T2DM) and the risk of postoperative CRS recurrence. METHODS A retrospective cohort study was conducted on clinical data of CRS patients who underwent surgery at our center between February 2019 and March 2022 and were followed up until June 2023. All CRS patients were categorized into two subgroups based on the presence of T2DM and postoperative recurrence. The Kaplan-Meier survival curves and binary logistic regression analyses were performed to examine the associations between FBG, T2DM, and the risk of postoperative CRS recurrence. RESULTS 1163 CRS patients were enrolled, including 134 in the T2DM group and 276 in the recurrent group. The recurrence rate in the T2DM group was significantly higher than that in the non-T2DM group (P < 0.05). T2DM prevalence and FBG levels were higher in the recurrent CRS group than in the non-recurrent CRS group (P < 0.05). The Kaplan-Meier survival curves and unadjusted and adjusted logistic regression models showed that T2DM was an independent risk factor for postoperative CRS recurrence (P < 0.05). Moreover, multivariate logistic regression analysis suggested that FBG, CRS duration, and allergic rhinitis were associated with the risk of postoperative CRS recurrence (P < 0.05). CONCLUSION Elevated FBG levels and accompanying T2DM were associated with an increased risk of postoperative CRS recurrence, which was independent of traditional risk factors. CRS duration and accompanying allergic rhinitis were also proven to be potential risk factors for postoperative CRS recurrence.
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Affiliation(s)
- Xuan Yuan
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Lai Meng
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Liyuan Liu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
| | - Benjian Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Shaobing Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Wei Zhong
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Jiaxin Jia
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Hua Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Weihong Jiang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China
| | - Zhihai Xie
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital of Central South University, 87 Xiangya Road, Kaifu District, Changsha, 410008, People's Republic of China.
- Hunan Province Key Laboratory of Otolaryngology Critical Diseases, Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, People's Republic of China.
- Anatomy Laboratory of Division of Nose and Cranial Base, Clinical Anatomy Center of Xiangya Hospital, Central South University, Changsha, People's Republic of China.
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Yang P, Ju Y, Shen N, Zhu S, He J, Yang L, Lei J, He X, Shao W, Lei L, Fang B. Exos-Loaded Gox-Modified Smart-Response Self-Healing Hydrogel Improves the Microenvironment and Promotes Wound Healing in Diabetic Wounds. Adv Healthc Mater 2025; 14:e2403304. [PMID: 39473310 DOI: 10.1002/adhm.202403304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2024] [Revised: 10/10/2024] [Indexed: 01/12/2025]
Abstract
Wound management has always been a challenge in the clinical treatment of diabetes. In this study, glucose oxidase (GOx) is grafted onto natural pullulan polysaccharides, and oxidization is carried out to form a self-healing hydrogel using carboxymethyl chitosan by means of reversible Schiff base covalent bonding. The smart-response drug release properties of this natural self-healing hydrogel are demonstrated in diabetic wounds by taking advantage of two key factors, namely the pH-responsive nature of Schiff base bonding and the fact that GOx reduces the pH in diabetic wounds. To further enhance the biological functions of the hydrogel dressing, exosomes (Exos) are introduced into the hydrogel system. The GOx present in the hydrogel system improves the high-glucose microenvironment of diabetic wounds, releasing H2O2 to impart antimicrobial effects, and ensuring that the hydrogel realizes a smart-response function. The carboxymethyl chitosan component used to construct the hydrogel plays an effective antibacterial role. Moreover, the Exos loaded into the hydrogel effectively promotes neovascularization of the wound. The Exos also regulates macrophage polarization and reduces the levels of persistent inflammation in diabetic wounds. These results suggest that this smart responsive, multifunctional, and self-healing hydrogel dressing is ideal for the management of diabetic wounds.
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Affiliation(s)
- Pu Yang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Yikun Ju
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Naisi Shen
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - Shuai Zhu
- College of Materials Science and Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Jiaqian He
- College of Materials Science and Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Lingxiu Yang
- College of Materials Science and Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Jiajie Lei
- College of Materials Science and Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Xiaoli He
- College of Materials Science and Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Wenjia Shao
- College of Materials Science and Engineering, Hunan University, Changsha, Hunan, 410082, China
| | - Lanjie Lei
- Key Laboratory of Artificial Organs and Computational Medicine in Zhejiang Province, Institute of Translational Medicine, Zhejiang Shuren University, Hangzhou, Zhejiang, 310015, China
| | - Bairong Fang
- Department of Plastic and Aesthetic (Burn) Surgery, The Second Xiangya Hospital, Central South University, Changsha, 410011, China
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Shook JC, Genito CJ, Darwitz BP, Tyson KJ, Velez AZ, Bridwell SK, Parsons JB, Rowe SE, Marshall CW, Conlon BP, Thurlow LR. Diabetes potentiates the emergence and expansion of antibiotic resistance. SCIENCE ADVANCES 2025; 11:eads1591. [PMID: 39937900 PMCID: PMC11817934 DOI: 10.1126/sciadv.ads1591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 01/13/2025] [Indexed: 02/14/2025]
Abstract
Individuals with diabetes mellitus frequently develop severe skin and soft tissue infections (SSTIs) that are recalcitrant to antibiotic treatment. We examined how diabetes affects the emergence of antibiotic resistance in a Staphylococcus aureus SSTI. We determined that S. aureus evolves antibiotic resistance rapidly in diabetic mice, while resistance did not occur in nondiabetic mice over the course of infection. Diabetes-associated immune cell dysfunction plays a minor role in the emergence of resistance, while hyperglycemia plays a dominant role facilitating the expansion and takeover of resistant mutants in diabetic infections. Furthermore, vancomycin intermediate resistant isolates display a pronounced fitness defect in nondiabetic mice but not in diabetic mice. Together, these data suggest that the diabetic infection environment represents an ideal reservoir for the emergence and proliferation of antibiotic resistance. Controlling the blood sugar of diabetic mice with insulin resulted in significantly decreased incidence of antibiotic-resistant S. aureus.
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Affiliation(s)
- John C. Shook
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Christopher J. Genito
- Department of Biomedical Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Benjamin P. Darwitz
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kaleb J. Tyson
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Amanda Z. Velez
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Sophia K. Bridwell
- Department of Biological Sciences, Marquette University, Milwaukee, WI 53233, USA
| | - Joshua B. Parsons
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Division of Infectious Diseases, Duke University School of Medicine, Durham, NC 27710, USA
| | - Sarah E. Rowe
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | | | - Brian P. Conlon
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Marsico Lung Institute, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Lance R. Thurlow
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
- Department of Biomedical Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
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Ding L, Lin H, Yang Z, Zhang P, Chen X. Polycaprolactone/gelatin-QAS/bioglass nanofibres accelerate diabetic chronic wound healing by improving dysfunction of fibroblasts. Int J Biol Macromol 2024; 283:136699. [PMID: 39442840 DOI: 10.1016/j.ijbiomac.2024.136699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 10/09/2024] [Accepted: 10/17/2024] [Indexed: 10/25/2024]
Abstract
Worldwide, more than 25 % of patients with diabetes develop chronic diabetic wounds in their lifetime. Infection and dysfunctional fibroblasts represent two significant etiological factors contributing to impaired wound healing in patients with diabetes. It is therefore evident that the development of wound dressings with both anti-infective and DM fibroblast modulating functions has the potential for clinical applications. In this study, a PCL/gelatine-quaternary ammonium salts (QAS)/bioglass (BG) electrospun nanofibrous membrane was developed with physico-chemical and biological properties that not only meet the clinical requirements for wound dressings but also exhibit remarkable moisturising (water adsorption rate of 382.39 ± 4.36 %) and tear-resistance properties (a tear strength of ~5.5 MPa). The incorporation of QAS and BG has enhanced the biocompatibility and bioactivity of the nanofibres, while also imparting remarkable antimicrobial properties. The antibacterial efficacy of PGQ-BG against E. coli and S. aureus was found to be 92.8 ± 0.78 % and 99.3 ± 0.55 %, respectively. Moreover, it was demonstrated that PGQ-BG nanofibers exerted a promoting effect on the extracellular matrix (ECM) in dysfunctional fibroblasts and upregulated the expression level of α-smooth muscle actin (α-SMA), a marker of their differentiation to myofibroblasts in vitro and in vivo. Furthermore, the COL-III/COL-I ratio was significantly increased, indicating that PGQ-BG may also accelerate wound healing. The nanofibrous dressing reduced scar formation by increasing the COL-III/COL-I ratio. This is the first report of BG improving fibroblast dysfunction via COL-III and COL-I promotion in fibroblasts, both in vitro and in vivo. Therefore, this novel bioactive nanofibrous dressing represents an effective and safe therapeutic strategy for improving chronic wound healing in patients with diabetes.
