Effect Evaluation of Platelet-Rich Plasma Combined with Vacuum Sealing Drainage on Serum Inflammatory Factors in Patients with Pressure Ulcer by Intelligent Algorithm-Based CT Image.

This work was to explore the efficacy of intelligent algorithm-based computed tomography (CT) to evaluate platelet-rich plasma (PRP) combined with vacuum sealing drainage (VSD) in the treatment of patients with pressure ulcers. Based on the u-net network structure, an image denoising algorithm based on double residual convolution neural network (Dr-CNN) was proposed to denoise the CT images. A total of 84 patients who were hospitalized in hospital were randomly divided into group A (without any intervention), group B (PRP treatment), group C (VSD treatment), and group D (PRP+VSD treatment). Procalcitonin (PCT) was detected by enzyme-linked immunosorbent assay (ELISA) combined with immunofluorescence method, C-reactive protein (CRP) was detected by rate reflectance turbidimetry (RRT), and interleukin-6 (IL-6) was detected by electrochemiluminescence method. The results showed that after treatment, 44 cases (52.38%) of pressure ulcers patients recovered, 24 cases (28.57%) had no change in stage, and 16 cases (19.04%) developed pressure ulcers. The pain scores of group D at 1 week (3.35 ± 0.56 points) and 2 weeks (2.76 ± 0.55 points) after treatment were significantly lower than those in group C (7.77 ± 0.58 points and 6.34 ± 0.44 points, respectively). The time of complete wound healing in group D (24.5 ± 2.32) was obviously lower in contrast to that in groups A, B, and C (35.54 ± 3.22 days, 30.23 ± 2 days, and 29.34 ± 2.15 days, respectively). In addition, the medical satisfaction of group D (8.74 ± 0.69) was significantly higher than that of groups A, B, and C (4.69 ± 0.85, 5.22 ± 0.31, and 5.18 ± 0.59, respectively). The levels of IL-6 and PCT in group D were lower than those in groups A, B, and C, and the differences were statistically significant (P < 0.01). The average values of peak signal to noise ratio (PSNR) and structural similarity index measure (SSIM) of the Dr-CNN network model were 37.21 ± 1.09 dB and 0.925 ± 0.01, respectively, which were higher than other algorithms. The mean values of root mean square error (MSE) and normalized mean absolute distance (NMAD) of the Dr-CNN network model were 0.022 ± 0.002 and 0.126 ± 0.012, respectively, which were significantly lower than other algorithms (P < 0.05). The experimental results showed that PrP combined with VSD could significantly reduce the inflammatory response of patients with pressure ulcers. PRP combined with VSD could significantly reduce the pain of dressing change for patients. Moreover, the performance model of image denoising algorithm based on double residual convolutional neural network was better than other algorithms.

Correlation between vitamin D levels and hard-to-heal wounds: a systematic review.

OBJECTIVE: Hard-to-heal wounds are a major biological, psychological, social and financial burden on both individual patients and the broader health system. They are associated with a variety of comorbidities and have a complex aetiology, but are typically associated with nutritional deficiencies, such as low vitamin D levels. This systematic literature review evaluates the current research regarding the connection between inadequate vitamin D status and wound healing. METHOD: PubMed and EBSCO databases were searched following PRISMA guidelines for primary research studies relating to pressure ulcers, diabetic ulcers or venous ulcers and vitamin D status. RESULTS: A total of 10 studies, involving 2359 participants, met the inclusion criteria. There was a strong correlation between low levels of 25-hydroxyvitamin D and the presence of all three types of hard-to-heal wounds. CONCLUSION: Research suggests a correlation between low vitamin D levels and hard-to-heal wounds. However, it is not clear if the relationship is causal or only correlational. There is also emerging evidence on the use of vitamin D supplementation for the treatment of hard-to-heal wounds. More research is needed to understand the correlation between vitamin D and hard-to-heal wounds.

Myoglobin and troponin concentrations are increased in early stage deep tissue injury.

