The Effects of Different Nutritional Measurements on Delayed Wound Healing After Hip Fracture in the Elderly

Japan is a country with a long average life expectancy. With this comes challenges in the form of a growing number of elderly people that require long-term support and care. Among the conditions that can affect the elderly are prolonged inflammation and delayed wound healing. Professor Keisuke Yamashiro, Department of Oral Health, Kobe Tokiwa Junior College, Japan, is working to understand more about the mechanisms behind these conditions. A key hypothesis for Yamashiro and his team is that inflammation may be prolonged by malnutrition. In addition to an insufficient or unbalanced diet, malnutrition can also be caused by the inability to swallow or ingest certain foodstuffs due to problems with the teeth or gums. A key focus for the researchers is on HMGB1, which is a molecule that plays important roles in inflammation and regeneration. The team is working to improve understanding of HMGB1 in order to improve patient outcomes. Yamashiro's current project builds on previous research on HMGB1 and the researchers recently succeeded in administering an anti-HMGB1 antibody that inhibits its action to periodontitis model mice and confirming the effect of bone resorption by periodontitis. This enabled the team to inhibit the translocation of HMGB1 to the nucleus in gingival epithelial cells and suppress the inflammation caused by periodontitis. Ultimately, the researchers believe that the development of an anti-HMG1 treatment will be useful for various diseases such as sepsis, traumatic brain injury and brain ischemia, as well as chronic and immunologic inflammation such as rheumatoid arthritis and arteriosclerosis.

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Deficiencies in micronutrients are common in Trauma patients but not related with delayed wound healing

Aktuelle Ernährungsmedizin ◽

10.1055/s-0029-1223898 ◽

2009 ◽

Vol 34 (03) ◽

Author(s):

SC Blass ◽

C Reimann ◽

S Ellinger ◽

H Goost ◽

C Burger ◽

...

Keyword(s):

Wound Healing ◽

Trauma Patients ◽

Delayed Wound Healing

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Pengaruh Luka Iris Pada Tikus Dengan Paparan Hidrogen Peroxida 3% terhadap Epitelisasi dan Pembentukan Eksudat pada Permukaan Epitel Kulit.

Hang Tuah Medical journal ◽

10.30649/htmj.v17i2.438 ◽

2020 ◽

Vol 17 (2) ◽

pp. 172

Author(s):

HARMAN AGUSAPUTRA ◽

MARIA SUGENG ◽

AYLY SOEKAMTO ◽

ATIK WULANDARI

Keyword(s):

Hydrogen Peroxide ◽

Wound Healing ◽

The Other ◽

Delayed Wound Healing ◽

Peroxide Group ◽

Hemostatic Effect ◽

Significant Difference ◽

Negative Effect ◽

Wound Healing Effect ◽

Epithelial Growth

AbstractBackground: Hydrogen peroxide (H2O2) as antiseptic has been used frequently to clean woundsin in hospitals and clinics. Hydrogen peroxide has the effectof strong oxidative that can kill pathogens. It can clean up debris and necrotic tissuesin wounds. Hydrogen peroxidealso has hemostatic effect that can help to stop bleeding. Besides antiseptic effects, hydrogen peroxide i s suspected of having negative effect in wound healing. Hydrogen peroxide presumably could cause delayed wound healing by exudate formation and delayed epithelial growth.Method: This study was conducted in the laboratory using 48 white mice that were divided into 2 groups. All the mice were purposely wounded. Afterwards in one group the wounds were clean up using hydrogen peroxide, while in the other group without hydrogen peroxide as control. The wounds of both groups were observed on day 1, day 3 and day 7. On day 1 and day 3, both groups did not show significant difference.Result : on day 7 showed that the wound healing in hydrogen peroxide group were delayed. Fifty percent of them had the formation of exudate and 62.5% of them showed delayed epithelial growth.Conclusion : This study could show hydrogen peroxide as wound antiseptic has delayed wound healing effect.Keyword: hydrogen peroxide, wound healing

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The impact of COVID-19 infection on hip fracture 30-day mortality

Trauma ◽

10.1177/1460408620949725 ◽

2021 ◽

pp. 146040862094972

Author(s):

Ahmed Fadulelmola ◽

Rob Gregory ◽

Gavin Gordon ◽

Fiona Smith ◽

Andrew Jennings

Keyword(s):