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Affiliation(s)
- Lin Ding
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, China; National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province and Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China
| | - Hao Lin
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, China; National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province and Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China
| | - Zhengyu Yang
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, China; National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province and Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China
| | - Peng Zhang
- School of Stomatology, Zhuhai Campus of Zunyi Medical University, Zhuhai 519040, China.
| | - Xiaofeng Chen
- School of Materials Science and Engineering, South China University of Technology, Guangzhou 510641, China; National Engineering Research Centre for Tissue Restoration and Reconstruction, Guangzhou 510006, China; Key Laboratory of Biomedical Engineering of Guangdong Province and Key Laboratory of Biomedical Materials and Engineering of the Ministry of Education, South China University of Technology, Guangzhou 510006, China.
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Fu M, Qi H, Zhu S, Zhu D, Sun C. Type 2 diabetes mellitus has a positive role in osteomyelitis: A Mendelian randomization analysis. Medicine (Baltimore) 2024; 103:e39833. [PMID: 39331936 PMCID: PMC11441940 DOI: 10.1097/md.0000000000039833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2024] [Accepted: 09/03/2024] [Indexed: 09/29/2024] Open
Abstract
According to clinical evidence, type 2 diabetes mellitus (T2D) and osteomyelitis (OM) are currently the 2 major causes of mortality and morbidity in humans. Despite accounts of their coexistence, there is still no understanding of their fundamental connection. We attempted to assess the causal effect of T2D on OM using the two-sample Mendelian randomization method. The whole gene-wide association study's aggregate data were examined. Single-nucleotide polymorphisms, which have a substantial correlation with T2D, were used as instrumental variables in a two-sample Mendelian randomization (MR) analysis to assess the causal relationship between T2D and OM risk using the inverse variance weighting, MR-egger regression, and weighted median approaches, respectively. A total of 114 single-nucleotide polymorphism were used as instrumental variables in this analysis. The inverse variance-weighted analysis showed a significant causal relationship between T2D and OM, indicating that T2D has a detrimental effect on OM risk. The odds ratio for the causal effect of T2D on OM was 1.317, with a 95% confidence interval of (1.140, 1.522) (P < .001). To assess heterogeneity, Cochran Q test statistics and MR-Egger regression were applied in the inverse variance-weighted technique. The P-value of .737 indicated a considerable level of heterogeneity was not absent in the data. This study used Mendelian randomization analysis to establish a causal relationship between T2D and OM. The findings suggest that T2D may increase the risk of OM.
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Affiliation(s)
- Ma Fu
- Department of Neonatology, Lianyungang Maternal and Child Health Care Hospital, Lianyungang, China
| | - Han Qi
- Department of Emergency Surgery, The Second People’s Hospital of Lianyungang, Lianyungang, China
| | - Suyue Zhu
- Department of Pediatric, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian, China
| | - Dongsheng Zhu
- Department of Pediatric Orthopedics, The First People’s Hospital of Lianyungang, Lianyungang, China
| | - Chao Sun
- Department of Pediatric Surgery, Lianyungang Maternal and Child Health Care Hospital, Lianyungang, China
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Darwitz BP, Genito CJ, Thurlow LR. Triple threat: how diabetes results in worsened bacterial infections. Infect Immun 2024; 92:e0050923. [PMID: 38526063 PMCID: PMC11385445 DOI: 10.1128/iai.00509-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024] Open
Abstract
Diabetes mellitus, characterized by impaired insulin signaling, is associated with increased incidence and severity of infections. Various diabetes-related complications contribute to exacerbated bacterial infections, including hyperglycemia, innate immune cell dysfunction, and infection with antibiotic-resistant bacterial strains. One defining symptom of diabetes is hyperglycemia, resulting in elevated blood and tissue glucose concentrations. Glucose is the preferred carbon source of several bacterial pathogens, and hyperglycemia escalates bacterial growth and virulence. Hyperglycemia promotes specific mechanisms of bacterial virulence known to contribute to infection chronicity, including tissue adherence and biofilm formation. Foot infections are a significant source of morbidity in individuals with diabetes and consist of biofilm-associated polymicrobial communities. Bacteria perform complex interspecies behaviors conducive to their growth and virulence within biofilms, including metabolic cross-feeding and altered phenotypes more tolerant to antibiotic therapeutics. Moreover, the metabolic dysfunction caused by diabetes compromises immune cell function, resulting in immune suppression. Impaired insulin signaling induces aberrations in phagocytic cells, which are crucial mediators for controlling and resolving bacterial infections. These aberrancies encompass altered cytokine profiles, the migratory and chemotactic mechanisms of neutrophils, and the metabolic reprogramming required for the oxidative burst and subsequent generation of bactericidal free radicals. Furthermore, the immune suppression caused by diabetes and the polymicrobial nature of the diabetic infection microenvironment may promote the emergence of novel strains of multidrug-resistant bacterial pathogens. This review focuses on the "triple threat" linked to worsened bacterial infections in individuals with diabetes: (i) altered nutritional availability in diabetic tissues, (ii) diabetes-associated immune suppression, and (iii) antibiotic treatment failure.
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Affiliation(s)
- Benjamin P. Darwitz
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Christopher J. Genito
- Division of Oral and Craniofacial Health Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Lance R. Thurlow
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Division of Oral and Craniofacial Health Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
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10
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Hecker C, Saha S, Niebel D, Hübner A. [Crisis resilience in medical practices and clinics]. DERMATOLOGIE (HEIDELBERG, GERMANY) 2024; 75:680-686. [PMID: 38935291 DOI: 10.1007/s00105-024-05386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Climate change because of anthropogenic greenhouse gas emissions increasingly triggers extreme weather events. Of all the continents, Europe is warming the fastest. Heat and drought, forest fires and floods will worsen in Europe even in optimistic global warming scenarios, affecting living conditions across the continent. Extreme weather events threaten energy and food security, ecosystems, infrastructure, water resources, financial stability, and people's healthcare. Many of these risks have already reached critical levels and could take on catastrophic proportions without immediate, decisive action. OBJECTIVES This paper outlines current challenges for medical practices and clinics in the context of climate change and provides examples and guidance for strengthening crisis resilience. MATERIALS AND METHODS Selective literature review on the different requirements for crisis resilience in practices and clinics was performed. RESULTS Medical practices and clinics achieve crisis resilience by high degrees of adaptability and flexibility. They prepare for climate change-related challenges and are, therefore, able to protect themselves and maintain their function in the healthcare system. Recent weather events in Germany revealed insufficient resilience among the healthcare sector; hence, improvements are necessary. CONCLUSIONS Changing environmental conditions urgently require the healthcare sector to adapt and effectively strengthen crisis resilience in order to ensure that critical infrastructure remains functional and the population has access to healthcare.
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Affiliation(s)
- Christina Hecker
- Arbeitsgemeinschaft Nachhaltigkeit in der Dermatologie (AGN) e. V., Guntramstr. 8, 79106, Freiburg, Deutschland.
| | - Susanne Saha
- Arbeitsgemeinschaft Nachhaltigkeit in der Dermatologie (AGN) e. V., Guntramstr. 8, 79106, Freiburg, Deutschland
| | - Dennis Niebel
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - Anne Hübner
- KLUG - Deutsche Allianz Klimawandel und Gesundheit e. V., Cuvrystr. 1, 10997, Berlin, Deutschland
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11
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De Vita E, Limongi F, Veronese N, Di Gennaro F, Saracino A, Maggi S. Association between Glycosylated Hemoglobin Levels and Vaccine Preventable Diseases: A Systematic Review. Diseases 2024; 12:187. [PMID: 39195186 DOI: 10.3390/diseases12080187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 08/14/2024] [Accepted: 08/16/2024] [Indexed: 08/29/2024] Open
Abstract
People with diabetes are at higher risk of serious complications from many vaccine-preventable diseases (VPDs). Some studies have highlighted the potential impact of glycosylated hemoglobin levels (HbA1c), but no systematic review has synthesized these findings. Of the 823 identified studies, 3 were included, for a total of 705,349 participants. Regarding the incidence of herpes zoster (HZ), one study found that higher HbA1c levels at the baseline (>10.3%) were associated with a significantly higher risk of HZ of 44%, compared to those with a good HbA1c control (6.7%). On the contrary, the second one reported that when compared to the reference group (HbA1c of 5.0-6.4%), participants with a HbA1c less than 5.0% were at higher risk of HZ of 63%, whilst participants with a HBA1c more than 9.5% had a similar risk. Finally, the third study observed that diabetes, defined using a value of HbA1c more than 7.5%, was associated with an increased risk of mortality in men with COVID-19. In conclusion, both high and low HBA1c levels appear to be associated with a higher risk of HZ. Regarding COVID-19, a value of HbA1c more than 7.5% was associated with a higher risk of death in COVID-19, but only in men.
