{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T16:08:47Z","timestamp":1789142927309,"version":"build-2803163510"},"reference-count":41,"publisher":"University of Toronto Press Inc. (UTPress)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clin Invest Med"],"published-print":{"date-parts":[[2026,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>This study aimed to explore the link between serum vitamin D levels and chronic refractory wounds (CRWs) using National Health and Nutrition Examination Survey (NHANES) data, as the exact relationship and molecular mechanisms have not been fully understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study included a cohort of 5,415 adult participants with complete data on serum vitamin D, CRW prevalence, and other pertinent covariates. To evaluate the associations between serum vitamin D levels and CRW prevalence, weighted logistic regression analysis, restricted cubic spline (RCS) models, and subgroup analyses were applied. Network pharmacology and molecular dynamics simulation (MDS) analyses were then performed to elucidate the potential pathways and key targets involved in vitamin D\u2013mediated wound healing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      After controlling for all confounding variables, a significant inverse relationship was identified between serum vitamin D levels and CRW prevalence. When stratifying serum vitamin D levels into quartiles, individuals in the highest quartile exhibited an approximately 37% reduced risk of CRW (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.04) compared to those in the lowest quartile. RCS analysis indicated a linear dose\u2013response relationship across serum vitamin D levels (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for nonlinearity = 0.328). This inverse association was consistently observed across various population subgroups. Furthermore, network pharmacology analysis suggested that vitamin D may influence wound healing through various targets and pathways, notably the AGE-RAGE, IL-17, and PI3K-Akt signalling pathways.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Our findings underscore a significant correlation between lower serum vitamin D levels and an increased risk of developing CRW. Vitamin D intake may constitute a modifiable lifestyle factor associated with CRW.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3138\/cim-2025-0211","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:16:51Z","timestamp":1786115811000},"page":"1-16","source":"Crossref","is-referenced-by-count":0,"title":["Serum vitamin D levels and chronic refractory wounds: Unveiling of association and exploration of potential molecular mechanisms"],"prefix":"10.3138","volume":"49","author":[{"given":"Guowei","family":"Zhou","sequence":"first","affiliation":[{"name":"Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qirui","family":"Xiong","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bing'e","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Thyroid and Breast Surgery, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaoqun","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1696","reference":[{"key":"e_1_3_11_2_2","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1186\/s12916-015-0288-5","article-title":"Seeking effective interventions to treat complex wounds: an overview of systematic reviews","volume":"13","author":"Tricco AC","year":"2015","unstructured":"Tricco AC, Antony J, Vafaei A, . 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