AimTo clarify the clinical characteristics of autoimmune disease (AID)-related ulcers to improve treatment outcomes.Materials and MethodsThe medical records of 189 patients treated for AID-related ulcers at two tertiary hospitals in Nanjing, China, from January 1, 2018 to December 31, 2022 were retrospectively reviewed. The relevant clinical data included diagnosis, type and severity of wounds, and prescribed medications.ResultsOf the 189 patients with AID-related ulcers, 146 (77.25%) were female and 43 (22.75%) were male. The top four immunological diagnoses were rheumatoid arthritis, systemic lupus erythematosus, Sjogren's syndrome, and vasculitis. The four most common wound sites were the lower limb, foot, hand, and upper limb. Regarding the number of wounds, 81 (42.86%) patients had one ulcer, 43 (22.75%) had two, 30 (15.87%) had three, and 35 (18.52%) had four or more. More than half of the patients (54%, 102/189) were previously treated for AID-related ulcers. Of these 102 patients, 27 (26.47%) had one previous diagnosis, 49 (40.83%) had two, and 26 (25.49%) had three or more. Among all 189 patients, 142 (75%) had clinical symptoms of local infection. Of these 142 patients, bacteria cultures were conducted for 70 (49.30%), of which 63 (90.00%) were positive. The most commonly detected bacteria were Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae. The median (interquartile range) duration of AID-related ulcers was 55 (39, 90) days. Most patients (87.3%, 165/189) received systemic therapy with immunosuppressants and hormones.ConclusionsThe most common clinical characteristics of AID-associated ulcers were spontaneous rupture, long duration, multiple wounds, bacterial infection, and recurrence. Clarification of the clinical characteristics of AID-associated ulcers can improve treatment outcomes.

Primary cutaneous lymphoma is a heterogeneous group of cutaneous lymphocytic primary tumors belonging to the extranodal category of non-Hodgkin lymphoma. Skin is the second most common site of extranodal non-Hodgkin lymphoma after the gastrointestinal tract. Skin lesions are the main manifestations of primary cutaneous lymphoma. Here, we report two successful cases of skin ulcers caused by primary cutaneous lymphoma, which is both rare and difficult to diagnose. One case involved primary cutaneous T-cell lymphoma, and the other involved primary cutaneous B-cell lymphoma. Systemic antitumor therapy combined with the right local wound management is the key to ulcer healing. For wound management, in addition to infection control, exudate management, pain control, and odor management, evaluation and intervention of debridement are worthy of consideration, but they must be evaluated by an expert group, and plans must be made for bleeding. Finally, the wounds of the two patients were completely healed after 79 and 65 days under active systemic therapy.

PURPOSE: The primary aims of this study were to evaluate the prevalence of wound-related pain (WRP) in patients with chronic wounds and assess the use of pain relief measures. DESIGN: A cross-sectional study. SUBJECTS AND SETTING: A convenience sample of patients with chronic wounds was recruited from outpatient clinics of 12 hospitals covering 7 of 13 cities in the Jiangsu province located in eastern China from July 10 to August 25, 2020. The sample comprised 451 respondents, and their mean age was 54.85 (SD 19.16) years; 56.1% (253/451) patients were male. METHODS: An investigator-designed questionnaire was used to collect pain-related information from patients. The questionnaire consisted of 4 parts: (1) basic demographic and clinical information (patient and wound characteristics); (2) wound baseline pain; (3) wound-related procedural pain and pain relief method; and (4) the effect of WRP on the patient. Pain was assessed using the Numerical Rating Scale (NRS) scored from 0 (no pain) to 10 (worst pain). Severity of pain was based on NRS scores' classification as mild (1-3), moderate (4-6), and severe (7-10). The survey was conducted from July 10 to August 25, 2020. Participants were instructed on use of the NRS and then completed the questionnaire following dressing change independently. RESULTS: The 3 most common types of chronic wounds were traumatic ulcers, surgical wounds, and venous leg ulcers. The 3 most prevalent locations were lower limbs, feet, and thorax/abdomen. Of all patients, 62.5% (282/451) and 93.8% (423/451) patients experienced wound baseline pain and wound-related procedural pain, respectively. The mean score of wound baseline pain was 3.76 (SD 1.60) indicating moderate pain. During wound management, the highest pain score was 6.45 (SD 2.75) indicating severe pain; the most severe pain scores were associated with debridement. The use of drugs to relieve wound pain was low, while the use of nondrug-based analgesia was relatively high. Because of WRP, patients with chronic wounds feared dressing changes, hesitated to move, and showed a decline in sleep quality. CONCLUSIONS: Wound baseline pain and wound-related procedural pain were very common in patients with chronic wounds. In the future, targeted intervention plans should be developed by combining drug-based and nondrug-based analgesia according to pain severity.