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Affiliation(s)
- Elda De Vita
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | | | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Via del Vespro 141, 90127 Palermo, Italy
| | - Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari Aldo Moro, 70124 Bari, Italy
| | - Stefania Maggi
- Aging Branch, CNR Institute of Neuroscience, 35127 Padua, Italy
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12
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Yu XL, Zhou LY, Huang X, Li XY, Pan QQ, Wang MK, Yang JS. Urgent call for attention to diabetes-associated hospital infections. World J Diabetes 2024; 15:1683-1691. [PMID: 39192868 PMCID: PMC11346093 DOI: 10.4239/wjd.v15.i8.1683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/14/2024] [Accepted: 06/07/2024] [Indexed: 07/25/2024] Open
Abstract
In this editorial, we discuss the recent article by Zhao et al published in the World Journal of Diabetes, which highlights the importance of recognizing the risk indicators associated with diabetes mellitus (DM). Given the severe implications of healthcare-associated infections (HAIs) in hospitalized individuals- such as heightened mortality rates, prolonged hospitalizations, and increased costs- we focus on elucidating the connection between DM and nosocomial infections. Diabetic patients are susceptible to pathogenic bacterial invasion and subsequent infection, with some already harboring co-infections upon admission. Notably, DM is an important risk factor for nosocomial urinary tract infections and surgical site infections, which may indirectly affect the occurrence of nosocomial bloodstream infections, especially in patients with DM with poor glycemic control. Although evidence regarding the impact of DM on healthcare-associated pneumonias remains inconclusive, attention to this potential association is warranted. Hospitalized patients with DM should prioritize meticulous blood glucose management, adherence to standard operating procedures, hand hygiene pra-ctices, environmental disinfection, and rational use of drugs during hospitalization. Further studies are imperative to explore the main risk factors of HAIs in patients with DM, enabling the development of preventative measures and mitigating the occurrence of HAIs in these patients.
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Affiliation(s)
- Xue-Lu Yu
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Li-Yun Zhou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xiao Huang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xin-Yue Li
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Qing-Qing Pan
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
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13
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Xu J, Chen T, Fang X, Xia L, Pan X. Prediction model of pressure injury occurrence in diabetic patients during ICU hospitalization--XGBoost machine learning model can be interpreted based on SHAP. Intensive Crit Care Nurs 2024; 83:103715. [PMID: 38701634 DOI: 10.1016/j.iccn.2024.103715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/21/2024] [Accepted: 04/26/2024] [Indexed: 05/05/2024]
Abstract
BACKGROUND The occurrence of pressure injury in patients with diabetes during ICU hospitalization can result in severe complications, including infections and non-healing wounds. AIMS The aim of this study was to predict the occurrence of pressure injury in ICU patients with diabetes using machine learning models. STUDY DESIGN In this study, LASSO regression was used for feature screening, XGBoost was employed for machine learning model construction, ROC curve analysis, calibration curve analysis, clinical decision curve analysis, sensitivity, specificity, accuracy, and F1 score were used for evaluating the model's performance. RESULTS Out of the 503 ICU patients with diabetes included in the study, pressure injury developed in 170 cases, resulting in an incidence rate of 33.8 %. The XGBoost model had a higher AUC for predicting pressure injury in patients with diabetes during ICU hospitalization (train: 0.896, 95 %CI: 0.863 to 0.929; test: 0.835, 95 % CI: 0.761-0.908). The importance of SHAP variables in the model from high to low was: 'Days in ICU', 'Mechanical Ventilation', 'Neutrophil Count', 'Consciousness', 'Glucose', and 'Warming Blanket'. CONCLUSION The XGBoost machine learning model we constructed has shown high performance in predicting the occurrence of pressure injury in ICU patients with diabetes. Additionally, the SHAP method enables the interpretation of the results provided by the machine learning model. RELEVANCE TO CLINICAL PRACTICE Improve the ability to predict the early occurrence of pressure injury in diabetic patients in the ICU. This will enable clinicians to intervene early and reduce the occurrence of complications.
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Affiliation(s)
- Jie Xu
- Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Tie Chen
- Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xixi Fang
- Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Limin Xia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
| | - Xiaoyun Pan
- Department of Thoracic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.
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14
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Nierenberg NE, Levine JM. Infectious Aspects of Chronic Wounds. Clin Geriatr Med 2024; 40:471-480. [PMID: 38960538 DOI: 10.1016/j.cger.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024]
Abstract
The treatment, maintenance, and suppression of infection in chronic wounds remain a challenge to all practitioners. From an infectious disease standpoint, knowing when a chronic wound has progressed from colonized to infected, when to use systemic antimicrobial therapy and when and how to culture such wounds can be daunting. With few standardized clinical guidelines for infections in chronic wounds, caring for them is an art form. However, there have been notable advances in the diagnosis, treatment, and management of infected wounds. This article will discuss the pathophysiology of infection in older adults, including specific infections such as cutaneous candidiasis, necrotizing soft tissue infection, osteomyelitis, and infections involving hardware.
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Affiliation(s)
- Natalie E Nierenberg
- Wound Care, Department of Infectious Diseases, Tufts Medical Center, Boston, MA 02111, USA
| | - Jeffrey M Levine
- Icahn School of Medicine at Mount Sinai, New York, NY 10010, USA.
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15
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Liao TI, Ho CY, Chin SC, Wang YC, Chan KC, Chen SL. Sequential Impact of Diabetes Mellitus on Deep Neck Infections: Comparison of the Clinical Characteristics of Patients with and without Diabetes Mellitus. Healthcare (Basel) 2024; 12:1383. [PMID: 39057526 PMCID: PMC11276557 DOI: 10.3390/healthcare12141383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2024] [Revised: 07/06/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND Deep neck infections (DNIs) can compromise the airway and are associated with high morbidity and mortality rates. Diabetes mellitus (DM) is a metabolic disorder characterized by chronic hyperglycemia that is associated with several comorbidities. We compared the clinical characteristics of DNI patients with and without DM. METHODS This study recorded the relevant clinical variables of 383 patients with DNIs between November 2016 and September 2022; of those patients, 147 (38.38%) had DM. The clinical factors between DNI patients with and without DM were assessed. RESULTS Patients with DM were older (p < 0.001), had higher white blood cell counts (p = 0.029) and C-reactive protein levels (CRP, p < 0.001), had a greater number of deep neck spaces (p = 0.002) compared to patients without DM, and had longer hospital stays (p < 0.001). Klebsiella pneumoniae was cultured more frequently from patients with DM than those without DM (p = 0.002). A higher CRP level (OR = 1.0094, 95% CI: 1.0047-1.0142, p < 0.001) was a significant independent risk factor for DM patients with prolonged hospitalization. The lengths of hospital stays in patients with poorly controlled DM were longer than those with well-controlled DM (p = 0.027). CONCLUSIONS DNI disease severity and outcomes were worse in patients with DM than those without DM. Antibiotics effective against Klebsiella pneumoniae should be used for DNI patients with DM. DNI patients with DM and high CRP levels had more prolonged hospitalizations. Appropriate blood glucose control is essential for DNI patients with DM.
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Affiliation(s)
- Ting-I Liao
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (T.-I.L.); (C.-Y.H.); (S.-C.C.); (K.-C.C.)
| | - Chia-Ying Ho
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (T.-I.L.); (C.-Y.H.); (S.-C.C.); (K.-C.C.)
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Shy-Chyi Chin
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (T.-I.L.); (C.-Y.H.); (S.-C.C.); (K.-C.C.)
- Department of Medical Imaging and Intervention, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Yu-Chien Wang
- Department of Otorhinolaryngology & Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City 23652, Taiwan;
- Department of Otorhinolaryngology & Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Kai-Chieh Chan
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (T.-I.L.); (C.-Y.H.); (S.-C.C.); (K.-C.C.)
- Department of Otorhinolaryngology & Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Shih-Lung Chen
- School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan; (T.-I.L.); (C.-Y.H.); (S.-C.C.); (K.-C.C.)
