Nursing beds equipped with multi-position adjustment capabilities play a crucial role in preventing pressure ulcers and promoting blood circulation in bedridden patients. This study presents a multi-position nursing bed that integrates back-lifting, leg-bending, and lateral positioning functions, ensuring smooth and stable transitions between various care postures. The back-lifting and leg-bending modules are designed using planar linkage mechanisms, while the lateral positioning module combines planar linkage mechanisms with a flexible bedsheet, enabling more compliant posture adjustments. Kinematic analysis of the back-lifting and leg-bending modules is performed using the generalized transmission ratio method, followed by the development of the corresponding dynamic model. For the lateral positioning module, a comprehensive geometric analysis of the positioning process is carried out, leading to the derivation of the input-output motion mapping. In the control system design, an adaptive fast nonsingular terminal sliding mode control (AFNTSMC) strategy is proposed for the back-lifting and leg-bending modules, while a PID control strategy is employed for the lateral positioning module. Finally, a functional prototype of the nursing bed is developed, and its posture transformation capabilities are validated.

Background/Objectives: Chronic wounds that fail to respond to standard wound care (SWC) remain a major clinical challenge. Platelet-rich plasma (PRP) is an advanced regenerative therapy that delivers platelet-derived growth factors involved in angiogenesis and tissue repair. However, clinical data in Asian populations and evidence regarding ulcers associated with vasculitis or microangiopathic ischemia remain limited. This study evaluated the efficacy, safety, and treatment frequency of autologous PRP gel prepared using the newly approved AutoloGel System[®] in Japan. Methods: This single-center retrospective study included 20 patients with chronic ulcers unresponsive to ≥28 days of conventional therapy by a wound specialist. PRP gel was applied weekly for up to eight sessions under current insurance coverage. Primary outcomes were wound healing rate at 12 weeks after PRP initiation and healing duration. Healing time during specialist-directed conventional therapy was compared with that following PRP using the Wilcoxon signed-rank test. Results: Twenty patients (mean age 60 ± 15 years) with diverse refractory ulcers-including diabetic foot ulcers, chronic limb-threatening ischemia, vasculitic ulcers, venous leg ulcers, pressure ulcers, and surgical site infections-were analyzed. All wounds achieved complete epithelialization within 12 weeks. Healing time decreased significantly from 87.2 ± 77.1 days during conventional therapy to 47.9 ± 28.5 days after PRP initiation (median 60 vs. 44 days, p = 0.0107). No treatment-related adverse events were observed. Conclusions: Weekly autologous PRP gel therapy prepared using the AutoloGel System[®] was associated with improved healing outcomes in refractory chronic wounds. Favorable outcomes were observed in traditionally difficult-to-treat conditions, including vasculitis-associated and microangiopathic ischemic ulcers. These findings suggest the potential role of PRP in promoting angiogenesis and improving microcirculatory perfusion in wounds associated with microvascular dysfunction.

