title: Elevated Levels of Protein Disulfide Isomerase and Binding Immunoglobulin Protein Implicated in Spinal Cord Injury Paraplegia Patients with Pressure Ulcers.
abstract: OBJECTIVE
  To explore the associations between two endoplasmic reticulum (ER) stress proteins, protein disulfide isomerase (PDI), binding immunoglobulin protein (BIP), and the development and progression of pressure ulcers (PUs) in spinal cord injury (SCI) paraplegia patients.
  
  
  METHODS
  ELISA kits were used to measure the levels of serum PDI and BIP in 67 SCI paraplegia patients with PUs and 61 SCI paraplegia patients without PUs. The associations between PDI and BIP, PU formation, PU staging, and pressure ulcer scale for healing (PUSH) score were analyzed.
  
  
  RESULTS
  The patients in the PU group had higher levels of PDI and BIP than those in the non-PU group (both p < 0.05). Furthermore, the levels of PDI were positively correlated with those of BIP (r = 0.707, p < 0.0001). There were significant differences in the PDI and BIP levels among the different stages of PU (all p < 0.05). As the PU stages progressed, the levels of PDI and BIP first increased, then decreased, and finally peaked at stage III of the PUs. The PUSH scores significantly declined 7 days after debridement for the PU stage II (p < 0.01) but showed no significant difference between stages III and IV at 7 days after debridement (p > 0.05). The PUSH scores also decreased at 28 days after debridement for stages II, III, and IV (all p < 0.01). Higher PUSH scores indicated a longer time of debridement accompanied by a longer wound surface healing time (p < 0.05).
  
  
  CONCLUSIONS
  ER stress proteins may be involved in the process of PU formation and healing; moreover, the levels of PDI and BIP were also associated with the severity of the PUs. Finally, we found that the PUSH scores can be used as a reference to evaluate PU severity and healing.
authors.affiliation: 1 Department of Gynecology, Linyi Tumor Hospital , Linyi, P.R. China .
authors.forename: Weiyan
authors.initials: W
authors.lastname: Chen
authors.affiliation: 1 Department of Gynecology, Linyi Tumor Hospital , Linyi, P.R. China .
authors.forename: Jing
authors.initials: J
authors.lastname: Liu
authors.affiliation: 2 Department of Orthopedics, Linyi Traditional Chinese Medicine Hospital , Linyi, P.R. China .
authors.forename: Liang
authors.initials: L
authors.lastname: Zhao
authors.affiliation: 3 Department of Orthopedics, Linyi People's Hospital , Linyi, P.R. China .
authors.forename: Cuijiang
authors.initials: C
authors.lastname: Wang
authors.affiliation: 4 Department of General Surgery, Tumor Hospital of Shandong Province , Jinan, P.R. China .
authors.forename: Zengjun
authors.initials: Z
authors.lastname: Li
authors.affiliation: 1 Department of Gynecology, Linyi Tumor Hospital , Linyi, P.R. China .
authors.forename: Ting
authors.initials: T
authors.lastname: Liu
mesh_terms: D000328:Adult; D000368:Aged; D004721:Endoplasmic Reticulum / Q000201:enzymology / Q000378:metabolism; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D008222:Lymphokines / Q000097:blood / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D010264:Paraplegia / Q000201:enzymology / Q000378:metabolism; D003668:Pressure Ulcer / Q000097:blood / Q000201:enzymology / Q000378:metabolism*; D019704:Protein Disulfide-Isomerases / Q000097:blood / Q000378:metabolism*; D012307:Risk Factors; D013119:Spinal Cord Injuries / Q000201:enzymology / Q000473:pathology*
chemical_list: D008222:Lymphokines; C013059:immunoglobulin-binding factors; D019704:Protein Disulfide-Isomerases