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COVID-19 , Colecalciferol , Deficiencia de Vitamina D , Población Negra , COVID-19/sangre , COVID-19/epidemiología , COVID-19/inmunología , COVID-19/prevención & control , Colecalciferol/metabolismo , Colecalciferol/farmacología , Hispánicos o Latinos , Humanos , Inflamación/metabolismo , Factores de Riesgo , SARS-CoV-2/fisiología , Estados Unidos/epidemiología , Deficiencia de Vitamina D/diagnóstico , Deficiencia de Vitamina D/etnología , Deficiencia de Vitamina D/inmunología , Deficiencia de Vitamina D/prevención & control , Vitaminas/metabolismo , Vitaminas/farmacologíaRESUMEN
Renal dysfunction has been associated with poor outcomes of wound healing in the diabetic population. The purpose of this study was to create an excisional wound healing model in diabetic mice with renal dysfunction to investigate the combined effects of diabetes and nephropathy on cutaneous ulcers. Renal impairment was introduced in diabetic db/db mice through unilateral nephrectomy and electrocoagulation of the contralateral kidney. Renal function was subsequently monitored with assays of blood urea nitrogen and spot urinary protein/creatinine ratio. After 8 weeks, splinted, full-thickness excisional wounds were created on the dorsal skin and harvested on postoperative days 7 and 14 for further evaluation of wound healing. Renal injury promoted the increase of blood urea nitrogen 3 weeks after initial operation, which was maintained at double the control level throughout the study, concomitantly leading to a significant increase of spot urinary protein excretion. Diabetic mice with renal injury displayed notably impaired wound healing processes, concurrent with reductions in cellular proliferation and angiogenesis, as well as increases in M1 polarized macrophages, infiltrated neutrophils, oxidative stress, and cellular apoptosis. Furthermore, quantitative polymerase chain reaction (qPCR) results displayed corresponding changes of related genes (TNF-α, IL-1ß, SOD2) in the wounds of renal injured db/db mice. Renal manipulation in this study accelerated the progress of renal impairment, which was demonstrated to aggravate impaired cutaneous wound healing in diabetic mice.
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Diabetes Mellitus Experimental/fisiopatología , Glomérulos Renales/lesiones , Insuficiencia Renal Crónica/fisiopatología , Piel/patología , Cicatrización de Heridas , Animales , Proliferación Celular/fisiología , Modelos Animales de Enfermedad , Tejido de Granulación/patología , Inflamación/patología , Masculino , Ratones , Ratones Endogámicos , Piel/lesionesRESUMEN
BACKGROUND: We sought to evaluate the results of a new mesh sutured repair technique for closure of contaminated incisional hernias. METHODS: 48 patients with contaminated hernias 5 cm wide or greater by CT scan were closed with mesh sutures. Surgical site occurrence, infections, and hernia recurrence were compared to similar patient series reported in the literature. RESULTS: Of the 48 patients, 20 had clean-contaminated wounds, 16 had contaminated wounds, and 12 were infected. 69% of the patients underwent an anterior perforator sparing components release for hernias that averaged 10.5 cm transversely (range 5 cm-25 cm). SSO occurred in 27% of patients while SSI was 19%. There were no fistulas or delayed suture sinuses. With a mean follow-up of almost 12 months, 3 midline hernias recurred (6%). In these same patients, three parastomal hernias repaired with mesh sutures failed out of 4 attempted for a total failure rate of 13%. CONCLUSION: Mesh sutured closure represents a simplified and effective surgical strategy for contaminated midline incisional hernia repair.