Systemic sclerosis is associated with lower limb vascular stiffness and microvascular impairment: results from a prospective study

Charles Cassius1,2,3 iD Vannina Seta4 & Jean-Benoit Monfort 1 & Nathalie Abdoucheli Baudot1 & Sébastien Rivière5 & Arsène Mekinian5 & Camille Frances1 & Annick Barbaud1 & Patricia Senet 1 Received: 12 January 2021 / Revised: 10 February 2021 /Accepted: 1 March 2021 # International League of Associations for Rheumatology (ILAR) 2021

Abstract

       Objective Systemic sclerosis (SSc) is a connective tissue disease characterized by microangiopathy. Peripheral arterial disease, increasingly studied during SSc, is responsible for digital ulcers, associated with a high risk of amputation. The aim of our study was to assess the frequency of lower limb arterial impairment in SSc patients by measuring ankle-brachial index (ABI), toe pressure (TP), and toe-brachial index (TBI).

       Methods Systemic sclerosis patients were included prospectively during 1 year in Tenon and Saint-Antoine Hospitals, Paris.Clinical and biological data were recorded. For each patient, ABI, TP, and TBI were measured and an arterial duplex ultrasonography was prescribed in case of abnormal results.

       Results Eighty-six patients were included (94% women, median age 62 years). Only 24% of them had no lower limb hemodynamic vascular abnormalities; 44% had an isolated microvascular abnormality (normal ABI and TBI<0.75); 31% had at least a macrovascular injury associated or not with microvascular impairment (abnormal ABI) and 12.6% had a TP<50 mmHg. During follow-up, there was a trend towards association of low TBI with more major adverse event (all-cause mortality, non-fatal stroke, non-fatal myocardial infarction, and lower limb ischemic manifestations) than normal TBI. Conclusion By measuring ABI and TP, we showed that 76% of SSc patients had hemodynamic arterial lower limb abnormalities related to macro- and/or microvascular impairment and that 28% had vascular stiffness. In SSc patients, ABI is not an accurate tool to detect lower limb arterial disease, likely due to underlying micro- and macrovascular changes.

Key Points

      The presence of lower limb macro-and/or microvascular involvement was detected in 76% of SSc patients.

      In SSc patients, ABI is not an accurate tool to detect lower limb arterial disease, likely due to underlying microvascular changes and frequent arterial.

Keywords Ankle-brachial index . Microangiopathy . Peripheral arterial disease . Systemic sclerosis . Toe-brachial index . Vascular stiffness

Treatment of Wound Healing with Sequential Therapy to Accelerate Recovery and Inhibit Scar Hyperplasia: A Case Report

Study Design/Patients and Methods: A 19-year-old male was reported to have a postoperative facial trauma suture as a result of being involved in a car accident. Red light emitting diode (LED) therapy (20 min, 96 J/cm2 , 633 nm), Botulinum Toxin Type A 36 IU injection, Broad Band Light and Er:YAG laser at various stages of wound healing were applied as the sequential therapy.

Results: Since the correction was promptly apparent and acceptable, the treatment proved secure and efficacious for repairing wound healing.

Conclusion: Clinically sequential therapy has demonstrated marked improvement in our case. Scar sequential therapy may offer a new strategy for wound healing recovery.

Keywords: wound healing, scar, keloid, treatment

The microbiology of diabetic foot infections: a meta-analysis

Katherine E. Macdonald1 , Sophie Boeckh2 , Helen J. Stacey3 and Joshua D. Jones1*

Abstract

Background: Diabetic foot ulcers are a common complication of poorly controlled diabetes and often become infected, termed diabetic foot infection. There have been numerous studies of the microbiology of diabetic foot infection but no meta-analysis has provided a global overview of these data. This meta-analysis aimed to investigate the prevalence of bacteria isolated from diabetic foot infections using studies of any design which reported diabetic foot infection culture results.

Methods: The Medline, EMBASE, Web of Science and BIOSIS electronic databases were searched for studies published up to 2019 which contained microbiological culture results from at least 10 diabetic foot infection patients. Two authors independently assessed study eligibility and extracted the data. The main outcome was the prevalence of each bacterial genera or species.

Results: A total of 112 studies were included, representing 16,159 patients from which 22,198 microbial isolates were obtained. The organism most commonly identified was Staphylococcus aureus, of which 18.0% (95% CI 13.8–22.6%; I2=93.8% [93.0–94.5%]) was MRSA. Other highly prevalent organisms were Pseudomonas spp., E. coli and Enterococcusspp. A correlation was identified between Gross National Income and the prevalence of Gram positive or negative organisms in diabetic foot infections.

Conclusion: The microbiology of diabetic foot infections is diverse, but S. aureus predominates. The correlation between the prevalence of Gram positive and negative organisms and Gross National Income could reflect differences in healthcare provision and sanitation. This meta-analysis has synthesised multiple datasets to provide a global overview of the microbiology of diabetic foot infections that will help direct the development of novel therapeutics.