Pressure-induced deep tissue injury is a form of pressure ulcer which is difficult to detect and diagnose at an early stage, before the wound has severely progressed and becomes visible at the skin surface. At the present time, no such detection technique is available. To test the hypothesis that muscle damage biomarkers can be indicative of the development of deep tissue injury after sustained mechanical loading, an indentation test was performed for 2 h on the tibialis anterior muscle of rats. Myoglobin and troponin were analysed in blood plasma and urine over a period of 5 days. The damage as detected by the biomarkers was compared to damage as observed with T2 MRI to validate the response. We found that myoglobin and troponin levels in blood increased due to the damage. Myoglobin was also increased in urine. The amount of damage observed with MRI immediately after loading had a strong correlation with the maximal biomarker levels: troponin in blood rs = 0.94; myoglobin in blood rs = 0.75; and myoglobin in urine rs = 0.57. This study suggests that muscle damage markers measured in blood and urine could serve as early diagnosis for pressure induced deep tissue injury.

Vitamin D Status Is Associated With Development of Hospital-Acquired Pressure Injuries in Critically Ill Surgical Patients.

BACKGROUND: Hospital-acquired pressure injuries (HAPIs) typically develop following critical illness due to immobility and suboptimal perfusion. Vitamin D helps to maintain epithelial cell integrity, particularly at barrier sites such as skin. It is unclear whether vitamin D status is a modifiable risk factor for HAPIs in critically ill patients. Our goal was to investigate the relationship between admission 25-hydroxyvitamin D (25OHD) levels with the development of HAPIs in surgical intensive care unit (ICU) patients. METHODS: We performed a retrospective cohort study of patients admitted to surgical ICUs at a major teaching hospital in Boston, Massachusetts. To investigate the association of 25OHD levels with subsequent development of HAPIs, we performed logistic regression analyses, controlling for body mass index, Nutrition Risk in the Critically Ill score, ICU length of stay, and cumulative ICU caloric or protein deficit. RESULTS: A total of 402 patients comprised our analytic cohort. Each unit increment in 25OHD was associated with 11% decreased odds of HAPIs (odds ratio [OR] 0.89; 95% CI 0.840.95). When vitamin D status was dichotomized, patients with 25OHD <20 ng/mL were >2 times as likely to develop HAPIs (OR 2.51; 95% CI 1.065.97) compared with patients with 25OHD >20 ng/mL. CONCLUSION: In our cohort of critically ill surgical patients, vitamin D status at ICU admission was linked to subsequent development of HAPIs. Randomized, controlled trials are needed to assess whether optimizing 25OHD levels in the ICU can reduce the incidence of HAPIs and improve other clinically relevant outcomes in critically ill patients.

Nutritional blood parameters and nutritional risk screening in patients with spinal cord injury and deep pressure ulcer-a retrospective chart analysis.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To describe (i) the nutritional blood parameters (NBP) and the nutritional risk screening (NRS) in patients with spinal cord injury (SCI) and pressure ulcers (PU) III and IV according to the EPUAP classification, and (ii) the relationship between both NBP and NRS. SETTING: SCI acute care and rehabilitation clinic in Switzerland. METHODS: The NBPs were measured upon the admission of patients treated for PU III and IV between 11/2011 and 12/2014. Descriptive analyses and group comparisons were done. RESULTS: A total of 170 patients, including 42 (25%) women, 19 (12%) people with paraplegia and 104 (61%) people with traumatic SCI, were admitted and analyzed. Pathologic blood values and NBP were found for c-reactive protein (83%), vitamin D (73%), protein (41%), erythrocyte sedimentation rate (ESR) (41%), albumin (34%), hemoglobin (34%), zinc (29%), folic acid (22%), transferrin (15.3%), and copper (1.2%). Overall, the NRS was >3 in 39% of the patients, wherefrom 28% in patients with PU III and 44% with PU IV (p=0.07). No statistical significant differences were found between patients with PU III and IV in terms of NBP and NRS. CONCLUSIONS: We found abnormal values in NBP and in NRS in a significant number of patients with SCI and PU of both III and IV. Both laboratory examinations and nutritional assessments at admission can help to detect and correct the nutritional deficits in patients at risk. Neither the grade of the PUs, nor the NBP or the NRS can replace one another.

Quantitative analysis of blood cells and inflammatory factors in wounds.