Chronic venous disease (CVD) is a prevalent condition that results from venous hypertension and leads to a variety of symptoms including leg pain, swelling, and venous ulcers. The condition significantly impacts quality of life (QoL) and imposes a burden on healthcare systems. Venoactive drugs (VADs) can manage CVD symptoms by improving venous tone, reducing inflammation, and enhancing microcirculation. In this review, six experts from Latin America provide a critical appraisal of the evidence supporting the use of VADs in CVD management. The review evaluates the efficacy of various VADs, including micronized purified flavonoid fraction (MPFF), rutosides, calcium dobesilate, sulodexide, horse chestnut seed extract, and red vine leaf extract. MPFF demonstrated robust efficacy in randomized controlled trials, significantly reducing symptoms such as pain, leg heaviness, and edema, and improving QoL. Other VADs, such as rutosides and calcium dobesilate, showed varying degrees of effectiveness, though the quality of supporting evidence remains inconsistent. This review also highlights variations in international guidelines - some recommending VADs more strongly than others, with MPFF emerging as the preferred option, supported by high-quality evidence. However, further research is necessary to clarify the role of other VADs and provide more definitive guidance on their use in clinical practice. PLAIN LANGUAGE SUMMARY: Chronic venous disease (CVD) is a condition that affects the veins in the legs, causing pain, swelling, and other symptoms like heaviness and cramping. It can also lead to more severe issues such as skin changes and ulcers. CVD is common and can greatly reduce a person's quality of life (QoL). It can also place a significant burden on healthcare systems. Venoactive drugs, or VADs, are medicines that help improve blood flow in the veins, reduce swelling, and ease inflammation. These drugs are used to alleviate CVD symptoms, especially when other conservative treatments, like compression stockings, are insufficient. This review describes the published evidence about different types of VADs and their effectiveness in CVD. Some drugs, like micronized purified flavonoid fraction (MPFF), have been shown to be particularly effective in reducing leg pain, swelling, and heaviness, as well as helping to improve the QoL of people with CVD. Other VADs, including rutosides, calcium dobesilate, and horse chestnut seed extract, have demonstrated clinical efficacy. Different medical guidelines for treating CVD from around the world recommend using VADs, though with some discrepancies on recommendation gradings. While MPFF is referred to in these guidelines as a leading option, further research is needed to better understand how different VADs can be used most effectively in treating CVD.

Chronic leg ulcers are a significant source of morbidity in elderly patients, particularly those with multiple comorbidities. The most common etiologies are vascular, including chronic venous insufficiency, peripheral arterial disease, and diabetic neuropathy. However, ulcers that are non-healing and refractory to standard treatment may reflect rarer underlying pathologies, warranting comprehensive reassessment. We report the case of an 87-year-old woman presenting with recurrent, painful, bilateral lower-limb ulcers, persisting for 18 months on the right leg and 10 months on the left. Her medical history was notable for chronic kidney disease, heart failure, and a previous myocardial infarction managed with dual coronary artery stenting. The ulcers had been treated in the community with dressings and multiple courses of oral antibiotics, with recurrent hospital admissions for secondary infection. She re-presented to the emergency department with worsening ulceration, rigours, raised inflammatory markers, and clinical features of infection. Initial management included intravenous antibiotics, analgesia, specialist wound care, and tissue viability input. Vascular surgical assessment confirmed adequate arterial supply, and there was no clinical evidence of peripheral neuropathy. Despite optimal conventional management, wound healing remained poor, prompting consideration of alternative diagnoses, including pyoderma gangrenosum, vasculitic ulceration, and cutaneous malignancy. Extensive autoimmune and vasculitis screening was negative. Punch biopsy demonstrated a vasculopathic pattern with increased vascular proliferation, fibrinoid necrosis of small vessels, diffuse neutrophilic infiltrates, and fibrin deposition extending into the deeper dermis. These findings were consistent with coexisting livedoid vasculopathy (LV) and acroangiodermatitis (AAD) secondary to chronic venous stasis, excluding other differentials. This combination is rare, particularly in advanced age. Treatment included topical clobetasol 0.05% cream to peri-wound skin, topical potassium permanganate 0.01% to infected areas, oral dapsone 50 mg twice daily for 3 months, and clopidogrel 75 mg daily, alongside compression therapy and multidisciplinary wound care. Marked clinical improvement was observed within two weeks. This case highlights the diagnostic complexity of chronic leg ulcers, the importance of maintaining a broad differential diagnosis, and the pivotal role of skin biopsy and multidisciplinary collaboration in guiding effective, individualised management.

We report a leg ulcer infection caused by Vibrio metschnikovii in a patient with chronic venous leg ulcers in Montevideo, Uruguay. Shotgun MS/MS combined with long-read whole-genome sequencing confirmed species assignment to V. metschnikovii. In addition, we incorporate a mini-review of the previous reported cases in Latin America.