Construction and validation of a predictive model for the risk of intraoperative acquired pressure injuries in the maxillofacial region in patients undergoing surgery in the prone position

Wei Li1 , Jing Huang1 , Hua Li1 , Tingchun Gou1 , Ling Tang1 , Xuesu Dong1 and Chunmei Luo2*

*Correspondence: Chunmei Luo 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1  Department of Anesthesiology, Xinqiao Hospital, Army Medical University, Chongqing, P.R. China

2 Department of Orthopedics, Xinqiao Hospital, Army Medical University,83 Xinqiao Main Street, Shapingba District, Chongqing 400037, P.R. China

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creati vecommons.org/licenses/by-nc-nd/4.0/.

Abstract

Objective To construct a model for predicting the risk of IAPI (Intraoperative acquired pressure injury) in the facial area of patients undergoing prone position surgery and to validate the predictive effectiveness of this model.

Methods We analyzed data from 970 patients who underwent prone position surgery at a tertiary general hospital in Chongqing, China, from January 2022 to October 2022. Using univariate analysis and logistic regression analysis, we identified risk factors for IAPI in the maxillofacial region of patients undergoing prone position surgery and constructed a nomogram prediction model using R software. On the basis of the selected predictive factors, a risk prediction model was constructed and evaluated using the concordance index (C-index) and the area under the curve (AUC). External validation was conducted to verify the model’s performance.

Results The incidence of IAPI in prone surgery patients was 17.8%. Multivariate logistic regression analysis revealed  that BMI, history of diabetes, surgical duration, muscle relaxant dosage, history of allergies, and preoperative Braden score were the most important factors for the occurrence of intraoperative pressure injuries in the facial region of patients who underwent prone position surgery (P<0.05). The area under the ROC curve of the prediction model is 0.863, the maximum Youden index is 0.681, the optimal cutoff value is 0.214, the sensitivity is 0.815, the specificity is 0.866, and the accuracy in actual application is 91.1%.

Conclusions The IAPI risk prediction model for maxillofacial surgery patients in the prone position constructed in this study demonstrated good predictive performance, providing a basis for clinical medical staff to quickly identify high risk patients and implement precise intervention plans before surgery.

Keywords Pressure ulcer, Prone position, Maxillofacial, Nomogram, Prediction model

Correlation between myocardial work and disease activity in rheumatoid arthritis patients with preserved left ventricular ejection fraction: a retrospective study based on non‑invasive pressure‑strain loop

Xiaolong Yu1  · Jing Xi1  · Jiabiao Wu2  · Ruixiao Song1

Received: 24 November 2024 / Revised: 18 January 2025 / Accepted: 16 February 2025 / Published online: 5 March 2025

© The Author(s) 2025

* Ruixiao Song 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 Department of Ultrasonics, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China

2 Rheumatology and Immunology Department, Wujin Hospital Affiliated with Jiangsu University, Changzhou, Jiangsu, China

Abstract

Background Early cardiac damage is very common in RA patients, but it is usually subclinical. Therefore, finding a non invasive method for the early detection and treatment of cardiac damage in autoimmune diseases is particularly important.

Objective To evaluate left ventricular function changes in rheumatoid arthritis (RA) patients with preserved left ventricular ejection fraction (LVEF) using left ventricular pressure-strain loop (LV-PSL) technology and to explore the correlation between myocardial work (MW) and disease activity.

Methods A total of 62 RA patients with preserved LVEF, treated at Wujin Hospital Affiliated with Jiangsu University from January 2021 to September 2023, were included. Patients were categorized into low (25), medium (18), and high (19) disease activity groups based on the 28 joint disease activity score (DAS28). A control group of 29 healthy individuals was also established. LV-PSL technology assessed left ventricular global longitudinal strain (GLS) and MW parameters: global constructive work (GCW), global wasted work (GWW), global work index (GWI), and global work efficiency (GWE). Cor relations between MW parameters, GLS, LVEF, and DAS28 scores were analyzed.

Results There were no significant differences in general data between study and control groups (p>0.05). However, labora tory indicators (RF, CRP, ESR) showed significant differences (p<0.05). GWI, GCW, GWE, and GLS were significantly lower in the high disease activity group compared to controls (p<0.05). GWI, GCW, and GWE were positively correlated with LVEF and absolute GLS, while GWW correlated negatively with LVEF (p<0.05).

Conclusion RA disease activity is closely associated with impaired myocardial work. LV-PSL technology effectively moni tors myocardial function abnormalities in RA patients, providing valuable insights for clinical management.

Key PointsMyocardial work is significantly impaired in RA patients with high disease activity. Left ventricular pressure-strain loop (LV-PSL) technology effectively assesses cardiac function in this patient population. Increased disease activity correlates with reduced myocardial work parameters.