OBJECTIVE: The aim of this study was to quantify blood cells and inflammatory markers, involved in the healing process, in exudates from wounds in different healing phases, to assess these markers in order to identify the inflammatory phase of the wounds. METHOD: Patients who presented with postsurgical wounds, which closed by first and second intention, and those who presented with pressure ulcers (PUs), which were closed by second intention, were included in the study. RESULTS: We examined wounds from 37 patients and collected samples from 52 wounds in the inflammatory phase, 30 in the proliferative phase and 29 in the maturation phase. The number of neutrophils and platelets in the exudate collected from wounds in the inflammatory phase was significantly higher (p<0.001), while the number of lymphocytes, was significantly lower in exudate from wounds in the inflammatory phase (p<0.001). Wound c-reactive protein (CRP) and immunoglobulin G (IgG) levels were higher in the inflammatory group (p<0.001). We found a significantly positive correlation between CRP levels and the percentage of neutrophils and monocytes (r=0.346, p=0.004; r=0.293, p=0.015), and a significantly negative correlation between CRP levels and the percentage of lymphocytes (r=-0.503, p<0.001). A stepwise logistic regression analysis was used to identify an optimal combination of these biomarkers. The optimal biomarker combinations were neutrophils + monocytes + platelets + IgG + CRP, with an area under the curve (AUC) of 0.981 [confidence interval (CI) 95%: 0.955-1.000, p<0.001] for the diagnosis of wounds in the inflammatory phase. The optimal cutpoint yielded 96.9 % sensitivity and 94.6 % specificity. The biomarker combination predicted the inflammatory phase and was superior to individual biomarkers. CONCLUSION: Our findings suggest that the combination of the markers, percentage of neutrophils and monocytes, platelets, CRP and IgG levels could be useful prognostic indicators of the inflammatory phase.

Elevated Levels of Protein Disulfide Isomerase and Binding Immunoglobulin Protein Implicated in Spinal Cord Injury Paraplegia Patients with Pressure Ulcers.

AIMS: To explore the associations between two endoplasmic reticulum (ER) stress proteins, protein disulfide isomerase (PDI), binding immunoglobulin protein (BIP), and the development and progression of pressure ulcers (PUs) in spinal cord injury (SCI) paraplegia patients. METHODS: ELISA kits were used to measure the levels of serum PDI and BIP in 67 SCI paraplegia patients with PUs and 61 SCI paraplegia patients without PUs. The associations between PDI and BIP, PU formation, PU staging, and pressure ulcer scale for healing (PUSH) score were analyzed. RESULTS: The patients in the PU group had higher levels of PDI and BIP than those in the non-PU group (both p < 0.05). Furthermore, the levels of PDI were positively correlated with those of BIP (r = 0.707, p < 0.0001). There were significant differences in the PDI and BIP levels among the different stages of PU (all p < 0.05). As the PU stages progressed, the levels of PDI and BIP first increased, then decreased, and finally peaked at stage III of the PUs. The PUSH scores significantly declined 7 days after debridement for the PU stage II (p < 0.01) but showed no significant difference between stages III and IV at 7 days after debridement (p > 0.05). The PUSH scores also decreased at 28 days after debridement for stages II, III, and IV (all p < 0.01). Higher PUSH scores indicated a longer time of debridement accompanied by a longer wound surface healing time (p < 0.05). CONCLUSION: ER stress proteins may be involved in the process of PU formation and healing; moreover, the levels of PDI and BIP were also associated with the severity of the PUs. Finally, we found that the PUSH scores can be used as a reference to evaluate PU severity and healing.

Early Detection of Pressure Ulcer Development Following Traumatic Spinal Cord Injury Using Inflammatory Mediators.

OBJECTIVE: To identify changes in concentrations of inflammatory mediators in plasma and urine after traumatic spinal cord injury (SCI) and before the occurrence of a first pressure ulcer. DESIGN: Retrospective; secondary analysis of existing data. SETTING: Acute hospitalization and inpatient rehabilitation sites at a university medical center. PARTICIPANTS: Individuals with a pressure ulcer and plasma samples (n=17) and individuals with a pressure ulcer and urine samples (n=15) were matched by age and plasma/urine sample days to individuals with SCI and no pressure ulcer (N=35). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Plasma and urine samples were assayed in patients with SCI, capturing samples within 4 days after the SCI to a week before the formation of the first pressure ulcer. The Wilcoxon signed-rank test was performed to identify changes in the inflammatory mediators between the 2 time points. RESULTS: An increase in concentration of the chemokine interferon-γ-induced protein of 10kd/CXCL10 in plasma (P<.01) and a decrease in concentration of the cytokine interferon-α in urine (P=.01) were observed before occurrence of a first pressure ulcer (∼4d) compared with matched controls. CONCLUSIONS: Altered levels of inflammatory mediators in plasma and urine may be associated with pressure ulcer development after traumatic SCI. These inflammatory mediators should be explored as possible biomarkers for identifying individuals at risk for pressure ulcer formation.