- Department of Otorhinolaryngology & Head and Neck Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
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16
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Ma X, Chen D, Liu J, Wang W, Feng Z, Cheng N, Li S, Wang S, Liu L, Chen Y. Risk factors for sternal wound infection after median sternotomy: A nested case-control study and time-to-event analysis. Int Wound J 2024; 21:e14965. [PMID: 38994878 PMCID: PMC11240533 DOI: 10.1111/iwj.14965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/13/2024] Open
Abstract
Although potential risk factors for sternal wound infection (SWI) have been extensively studied, the onset time of SWI and different risk factors for superficial and deep SWI were rarely reported. This nested case-control study aims to compare the onset time and contributors between superficial and deep SWI. Consecutive adult patients who underwent cardiac surgery through median sternotomy in a single center from January 2011 to January 2021 constituted the cohort. The case group was those who developed SWI as defined by CDC and controls were matched 6:1 per case. Kaplan-Meier analysis, LASSO and univariate and multivariate Cox regressions were performed. A simple nomogram was established for clinical prediction of the risk of SWI. The incidence of SWI was 1.1% (61 out of 5471) in our cohort. Totally 366 controls were matched to 61 cases. 26.2% (16 of 61) SWI cases were deep SWI. The median onset time of SWI was 35 days. DSWI had a longer latency than SSWI (median time 46 days vs. 32 days, p = 0.032). Kaplan-Meier analyses showed different time-to-SWI between patients with and without DM (p = 0.0011) or MI (p = 0.0019). Multivariate Cox regression showed that BMI (HR = 1.083, 95% CI: 1.012-1.116, p = 0.022), DM (HR = 2.041, 95% CI: 1.094-3.805, p = 0.025) and MI (HR = 2.332, 95% CI: 1.193-4.557, p = 0.013) were independent risk factors for SWI. Superficial SWI was only associated with BMI (HR = 1.089, 95% CI: 1.01-1.175, p = 0.027), while deep SWI was associated with DM (HR = 3.271, 95% CI: 1.036-10.325, p = 0.043) and surgery time (HR = 1.004, 95% CI: 1.001-1.008, p = 0.027). The nomogram for SWI prediction had an AUC of 0.67, good fitness and clinical effectiveness as shown by the calibration curve and decision curve analyses. BMI, DM and MI were independent risk factors for SWI. DSWI had a longer latency and different risk factors compared to SSWI. The nomogram showed a fair performance and good effectiveness for the clinical prediction of SWI.
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Affiliation(s)
- Xiaolong Ma
- Institute of Hospital Management, Department of Innovative Medical ResearchChinese PLA General HospitalBeijingChina
| | - Dongsheng Chen
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
| | - Jianchao Liu
- Institute of Hospital Management, Department of Innovative Medical ResearchChinese PLA General HospitalBeijingChina
| | - Wenqing Wang
- Institute of Hospital Management, Department of Innovative Medical ResearchChinese PLA General HospitalBeijingChina
| | - Zekun Feng
- Division of Adult Cardiac Surgery, Department of CardiologyThe Sixth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Nan Cheng
- Division of Adult Cardiac Surgery, Department of CardiologyThe Sixth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Shuanglei Li
- Division of Adult Cardiac Surgery, Department of CardiologyThe Sixth Medical Center of Chinese PLA General HospitalBeijingChina
| | - Shan Wang
- Institute of Hospital Management, Department of Innovative Medical ResearchChinese PLA General HospitalBeijingChina
| | - Lihua Liu
- Institute of Hospital Management, Department of Innovative Medical ResearchChinese PLA General HospitalBeijingChina
| | - Youbai Chen
- Department of Plastic and Reconstructive SurgeryThe First Medical Centre of Chinese PLA General HospitalBeijingChina
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17
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Alexander M, Cho E, Gliozheni E, Salem Y, Cheung J, Ichii H. Pathology of Diabetes-Induced Immune Dysfunction. Int J Mol Sci 2024; 25:7105. [PMID: 39000211 PMCID: PMC11241249 DOI: 10.3390/ijms25137105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Revised: 06/18/2024] [Accepted: 06/19/2024] [Indexed: 07/16/2024] Open
Abstract
Diabetes is associated with numerous comorbidities, one of which is increased vulnerability to infections. This review will focus on how diabetes mellitus (DM) affects the immune system and its various components, leading to the impaired proliferation of immune cells and the induction of senescence. We will explore how the pathology of diabetes-induced immune dysfunction may have similarities to the pathways of "inflammaging", a persistent low-grade inflammation common in the elderly. Inflammaging may increase the likelihood of conditions such as rheumatoid arthritis (RA) and periodontitis at a younger age. Diabetes affects bone marrow composition and cellular senescence, and in combination with advanced age also affects lymphopoiesis by increasing myeloid differentiation and reducing lymphoid differentiation. Consequently, this leads to a reduced immune system response in both the innate and adaptive phases, resulting in higher infection rates, reduced vaccine response, and increased immune cells' senescence in diabetics. We will also explore how some diabetes drugs induce immune senescence despite their benefits on glycemic control.
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Affiliation(s)
- Michael Alexander
- Division of Transplantation, Department of Surgery, University of California, Irvine, CA 92868, USA
| | - Eric Cho
- Division of Transplantation, Department of Surgery, University of California, Irvine, CA 92868, USA
| | - Eiger Gliozheni
- Division of Transplantation, Department of Surgery, University of California, Irvine, CA 92868, USA
| | - Yusuf Salem
- Division of Transplantation, Department of Surgery, University of California, Irvine, CA 92868, USA
| | - Joshua Cheung
- Division of Transplantation, Department of Surgery, University of California, Irvine, CA 92868, USA
| | - Hirohito Ichii
- Division of Transplantation, Department of Surgery, University of California, Irvine, CA 92868, USA
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18
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Tian H, Zhu H, Xue Y, Wang M, Xing K, Li Z, Loh XJ, Ye E, Ding X, Li BL, Yin X, Leong DT. White light powered antimicrobial nanoagents for triple photothermal, chemodynamic and photodynamic based sterilization. NANOSCALE HORIZONS 2024; 9:1190-1199. [PMID: 38757185 DOI: 10.1039/d4nh00060a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Antibacterial nanoagents have been increasingly developed due to their favorable biocompatibility, cost-effective raw materials, and alternative chemical or optical properties. Nevertheless, there is still a pressing need for antibacterial nanoagents that exhibit outstanding bacteria-binding capabilities and high antibacterial efficiency. In this study, we constructed a multifunctional cascade bioreactor (GCDCO) as a novel antibacterial agent. This involved incorporating carbon dots (CDs), cobalt sulfide quantum dots (CoSx QDs), and glucose oxidase (GOx) to enhance bacterial inhibition under sunlight irradiation. The GCDCO demonstrated highly efficient antibacterial capabilities attributed to its favorable photothermal properties, photodynamic activity, as well as the synergistic effects of hyperthermia, glucose-augmented chemodynamic action, and additional photodynamic activity. Within this cascade bioreactor, CDs played the role of a photosensitizer for photodynamic therapy (PDT), capable of generating ˙O2- even under solar light irradiation. The CoSx QDs not only functioned as a catalytic component to decompose hydrogen peroxide (H2O2) and generate hydroxyl radicals (˙OH), but they also served as heat generators to enhance the Fenton-like catalysis process. Furthermore, GOx was incorporated into this cascade bioreactor to internally supply H2O2 by consuming glucose for a Fenton-like reaction. As a result, GCDCO could generate a substantial amount of reactive oxygen species (ROS), leading to a significant synergistic effect that greatly induced bacterial death. Furthermore, the in vitro antibacterial experiment revealed that GCDCO displayed notably enhanced antibacterial activity against E. coli (99+ %) when combined with glucose under simulated sunlight, surpassing the efficacy of the individual components. This underscores its remarkable efficiency in combating bacterial growth. Taken together, our GCDCO demonstrates significant potential for use in the routine treatment of skin infections among diabetic patients.
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Affiliation(s)
- Hua Tian
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Singapore 117585, Singapore.
- Hainan Provincial Fine Chemical Engineering Research Centre, Hainan University, Haikou, Hainan, 570228, P. R. China.
| | - Houjuan Zhu
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Singapore.
| | - Yuling Xue
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Singapore 117585, Singapore.
| | - Maonan Wang
- Department of Pathology, Xiangya Hospital, School of Basic Medical Sciences, Central South University, Changsha, China
| | - Kuoran Xing
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Singapore 117585, Singapore.
| | - Zibiao Li
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Singapore.
| | - Xian Jun Loh
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Singapore.
| | - Enyi Ye
- Institute of Materials Research and Engineering (IMRE), Agency for Science, Technology and Research (A*STAR), 2 Fusionopolis Way, Innovis #08-03, Singapore 138634, Singapore.
| | - Xianguang Ding
- Key Laboratory for Organic Electronics and Information Displays & Jiangsu Key Laboratory for Biosensors, Nanjing University of Posts & Telecommunications, Nanjing, 210023, China
| | - Bang Lin Li
- School of Chemistry and Chemical Engineering, Southwest University, Chongqing 400715, P. R. China
| | - Xueqiong Yin
- Hainan Provincial Fine Chemical Engineering Research Centre, Hainan University, Haikou, Hainan, 570228, P. R. China.
| | - David Tai Leong
- Department of Chemical and Biomolecular Engineering, National University of Singapore, Singapore 117585, Singapore.