Keywords: Diabetes, Diabetic foot infection, Diabetic foot ulcer, Meta-analysis, Microbiology, Prevalence

Nicotinamide Riboside Enhances Endothelial Precursor Cell Function to Promote Refractory Wound Healing Through Mediating the Sirt1/AMPK Pathway

Zhen-hua Wang1,2† , Xiao-gang Bao3† , Jun-jie Hu4 , Si-bo Shen5 , Guo-hua Xu3 * and Ye-lin Wu1*

1 Tongji University Cancer Center, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China,  2 Department of Laboratory Medicine, Changzheng Hospital, Naval Medical University, Shanghai, China, 3 Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, Shanghai, China, 4 Basic Medical College, Naval Medical University, Shanghai, China, 5 Hebei Key Laboratory of Active Components and Functions in Natural Products, College of Chemical Engi-neering, Hebei Normal University of Science and Technology, Qinhuangdao, China

       Lack of vascularization is directly associated with refractory wound healing in diabetes mellitus (DM). Enrichment of endothelial precursor cells (EPCs) is a promising but challenging approach for the treatment of diabetic wounds. Herein, we investigate the action of nicotinamide riboside (NR) on EPC function for improved healing of diabetic wounds. Db/ db mice that were treated with NR-supplemented food (400 mg/kg/d) for 12 weeks exhibited higher wound healing rates and angiogenesis than untreated db/db mice. In agreement with this phenotype, NR supplementation significantly increased the number of blood EPCs and bone marrow (BM)-derived EPCs of db/db mice, as well as the tube formation and adhesion functions of BM-EPCs. Furthermore, NR-supplemented BM-EPCs showed higher expression of sirtuin 1 (Sirt1), phosphorylated adenosine monophosphate–activated protein kinase (p-AMPK), and lower expression of acetylated peroxisome proliferator–activated receptor γ coactivator (PGC-1α) than BM-EPCs isolated from untreated db/db mice. Knockdown of Sirt1 in BM-EPCs significantly abolished the tube formation and adhesion function of NR as well as the expression of p-AMPK and deacetylated PGC-1a. Inhibition of AMPK abolished the NR-regulated EPC function but had no effect on Sirt1 expression, demonstrating that NR enhances EPC function through the Sirt1-AMPK pathway. Overall, this study demonstrates that the oral uptake of NR enhances the EPC function to promote diabetic wound healing, indicating that NR supplementation might be a promising strategy to prevent the progression of diabetic complications.

Keywords: diabetes mellitus, endothelial precursor cells, nicotinamide riboside, wound healing, sirtuin 1, adenosine monophosphate–activated protein kinase

Kikuhime Device in the Management of Venous Leg Ulcers

This article was published in the following Dove Press journal: Clinical Interventions in Aging

Marian Karafa Anna Karafova Faculty of Physical Education, Gdansk University of Physical Education and Sport, Gdansk, Poland

Abstract: The effectiveness of compression therapy in the treatment of venous leg ulcers has been confirmed in many scientific studies. The healing process depends on many of its parameters, such as the type of compression bandages, their elastic properties and subbandage pressure. However, there is no standard protocol that would ensure success for all patients. A pressure of about 83 mmHg provides complete compression for both superficial and deep veins; however, applying compression bandages under such high pressure is a difficult task, even for experienced therapists. Here, we present the case of a 61-year-old woman with approximately 2.5-year-old venous ulcer in her left leg due to chronic venous insufficiency (CVI). Our study aimed to show that routine pressure control at each bandage renewal using the Kikuhime device, as well as their twice daily application in the first week of therapy reduced the healing time of a venous leg ulcer with an area of about 20 cm2 to four weeks.

Keywords: venous ulcers, compression therapy, sub-bandage pressure, Kikuhime device

Clinical effects of high-intensity laser therapy on patients with chronic refractory wounds: a randomised controlled trial

Qian Lu,1 Zhifei Yin,2 Xuefeng Shen,3 Jinhua Li,3 Panpan Su,1 Min Feng,1 Xingjun Xu,2 Weiwei Li,1 Chuan He,1 Ying Shen

ABSTRACT

Objective To investigate the effectiveness of highintensity laser therapy (HILT) on chronic refractory wounds.

Design

Randomised controlled trial.

Setting The outpatient wound care department of the Affiliated Jiangsu Shengze Hospital of Nanjing Medical University from August 2019 to June 2020.

Participants Sixty patients were enrolled in this study and were randomised into control (n=30) and treatment (n=30) groups.

Interventions and outcome measures The control group was treated only with conventional wound dressing, whereas the treatment group received irradiation with HILT in addition to standard wound care, such as debridement, wound irrigation with normal saline solution and application of dressing and sterile gauze. Patient scores on the Bates-Jensen Wound Assessment Tool (BWAT) and Pressure Ulcer Scale for Healing (PUSH) were evaluated before and after 1, 2 and 3 weeks of treatment.

Results One patient was excluded from the control group, and a total of 59 subjects completed the trial. The BWAT scores significantly decreased in the treatment group compared with the control group at the end of 3-week treatment (difference=−3.6; 95% CI −6.3 to–0.8; p<0.01). Similarly, patients in treatment group showed a significant reduction of PUSH scores compared with the control group (difference=−5.3; 95% CI −8.1 to –2.6; p<0.01).

Conclusions The therapeutic effects of HILT on chronic refractory wounds are significant and far more superior to those of conventional wound dressing.

Trial registration number Chinese Clinical Trial Registry; ChiCTR1900023157. URL: http://www.chictr.org.cn/ showproj.aspx?proj=38866