AIM:To explore the prevalence and risk factors for medical adhesive-related skin injury (MARSI) caused by protective dressings among medical staff members during the 2019 coronavirus disease pandemic (COVID-19) in China.MATERIALS AND METHODS:A cross-sectional survey was conducted using a questionnaire. The questionnaire was released through the Questionnaire Star website and was completed online. The prevalence of MARSI was calculated and risk factors were analyzed using a multiple regression model.RESULTS:A total of 414 front-line medical staff members treating COVID-19 patients were enrolled from 46 hospitals across four provinces and two municipalities. Overall, 83.1% used protective medical adhesive dressings applied to the head and face to prevent skin damage from personal protective equipment. The prevalence of MARSI caused by adhesive dressings was 41.9%. By multiple regression analysis, the type of dressing, duration of dressing usage, and pain score were risk factors for MARSI development.CONCLUSIONS:The high prevalence indicates MARSI is common among front-line medical staff members, especially those using hydrocolloid dressings and longer durations of dressing usage. Pain upon dressing removal can be severe and increased the risk of MARSI. We call for paying more attention to MARSI and recommend multisite studies with larger sample sizes to enhance the generalizability of these findings.

Background: Photobiomodulation (PBM) becomes a remedial technology with growing popularity. The primary goal of this article is to conduct a PBM literature review, providing an overall systematic understanding of current and future trends. Methods: A dataset was made with topic retrieval, concerning PBM research retrieved from the Web of Science Core Collection. We analyzed to forecast research frontiers in this field using the softwares: VOSviewer, CiteSpace, and Biblioshiny. Results: Four thousand five hundred thirty pieces of literature were retrieved from our database. Current trends were characterized by keywords of "light," "spinal cord injury," "skeletal muscle," and so on. Future trends were characterized probably by six cutting-edge terms: "wound healing," "pain," "oral mucositis," "Alzheimer's disease," "Parkinson's disease," and "orthodontics." Conclusions: This study finds that the inadequacy of in-depth reliable interpretation of current clinical data calls for molecular biological mechanisms together with well-designed, large-sample, multicenter clinical trials. The study of oral, wound, and neural-related mechanisms and the exploration of therapeutic effects may be the popular trend at present and in the next few years.

Chronic wounds are very common wound types in clinics which have a prolonged and painful healing process. Chronic wounds affect health‐related quality of life (HRQoL) on patients. However, there is no specific instrument to measure the HRQoL in Chinese patients with chronic wounds. Wound‐QoL is a questionnaire targeted the experience of health‐related life to patients with chronic wounds. The study aims to translate and cross‐culturally adapt the Wound‐QoL into Chinese and to evaluate its psychometric properties (validity, reliability, floor, and ceiling effect) in a convenience sample of 203 Chinese outpatients with chronic wounds. Reliability was good, with internal consistency of 0.798–0.960 and test–retest reliability of 0.720–0.838. Criterion‐related validity was assessed by the correlation coefficient between Wound‐QoL and generic European QoL instrument‐ EQ‐5D‐5L, which was found statistically significant ( P <.001). No signs of floor or ceiling effect could be detected. Further, confirmatory factor analysis (CFA) was used to verify the reliability and validity of the instrument in this study. In conclusion, the Chinese Wound‐QoL is a valid and reliable tool for measuring HRQoL in populations with chronic wounds.

