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Vatandoust D, Ahmadi H, Amini A, Mostafavinia A, Fathabady FF, Moradi A, Fridoni M, Hamblin MR, Ebrahimpour-Malekshah R, Chien S, Bayat M. Photobiomodulation preconditioned diabetic adipose derived stem cells with additional photobiomodulation: an additive approach for enhanced wound healing in diabetic rats with a delayed healing wound. Lasers Med Sci 2024; 39:86. [PMID: 38438583 DOI: 10.1007/s10103-024-04034-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/23/2024] [Indexed: 03/06/2024]
Abstract
In this preclinical investigation, we examined the effects of combining preconditioned diabetic adipose-derived mesenchymal stem cells (AD-MSCs) and photobiomodulation (PBM) on a model of infected ischemic delayed healing wound (injury), (IIDHWM) in rats with type I diabetes (TIDM). During the stages of wound healing, we examined multiple elements such as stereology, macrophage polarization, and the mRNA expression levels of stromal cell-derived factor (SDF)-1α, vascular endothelial growth factor (VEGF), hypoxia-induced factor 1α (HIF-1α), and basic fibroblast growth factor (bFGF) to evaluate proliferation and inflammation. The rats were grouped into: (1) control group; (2) diabetic-stem cells were transversed into the injury site; (3) diabetic-stem cells were transversed into the injury site then the injury site exposed to PBM; (4) diabetic stem cells were preconditioned with PBM and implanted into the wound; (5) diabetic stem cells were preconditioned with PBM and transferred into the injury site, then the injury site exposed additional PBM. While on both days 4, and 8, there were advanced histological consequences in groups 2-5 than in group 1, we found better results in groups 3-5 than in group 2 (p < 0.05). M1 macrophages in groups 2-5 were lower than in group 1, while groups 3-5 were reduced than in group 2 (p < 0.01). M2 macrophages in groups 2-5 were greater than in group 1, and groups 3-5 were greater than in group 2. (p ≤ 0.001). Groups 2-5 revealed greater expression levels of bFGF, VEGF, SDF- 1α, and HIF- 1α genes than in group 1 (p < 0.001). Overall group 5 had the best results for histology (p < 0.05), and macrophage polarization (p < 0.001). AD-MSC, PBM, and AD-MSC + PBM treatments all enhanced the proliferative stage of injury repairing in the IIDHWM in TIDM rats. While AD-MSC + PBM was well than the single use of AD-MSC or PBM, the best results were achieved with PBM preconditioned AD-MSC, plus additional PBM of the injury.
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Affiliation(s)
- Dorsa Vatandoust
- Student Research Committee at Shahid Beheshti University of Medical Sciences (SBMU) in, Tehran, Iran
| | - Houssein Ahmadi
- Department of Biology and Anatomical Sciences at Shahid Beheshti University of Medical Sciences, Arabi Ave, Iran
| | - Abdollah Amini
- Department of Biology and Anatomical Sciences at Shahid Beheshti University of Medical Sciences, Arabi Ave, Iran.
| | - Atarodalsadat Mostafavinia
- Department of Anatomical Sciences and Cognitive Neuroscience at the Faculty of Medicine, Tehran Medical Sciences, Islamic Aza University in Tehran, Tehran, Iran
| | - Fatemeh Fadaei Fathabady
- Student Research Committee at Shahid Beheshti University of Medical Sciences (SBMU) in, Tehran, Iran
| | - Ali Moradi
- Department of Biology and Anatomical Sciences at Shahid Beheshti University of Medical Sciences, Arabi Ave, Iran
| | - Mohammadjavad Fridoni
- Department of Biology and Anatomical Sciences, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Michael R Hamblin
- Laser Research Centre at the Faculty of Health Science, University of Johannesburg in Doornfontein 2028, Johannesburg, South Africa
| | | | - Sufan Chien
- Price Institute of Surgical Research at the University of Louisville and Noveratech LLC of Louisville in Louisville, KY, USA.
| | - Mohammad Bayat
- Price Institute of Surgical Research at the University of Louisville and Noveratech LLC of Louisville in Louisville, KY, USA.