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Fallah Huseini H, Yaghoobi M, Fallahi F, Boroumand F, Ezzati MH, Tabatabaei SM, Sotvan H, Ahvazi M, Badiee Aval S, Ziaee M. Topical Administration of Teucrium polium on Diabetic Foot Ulcers Accelerates Healing: A Placebo-Controlled Randomized Clinical Study. INT J LOW EXTR WOUND 2024; 23:238-246. [PMID: 34719966 DOI: 10.1177/15347346211048371] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Diabetic foot ulcer is one of the most devastating complications of uncontrolled diabetes. Although there have been advances in the management of diabetic foot ulcers, still diabetic foot ulcers are a major cause of many amputations in diabetic patients. Teucrium polium (T. polium) is widely used by folk medicine practitioners in Iran for the treatment of diabetic ulcers.The present study was designed to evaluate the safety and efficacy of topical T. polium ointment besides the standard treatment in diabetic foot ulcers.A total of 70 diabetic patients with foot ulcers grade 1 or 2 according to Wagner's scale were enrolled in this study. Patients were randomly divided into two groups. Patients in both groups received standard treatment for diabetic foot ulcers. In addition, group 1 received topical T. polium ointment, and group 2 received topical placebo ointment for 4 weeks. The T. polium and placebo ointments were rubbed twice daily two hours before the conventional dressing. The ulcer size, healing time, and laboratory tests were measured in both groups at baseline and end of the study after 4 weeks.Twenty-nine patients remained in the T. polium group and 26 in the placebo group until the end of the study. The mean surface area of ulcers was 3.52 ± 1.47 and 3.21 ± 1.67 cm2 in T. polium group and placebo group respectively at baseline which decrease to .717 ± .19 and 1.63 ± .72 cm2 respectively at the endpoint. The mean ulcer surface area was significantly lower in T. polium compared with the placebo group (p < .0001) at end of the study. Also, the number of patients that completely recovered in the T. polium group was significantly higher than the placebo group (p < .001) at the end of the study.The addition of topical T. polium ointment to standard treatment significantly improves the healing time of diabetic non-infected foot ulcers.
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Affiliation(s)
- Hasan Fallah Huseini
- Medicinal Plants Research Center, Institute of Medicinal Plants , ACECR, Karaj, Iran
| | - Maryam Yaghoobi
- Department of Epidemiology, Iran University of Medical Sciences, Tehran, Iran
- Clinical Research Development Unit, Imam Reza Hospital, University of Medical Sciences, Mashhad, Iran
| | - Farhad Fallahi
- Diabetic Clinic, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Boroumand
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Seyyed Mohammad Tabatabaei
- Clinical Research Development Unit, Imam Reza Hospital, University of Medical Sciences, Mashhad, Iran
- Medical Informatics Department, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Homa Sotvan
- Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Ahvazi
- Medicinal Plants Research Center, Institute of Medicinal Plants , ACECR, Karaj, Iran
| | - Shapour Badiee Aval
- Department of Complementary and Chinese Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Ziaee
- Medicinal Plants Research Center, Maragheh University of Medical Sciences, Maragheh, Iran
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20
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Mitroi RM, Roșu MM, Clenciu D, Pădureanu V, Mitrea A, Grigore MA, Mazilu ER, Rădulescu D, Vladu IM. Vasculitis and infectious risk in a patient with type 2 diabetes mellitus: A case report. Exp Ther Med 2024; 27:234. [PMID: 38628659 PMCID: PMC11019656 DOI: 10.3892/etm.2024.12522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 01/16/2024] [Indexed: 04/19/2024] Open
Abstract
The connection between vasculitis and infection is complex. The present study described a typical situation for a patient with unbalanced type 2 diabetes and chronic complications, in which a lack of adherence to the protection and care measures ultimately led to the appearance of some of the worst consequences of the condition, namely, ulceration, gangrene and amputation. In the context of an unstable condition with significant metabolic imbalance there was an impaired response to infections in the present patient, and the amputation resulted in wound persistence and ulcer development, followed by superinfection with methicillin-resistant Staphylococcus aureus according to the antibiogram performed. In this case, an episode of vasculitis was triggered without evidence of bacteraemia. The present case report highlighted the importance of proper hygiene and good metabolic control in patients with diabetes that suffer from amputations and conditions that expose them to certain complications, including vasculitis.
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Affiliation(s)
- Roxana Mădălina Mitroi
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Maria Magdalena Roșu
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Diana Clenciu
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical Municipal Hospital ‘Philanthropy’ of Craiova, 200143 Craiova, Romania
| | - Vlad Pădureanu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Adina Mitrea
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, Clinical Municipal Hospital ‘Philanthropy’ of Craiova, 200143 Craiova, Romania
| | - Maria Andreea Grigore
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Emilia Roxana Mazilu
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
| | - Dumitru Rădulescu
- Department of General Surgery, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ionela Mihaela Vladu
- Department of Diabetes, Nutrition and Metabolic Diseases, County Clinical Emergency Hospital of Craiova, 200642 Craiova, Romania
- Department of Diabetes, Nutrition and Metabolic Diseases, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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21
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Rogero RG, Swamy S, Bettin CC. The Differentiation Between Infection and Acute Charcot. Orthop Clin North Am 2024; 55:299-309. [PMID: 38403375 DOI: 10.1016/j.ocl.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
The differentiation between acute Charcot neuroarthropathy and infection in the foot and ankle should be supported by multiple criteria. A detailed history and physical examination should always be completed. Plain radiographs should be performed, though advanced imaging, currently MRI, is more helpful in diagnosis. Scintigraphy and PET may become the standard imaging modalities once they are more clinically available due to their reported increased accuracy. Laboratory analysis can also act as a helpful diagnostic tool. Histopathology with culturing should be performed if osteomyelitis is suspected. The prompt diagnosis and initiation of treatment is vital to reducing patient morbidity and mortality.
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Affiliation(s)
- Ryan G Rogero
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite #510, Memphis, TN 38104, USA
| | - Samhita Swamy
- University of Tennessee Health Science Center College of Medicine, 847 E Parkway S, Memphis, TN 38104, USA
| | - Clayton C Bettin
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee Health Science Center-Campbell Clinic, 1211 Union Avenue, Suite #510, Memphis, TN 38104, USA.
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22
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Morata Ruiz L, Ruggieri A, Falcone M, Pasquau Liaño J, Gentile I, Salavert Lletí M, Moreno Núñez L, Cascio A, Tascini C, Loeches Yagüe M, De Rosa FG, Ori A, Comandini A, Cattaneo A, Grossi PA. Dalbavancin real-life utilization among diabetic patients suffering from infections in Italy and Spain: The DALBADIA retrospective cohort study. J Glob Antimicrob Resist 2024; 36:200-209. [PMID: 38211660 DOI: 10.1016/j.jgar.2023.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/14/2023] [Accepted: 11/29/2023] [Indexed: 01/13/2024] Open
Abstract
OBJECTIVES To retrospectively describe the patterns of use of dalbavancin for treating infections in diabetic patients in Italian and Spanish standard clinical practice. METHODS DALBADIA [NCT04959799] was a multicentre, observational, retrospective cohort study, conducted in Italy and Spain. The study enrolled 97 adults with type 1 or 2 diabetes mellitus, treated with dalbavancin as per standard clinical practice for a Gram-positive bacterial infection or the Gram-positive component of a mixed infection. RESULTS Dalbavancin was used to treat cellulitis (18/92 patients, 19.6%), followed by prosthetic joint infection (14 patients, 15.2%), endocarditis (13 patients, 14.1%), and primary bacteraemia (10 patients, 10.9%); 78/92 (84.8%) patients had Gram-positive infections only, and 14 (15.2%) had mixed infections. The most frequently isolated microorganisms were Staphylococcus aureus in 43 (55.8% of the patients with microbial isolation), 25.6% of which methicillin-resistant; Staphylococcus epidermidis in 13 (16.9%), 53.8% of which methicillin-resistant; Enterococcus faecalis in 11 (14.3%). The main reason for the dalbavancin choice was the intent to simplify the antibiotic regimen (81.5% of cases). A multidisciplinary team participated in the treatment choice process for 53 (57.6%) patients. Dalbavancin was given as first-line antibiotic in 34 (37.0%) patients and administered as one infusion in 32 (34.8%), and as two infusions in 39 (42.4%). In total, 57/62 (91.9%) eligible patients with available assessment were judged clinically cured or improved at the end of observation. CONCLUSION In clinical practice, dalbavancin was used in diabetic patients to treat ABSSSIs and other difficult-to-treat infections with a favourable safety profile and a high rate of positive clinical responses.