Postoperative gluteal skin damage associated with latent development of gluteal muscle damage.

Preceding this study, we observed two cases of concurrent postoperative gluteal skin and muscle damage with extremely high serum creatine kinase (CK) levels, both of which were unrelated to pressure-induced tissue injury. However, postoperative gluteal skin damage accompanied by gluteal muscle damage has not been previously reported and the association between gluteal skin damage, gluteal muscle damage and pressure-induced tissue injury has not previously been investigated. Therefore, we conducted this study to determine the postoperative incidence of gluteal skin damage associated with gluteal muscle damage and assess associations with postoperative serum CK levels and pressure-induced tissue injury. We prospectively evaluated postoperative incidence of gluteal skin damage and measured serum CK levels in 929 consecutive patients who underwent abdominal, urological or gynecological surgery at our hospital. Magnetic resonance imaging (MRI) of the pelvis was performed in 67 patients who consented. As a result, two of 929 patients developed postoperative gluteal skin damage accompanied by gluteal muscle damage. Gluteal muscle damage without gluteal skin damage was observed in 23 of the 67 patients who underwent MRI, and volumes of damaged gluteal muscle and postoperative serum CK levels were positively correlated. Both gluteal skin and muscle damage were distinguishable from pressure-induced tissue injury. Based on the results of this study, we could confirm the occurrence of postoperative gluteal skin damage, distinct from pressure sores, accompanied by gluteal muscle damage. We also revealed latent development of postoperative gluteal muscle damage, distinguishable from compression-induced tissue injury, without accompanying gluteal skin damage.

Hematological change parameters in patients with pressure ulcer at long-term care hospital.

OBJECTIVE: To assess factors associated with the development of pressure ulcers, and to compare the effectiveness of pharmacological treatments. METHODS: The factors associated with the development of pressure ulcers were compared in lesion-carrying patients (n=14) and non-carriers (n=16). Lesion-carrying patients were treated with 1% silver sulfadiazine or 0.6IU/g collagenase and were observed for 8 weeks. The data collected was analyzed with p<0.05 being statistically relevant. RESULTS: The prevalence of pressure ulcers was about 6%. The comparison of carrier and non-carrier groups of pressure ulcers revealed no statistically significant difference in its occurrence with respect to age, sex, skin color, mobility, or the use of diapers. However, levels of hemoglobin, hematocrit, and red blood cells were found to be statistically different between groups, being lower in lesion-carrying patients. There was no significant difference found in lesion area between patients treated with collagenase or silver sulfadiazine, although both groups showed an overall reduction in lesion area through the treatment course. CONCLUSION: Hematologic parameters showed a statistically significant difference between the two groups. Regarding the treatment of ulcers, there was no difference in the area of the lesion found between the groups treated with collagenase and silver sulfadiazine.

Hematological change parameters in patients with pressure ulcer at long-term care hospital / Alterações dos parâmetros hematológicos em pacientes portadores de úlcera por pressão em um hospital de longa permanência

Objective To assess factors associated with the development of pressure ulcers, and to compare the effectiveness of pharmacological treatments. Methods The factors associated with the development of pressure ulcers were compared in lesion-carrying patients (n=14) and non-carriers (n=16). Lesion-carrying patients were treated with 1% silver sulfadiazine or 0.6IU/g collagenase and were observed for 8 weeks. The data collected was analyzed with p<0.05 being statistically relevant. Results The prevalence of pressure ulcers was about 6%. The comparison of carrier and non-carrier groups of pressure ulcers revealed no statistically significant difference in its occurrence with respect to age, sex, skin color, mobility, or the use of diapers. However, levels of hemoglobin, hematocrit, and red blood cells were found to be statistically different between groups, being lower in lesion-carrying patients. There was no significant difference found in lesion area between patients treated with collagenase or silver sulfadiazine, although both groups showed an overall reduction in lesion area through the treatment course. Conclusion Hematologic parameters showed a statistically significant difference between the two groups. Regarding the treatment of ulcers, there was no difference in the area of the lesion found between the groups treated with collagenase and silver sulfadiazine. .

