Closing the gap in acute lower limb care: a two-year review

Background: The management of leg ulceration through compression has predominately been considered a community care need. In 2021, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust, in partnership with the Doncaster Wound Care Alliance, developed and launched a framework of interventions including education, a joint wound care formulary and clinical pathways, all aimed at standardising care. Additionally, they introduced the UrgoKTwo multicomponent compression system to provide seamless care across community, primary and secondary care using the National Wound Care Strategy Programme's (NWCSP) 2020 lower limb recommendations. As a result of changes implemented by the Skin Integrity Team at Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust,within secondary care, the knowledge of hospital staff increased by an average of 34% following attendance at structured education programmes, with 99% of staff being assessed as competent in the practical application of UrgoKTwo multicomponent compression bandage system. These improvements allowed the Skin Integrity Team to perform timely assessments, diagnoses and treatments for venous leg ulcers (VLUs), resulting in 89% of VLUs commencing UrgoKTwo multicomponent compression bandage system while patients were in the hospital and achieved healing within 12 months.

KEY WORDS

Education Healing rates Leg ulcers Lower limb UrgoKTwo

KELLY PHILLIPS Lead Nurse, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust, FRAN MCNAB Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

KATIE PHILLIPS Acting Clinical Nurse Specialist, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

TONI PLUMB Specialist Sister, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

LOUISE WALL Specialist Sister, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

VICTORIA DODD Specialist Sister, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

GEMMA LONG Specialist Support Worker, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

ENIKKA BARNES Specialist Support Worker, Skin Integrity Team, Doncaster and Bassetlaw Teaching Hospitals, NHS Foundation Trust.

深度烧伤创面削痂后植皮结合自体细胞再生技术治疗的临床研究

关键词：深度烧伤;临床研究;皮片移植

CGM for children and young people with type 1 diabetes: NICE criteria and effects of decision fatigue and alarm fatigue

Imogen Stamford

Research has shown that use of continuous glucose monitoring (CGM) is associated with improved time in range, improved HbA1c, and decreased risk of long-term complications secondary to type 1 diabetes. There are, however, several barriers that can lead to discontinuation of CGM, including pain, skin reactions, concerns around accuracy, sensor loss, interference with daily activity, and alarm fatigue. This review paper will outline the impact of decision fatigue and alarm fatigue in children and young people using CGM.

Citation: Stamford I (2022) CGM for children and young people with type 1 diabetes: NICE criteria and effects of decision fatigue and alarm fatigue. for Children & Young People Diabetes Care 12: [Early view publication]

Article points

1. While the advantages of continuous glucose monitoring (CGM) are well recognised, as practitioners it is important to be aware of the implications of CGM use.

2. People with diabetes can never have a day without checking and responding to ever-changing glucose levels, which puts them at an increased risk of developing decision fatigue.

3. It is important for practitioners to support patients in creating balance between setting alarm limits that are narrow enough to ensure patient safety, but not so narrow that alarms will be repeatedly triggered can lead to the risk of alarms being ignored.

Key words

- Alarm fatigue

- Continuous glucose monitoring

- Decision fatigue

- Type 1 diabetes

Author

Imogen Stamford, Paediatric Diabetes Specialist Nurse, Oxford University Hospitals NHS Foundation Trust

Epidermal stem cell derived exosomes alleviate excessive autophagy induced endothelial cell apoptosis by delivering miR200b-3p to diabetic wounds.

Journal Pre-proof

Epidermal stem cell derived exosomes alleviate excessive autophagy induced endothelial cell apoptosis by delivering miR200b-3p to diabetic wounds. Hailin Xu, Hao Yang, Zhiyong Wang, Qizhi Tang, Xiaoling Cao, Chufen Chen, Yunxian Dong, Zhongye Xu, Dongming Lv, Yanchao Rong, Miao Chen, Bing Tang, Wuguo Deng, Jiayuan Zhu, Zhicheng Hu

PII:

S0022-202X(23)02951-2

DOI:

https://doi.org/10.1016/j.jid.2023.08.030

Reference:

JID 4023

To appear in:

The Journal of Investigative Dermatology

Received Date: 2 December 2022

Revised Date: 3 August 2023

Accepted Date: 30 August 2023

Please cite this article as: Xu H, Yang H, Wang Z, Tang Q, Cao X, Chen C, Dong Y, Xu Z, Lv D, Rong Y, Chen M, Tang B, Deng W, Zhu J, Hu Z, Epidermal stem cell derived exosomes alleviate excessive autophagy induced endothelial cell apoptosis by delivering miR200b-3p to diabetic wounds., The Journal of Investigative Dermatology (2023), doi: https://doi.org/10.1016/j.jid.2023.08.030.

This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

© 2023 The Authors. Published by Elsevier, Inc. on behalf of the Society for Investigative Dermatology.

Epidermal stem cell derived exosomes alleviate excessive autophagy induced endothelial cell apoptosis by delivering

miR200b-3p to diabetic wounds.

Hailin Xu1, #, Hao Yang1, #, Zhiyong Wang1, # , Qizhi Tang2, #, Xiaoling Cao1 , Chufen Chen1 , Yunxian

Dong1 , Zhongye Xu1 , Dongming Lv 1 , Yanchao Rong1 , Miao Chen2 , Bing Tang1 , Wuguo Deng3 *,

Jiayuan Zhu1 *, Zhicheng Hu1, *

Epidermal stem cell derived exosomes alleviate excessive autophagy induced endothelial cell apoptosis by delivering miR200b-3p to diabetic wounds.