Antiphospholipid syndrome (APS) is a group of rare autoimmune diseases caused by antiphospholipid antibodies that is mainly associated with arterial or venous thrombosis and/or complications during pregnancy. Skin lesions occur in approximately 30% of APS patients as initial manifestations. However, previous studies have primarily focused on the treatment of APS rather than the management of skin lesions. Here, the authors report a case of an APS-related lower limb skin ulcer that had remained unhealed for more than 7 years. The difficulties in this case were the diagnosis of APS, the risk of bleeding during debridement, wound infection, biofilm formation, reduced venous return from the lower limbs, and compliance with compression therapy and follow-up. A three-step wound care regimen based on a multidisciplinary team approach resulted in effective control of APS and healing of the ulcer to the lower leg in 95 days. Over two follow-ups, there was no recurrence of the ulcer.

Abstract Background This study aimed to explore the clinical features of gout in adult patients with glycogen storage disease type Ia (GSD Ia). Methods Ninety-five adult patients with GSD Ia admitted to Peking Union Medical College Hospital were retrospectively analysed. A clinical diagnosis of GSD Ia was confirmed in all patients through gene sequencing. All patients had hyperuricaemia; 31 patients complicated with gout were enrolled, and 64 adult GSD Ia patients with asymptomatic hyperuricaemia were selected as a control group during the same period. Clinical characteristics were analysed and compared between the two groups. Results Thirty-one of the 95 patients had complications of gout (median age, 25 years; 11 (35.5%) females). All 31 patients had hepatomegaly, abnormal liver function, fasting hypoglycaemia, hyperuricaemia, hyperlipaemia, and hyperlacticaemia. A protuberant abdomen, growth retardation, recurrent epistaxis, and diarrhoea were the most common clinical manifestations. Among these 31 patients, 10 patients (32.3%) had gout as the presenting manifestation and were diagnosed with GSD Ia at a median time of 5 years (range, 1–14) after the first gout flare. The median age of gout onset was 18 years (range, 10–29). Fifteen of the 31 GSD Ia-related gout patients were complicated with gouty tophi, which has an average incidence time of 2 years after the first gouty flare. The mean value of the maximum serum uric acid (SUA) was 800.5 μmol/L (range, 468–1068). The incidence of gout in adult GSD Ia patients was significantly associated with the initial age of regular treatment with raw corn starch, the proportion of urate-lowering therapy initiated during the asymptomatic hyperuricaemic stage, maximum SUA level, and mean cholesterol level. Conclusions Determination of GSD Ia should be performed for young-onset gout patients with an early occurrence of gouty tophi, especially in patients with hepatomegaly, recurrent hypoglycaemia, or growth retardation. Early detection and long-term regulatory management of hyperuricaemia, in addition to early raw corn starch and lifestyle intervention, should be emphasized for GSD Ia patients in order to maintain good metabolic control. Trial registration Retrospectively registered.

ABSTRACT Glycogen storage diseases (GSDs) are a group of rare inherited metabolic disorders caused by enzyme deficiencies in glycogen catabolism. The more common type, GSD type Ia, is caused by glucose-6-phosphatase deficiency and often complicated by gout from hyperuricemia. Here, the authors report a rare case of a tophi wound caused by GSD type Ia in a Chinese patient. Difficulties in this case included the control of abnormal blood markers, especially uric acid; removal of tophi deposited in the tissues; restoration of hand function after wound healing; and patient adherence to treatment and follow-up. A multidisciplinary team was set up consisting of experts from the authors’ wound care center and the departments of endocrinology, orthopedics, and rehabilitation. The wound healed in 53 days and was followed up for about 7 months. During follow-up, the patient’s hand function returned to normal, and no new tophi formed. Because GSDs are a congenital lifelong condition, regular follow-ups are especially important.