Objetivo Avaliar os fatores associados ao desenvolvimento da úlcera por pressão e comparar a efetividade de tratamentos farmacológicos. Métodos Os fatores associados ao desenvolvimento de úlcera por pressão foram comparados entre pacientes portadores (n=14) e não portadores (n=16) da lesão. Os pacientes com a ferida foram tratados com sulfadiazina de prata 1% ou colagenase 0,6UI/g, sendo acompanhados durante 8 semanas. Os dados coletados foram analisados considerando-se estatisticamente significativo se p<0,05. Resultados A prevalência de úlcera por pressão foi de cerca de 6%. A comparação entre os grupos de portadores e não portadores de úlcera por pressão não revelou diferença estatística significativa entre ocorrência desta segundo idade, sexo, cor da pele, mobilidade e uso de fralda. Por outro lado, os valores de hemoglobina, hematócrito e hemácias foram estatisticamente diferentes entre os grupos, sendo menor naqueles pacientes portadores da lesão. Não houve diferença significativa na área da lesão entre aqueles pacientes tratados com colagenase ou sulfadiazina de prata, embora ambos os tratamentos tenham evidenciado uma redução média da área da lesão. Conclusão Os parâmetros hematológicos apresentaram diferença estatística entre os dois grupos avaliados, ao contrário das demais variáveis analisadas. Em relação ao tratamento das úlceras, não houve diferença na área da lesão na comparação entre a colagenase e a sulfadiazina. .

Oral treatment of pressure ulcers with polaprezinc (zinc L-carnosine complex): 8-week open-label trial.

Polaprezinc (zinc L-carnosine complex) is a tablet commonly prescribed for gastric ulcers in Japan. Recently, we reported the effects of polaprezinc on pressure ulcer healing at 4-week follow-up. We aimed to further evaluate the efficacy and safety of polaprezinc in 8-week treatment for chronic pressure ulcers. Patients with stage II-IV pressure ulcers for ≥ 8 weeks received 150 mg/day polaprezinc (containing 116 mg L-carnosine and 34 mg zinc) per os for a maximum of 8 weeks. We measured the severity of pressure ulcers weekly using the Pressure Ulcer Scale for Healing (PUSH) score and monitored blood biochemistry. Fourteen patients (nine men; 68.4 ± 11.8 years) were enrolled. Pressure ulcer stages were II (one patient; 7 %), III (nine; 64 %), and IV (four; 29 %). The PUSH score improved significantly from 8.1 [95 % CI, 6.0-10.3] at baseline to -1.4 [-4.0 to 1.1] after 8 weeks (P < 0.001). Differences from baseline were significant after 1 week (P < 0.05). The mean weekly improvement in PUSH score was 2.0. Eleven patients healed within 8 weeks and none dropped out. Serum zinc levels increased significantly (P < 0.001), whereas serum copper levels (P = 0.001) and copper/zinc ratios (P < 0.001) decreased significantly. In one patient, preexisting copper deficiency deteriorated. These preliminary data suggest that polaprezinc may be effective and well-tolerated in 8-week treatment of pressure ulcers and could be a candidate for their oral treatment.

Low serum albumin level as an independent risk factor for the onset of pressure ulcers in intensive care unit patients.

Critically ill patients are at high risk of developing pressure ulcers (PUs) and patients who develop PUs remain significantly longer in the intensive care unit (ICU) with significantly increased morbidity and mortality. Therefore, the identification of patients at truly increased risk is important. The aim of this study was to examine the association of low serum albumin present at admission in ICU patients with the onset of PUs. We conducted a retrospective cohort study on 610 patients who were admitted to intensive care unit. Level of serum albumin and other biochemical indices, recorded at the time of admission, were collected. We collected information about PU occurrence after admission and conducted a statistical analysis with biomarkers at ICU admission and during hospital stay. The incidence of PU in the ICUs was 31% and about 70% of patients with PUs had hypoalbuminemia at admission. The lowest values of serum albumin in patients with PUs were directly proportional to the severity of ulcers. In this study, we found a close association between serum albumin and PUs. In fact serum albumin was negatively correlated with PU and may be considered one of the independent determinants of PU occurrence in patients admitted to ICUs.

Mini nutritional assessment as a useful method of predicting the development of pressure ulcers in elderly inpatients.