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Affiliation(s)
- Laura Morata Ruiz
- Hospital Clìnic, Department of Infectious Diseases, University of Barcelona, Barcelona, Spain
| | | | - Marco Falcone
- AOU Pisana PO Cisanello, UO Malattie Infettive, University of Pisa, Pisa, Italy
| | - Juan Pasquau Liaño
- Hospital Universitario Virgen de las Nieve, Unidad de Enfermedades Infecciosas, Granada, Spain
| | - Ivan Gentile
- AOU Federico II, Malattie Infettive, Patologia Clinica e Medicina Interna, Università di Napoli Federico II, Naples, Italy
| | - Miguel Salavert Lletí
- Hospital Universitario y Politécnico La Fe, Unidad de Enfermedades Infecciosas, Valencia, Spain
| | - Leonor Moreno Núñez
- Hospital Universitario Fundación Alcorcón, Enfermedades Infecciosas, Madrid, Spain
| | - Antonio Cascio
- AOU Policlinico Giaccone, UOC Malattie Infettive e Tropicali, Palermo, Italy
| | | | | | - Francesco Giuseppe De Rosa
- Ospedale Cardinal Massaia, SC Malattie Infettive, Asti, Italy, AOU Città della Salute e Scienza, Presidio Molinette, Turin, Italy
| | | | | | | | - Paolo Antonio Grossi
- ASST Sette Laghi, SC Malattie Infettive e Tropicali, University of Insubria, Varese, Italy
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23
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Peng L, Li W, Peng G, Wei D, Gou L, Zhou Y, Zhou Y, Chen X, Wu L, Zhang W, Hu L, Cao Q, Wang C, Zhang Y. Antibacterial and DNA-Based Hydrogels In Situ Block TNF-α to Promote Diabetic Alveolar Bone Rebuilding. Macromol Rapid Commun 2024; 45:e2300559. [PMID: 38014713 DOI: 10.1002/marc.202300559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 11/23/2023] [Indexed: 11/29/2023]
Abstract
Alveolar bone injury under diabetic conditions can severely impede many oral disease treatments. Rebuilding diabetic alveolar bone in clinics is currently challenging due to persistent infection and inflammatory response. Here, an antibacterial DNA-based hydrogel named Agantigel is developed by integrating silver nanoclusters (AgNCs) and tumor necrosis factor-alpha (TNF-α) antibody into DNA hydrogel to promote diabetic alveolar bone regeneration. Agantigel can effectively inhibit bacterial growth through AgNCs while exhibiting negligible cytotoxicity in vitro. The sustained release of TNF-α antibody from Agantigel effectively blocks TNF-α and promotes M2 polarization of macrophages, ultimately accelerating diabetic alveolar bone regeneration in vivo. After 21 days of treatment, Agantigel significantly accelerates the defect healing rate of diabetic alveolar bone up to 82.58 ± 8.58% and improves trabecular architectures compared to free TNF-α (42.52 ± 15.85%). The results imply that DNA hydrogels are potential bio-scaffolds helping the sustained release of multidrug for treating DABI or other oral diseases.
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Affiliation(s)
- Linrui Peng
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Li
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ge Peng
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Danfeng Wei
- Department of Dermatology, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Liping Gou
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Ye Zhou
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
- Animal Experimental Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yaojia Zhou
- Animal Experimental Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Xiaoting Chen
- Animal Experimental Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lei Wu
- Core facility of West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Wanli Zhang
- Core facility of West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Liqiang Hu
- WestChina-California Research Center for Predictive Intervention Medicine, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Qi Cao
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, 2145, Australia
| | - Chengshi Wang
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuwei Zhang
- Department of Endocrinology and Metabolism, Center for Diabetes and Metabolism Research, West China Hospital, Sichuan University, Chengdu, 610041, China
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24
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Guo L, Xiao X. Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). Aging Med (Milton) 2024; 7:5-51. [PMID: 38571669 PMCID: PMC10985780 DOI: 10.1002/agm2.12294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 04/05/2024] Open
Abstract
With the deepening of aging in China, the prevalence of diabetes in older people has increased noticeably, and standardized diabetes management is critical for improving clinical outcomes of diabetes in older people. In 2021, the National Center of Gerontology, Chinese Society of Geriatrics, and Diabetes Professional Committee of Chinese Aging Well Association organized experts to write the first guideline for diabetes diagnosis and treatment in older people in China, the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2021 Edition). The guideline emphasizes that older patients with diabetes are a highly heterogeneous group requiring comprehensive assessment and stratified and individualized management strategies. The guideline proposes simple treatments and de-intensified treatment strategies for older patients with diabetes. This edition of the guideline provides clinicians with practical and operable clinical guidance, thus greatly contributing to the comprehensive and full-cycle standardized management of older patients with diabetes in China and promoting the extensive development of clinical and basic research on diabetes in older people and related fields. In the past 3 years, evidence-based medicine for older patients with diabetes and related fields has further advanced, and new treatment concepts, drugs, and technologies have been developed. The guideline editorial committee promptly updated the first edition of the guideline and compiled the Guideline for the Management of Diabetes Mellitus in the Elderly in China (2024 Edition). More precise management paths for older patients with diabetes are proposed, for achieving continued standardization of the management of older Chinese patients with diabetes and improving their clinical outcomes.
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Affiliation(s)
- Lixin Guo
- National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well AssociationBeijingChina
- Department of Endocrinology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric MedicineChinese Academy of Medical SciencesBeijingChina
| | - Xinhua Xiao
- National Center of Gerontology, Chinese Society of Geriatrics, Diabetes Professional Committee of Chinese Aging Well AssociationBeijingChina
- Department of EndocrinologyPeking Union Medical College Hospital, Chinese Academy of Medical SciencesBeijingChina
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25
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Genito CJ, Darwitz BP, Greenwald MA, Wolfgang MC, Thurlow LR. Hyperglycemia potentiates increased Staphylococcus aureus virulence and resistance to growth inhibition by Pseudomonas aeruginosa. Microbiol Spectr 2023; 11:e0229923. [PMID: 37933971 PMCID: PMC10715105 DOI: 10.1128/spectrum.02299-23] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/29/2023] [Indexed: 11/08/2023] Open
Abstract
IMPORTANCE Individuals with diabetes are prone to more frequent and severe infections, with many of these infections being polymicrobial. Polymicrobial infections are frequently observed in skin infections and in individuals with cystic fibrosis, as well as in indwelling device infections. Two bacteria frequently co-isolated from infections are Staphylococcus aureus and Pseudomonas aeruginosa. Several studies have examined the interactions between these microorganisms. The majority of these studies use in vitro model systems that cannot accurately replicate the microenvironment of diabetic infections. We employed a novel murine indwelling device model to examine interactions between S. aureus and P. aeruginosa. Our data show that competition between these bacteria results in reduced growth in a normal infection. In a diabetic infection, we observe increased growth of both microbes and more severe infection as both bacteria invade surrounding tissues. Our results demonstrate that diabetes changes the interaction between bacteria resulting in poor infection outcomes.
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Affiliation(s)
- Christopher J. Genito
- Division of Oral and Craniofacial Health Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
| | - Benjamin P. Darwitz
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Matthew A. Greenwald
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Marsico Lung Institute, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Matthew C. Wolfgang
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
- Marsico Lung Institute, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
| | - Lance R. Thurlow
- Division of Oral and Craniofacial Health Sciences, University of North Carolina at Chapel Hill Adams School of Dentistry, Chapel Hill, North Carolina, USA
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina, USA
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26
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Huang H, Xin R, Li X, Zhang X, Chen Z, Zhu Q, Tai Z, Bao L. Physical therapy in diabetic foot ulcer: Research progress and clinical application. Int Wound J 2023; 20:3417-3434. [PMID: 37095726 PMCID: PMC10502280 DOI: 10.1111/iwj.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Diabetes foot ulcer (DFU) is one of the most intractable complications of diabetes and is related to a number of risk factors. DFU therapy is difficult and involves long-term interdisciplinary collaboration, causing patients physical and emotional pain and increasing medical costs. With a rising number of diabetes patients, it is vital to figure out the causes and treatment techniques of DFU in a precise and complete manner, which will assist alleviate patients' suffering and decrease excessive medical expenditure. Here, we summarised the characteristics and progress of the physical therapy methods for the DFU, emphasised the important role of appropriate exercise and nutritional supplementation in the treatment of DFU, and discussed the application prospects of non-traditional physical therapy such as electrical stimulation (ES), and photobiomodulation therapy (PBMT) in the treatment of DFU based on clinical experimental records in ClinicalTrials.gov.