BACKGROUND Pressure ulcers (PUs) are encountered in all types of care settings. The incidence of PUs in the intensive care unit (ICU) is higher for a variety of reasons. The Braden Scale is a widely used tool to assess the risk of PU, but its predictive power is controversial in ICU settings. In this systematic review and meta-analysis, we aimed to evaluate the predictive accuracy of the Braden Scale for measurement of risk of PU in adult ICU patients. METHODS A comprehensive literature search in English databases (PubMed, Cochrane Library, OVID, and Web of Science), Chinese databases (SinoMed, CNKI, and Wanfang), and gray literature was performed. Studies assessing the predictive value of the Braden Scale for risk of PU in adult ICU patients were searched. Quality of the studies was scored with Quality Assessment of Diagnostic Accuracy Studies-2. Country, study design, setting, blinding, and characteristics of included studies were extracted. RESULTS Eleven full-text articles containing 10 044 patients, comprising 1058 patients with PUs were included. The pooled sensitivity and specificity of the Braden Scale for predicting PU risk in ICU adults were 0.89 (95% CI, 0.87-0.91; I2 = 94.9%, P = .0000) and 0.28 (95% CI, 0.27-0.29; I2 = 99.2%, P = .0000), respectively. The pooled DOR was 6.29 (95% CI: 4.09-9.68). The overall weighted AUC was 0.7812 ± 0.0331 (95% CI: 0.7163-0.8461) and the Q* value was 0.7196 ± 0.0283 (95% CI: 0.6641-0.7751). Significant heterogeneity was noted among the included studies. Meta-regression analysis showed that there was no heterogeneity in blinding (P = .074), study design (P = .679), or cut-off value (P = .821). CONCLUSIONS This meta-analysis demonstrated that the Braden Scale had a moderate predictive validity with good sensitivity and low specificity in adult critically ill patients. Further development and modification of this tool or generation of a new tool with higher predictive power is warranted for use in ICU populations. RELEVANCE TO CLINICAL PRACTICE The first step in prevention of PU is risk assessment. In this meta-analysis, we aimed to evaluate the predictive power of the Braden Scale for assessing risk of PU in ICU adult patients, which could potentially guide clinical practice.

OBJECTIVE: To determine the prevalence and characteristics of incontinence-associated dermatitis (IAD) among hospitalized Chinese patients. DATA SOURCES: Authors searched Chinese (China National Knowledge Infrastructure, Wanfang Data, VIP Data, Chinese Biomedicine) and English (PubMed, Web of Science) electronic databases for articles published from 1987 through February 2019. STUDY SELECTION: The preliminary search identified 558 studies. After removal of duplicates (n = 202), application of exclusion criteria, and screening titles and abstracts (n = 346), 10 studies met the inclusion criteria. DATA EXTRACTION: A standardized form was constructed to extract data from eligible studies, and this information was extracted by two independent authors. DATA SYNTHESIS: A pooled analysis of the 10 studies (total sample size, 40,039) showed the prevalence of IAD in hospitalized Chinese patients was 1.44% (95% confidence interval, 1.10%-1.79%). Subgroup analysis indicated no significant association between sex and IAD. Patients older than 90 years had the highest incidence of IAD (8.64%). The most common type was mild IAD (1.00%). Fecal incontinence (48.02%) led to more cases of IAD than urinary incontinence (11.35%) or both (25.78%). The most common types of IAD were perineal (0.92%) and perianal (0.90%). CONCLUSIONS: Incontinence-associated dermatitis is a global health problem that requires more attention. Understanding the prevalence and characteristics of IAD is helpful in the formulation of IAD prevention and treatment programs in China.

AIM:To assess the prevalence, related factors, and strategies for the prevention and treatment of pressure ulcers (PUs) in nursing homes in eastern China.MATERIALS AND METHODS:In this cross-sectional multicenter survey, assessments of 1158 residents in nine nursing homes in eastern China were conducted on a single day in August of 2019.RESULTS:Of the 1158 residents, 56 (4.8%) had at least one PU. Most of the identified PUs were classified as stage 3 (39.3%) and developed at home (55.4%). By multiple regression analysis, eating mode, bed-bound, and Braden score were significant association with the development of PUs in nursing homes.CONCLUSIONS:The prevalence of PUs in this study was similar to that reported by previous international studies. The implementation of measures for the prevention and treatment of PUs is insufficient in nursing homes in eastern China. Further, this study raised the issue of the lack of measures to prevent the development of PUs at home.