OBJECTIVES: To determine the usefulness of the Mini Nutritional Assessment (MNA) and plasma amino acid analysis in predicting the formation of pressure ulcers (PUs) in inpatients. DESIGN: Prospective, observational cohort study with a mean observation period of 62.2 ± 86.4 days. SETTING: Intermediate and acute care wards of a hospital in rural Japan. PARTICIPANTS: Inpatients with an average age of 85.0 ± 7.6 (N = 422). MEASUREMENTS: Mini Nutritional Assessment, Subjective Global Assessment (SGA), Braden Scale (PU prognostic score), PU formation, and biochemical analysis including plasma amino acid concentrations. RESULTS: PUs developed in 7.1% of participants. A MNA score of less than 8 was more sensitive than a rating of moderate or severe malnourishment on the SGA combined with a Braden Scale score of less than 15 in predicting future PUs. The area under the receiver operating characteristic curve (AUC) of the MNA was superior to that of the Braden Scale. The Braden Scale nutrition subscore had the lowest AUC of the six Braden Scale subscores. Individuals who developed PUs had significantly lower plasma arginine concentrations than those who did not. CONCLUSION: Mini Nutritional Assessment was able to predict the development of PUs. A MNA score of less than 8 performed better than the SGA, Braden Scale, and plasma arginine levels in predicting PU development. Although lower plasma arginine concentration at time of admission was associated with PU development, the AUC for arginine was not significantly different from 0.50. The findings from this prospective study support the use of nutritional assessment in inpatients to predict PU risk and target appropriate interventions.

Serum metalloproteinases 2 and 9 as predictors of gait status, pressure ulcer and mortality after hip fracture.

INTRODUCTION: The aim of this study is to evaluate the serum activity of metalloproteinases (MMPs) -2 and -9 as predictors of pressure ulcer (PU), gait status and mortality 6 months after hip fracture. METHODS: Eighty-seven patients over the age of 65 admitted to the orthopedic unit from January to December 2010 with hip fracture were prospectively evaluated. Upon admission, patient demographic information, including age, gender and concomitant diseases, was recorded. Blood samples were taken for analysis of MMP -2 and -9 activity by gel zymography and for biochemical examination within the first 72 hours of the patient's admission, after clinical stabilization. The fracture pattern (neck, trochanteric or subtrochanteric), time from admission to surgery, surgery duration and length of hospital stay were also recorded. RESULTS: Two patients were excluded due to the presence of pathological fractures (related to cancer), and three patients were excluded due to the presence of PU before admission. Eighty-two patients, with a mean age of 80.4 ± 7.3 years, were included in the analysis. Among these patients, 75.6% were female, 59.8% had PU, and 13.4% died 6 months after hip fracture. All patients underwent hip fracture repair. In a univariate analysis, there were no differences in serum MMP activity between hip fracture patients with or without PU. In addition, the multiple logistic regression analysis models, which were adjusted by age, gender, length of hospital stay and C-reactive protein, showed that the pro-MMP-9 complexed with neutrophil gelatinase-associated lipocalin form (130 kDa) was associated with gait status recovery 6 months after hip fracture. CONCLUSIONS: In conclusion, serum pro-MMP-9 is a predictor of gait status recovery 6 months after hip fracture.

Plasma variations of biomarkers for muscle damage in male nondisabled and spinal cord injured subjects.

Deep pressure ulcers represent a major problem for individuals with spinal cord injury (SCI), with the initial damage often hidden underneath intact skin. Accordingly, early detection is difficult and treatment is problematic. In the present study, circulatory levels of biomarkers for muscle damage were investigated to explore their potential in the early detection of deep pressure ulcers. Baseline concentrations of creatine kinase, myoglobin (Mb), heart-type fatty acid binding protein (H-FABP), and C-reactive protein (CRP) were measured in small groups of nondisabled (age 39-66 yr) subjects and subjects with SCI (age 40-68 yr, American Spinal Injury Association grade A-B, level of injury thoracic 11 to lumbar 3) over a period of 5 days. Each subject exhibited a unique concentration profile for all markers, although some correlations were observed; for example, Mb and H-FABP were correlated for both subject groups. No significant differences were found in marker concentrations between the two subject groups, although a trend toward higher CRP levels was observed in the SCI subjects. Furthermore, one SCI subject with a category II pressure ulcer exhibited higher H-FABP and CRP concentrations than all other subjects. Because the variations in each of the marker concentrations were smaller than the predicted increases after pressure ulcers, this combination of plasma markers may prove appropriate for the early detection of deep pressure ulcers.