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Affiliation(s)
- Hao Huang
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Rujuan Xin
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiaolong Li
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xinyue Zhang
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhongjian Chen
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Quangang Zhu
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Leilei Bao
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
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27
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Mittal G, Jakhar P, Patel A, Bhagwat DP. Pharmacokinetic assessment of cefpodoxime proxetil in diabetic rats. J Diabetes Metab Disord 2023; 22:385-392. [PMID: 37255782 PMCID: PMC10225406 DOI: 10.1007/s40200-022-01156-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 10/30/2022] [Indexed: 06/01/2023]
Abstract
Purpose In diabetes, multi-organ level dysfunction arising from metabolic complications is reported to influence the pharmacokinetics (PK) profile of many drugs. Hence, the present study was planned in rats to evaluate the effect of diabetes on the PK profile of cefpodoxime, a widely prescribed oral antibiotic. Method PK profile of cefpodoxime was assessed after oral administration of cefpodoxime proxetil (10 and 20 mg/kg) and intravenous (i.v) administration of cefpodoxime sodium (10 mg/kg) in normal and streptozotocin induced diabetic rats. To evaluate the impact of diabetes on oral absorption and serum protein binding, in situ intestinal permeability and in vitro serum protein binding studies were performed for cefpodoxime using Single Pass Intestinal Perfusion model (SPIP) and ultracentrifugation technique, respectively. Result In diabetic rats, there was significant (p < 0.01) decrease in maximum concentration (Cmax) and area under the curve (AUC) of cefpodoxime by both oral and intravenous route, which was attributed to augmented clearance of cefpodoxime. There was no change in the time to achieve Cmax (Tmax) suggesting no alteration in oral absorption which was further confirmed through unaltered intestinal permeability in diabetic rats. The protein binding in diabetic rats also remained unchanged, indicating no influence of protein binding on elevated clearance. Conclusion The plasma exposure of cefpodoxime, a renally eliminated drug was significantly lowered in diabetic rats due to enhanced glomerular filtration. However, this observation needs to be confirmed through well controlled clinical trials.
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Affiliation(s)
- Garima Mittal
- Department of Pharmacy, Panipat Institute of Engineering and Technology, Panipat, Haryana India
| | - Priyanka Jakhar
- Amar Shaheed Baba Ajit Singh Jujhar Singh Memorial College of Pharmacy, Ropar, Punjab India
| | - Anasuya Patel
- Wockhardt Research Centre, Chikalthana, Aurangabad, Maharashtra India
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28
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Amin AN, Dellinger EP, Harnett G, Kraft BD, LaPlante KL, LoVecchio F, McKinnell JA, Tillotson G, Valentine S. It's about the patients: Practical antibiotic stewardship in outpatient settings in the United States. Front Med (Lausanne) 2022; 9:901980. [PMID: 35966853 PMCID: PMC9363693 DOI: 10.3389/fmed.2022.901980] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2022] Open
Abstract
Antibiotic-resistant pathogens cause over 35,000 preventable deaths in the United States every year, and multiple strategies could decrease morbidity and mortality. As antibiotic stewardship requirements are being deployed for the outpatient setting, community providers are facing systematic challenges in implementing stewardship programs. Given that the vast majority of antibiotics are prescribed in the outpatient setting, there are endless opportunities to make a smart and informed choice when prescribing and to move the needle on antibiotic stewardship. Antibiotic stewardship in the community, or "smart prescribing" as we suggest, should factor in antibiotic efficacy, safety, local resistance rates, and overall cost, in addition to patient-specific factors and disease presentation, to arrive at an appropriate therapy. Here, we discuss some of the challenges, such as patient/parent pressure to prescribe, lack of data or resources for implementation, and a disconnect between guidelines and real-world practice, among others. We have assembled an easy-to-use best practice guide for providers in the outpatient setting who lack the time or resources to develop a plan or consult lengthy guidelines. We provide specific suggestions for antibiotic prescribing that align real-world clinical practice with best practices for antibiotic stewardship for two of the most common bacterial infections seen in the outpatient setting: community-acquired pneumonia and skin and soft-tissue infection. In addition, we discuss many ways that community providers, payors, and regulatory bodies can make antibiotic stewardship easier to implement and more streamlined in the outpatient setting.
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Affiliation(s)
- Alpesh N. Amin
- Department of Medicine, University of California, Irvine, Irvine, CA, United States
| | | | - Glenn Harnett
- No Resistance Consulting, Birmingham, AL, United States
| | - Bryan D. Kraft
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, MO, United States
| | - Kerry L. LaPlante
- College of Pharmacy, University of Rhode Island, Kingston, RI, United States
| | - Frank LoVecchio
- Department of Emergency Medicine, Valleywise Health, Arizona State University, Phoenix, AZ, United States
| | - James A. McKinnell
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Lundquist Research Institute at Harbor-UCLA, Torrance, CA, United States
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29
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The Efficacy of Targeted Perioperative Management for Diabetic Patients with Traumatic Calcaneal Fractures. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:1294416. [PMID: 35800010 PMCID: PMC9256409 DOI: 10.1155/2022/1294416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/17/2022]
Abstract
Objective To assess the efficacy of targeted perioperative management for diabetic patients with traumatic calcaneal fractures. Methods Between April 2020 and December 2020, 100 diabetic patients with traumatic calcaneal fractures treated in our institution satisfying the inclusion criteria were enrolled and assigned to receive either conventional treatment with surgery or plaster fixation (observation group) or targeted treatment with surgery or plaster fixation (experimental group) via the random number table method, with 50 patients in each group. All eligible patients were followed up for 1 year postoperatively. Outcome measures included length of hospital stay, recovery time, fracture healing, duration of postoperative wound drainage, complication rate, blood glucose, and treatment satisfaction. The Maryland score was used for the assessment of foot function. Results The duration of postoperative wound drainage, length of hospital stay, and recovery time in the experimental group (3.63 ± 1.04 d, 12.13 ± 3.77 d, and 111.22 ± 16.24 d) were significantly shorter than those in the observation group (5.71 ± 2.34 d, 15.28 ± 4.42 d, 123.10 ± 22.82 d) (P < 0.01). The experimental group obtained a markedly higher complete healing rate versus the observation group (P < 0.001). A significantly lower complication rate was observed in the experimental group than in the observation group (P < 0.05). The Maryland scores results were dichotomized into good (≥75 points) and poor (<75 points). The experimental group showed significantly higher Maryland scores good rate and treatment satisfaction versus the observation group (P < 0.01). The experimental group patients were associated with better postoperative fasting glucose and 2 h postprandial glucose versus those in the observation group (P < 0.05). Conclusion Targeted treatment in the perioperative management of diabetic patients with traumatic calcaneal fractures significantly promotes the recovery of patients, reduces the incidence of complications, increases treatment satisfaction, and ameliorates the doctor-patient relationship.