Background Pressure ulcers (PUs) are encountered in all types of care settings. The incidence of PUs in the intensive care unit (ICU) is higher for a variety of reasons. The Braden Scale is a widely used tool to assess the risk of PU, but its predictive power is controversial in ICU settings. In this systematic review and meta-analysis, we aimed to evaluate the predictive accuracy of the Braden Scale for measurement of risk of PU in adult ICU patients. Methods A comprehensive literature search in English databases (PubMed, Cochrane Library, OVID, and Web of Science), Chinese databases (SinoMed, CNKI, and Wanfang), and gray literature was performed. Studies assessing the predictive value of the Braden Scale for risk of PU in adult ICU patients were searched. Quality of the studies was scored with Quality Assessment of Diagnostic Accuracy Studies-2. Country, study design, setting, blinding, and characteristics of included studies were extracted. Results Eleven full-text articles containing 10 044 patients, comprising 1058 patients with PUs were included. The pooled sensitivity and specificity of the Braden Scale for predicting PU risk in ICU adults were 0.89 (95% CI, 0.87-0.91; I-2 = 94.9%, P = .0000) and 0.28 (95% CI, 0.27-0.29; I-2 = 99.2%, P = .0000), respectively. The pooled DOR was 6.29 (95% CI: 4.09-9.68). The overall weighted AUC was 0.7812 +/- 0.0331 (95% CI: 0.7163-0.8461) and the Q* value was 0.7196 +/- 0.0283 (95% CI: 0.6641-0.7751). Significant heterogeneity was noted among the included studies. Meta-regression analysis showed that there was no heterogeneity in blinding (P = .074), study design (P = .679), or cut-off value (P = .821). Conclusions This meta-analysis demonstrated that the Braden Scale had a moderate predictive validity with good sensitivity and low specificity in adult critically ill patients. Further development and modification of this tool or generation of a new tool with higher predictive power is warranted for use in ICU populations. Relevance to clinical practice The first step in prevention of PU is risk assessment. In this meta-analysis, we aimed to evaluate the predictive power of the Braden Scale for assessing risk of PU in ICU adult patients, which could potentially guide clinical practice.

To evaluate the efficacy of antibacterial protease combined with silver dressing on biofilm reduction and healing in chronic wounds. A pilot, single-blinded randomized controlled trial was conducted. Fifty-six participants with chronic wounds were recruited and randomized (1:1) to the experiment group (antibacterial protease solution + silver dressing, AP) or a control group (0.9% normal saline + silver dressing, NS). The interventions were carried out once two days and the wounds were monitored for 28 days. The wound tissue samples were collected. The bacteria and extracellular polymeric substance in the biofilm of the wound tissues were pathologically checked by transmission electron microscope (TEM) and confocal laser scanning microscope (CLSM). The wound volume reduction rate, Pressure Ulcer Scale for Healing (PUSH) score, pH and temperature were measured. After treatment for 28 days, in the AP group, bacteria and extracellular polymeric substance in the biofilm of the wound tissues decreased more significantly than those in the NS group when observed by CLSM (P < 0.001). Furthermore, the AP group displayed more significant reduction in the wound volume reduction rate, Pressure Ulcer Scale for Healing Score (PUSH) and pH compared to the NS group (P = 0.030, 0.023, 0.015, respectively). There were no statistical differences in wound temperature between the groups (P = 0.422). The application of antibacterial protease combined with silver dressing showed higher efficacy of the biofilm reduction in chronic wounds.

ObjectiveTo identify the risk factors of incontinence⁃associated dermatitis(IAD) in critically ill patients using Meta-analysis.MethodsLiteratures on IAD risk factors of critically ill patients were searched in PubMed,Cochrane Library,Web of Science,CINAHL,MedLine,Springer,CNKI,CMB,VIP and Wanfang database. Two researchers independently screened the literatures according to inclusion and exclusion criteria,conducted quality evaluation and data extraction.And Meta-analysis was performed by RevMan5.3 software.Results14 references met the inclusion criteria,with a total sample size of 1 618 cases,522 cases in the IAD group and 1 096 cases in the non-IAD group.A total of 23 factors were included for analysis.Meta analysis showed that age,diabetes,coronary heart disease,fever,coma,urinary and fecal incontinence,watery stool,fecal incontinence frequency no less than three times a day,antibiotics,enteral nutrition and hypoalbuminemia were associated with the occurrence of IAD in critically ill patients.ConclusionWe should fully understand the individual situation of patients,and formulate targeted measures to prevent the occurrence and development of IAD by overall assessing,predicting and identifying the high⁃risk patients.