Hip Fracture ◽

Hip Fractures ◽

Hospital Admissions ◽

The Elderly ◽

Primary Outcome Measure ◽

Time To Death ◽

Significant Difference ◽

The Mean ◽

The Impact ◽

Mean Time

Introduction: A novel virus, SARS-CoV-2, has caused a fatal global pandemic which particularly affects the elderly and those with comorbidities. Hip fractures affect elderly populations, necessitate hospital admissions and place this group at particular risk from COVID-19 infection. This study investigates the effect of COVID-19 infection on 30-day hip fracture mortality. Method: Data related to 75 adult hip fractures admitted to two units during March and April 2020 were reviewed. The mean age was 83.5 years (range 65–98 years), and most (53, 70.7%) were women. The primary outcome measure was 30-day mortality associated with COVID-19 infection. Results: The COVID-19 infection rate was 26.7% (20 patients), with a significant difference in the 30-day mortality rate in the COVID-19-positive group (10/20, 50%) compared to the COVID-19-negative group (4/55, 7.3%), with mean time to death of 19.8 days (95% confidence interval: 17.0–22.5). The mean time from admission to surgery was 43.1 h and 38.3 h, in COVID-19-positive and COVID-19-negative groups, respectively. All COVID-19-positive patients had shown symptoms of fever and cough, and all 10 cases who died were hypoxic. Seven (35%) cases had radiological lung findings consistent of viral pneumonitis which resulted in mortality (70% of mortality). 30% ( n = 6) contracted the COVID-19 infection in the community, and 70% ( n = 14) developed symptoms after hospital admission. Conclusion: Hip fractures associated with COVID-19 infection have a high 30-day mortality. COVID-19 testing and chest X-ray for patients presenting with hip fractures help in early planning of high-risk surgeries and allow counselling of the patients and family using realistic prognosis.

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Hip fractures among the elderly in Kyoto, Japan: a 10-year study

Archives of Osteoporosis ◽

10.1007/s11657-021-00888-8 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Maki Asada ◽

Motoyuki Horii ◽

Kazuya Ikoma ◽

Tsuyoshi Goto ◽

Naoki Okubo ◽

...

Keyword(s):

Hip Fracture ◽

Femoral Neck ◽

Incidence Rate ◽

Acute Care ◽

Hip Fractures ◽

Age Groups ◽

The Elderly ◽

Femoral Neck Fractures ◽

Age Group ◽

Trochanteric Fractures

Abstract Summary In Kyoto Prefecture, Japan, the number of hip fractures increased during 2013–2017 compared to 2008–2012. However, the estimated overall incidence rate increased only in femoral neck fractures in men aged ≥75 and women aged ≥85. Purpose The incidence rate of hip fractures in Japan has plateaued or decreased. We investigated the annual hip fracture occurrences in Kyoto Prefecture, Japan, from 2008 to 2017. Methods Patients aged 65 years and above who sustained hip fractures between 2008 and 2017 and were treated at one of the participating 11 hospitals were included. The total number of beds in these institutions was 3701, accounting for 21.5% of the 17,242 acute-care beds in Kyoto Prefecture. The change in incidence rate was estimated utilizing the population according to the national census conducted in 2010 and 2015. Results The total number of hip fractures was 10,060, with 47.5% femoral neck fractures and 52.5% trochanteric fractures. A decrease in number was seen only in trochanteric fractures in the group of 75- to 84-year-old women. The population-adjusted numbers of femoral neck fractures showed a significant increase in all age groups in men, whereas in women, there was an increase in femoral neck fractures in the ≥85 group and trochanteric fractures in the age group 65–74, and a decrease in trochanteric fractures in the age group 75–84. The estimated change in incidence rate showed an increase in femoral neck fractures in men aged ≥75 and women aged ≥85. Conclusion In Kyoto Prefecture, the number of hip fractures increased in the second half of the study period (2013–2017) compared to the first half (2008–2012). However, the incidence rate had not increased, except in femoral neck fractures in men aged ≥75 and women aged ≥85.

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Cutaneous wound healing is impaired in hemophilia B

Blood ◽

10.1182/blood-2006-05-020495 ◽

2006 ◽

Vol 108 (9) ◽

pp. 3053-3060 ◽

Cited By ~ 74

Author(s):

Maureane Hoffman ◽

Anna Harger ◽

Angela Lenkowski ◽

Ulla Hedner ◽

Harold R. Roberts ◽

...

Keyword(s):

Wound Healing ◽

Time Course ◽

Ferric Iron ◽

Hemophilia B ◽

Cutaneous Wound Healing ◽

Delayed Wound Healing ◽

Cutaneous Wound ◽

Time Points ◽

Hemophilic Arthropathy ◽

Healing Wounds

Abstract We used a mouse model to test the hypothesis that the time course and histology of wound healing is altered in hemophilia B. Punch biopsies (3 mm) were placed in the skin of normal mice and mice with hemophilia. The size of the wounds was measured daily until the epidermal defect closed. All wounds closed in mice with hemophilia by 12 days, compared with 10 days in normal animals. Skin from the area of the wound was harvested at different time points and examined histologically. Hemophilic animals developed subcutaneous hematomas; normal animals did not. Macrophage infiltration was significantly delayed in hemophilia B. Unexpectedly, hemophilic mice developed twice as many blood vessels in the healing wounds as controls, and the increased vascularity persisted for at least 2 weeks. The deposition and persistence of ferric iron was also greater in hemophilic mice. We hypothesize that iron plays a role in promoting excess angiogenesis after wounding as it had been proposed to do in hemophilic arthropathy. We have demonstrated that impaired coagulation leads to delayed wound healing with abnormal histology. Our findings have significant implications for treatment of patients with hemophilia, and also highlight the importance of rapidly establishing hemostasis following trauma or surgery.