Physical activity and transcutaneous oxygen pressure in men with spinal cord injury.

This pilot study proposed a method for assessing the status of vascular flow measured by transcutaneous oxygen pressure (TcPO2) in the area of the ischium in people with spinal cord injury (SCI). In a sample of 38 men (two groups: 12 physically active and 26 sedentary) with thoracic SCI, the distribution of the physiological response of the tissues under load during sitting was assessed through analysis of ischium TcPO2 values obtained by an oximeter. TcPO2 baseline, recovery time of TcPO2 after sitting (Trec), the percentage of TcPO2 (%TcPO2) of maximum pressure TcPO2, and mechanic maximal pressure (Pmax) were evaluated. Trec in the physically active group was significantly lower (p < 0.05) than in the sedentary group. Likewise, significant differences in %TcPO2 between groups (p < 0.05) were also found. We concluded that the physiological response of the tissues under an individual with SCI's own weight resulting from prolonged sitting is better in those who are physically active.

Enteral n-3 fatty acids and micronutrients enhance percentage of positive neutrophil and lymphocyte adhesion molecules: a potential mediator of pressure ulcer healing in critically ill patients.

n-3 Fatty acids are recognised as influencing both wound healing and immunity. We assessed the impact of a fish oil- and micronutrient-enriched formula (study formula) on the healing of pressure ulcers and on immune function in critically ill patients in an intensive care unit. A total of forty patients with pressure ulcers and receiving nutritional support were enrolled (intervention group, n 20, received study formula; and a control group, n 20, received an isoenergetic formula). Total and differential leucocyte count and percentage of adhesion molecule positive granulocyte and lymphocyte cells (CD11a, CD11b, CD18 and CD49b) were measured on days 0, 7 and 14. Percentage of positive lymphocytes for CD54, CD49b, CD49d and CD8 were also measured on days 0, 7 and 14. The state of pressure ulcers was assessed by using the pressure ulcer scale for healing tool score on days 7, 14 and 28 of treatment. No between-group differences in patient demographics, anthropometry or diagnostic class were observed. Patients who received the study formula showed significant increases in the percentage of positive CD18 and CD11a lymphocytes and of CD49b granulocytes as compared to controls (P < 0·05). While the severity of pressure ulcers was not significantly different between the two groups on admission, severity increased significantly over time for the control group (P < 0·05), but not for the study group. The present study suggests that a fish oil- and micronutrient-enriched formula may prevent worsening of pressure ulcers and that this effect may be mediated by an effect on adhesion molecule expression.

Association between vitamin D and pressure ulcers in older ambulatory adults: results of a matched case-control study.

BACKGROUND: Pressure ulcers are common among older adults, but knowledge about nutritional risk factors is still developing. Vitamin D deficiency is common in the elderly population and is required for normal skin proliferation. The role of vitamin D in pressure ulceration and wound healing is not known. The purpose of this case-control study was to determine the association between vitamin D levels and pressure ulceration in an older community-dwelling cohort. METHODS: All cases and controls were community-dwelling elderly older than 60 years in a primary care panel in Olmsted County, MN. Pressure ulcer cases were defined clinically. The controls were age-matched and gender-matched to controls without pressure ulceration. The main exposure variable was 25-hydroxyvitamin D levels in both groups. The other exposure variable was the Charlson Comorbidity Index used to measure medical comorbidity. The analysis included univariate and conditional logistic regression for 25-hydroxyvitamin D levels. RESULTS: The average (standard deviation) age of the study participants with a pressure ulcer was 80.46 years (±8.67), and the average vitamin D level was 30.92 ng/mL (±12.46). In univariate analysis, Vitamin D deficiency (levels < 25 ng/mL) was associated with pressure ulcers (odds ratio: 1.871, P = 0.0154). Comorbidities of the subjects calculated using the Charlson Comorbidity Index were also associated with pressure ulcers (odds ratio: 1.136, P < 0.001). In the final conditional logistical regression model, the association of Vitamin D and pressure ulcers became nonsignificant after adjustment for comorbid illness. CONCLUSION: Medical comorbidities increased the risk of pressure ulceration. Vitamin D deficiency was not an independent risk factor for pressure ulceration, and may be a marker of comorbid illness.