An unusual presentation of Mycobacterium avium complex (MAC), unlikely to be encountered in an outpatient dermatology setting, was diagnosed in a patient without an immunodeficiency. A 47-year-old woman, who was immunocompetent and had no risk factors, presented with a full-thickness, infected wound (large amounts of purulent exudate and severe pain) on her back, which had been present for two months. She was diagnosed as having an MAC infection, using a DNA microarray chip method. The patient underwent wound drainage and a fresh silver-containing dressing was applied daily for two months. Although systemic antibiotics were given for one week and anti-tuberculous medication for one month, there was no response. She also complained of bloating, nausea, loss of appetite and other problems, apparently due to drug-induced liver damage, confirmed by laboratory tests. Based on her characteristics and a literature review related to MAC infection, we implemented an individualised, holistic care protocol for the patient that included a daily diet of appropriate fresh vegetables and fruits, and adequate high-quality protein, aerobic exercises for two hours per day, and sleep for 6-8 hours per day, to alleviate the iatrogenic liver damage, improve immune function and reduce the stress response. The wound continued treatment with sharp debridement as needed, and fresh antimicrobial silver-containing dressings every other day. Wound size was measured once a week to evaluate the effects. The wound healed after 48 days, and the patient was followed-up for 18 months at the outpatient wound care centre and through social media. No recurrence or scar hyperplasia was observed.

Objective To investigate the clinical research status and hotspot distribution in the prevention and nursing of diabetic foot, analyze the existing problems, and provide references for further improvement in this area through the bibliometric analysis of clinical researches published in 12 domestic nursing journals. Methods Literatures of clinical researches in the prevention and nursing of diabetic foot were retrieved from 12 domestic nursing journals in CNKI, WanFang Database and VIP. The retrieval time was from the time of database foundation until September 30th, 2017. NoteExpress software was used for algorithm removal, while SPSS was applied for the database foundation. The basic information and clinical research content of the literature were analyzed, and the quality of the randomized controlled trial was evaluated. Results Totally 349 papers were included. The number of published papers was rising. The amount of published papers and foundation projects in the eastern region were superior to those in the middle and western regions. Quantitative study accounted for the largest proportion among different types of research. Research on different grades of foot care, health education, and cognitive or behavioral status of diabetic foot were the hot topics in this field; however, the quality of researches was not high up to now. Conclusions The clinical researches on the prevention and nursing of diabetic foot develop rapidly, but the design and quality of researches need to be improved. In the future, we should standardize the design, refine the research content, and provide high quality evidence for effective prevention and nursing of diabetic foot. Key words: Diabetic foot; Nursing; Bibliometrics; Prevention

灾难性抗磷脂综合征(catastrophic antiphospholipid syndrome,CAPS)于1992年Asherson首次定义,指由多发微血管血栓形成而导致的爆发性多器官衰竭,是一种急性进行性的严重危及生命的抗磷脂综合征(antiphospholipid syndrome,APS).儿童CAPS目前存在因误诊率高延误诊断而导致高死亡率(30%)的报道[1],如何早期及时诊断,积极联合治疗,降低CAPS患儿的死亡率成为儿科医师关注的焦点.

巨噬细胞活化综合征(MAS)为儿童慢性风湿性疾病少见但凶险的合并症,近来国外有所报道,国内病例尚少报道,我科2003年12月收治1例幼年特发性关节炎(JIA)全身型合并MAS,现报告如下.

IgA肾病于1969年由Berger首先描述,被公认为当今世界上最常见的原发性肾小球疾病,其病理特点是肾小球系膜细胞增生及系膜基质增加,并在系膜区和/或肾小球毛细血管袢出现以IgA为主的免疫球蛋白及补体成分的沉积,临床表现为血尿和/或蛋白尿,上呼吸道感染常导致血尿复发.