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The aim of this study was to develop a predictive model of nutritional risk in elderly CAPI patients through retrospective cross-sectional data, to identify core predictors applicable to community/nursing home settings, and to validate the predictive augmentation of the combined Braden Score and Nutritional Blood Indicator in hospitalised patients, to provide a basis for stratified nutritional risk management. A retrospective study was conducted to include 424 elderly CAPI patients. They were divided into two groups according to NRS2002 score. Demographic parameters, physiological function parameters and blood parameters were collected. All above indicators of the patients with CAPI were analysed to explore their correlation with nutritional risk. Among 424 participants, 294 patients (69.34%) were at nutritional risk. Independent risk factors identified were aged ≥ 70 years, reduced intake in the last week, and decrease in BMI, Braden score, ALB (albumin), and PA (prealbumin) levels. The AUCs of the first four parameters mentioned above and all the above parameters were 0.816 and 0.872, respectively. The value of aged ≥ 70 years, reduced intake in the past week, BMI, and Braden score in combination to predict and assess nutritional risk is high, which can be used to predict nutritional risk for elderly patients with CAPI who are at home or in nursing homes. The combination of the above parameters combined with albumin and prealbumin has an even higher predictive value in elderly patients hospitalised with CAPI.
Although topical oxygen therapy (TOT) is a promising treatment for chronic wounds, its clinical efficacy and safety remain to be rigorously established. We conducted a two-arm randomised controlled trial to evaluate the efficacy and safety of TOT for treating chronic wounds by a commercially available portable continuous diffusion of oxygen (CDO) system. Eighty-eight patients were allocated to the TOT (n = 44) or moist wound therapy (MWT) (n = 44) group for a 28-day intervention period, followed by standardised MWT for unhealed wounds until the 12-week endpoint. Eighty-eight patients were allocated to either the TOT group (n = 44) or the standard MWT group (n = 44) for 28 days (or until wound closure) and were followed for up to 12 weeks. Wound area, depth, pH, healing rate and healing time were assessed weekly for 28 days or until 12 weeks. Any adverse event was observed at the same time. At day 28, the TOT group demonstrated significantly greater reductions in wound area and depth compared with the MWT group (p < 0.05). The wound bed pH in the TOT group was lower than the MWT group at day 14 and 28. Although the healing rate was higher in the TOT group than in the MWT group at day 28 (45.5% vs. 11.4%, p < 0.001), the healing rate in both groups was similar at week 12 (95.5% vs. 90.9%, p = 0.536). The healing time of the TOT group was shorter than that of the MWT group at week 12 by 13.5 days (95% CI: 6.74–15.40; p = 0.004). No TOT-related adverse events were reported. These findings indicate that portable TOT can significantly accelerate wound healing, particularly by improving wound bed pH that could facilitate subsequent healing processes in patients with chronic wounds.
The aim in this human trial is to compare the efficacy and safety of polygalacturonic–caprylic acid (PG–CAP) ointment to MediHoney in chronic wounds at three international medical centres. In this prospective open-label study, patients with chronic full-thickness wounds were randomised to daily treatment with PG–CAP ointment or MediHoney. Assessments were obtained weekly for 6 weeks. The validated Pressure Ulcer Scale for Healing (PUSH) score was used to track healing. Efficacies were compared using the Wilcoxon rank-sum test for continuous variables and chi-square or Fisher's exact test for categorical variables. Twenty-six patients with chronic wounds were included. Baseline characteristics were comparable between the groups; however, the history of diabetes mellitus was higher in the PG–CAP group (p = 0.011). All 13 PG–CAP patients showed improvement (100%), compared to only 69% of the 13 MediHoney patients (p = 0.023). Half of the failures in the MediHoney arm were associated with death (15%). No failures, adverse events or deaths occurred in the PG–CAP arm. PG–CAP wound ointment is a novel combination of two plant-based compounds that pose minimal risk of promoting antimicrobial resistance, was highly effective for eradicating wound-pathogen biofilms in vitro and promoted chronic wound healing in vivo with minimal inflammatory reactions. Our findings support PG–CAP as safe, noninferior and possibly more effective than MediHoney in healing chronic contaminated wounds.
The treatment of chronic wounds in the Aged is often difficult. Masquelet technique is used for the treatment of infected large segmental bone defects as it provides an adequate blood supply for bone and soft tissue reconstruction. In this study, a two-stage wound management strategy was used, consisting of covering the initial wound with bone cement and skin grafting under induced membranes. From September 2020 to September 2022, 20 Aged patients with chronic refractory wounds of the lower extremities with exposed bone or tendons were recruited in the Department of Wound Repair Surgery of the Second Affiliated Hospital of Wenzhou Medical University. Each patient was reconstructed according to a two-stage process. In the first stage, while treating the patient's underlying disease, several debridements were first performed on the wound; subsequently, the Masquelet technique was applied to seal the wound with antibiotic bone cement. Four to 6 weeks later, the second stage was initiated—after confirming the sufficient formation of wound induced membranes, the bone cement was removed, and free skin grafts were finally used to cover the chronic refractory wounds on the extremities. The area of the defects ranged from 4.5 × 3.0 cm to 15.0 × 6.0 cm, and all soft tissue defects were associated with tendon or bone exposure. After the surgery, patients attended regular outpatient visits and were followed up by telephone and video to observe the healing of the wounds and whether there were any complications in the donor site. The Lower Extremity Function Scale (LEFS) score was used to evaluate the functional recovery of the lower extremities. We found that all implants survived without necrosis or infection. All 20 cases were followed up regularly after surgery for 3 to 12 months, with a mean of 7.6 months. In the first stage, Induced Membranes induction was performed 1–4 times, with an average of (1.3 ± 0.7) times, and in the second stage, free skin grafting was performed on the induction membrane, and all 20 cases of skin grafting survived without necrosis or infection; the appearance and texture of the skin in the grafted area were satisfactory, and the postoperative LEFS score was (69.83 ± 10.82). Finally, our strategy for the management of chronic refractory wounds in the Aged can achieve satisfactory clinical results, reduce surgical risk, be simple and reliable, and be an effective addition to the repair modality.
Pressure injuries remain a significant concern in military hospital settings, leading to increased morbidity and healthcare costs. Understanding the interplay of multiple risk factors is critical for effective prevention. To identify key risk factors and their combined effects on pressure injury development among inpatients in multi-centre military hospitals using factor analysis. A cross-sectional study was conducted involving 4876 inpatients across multiple military hospitals. Data were collected on 15 potential risk factors, including incontinence, care dependency, mobility limitations, comorbidities, medication use, nutritional status, and demographics. Factor analysis with principal component analysis and varimax rotation was applied, and maximum canonical correlation coefficients were calculated to evaluate the predictive contribution of single and combined factors. Single-factor analysis identified incontinence as the strongest predictor (MaxCanonicalCorr = 0.50126), followed by care dependency (0.31982) and bedridden status (0.30061). Two-factor analysis revealed incontinence combined with care dependency as the highest-performing model (MaxCanonicalCorr = 0.50867). Three-factor models incorporating incontinence, health conditions, and care dependency achieved the greatest predictive capacity (MaxCanonicalCorr = 0.5157), demonstrating that multi-factor interactions enhance risk prediction beyond single-factor effects. Incontinence is the primary modifiable risk factor for pressure injury in military hospital inpatients. Integrating continence management with assessments of functional status and comorbidities can improve early identification of high-risk patients and guide targeted preventive strategies.
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