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Esposito S, Pagliano P, De Simone G, Pan A, Brambilla P, Gattuso G, Mastroianni C, Kertusha B, Contini C, Massoli L, Francisci D, Priante G, Libanore M, Bicocchi R, Borgia G, Maraolo AE, Brugnaro P, Panese S, Calabresi A, Amendola G, Savalli F, Geraci C, Tedesco A, Fossati S, Carretta A, Santantonio T, Cenderello G, Crisalli MP, Schiaroli E, Rovere P, Masini G, Ferretto R, Cascio A, Colomba C, Gioè C, Tumbarello M, Losito AR, Foti G, Prestileo T, Buscemi C, Iaria C, Iacobello C, Sonia S, Starnini G, Ialungo A, Sapienza M. Epidemiology, aetiology and treatment of skin and soft tissue infections: final report of a prospective multicentre national registry. J Chemother 2022; 34:524-533. [DOI: 10.1080/1120009x.2022.2075170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Silvano Esposito
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Pasquale Pagliano
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Giuseppe De Simone
- Department of Infectious Diseases, University of Salerno, Salerno, Italy
| | - Angelo Pan
- Department of Infectious Diseases, Istituti Ospitalieri of Cremona, Cremona, Italy
| | - Paola Brambilla
- Department of Infectious Diseases, Istituti Ospitalieri of Cremona, Cremona, Italy
| | - Gianni Gattuso
- Department of Infectious Diseases, Carlo Poma Hospital, Mantova, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, Latina, Italy
| | - Blertha Kertusha
- Department of Public Health and Infectious Diseases, Sapienza University, Latina, Italy
| | - Carlo Contini
- Department of Medical Sciences, Section of Infectious Diseases and Dermatology, University of Ferrara, Ferrara, Italy
| | - Lorenzo Massoli
- Department of Medical Sciences, Section of Infectious Diseases and Dermatology, University of Ferrara, Ferrara, Italy
| | - Daniela Francisci
- Infectious Diseases Clinic, University Hospital “S. Maria”, University of Perugia, Perugia, Italy
| | - Giulia Priante
- Infectious Diseases Clinic, University Hospital “S. Maria”, University of Perugia, Perugia, Italy
| | - Marco Libanore
- Infectious Diseases Unit, Department of Infectious Diseases, S. Anna University Hospital, Ferrara, Italy
| | - Roberto Bicocchi
- Infectious Diseases Unit, Department of Infectious Diseases, S. Anna University Hospital, Ferrara, Italy
| | - Guglielmo Borgia
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Albert Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Pierluigi Brugnaro
- Infectious Diseases Department, Ospedale Civile “SS. Giovanni e Paolo”, Venice, Italy
| | - Sandro Panese
- Infectious Diseases Department, Ospedale Civile “SS. Giovanni e Paolo”, Venice, Italy
| | - Alessandra Calabresi
- Emergency Department, Hospital “Santi Antonio e Biagio e C. Arrigo”, Alessandria, Italy
| | - Giovanni Amendola
- Emergency Department, Hospital “Santi Antonio e Biagio e C. Arrigo”, Alessandria, Italy
| | | | - Consuelo Geraci
- Infectious Diseases Unit, Hospital of Trapani, Trapani, Italy
| | - Andrea Tedesco
- Infectious Diseases Unit, Hospital Fracastoro San Bonifacio, Verona, Italy
| | - Sara Fossati
- Infectious Diseases Unit, University Hospital of Trieste, Trieste, Italy
| | - Anna Carretta
- Department of Infectious Diseases, University Hospital “Ospedali Riuniti” of Foggia, Foggia, Italy
| | - Teresa Santantonio
- Department of Infectious Diseases, University Hospital “Ospedali Riuniti” of Foggia, Foggia, Italy
| | | | | | - Elisabetta Schiaroli
- Department of Medicine, Section of Infectious Diseases, University of Perugia, Perugia, Italy
| | | | - Giulia Masini
- Infectious Diseases Unit, Legnago Hospital, Verona, Italy
| | - Roberto Ferretto
- Infectious Diseases Unit, “Alto Vicentino” Santorso Hospital, Vicenza, Italy
| | - Antonio Cascio
- Infectious Diseases Unit, Universita degli Studi di Palermo, Palermo, Italy
| | - Claudia Colomba
- Infectious Diseases Unit, Universita degli Studi di Palermo, Palermo, Italy
| | - Claudia Gioè
- Infectious Diseases Unit, Universita degli Studi di Palermo, Palermo, Italy
| | - Mario Tumbarello
- Institute of Infectious Diseases, Foundation Policlinico Universitario A. Gemelli IRCCS, Cattolica del Sacro Cuore University, Rome, Italy
| | - Angela Raffaella Losito
- Institute of Infectious Diseases, Foundation Policlinico Universitario A. Gemelli IRCCS, Cattolica del Sacro Cuore University, Rome, Italy
| | - Giuseppe Foti
- Infetious Diseases Unit, “Bianchi-Melacrino-Morelli” Hospital, Reggio Calabria, Italy
| | | | | | - Chiara Iaria
- Infectious Diseases Unit, Arnas Civico Hospital, Palermo, Italy
| | | | - Sofia Sonia
- Infectious Diseases Unit, Cannizzaro Hospital, Catania, Italy
| | | | - Anna Ialungo
- Infectious Diseases Unit, Belcolle Hospital, Viterbo, Italy
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Fourier transform-based data augmentation in deep learning for diabetic foot thermograph classification. Biocybern Biomed Eng 2022. [DOI: 10.1016/j.bbe.2022.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Gill CM, Fratoni AJ, Shepard AK, Kuti JL, Nicolau DP. OUP accepted manuscript. J Antimicrob Chemother 2022; 77:1372-1378. [PMID: 35194643 PMCID: PMC9047675 DOI: 10.1093/jac/dkac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/05/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives We assessed the plasma and soft-tissue pharmacokinetic exposure of omadacycline in infected patients with diabetic foot infection (DFI) and healthy volunteers using in vivo microdialysis. Methods Eight patients and six healthy volunteers were enrolled and received an omadacycline IV loading dose (200 mg) followed by two oral doses (300 mg) every 24 h. Microdialysis catheters were placed in the soft tissue near the infected diabetic foot wound (patients) or thigh (healthy volunteers). Plasma and dialysate fluid samples were collected, starting immediately prior to the third dose and continued for 24 h post-dose. Protein binding was determined by ultracentrifugation. Results The mean ± SD omadacycline pharmacokinetic parameters in plasma for infected patients and healthy volunteers were: Cmax, 0.57 ± 0.15 and 1.14 ± 0.26 mg/L; t½, 16.19 ± 5.06 and 25.34 ± 12.92 h; and total omadacycline AUC0–24, 6.27 ± 1.38 and 14.06 ± 3.40 mg·h/L, respectively. The omadacycline mean plasma free fraction was 0.21 and 0.20 for patients and healthy volunteers, corresponding to free plasma AUC0–24 of 1.13 ± 0.37 and 2.78 ± 0.55 mg·h/L, respectively. Omadacycline tissue AUC0–24 was 0.82 ± 0.38 and 1.37 ± 0.48 mg·h/L for patients and volunteers, respectively. Conclusions The present study describes the plasma and soft-tissue exposure of omadacycline in patients with DFI and healthy volunteers. Integrating these data with the microbiological, pharmacokinetic/pharmacodynamic and clinical efficacy data is foundational to support clinical assessments of omadacycline efficacy specifically for DFI. This, coupled with the once-daily oral administration, suggests omadacycline could be an advantageous translational therapy for the hospital and outpatient setting.
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Affiliation(s)
- Christian M Gill
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
| | - Andrew J Fratoni
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
| | - Ashley K Shepard
- Hartford Healthcare Medical Group, Podiatric Surgery, Hartford, CT, USA
| | - Joseph L Kuti
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
| | - David P Nicolau
- Center for Anti-Infective Research and Development, Hartford Hospital, Hartford, CT, USA
- Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA
- Corresponding author. E-mail:
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Photodynamic Therapy Combined with Antibiotics or Antifungals against Microorganisms That Cause Skin and Soft Tissue Infections: A Planktonic and Biofilm Approach to Overcome Resistances. Pharmaceuticals (Basel) 2021; 14:ph14070603. [PMID: 34201530 PMCID: PMC8308592 DOI: 10.3390/ph14070603] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/14/2021] [Accepted: 06/16/2021] [Indexed: 12/18/2022] Open
Abstract
The present review covers combination approaches of antimicrobial photodynamic therapy (aPDT) plus antibiotics or antifungals to attack bacteria and fungi in vitro (both planktonic and biofilm forms) focused on those microorganisms that cause infections in skin and soft tissues. The combination can prevent failure in the fight against these microorganisms: antimicrobial drugs can increase the susceptibility of microorganisms to aPDT and prevent the possibility of regrowth of those that were not inactivated during the irradiation; meanwhile, aPDT is effective regardless of the resistance pattern of the strain and their use does not contribute to the selection of antimicrobial resistance. Additive or synergistic antimicrobial effects in vitro are evaluated and the best combinations are presented. The use of combined treatment of aPDT with antimicrobials could help overcome the difficulty of fighting high level of resistance microorganisms and, as it is a multi-target approach, it could make the selection of resistant microorganisms more difficult.
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Veis DJ, Cassat JE. Infectious Osteomyelitis: Marrying Bone Biology and Microbiology to Shed New Light on a Persistent Clinical Challenge. J Bone Miner Res 2021; 36:636-643. [PMID: 33740314 DOI: 10.1002/jbmr.4279] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/01/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022]
Abstract
Infections of bone occur in a variety of clinical settings, ranging from spontaneous isolated infections arising from presumed hematogenous spread to those associated with skin and soft tissue wounds or medical implants. The majority are caused by the ubiquitous bacterium Staphyloccocus (S.) aureus, which can exist as a commensal organism on human skin as well as an invasive pathogen, but a multitude of other microbes are also capable of establishing bone infections. While studies of clinical isolates and small animal models have advanced our understanding of the role of various pathogen and host factors in infectious osteomyelitis (iOM), many questions remain unaddressed. Thus, there are many opportunities to elucidate host-pathogen interactions that may be leveraged toward treatment or prevention of this troublesome problem. Herein, we combine perspectives from bone biology and microbiology and suggest that interdisciplinary approaches will bring new insights to the field. © 2021 American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Deborah J Veis
- Division of Bone and Mineral Diseases, Departments of Medicine and Pathology, Washington University School of Medicine, St. Louis, MO, USA.,Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, USA.,Musculoskeletal Research Center, Washington University School of Medicine, St. Louis, MO, USA.,Shriners Hospitals for Children, St. Louis, MO, USA
| | - James E Cassat
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville,, TN, USA.,Department of Pediatrics, Division of Pediatric Infectious Diseases, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA.,Vanderbilt Institute for Infection, Immunology and Inflammation (VI4), Vanderbilt University Medical Center, Nashville, TN, USA.,Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA
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