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PP045-SUN INTEGRATED NUTRITIONAL INTERVENTION IN THE ELDERLY AFTER HIP FRACTURE. A PROCESS EVALUATION

Clinical Nutrition Supplements ◽

10.1016/s1744-1161(12)70097-2 ◽

2012 ◽

Vol 7 (1) ◽

pp. 43 ◽

Cited By ~ 2

Author(s):

J.J. Breedveld-Peters ◽

P.L. Reijven ◽

C.E. Wyers ◽

S. van Helden ◽

J.J.C. Arts ◽

...

Keyword(s):

Hip Fracture ◽

Process Evaluation ◽

The Elderly ◽

Nutritional Intervention

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SAT0047 RISK FACTORS FOR THE POSTOPERATIVE DELAYED WOUND HEALING IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH A BIOLOGICAL AGENT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3424 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 954.3-954

Author(s):

S. Okita ◽

H. Ishikawa ◽

A. Abe ◽

S. Ito ◽

A. Murasawa ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Wound Healing ◽

Retrospective Study ◽

Nutritional Status ◽

Disease Activity ◽

Disease Duration ◽

Foot And Ankle ◽

Delayed Wound Healing ◽

Chugai Pharmaceutical

Background:It has been suggested that perioperative use of biological disease-modifying anti-rheumatic drugs (bDMARDs) in rheumatoid arthritis (RA) patients carries risks for the surgical-site infection and the delayed wound healing (DWH); however, the risk of DWH with perioperative use of bDMARDs has not reached a general consensus.Objectives:This retrospective study aimed to investigate the risk factors associated with DWH after orthopedic surgery in RA patients treated with bDMARDs.Methods:We reviewed medical records of 277 orthopedic procedures for 188 RA patients treated with bDMARDs between from 2014 to 2017 in Niigata Rheumatic Center. As preoperative nutritional status assessment, we evaluated body mass index (BMI), prognostic nutritional index (PNI), and CONtrolling NUTritional status (CONUT). In addition, we evaluated DAS28-CRP, DAS28-ESR, face scale for pain, global health (GH), and Health Assessment Questionnaire-Disability Index (HAQ-DI) to assess the disease activity. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factor for DWH.Results:The major characteristics of the patients in 277 procedures were mean age of 63.2 years old and mean disease duration of 18.2 years. Surgical site were hand and wrist (145 procedures), foot and ankle (76), hip and knee (31), elbow and shoulder (24), and spine (1). Seventy-four patients were treated with tocilizumab, 62 with etanercept, 55 with golimumab, 49 with abatacept, 16 with infliximab, 15 with adalimumab, and 6 with certolizumab. According to nutritional assessment in PNI and CONUT, 63% (n=175) and 47% (n=130) were normal nourished patients, respectively.In 277 procedures, DWH were identified in 24 patients (8.6%). The following variables were significant in the univariate analyses: disease duration (OR 1.053; 95% CI 1.010–1.099; p=0.016), foot and ankle surgery (OR 7.091; 95% CI 2.130–23.603; p=0.001), tocilizumab (OR 0.286; 95% CI 0.093–0.881; p=0.029) (Table 1). These variables were entered into a multivariate model, and it was revealed that pre-operative use of tocilizumab (OR 0.265; 95% CI 0.074–0.953; p=0.042) and procedures in the foot and ankle (OR 6.915; 95% CI 1.914–24.976; p=0.003) were associated with an increased risk of DWH (Table 1).Conclusion:As previous study on tocilizumab described, the current retrospective study suggested that pre-operative use of tocilizumab and procedures in the foot and ankle were risk factors for DWH. Pre-operative disease activity and nutritional status were not independent risk factors for an increase in the prevalence of DWH.References:[1] Momohara S, Hashimoto J, Tsuboi H et al. Analysis of perioperative clinical features and complications after orthopaedic surgery in rheumatoid arthritis patients treated with tocilizumab in a real-world setting: Results from the multicentre tocilizumab in perioperative period (TOPP) study. Modern rheumatology. 2013, 23: 440-9.Disclosure of Interests:Shunji Okita: None declared, Hajime Ishikawa: None declared, Asami Abe: None declared, Satoshi Ito Speakers bureau: Abbvie,Eisai, Akira Murasawa: None declared, Keiichiro Nishida Grant/research support from: K. Nishida has received scholarship donation from CHUGAI PHARMACEUTICAL Co., Eisai Co., Mitsubishi Tanabe Pharma and AbbVie GK., Speakers bureau: K. Nishida has received speaking fees from CHUGAI PHARMACEUTICAL Co., Eli Lilly, Janssen Pharmaceutical K.K., Eisai Co. and AYUMI Pharmaceutical Corporation., Toshifumi Ozaki: None declared

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