Keywords Left ventricular pressure-strain loop · Myocardial work · Rheumatoid arthritis · Speckle-tracking echocardiography

Hypercholesterolemia Duration and Brain Area Determine Inflammatory Response Intensity and Apoptotic Mediator Activation in Apo E−/−/LDLR−/− Double‑Knockout Mice

Ewelina Czuba‑Pakuła1  · Jolanta Ochocińska2  · Sebastian Głowiński3  · Alicja Braczko4  · Ryszard T. Smoleński4  · Grażyna Lietzau1  · Przemysław Kowiański1,3

Received: 14 August 2024 / Accepted: 7 May 2025 © The Author(s) 2025

* Ewelina Czuba-Pakuła 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

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Ryszard T. Smoleński 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

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1 Division of Anatomy and Neurobiology, Faculty of Medicine, Medical University of Gdansk, Dębinki 1, 80-211 Gdańsk, Poland

2 Department of Conservative Dentistry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland

3 Institute of Health Sciences, Pomeranian University in Słupsk, Słupsk, Poland

4 Department of Biochemistry, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland

Abstract

      Hypercholesterolemia (Hch) is a risk factor for cerebrovascular and neurodegenerative diseases, manifesting with symptoms that vary depending on damage to specific brain regions. Hch triggers inflammatory responses and cell death. However, the progression of these processes in relation to the duration of Hch and the location of pathology in the central nervous system remains unclear. Therefore, we aimed to investigate (1) the impact of age and duration of Hch on neuroinflammatory responses and programmed cell death in the brain and (2) the intensity of these processes in various brain areas during Hch. In this study, we used 3-, 6-, and 12-month-old male Apo E−/−/LDLR−/− double-knockout mice and age-matched wild-type C57BL/6 mice (control group). Concentrations of cytokines IL-1β, IL-4, and IL-6, as well as apoptotic mediators AIF and Cas-3, were measured using enzyme-linked immunosorbent assay in the whole brain and separately in the prefrontal cortex (PFCx), hippocampus (HIP), and striatum (STR). The results showed that the Hch-induced release of cytokines IL-1β and IL-6, decreased expression of IL-4, and elevated level of apoptotic markers AIF and Cas-3 correlated with Hch duration. The inflammatory response and expression of apoptotic markers were more pronounced in the HIP and STR compared to the PFCx. Our results indicate a correlation between the neurodegenerative effects of Hch and its duration and highlight the varying susceptibility of different brain areas to Hch-induced damage.

Graphical Abstract

      Hypercholesterolemia (Hch)-induced inflammatory response and programmed cell death activation in the prefrontal cortex (PFCx), hippocampus (HIP), and striatum (STR) of 3-, 6-, and 12-month-old, Apo E−/−/LDLR−/− double-knockout mice. In three age-groups the Hch-induced response involved release of inflammatory cytokines (IL-1ß and IL-6), a decrease of anti-inflammatory (IL-4) cytokine level, and activation of programmed cell death markers (AIF and Cas-3). The inflam matory response and expression of apoptotic markers were more pronounced in the HIP and STR, compared to the PFCx.

Keywords Apoptosis · Atherosclerosis · Cytokines · Hypercholesterolemia · Neurodegeneration · Neuroinflammation

Salt‑sensitive hypertension in GR mutant rats is associated with altered plasma polyunsaturated fatty acid levels and aortic vascular reactivity

S.Verouti1,2,3 · G. Aeschlimann1  · Q. Wang4  · D. Ancin Del Olmo1  · A. C. Peyter5  · S. Menétrey5  ·D.V. Winter6 · A. Odermatt6  · D. Pearce7  · E. Hummler1,2  · P. E. Vanderriele1,2

Received: 30 April 2024 / Revised: 22 August 2024 / Accepted: 23 August 2024 / Published online: 10 September 2024 © The Author(s) 2024

* P. E. Vanderriele 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

1 Department of Biomedical Sciences, University of Lausanne, Lausanne, Switzerland

2 National Center of Competence in Research, Kidney.CH, Lausanne, Switzerland

3 Department for BioMedical Research (DBMR), University of Bern, Bern, Switzerland

4 Division of Nephrology and Hypertension, Lausanne University Hospital (CHUV), Lausanne, Switzerland

5 Neonatal Research Laboratory, Clinic of Neonatology, Department Woman-Mother-Child, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland

6 Division of Molecular and Systems Toxicology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland

7 Department of Medicine and Cellular & Molecular Pharmacology, University of California, San Francisco, USA

Abstract

In humans, glucocorticoid resistance is attributed to mutations in the glucocorticoid receptor (GR). Most of these mutations result in decreased ligand binding, transactivation, and/or translocation, albeit with normal protein abundances. However, there is no clear genotype‒phenotype relationship between the severity or age at disease presentation and the degree of functional loss of the receptor. Previously, we documented that a GR+/− rat line developed clinical features of glucocorticoid resistance, namely, hypercortisolemia, adrenal hyperplasia, and salt-sensitive hypertension. In this study, we analyzed the GR+/em4 rat model heterozygously mutant for the deletion of exon 3, which encompasses the second zinc finger, including the domains of DNA binding, dimerization, and nuclear localization signals. On a standard diet, mutant rats exhibited a trend toward increased corticosterone levels and a normal systolic blood pressure and heart rate but presented with adrenal hyperplasia. They exhibited increased adrenal soluble epoxide hydroxylase (sEH), favoring an increase in less active poly unsaturated fatty acids. Indeed, a significant increase in nonactive omega-3 and omega-6 polyunsaturated fatty acids, such as 5(6)-DiHETrE or 9(10)-DiHOME, was observed with advanced age (10 versus 5 weeks old) and following a switch to a high-salt diet accompanied by salt-sensitive hypertension. In thoracic aortas, a reduced soluble epoxide hydrolase (sEH) protein abundance resulted in altered vascular reactivity upon a standard diet, which was blunted upon a high-salt diet. In conclusion, mutations in the GR affecting the ligand-binding domain as well as the dimerization domain resulted in deregu lated GR signaling, favoring salt-sensitive hypertension in the absence of obvious mineralocorticoid excess.

Keywords Adrenal gland hyperplasia · Hypertension · Glucocorticoid receptor · Soluble epoxide hydrolase · Chrousos syndrome

Abbreviations

ACTH Adrenocorticotropic hormone DiHETrE Dihydroxyeicosatrienoic acid DiHOME Dihydroxy-9Z-octadecenoic acid EET Epoxyeicosatrienoic acid EpETrE Epoxyeicosatrienoic acid GR Glucocorticoid receptor HETE Hydroxyeicosatetraenoic acid KODE Ketooctadecenoic acid sEH Soluble epoxide hydrolase

◂Fig.1 GR+/em4 rats presented adrenal hyperplasia of the cortex and the medulla accompanied by a trend toward an increase in the plasma glucocorticoid concentration under standard diet. A Scheme of the wild-type (GR+, upper panel) and the mutated GRem2 (middle) and GRem4 (lower panel) structure of the GR. B Representation of the zinc finger domain of the GR with the deleted amino acids in red. C Rep resentative macroscopic images (scale bar, 1 mm) and D hematoxy lin/eosin-stained sections of whole adrenal glands (left panels; scale bar, 1  mm) and cortex (right panels; scale bar, 300  µm) from 3- to 4-week-old male GR+/+ and GR+/em4 rats (n=3) fed a standard salt diet; zf, zona fasciculata; zg, zona glomerulosa. E Measurement of the adrenal weight/body weight ratio (GR+/+, n=12; GR+/em4, n=14) and F cortex (left) and medulla (right panel) size (GR+/+ (n=3) and GR+/em4 (n=4)). G Determination of plasma concentrations of the glucocorticoids corticosterone, 11-dehydrocorticosterone and the corticosterone/11-dehydrocorticosterone ratio and H the mineralo corticoid aldosterone and its precursor 11-deoxycorticosterone in the morning (7–8 am) and afternoon (6–7  pm) of GR+/+ and GR.+/em4 (n=4 – 16) rats. The size measurements were evaluated using QuPath (vO.4.4), and the plasma concentrations were evaluated by two-way ANOVA and subsequently compared with an unpaired two tailed t test with Welch’s correction. The values are presented as the mean±SEMs. Differences were assessed at *P<0.05 and **P<0.01

Nutritional Interventions for Pressure Ulcer Prevention in Hip Fracture Patients: A Systematic Review and Meta-Analysis of Controlled Trials

Jose M. Moran 1,* , Laura Trigo-Navarro 2 , Esther Diestre-Morcillo 3 , Elena Pastor-Ramon 4 and Luis M. Puerto-Parejo 5

1 Nursing and Occupational Therapy College, University of Extremadura, 10001 Caceres, Spain

2 Área de Salud de Badajoz, Supervisora del Bloque Quirúrgico, Hospital Materno Infantil de Badajoz, Calle Violeta 3, 06010 Badajoz, Spain; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

3 Área de Salud de Badajoz, Banco de Sangre, Hospital Universitario de Badajoz, Av. de Elvas, s/n, 06080 Badajoz, Spain

4 Biblioteca Virtual de ciencias de la Salud de las Illes Balears (Bibliosalut), Ctra. De Valldemossa, 79,  mòdul L+1, 07120 Palma, Spain; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