Hailin Xu1, #, Hao Yang1, #, Zhiyong Wang1, # , Qizhi Tang2, #, Xiaoling Cao1 , Chufen Chen1 , Yunxian Dong1 , Zhongye Xu1 , Dongming Lv 1 , Yanchao Rong1 , Miao Chen2 , Bing Tang1 , Wuguo Deng3 *, Jiayuan Zhu1 *, Zhicheng Hu1, *

1 First Affiliated Hospital of Sun Yat-sen University, Burn department, Guangzhou 51080, China.

2 Guangdong Provincial Hospital of Integrated Traditional Chinese and Western Medicine; Affiliated Nanhai Hospital of Traditional Chinese Medicine of Jinan University, Foshan 528200,

3 Sun Yat-sen University Cancer Center; State Key Laboratory of Oncology in South China; Collaborative Innovation Center of Cancer Medicine, Guangzhou 510080, China.

#These authors contribute the same to the study.

*Corresponding author:

Zhicheng Hu, First Affiliated Hospital of Sun Yat-sen University, Burn department, Guangzhou, China (E-mail: 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。).

ORCIDs：

Hailin Xu, http://orcid.org/0000-0002-6448-7343

Hao Yang, http://orcid.org/0000-0002-5388-5039

Zhiyong Wang, http://orcid.org/0000-0003-3818-1073

Qizhi Tang, http://orcid.org/0009-0000-8674-7655

Xiaoling Cao, http://orcid.org/0000-0003-4993-8385

Chufen Chen, http://orcid.org/0000-0002-7148-2858

Yunxian Dong, http://orcid.org/0000-0002-7112-2369

Zhongye Xu, http://orcid.org/0000-0002-7551-0270

Dongming Lv, http://orcid.org/0000-0001-9642-0410

Yanchao Rong, http://orcid.org/ 0000-0001-9125-189X

Miao Chen, http://orcid.org/0000-0002-3538-8231

Bing Tang, http://orcid.org/0000-0001-5859-8250

Wuguo Deng, http://orcid.org/0000-0002-1193-1500

Jiayuan Zhu, http://orcid.org/0000-0003-1501-6999

Zhicheng Hu，http://orcid.org/0000-0002-0026-0676

Key words: diabetes, diabetic wound, exosomes, stem cell, apoptosis, endothelial cell

Can you help us to make every contact count and eliminate avoidable pressure ulcers in all health and care settings?

JACQUI FLETCHER OBE Clinical Editor, Wounds UK on behalf of the 4 Nations Stop the Pressure Team.

With thanks to:

The Society of Tissue Viability NWCSP, Pink Marketing, Tissue Viability colleagues from England, Northern Ireland, Scotland and Wales, Wounds UK, Journal of Wound Care, The Journal of Tissue Viability and our commercial colleagues

Single-stage transplantation combined with epidermal stem cells promotes the survival of tissue-engineered skin by inducing early angiogenesis

Zhiyong Wang1†, Hailin Xu1†, Hao Yang1†, Yi Zhang3 , Xiaoyan Wang1 , Peng Wang1 , Zhongye Xu1 ,Dongming Lv1 , Yanchao Rong1 , Yunxian Dong4 , Bing Tang1 , Zhicheng Hu1*, Wuguo Deng2* and Jiayuan Zhu1*

Abstract

Background The composite transplantation of a split-thickness skin graft (STSG) combined with an acellular dermal matrix (ADM) is a promising repair method for full-thickness skin defects. Due to delayed vascularization of the ADM, no currently available engineered skin tissue is able to permanently cover full-thickness skin defects via a single-stage procedure. Epidermal stem cells (EpSCs) have been found to promote angiogenesis in the wound bed. Whether EpSCs can induce early angiogenesis of dermal substitutes and promote the survival of single-stage tissue-engineered skin transplantation needs to be further studied.

Methods In vitro, rat vascular endothelial cells (RVECs) were treated with the supernatant of EpSCs cultured in ADM and stimulated for 48 h. RVECs were analysed by RNA sequencing and tube formation assays. For the in vivo experiment, 75 rats were randomly divided into five groups: ADM, ADM+EpSCs (AE), STSG, ADM+STSG (AS), and ADM+STSG+EpSCs (ASE) groups. The quality of wound healing was estimated by general observation and H&E and Masson staining. The blood perfusion volume was evaluated using the LDPI system, and the expression of vascular markers was determined by immunohistochemistry (IHC).

Results The active substances secreted by EpSCs cultured in ADM promoted angiogenesis, as shown by tube formation experiments and RNA-seq. EpSCs promoted epithelialization of the ADM and vascularization of the ADM implant. The ASE group showed significantly increased skin graft survival, reduced skin contraction, and an improved cosmetic appearance compared with the AS group and the STSG control group.

† Zhiyong Wang, Hailin Xu and Hao Yang contributed equally to this work

*Correspondence:

Zhicheng Hu 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。

Wuguo Deng 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。

Jiayuan Zhu 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。 Full list of author information is available at the end of the article

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, 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 changes were made. 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/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Conclusions In summary, our findings suggest that EpSCs promote the formation of new blood vessels in dermal substitutes and support one-step transplantation of tissue-engineered skin, and thereby provide new ideas for clinical

Keywords Epidermal stem cells, Acellular dermal matrix, Tissue-engineered skin, Vascularization, Angiogenesis