Lower limb wounds in diabetes: the challenges of wound healing

The Wound Care Pathway: a Danish effect study

AIMS

To investigate how the implementation and training in the WCP affects the behaviour of generalist nurses, focusing on four specific endpoints: motivation, confidence, critical thinking and knowledge.

METHODS

A total of 89 generalist nurses received 6 hours of training in the WCP, over a period of 10-16 weeks. The participants filled a questionnaire before and after the training. Data were collected between January 2023 and January 2024.

FINDINGS

There was a significant improvement in the participants' wound care knowledge, motivation and self-efficacy. The participants' confidence in their wound care skills also increased after the training. A notable improvement was seen in nurses' critical thinking when treating wounds and delivering wound care.

CONCLUSIONS

The WCP guide supports healthcare professionals in their day-to-day work and strengthens their critical thinking and knowledge of wound care management.

Gel/hydrogel-based in situ biomaterial platforms for cancer postoperative treatment and recovery

Tumor surgical resection is the major strategy for cancer treatment. Meanwhile, perioperative treatment especially the postoperative adjuvant anticancer strategies play essential roles in satisfying therapeutic results and rapid recovery. Postoperative tumor recurrence, metastasis, bleeding, inter-tissue adhesion, infection, and delayed wound healing are vital risks that could lead to poor prognosis or even treatment failure. Therefore, methods targeting these postoperative complications are in desperate need. In situ biomaterial-based drug delivery platforms are promising candidates for postoperative treatment and recovery, resulting from their excellent properties including good biocompatibility, adaptive shape, limited systemic effect, designable function, and easy drug loading. In this review, we focus on introducing the gel/hydrogel-based in situ biomaterial platforms involving their properties, advantages, and synthesis procedures. Based on the loaded contents in the gel/hydrogel such as anticancer drugs, immunologic agents, cell components, and multifunctional nanoparticles, we further discuss the applications of the in situ platforms for postoperative tumor recurrence and metastasis inhibition. Finally, other functions aiming at fast postoperative recovery were introduced, including hemostasis, antibacterial infection, adhesion prevention, tissue repair, and wound healing. In conclusion, gel/hydrogel is a developing and promising platform for postoperative treatment, exhibiting gratifying therapeutic effects and inconspicuous toxicity to normal tissues, which deserves further research and exploration.

Protective Effects of Engineered Lactobacillus crispatus on Intrauterine Adhesions in Mice via Delivering CXCL12

Endometrial injury is the main cause of intrauterine adhesions (IUA), and there is currently no effective prevention and treatment. Immune cells play an important role in damage repair by sensing the change in the microenvironment. Exogenous CXCL12 can promote tissue regeneration and repair by recruiting immune cells, but its effect and possible mechanism on endometrial regeneration and repair have not been reported. In the present study, we constructed an engineered a Lactobacillus crispatus strain by transforming a pMG36e plasmid carrying a CXCL12 gene into the bacterium, and developed two animal models, the intrauterine adhesion mice with or without diabetes to evaluate the positive effects of this strain on the prevention of IUA after accepting intrauterine surgery in normal and diabetic mice. The results showed that vaginal application of L. crispatus-pMG36e-mCXCL12 strains significantly diminished the levels of pro-inflammatory factors interleukin-1β (IL-1β) and tumour necrosis factor-α (TNF-α) in serum and uterine tissues of IUA mice, and resulted in the inhibition of the inflammatory (toll-like receptor 4/nuclear factor-κb, TLR4/NF-κB) and fibrotic (transforming growth factor-β1/smads, TGF-β1/Smads) signalling pathways in the uterine tissues. The high-throughput sequencing results further indicated that treatment with L. crispatus-pMG36e-mCXCL12 strains greatly increased the abundance of Lactobacillus spp. and reduced that of the pathogenic Klebsiella spp. in IUA mice. Furthermore, among intrauterine adhesion mice with diabetes, we obtained similar results to non-diabetic mice, that is, L.crispatus-pMG36e-mCXCL12 significantly improved fibrosis and inflammation in the uterine cavity of diabetic mice, and restored the vaginal microbiota balance in diabetic mice. Therefore, we speculated that vaginal administration of L. crispatus-pMG36e-mCXCL12 strains can effectively alleviate intrauterine adhesions by restoring the microbial balance and reducing inflammation and fibrosis caused by surgery.

Diabetic leg and foot ulcers: how district nurses can promote wound healing through blood glucose control

Diabetes is a chronic and often life-long condition that is a consequence of the blood glucose level being too high (National Institute for Health and Clinical Excellence (NICE), 2019). Diabetes covers a range of conditions such as type 1 diabetes, type 2 diabetes and gestational diabetes. It has been well documented that uncontrolled blood glucose levels can lead to further circulatory damage, which impedes the wound healing process and often results in chronic wounds that do not heal. This article uses data collected from an audit and explores how district nursing teams can improve wound healing for those living at home with diabetic ulcers (DUs) by regularly monitoring blood glucose levels. This is followed by a discussion on how district nurses can support their team to adapt best practice, and the benefits of regularly checking blood glucose levels, even for service users that manage their diabetes with diet or oral medication. The article also explores how the multidisciplinary team can be accessed and used efficiently and how leadership skills can improve service user care and safety.