5 Gerencia del Área de Salud de Badajoz, Supervisor del Área de Investigación, Proyectos y Gestión, Av. de Huelva, 8, 06005 Badajoz, Spain; 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

* Correspondence: 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。

Academic Editor: Yi-Chia Huang

Received: 22 January 2025

Revised: 6 February 2025

Accepted: 8 February 2025

Published: 11 February 2025

Citation: Moran, J.M.; Trigo-Navarro, L.; Diestre-Morcillo, E.; Pastor-Ramon, E.; Puerto-Parejo, L.M. Nutritional Interventions for Pressure Ulcer Prevention in Hip Fracture Patients: A Systematic Review and Meta-Analysis of Controlled Trials. Nutrients 2025, 17, 644. https://doi.org/10.3390/ nu17040644

Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/ licenses/by/4.0/

Abstract: Background/Objective: Pressure ulcers represent a significant complication in patients with reduced mobility, such as those recovering from hip fractures. In the present study, we aimed to comprehensively assess the impact of oral nutritional interventions on the development of pressure ulcers in hip fracture patients via a systematic review and meta analysis of controlled studies evaluating the effectiveness of oral nutritional supplements compared with standard care. Methods: In accordance with PRISMA standards, this systematic review and meta-analysis of controlled studies evaluated the effectiveness of any type of oral nutritional supplements compared with standard care in hip fracture patients. The risk of bias was evaluated using the Cochrane ROB2 tool for randomized controlled trials and the ROBINS-1 tool for nonrandomized trials. Results: Fourteen studies (10 randomized controlled trials and 4 controlled trials) published since 1990 (n = 1648) were included. Oral nutritional supplementation was associated with a statistically significant decrease in the odds ratio of developing pressure ulcers in hip fracture patients (OR 0.54, 95% CI: 0.40–0.73, p < 0.001). Conclusions: The incidence and evolution of pressure ulcers can be improved by oral dietary supplementation in patients who have undergone hip fracture surgery. Accordingly, we propose that oral nutritional supplementation should be considered an essential component of comprehensive post-hip-fracture care.

Keywords: hip fracture; pressure ulcers; oral nutritional supplement; pressure sores; meta-analysis; wound healing; nutritional intervention

CB-MNCs@ CS/HEC/GP promote wound healing in aged murine pressure ulcer model

Zhi‑cheng Yang1,3, He Lin1 , Guo‑jun Liu2 , Hui Pan1 , Jun‑lu Zhu3 , Xiao‑hong Zhang3 , Feng Gao2 , Zhong Wang2 and Zhi‑hao Wang1* *Correspondence: Zhi‑hao Wang 该Email地址已收到反垃圾邮件插件保护。要显示它您需要在浏览器中启用JavaScript。 1 Department of Geriatric Medicine & Laboratory of Gerontology and Anti‑Aging Research, Qilu Hospital of Shandong University, Jinan 250012, Shandong, China 2 Shandong Qilu Stem Cell Engineering Co., Ltd, Jinan 250012, Shandong, China 3 School of Nursing and Rehabilitation, Shandong University, Jinan 250012, Shandong, China

© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-​nc-​nd/4.0/.

Abstract

Background Non-healing pressure ulcers impose heavy burdens on patients and clinicians. Cord blood mononu‑ clear cells (CB-MNCs) are a novel type of tissue repair seed cells. However, their clinical application is restricted by low retention and survival rates post-transplantation. This study aims to investigate the role of thermo-sensitive chitosan/ hydroxyethyl cellulose/glycerophosphate (CS/HEC/GP) hydrogel encapsulated CB-MNCs in pressure ulcer wound

Methods Pressure ulcers were induced on the backs of aged mice. After construction and validation of the charac‑ terization of thermo-sensitive CS/HEC/GP hydrogel, CB-MNCs are encapsulated in the hydrogel, called CB-MNCs@ CS/HEC/GP which was locally applied to the mouse wounds. Mouse skin tissues were harvested for histological and molecular biology analyses.

Results CB-MNCs@CS/HEC/GP therapy accelerated pressure ulcer wound healing, attenuated inflammatory responses, promoted cell proliferation, angiogenesis, and collagen synthesis. Further investigation revealed that CB MNCs@CS/HEC/GP exerted therapeutic effects by promoting changes in cell types, including fibroblasts, endothelial cells, keratinocytes, and smooth muscle cells.

Conclusion CB-MNCs@CS/HEC/GP enhanced the delivery efficiency of CB-MNCs, preserved the cell viability, and contributed to pressure ulcer wound healing. Thus, CB-MNCs@CS/HEC/GP represents a novel therapeutic approach for skin regeneration of chronic wounds.

Keywords Wound healing, Aged, Pressure ulcers, Cord blood mononuclear cells, Thermo-sensitive hydrogel