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Liao C, Zhu M, Ding H, Li Y, Sun Q, Li X. Comparing the traditional and emerging therapies for enhancing wound healing in diabetic patients: A pivotal examination. Int Wound J 2023; 21:e14488. [PMID: 37984812 PMCID: PMC10898383 DOI: 10.1111/iwj.14488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 10/22/2023] [Accepted: 10/23/2023] [Indexed: 11/22/2023] Open
Abstract
Chronic non-healing ulcers are common among diabetic patients, posing significant therapeutic challenges. This study compared traditional therapies (TT) and emerging therapies (ET) for enhancing diabetic patients' wound healing. A total of 150 diabetic patients with chronic ulcers, ages 30-65, were randomly assigned to one of two groups: TT (n = 75) or ET (n = 75). ET included growth factors, bioengineered skin substitutes, and hyperbaric oxygen therapy, while TT for wound healing predominantly included debridement, saline-moistened dressings, and off-loading techniques. The primary outcome was the percentage of lesions that healed within 12 weeks, which was assessed at intervals. Secondary outcomes included time to wound recovery, pain using Visual Analogue Scale (VAS), and life quality via Wound-QoL questionnaire. By the 12th week, the ET group had a repair rate of 81.33% compared to 57.33% in TT group (p < 0.05). ET exhibited superior pain reduction (VAS score: 4.7 ± 1.6 for ET vs. 6.2 ± 1.4 for TT, p < 0.05) and improved life quality (Wound-QoL score: 61.8 ± 9.1 for ET vs. 44.3 ± 10.3 for TT, p < 0.05). However, there were slightly more cases of cutaneous irritation and hematomas among ET patients. ET have demonstrated significant efficacy in accelerating wound healing in diabetic patients, surpassing traditional methods, with additional advantages in pain management and life quality. Due to the observed minor complications, however, caution is required.
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Affiliation(s)
- Chunfen Liao
- Department of Endocrinology, Renmin HospitalHubei University of MedicineShiyanChina
| | - Mingjie Zhu
- Department of Endocrinology, Renmin HospitalHubei University of MedicineShiyanChina
| | - Hongchen Ding
- Department of Endocrinology, Renmin HospitalHubei University of MedicineShiyanChina
| | - Yanli Li
- Department of Endocrinology, Renmin HospitalHubei University of MedicineShiyanChina
| | - Qianshu Sun
- Department of Endocrinology, Renmin HospitalHubei University of MedicineShiyanChina
| | - Xueqin Li
- Department of Endocrinology, Renmin HospitalHubei University of MedicineShiyanChina
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Huang H, Xin R, Li X, Zhang X, Chen Z, Zhu Q, Tai Z, Bao L. Physical therapy in diabetic foot ulcer: Research progress and clinical application. Int Wound J 2023; 20:3417-3434. [PMID: 37095726 PMCID: PMC10502280 DOI: 10.1111/iwj.14196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Diabetes foot ulcer (DFU) is one of the most intractable complications of diabetes and is related to a number of risk factors. DFU therapy is difficult and involves long-term interdisciplinary collaboration, causing patients physical and emotional pain and increasing medical costs. With a rising number of diabetes patients, it is vital to figure out the causes and treatment techniques of DFU in a precise and complete manner, which will assist alleviate patients' suffering and decrease excessive medical expenditure. Here, we summarised the characteristics and progress of the physical therapy methods for the DFU, emphasised the important role of appropriate exercise and nutritional supplementation in the treatment of DFU, and discussed the application prospects of non-traditional physical therapy such as electrical stimulation (ES), and photobiomodulation therapy (PBMT) in the treatment of DFU based on clinical experimental records in ClinicalTrials.gov.
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Affiliation(s)
- Hao Huang
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Rujuan Xin
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiaolong Li
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xinyue Zhang
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhongjian Chen
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Quangang Zhu
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Leilei Bao
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
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Yip K, Yip Y, Tsui W. Thoughts and experiences regarding leg amputation among patients with diabetic foot ulcers: A phenomenological study. Int Wound J 2023; 20:2159-2168. [PMID: 36718017 PMCID: PMC10333000 DOI: 10.1111/iwj.14094] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 01/07/2023] [Indexed: 02/01/2023] Open
Abstract
Despite lower-limb amputation being common among patients with diabetic foot ulcers, few studies have qualitatively investigated the patients' perspectives. Therefore, this study aimed to explore the thoughts and experiences of patients with diabetic foot ulcers regarding lower-limb amputation in Hong Kong. A phenomenological study using individual, semi-structured interviews was conducted with 18 participants with foot ulcers recruited in Hong Kong between July and September 2022. The interviews were audio-recorded, transcribed verbatim, and analysed using an interpretative phenomenological approach and a constant comparison strategy. The results highlighted four substantial themes: (a) coping or being alone and taciturn, (b) altered appearance impacting one's sense of maintaining social relations, (c) thoughts about self-efficacy and encountering a new normal, and (d) the possibility of a reduced gap in physical consequences between the old and new self. This study provided different perspectives of patients with a history of diabetic foot ulcers, even in cases where lower-limb amputation has not yet been performed. The results demonstrate that lower-limb amputation is considered a forbidden topic. This makes it culturally difficult for Chinese patients to discuss the matter with healthcare authorities and family members. Healthcare workers should be aware of how they communicate regarding lower-limb amputation.
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Affiliation(s)
- Ka‐Huen Yip
- Caritas Institute of Higher EducationSchool of Health SciencesTseung Kwan OHong KongChina
| | - Yuk‐Chiu Yip
- Hong Kong Metropolitan UniversityLi Ka Shing School of Professional and Continuing EducationHong KongChina
| | - Wai‐King Tsui
- Caritas Institute of Higher EducationSchool of Health SciencesTseung Kwan OHong KongChina
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Moravej FG, Amini A, Masteri Farahani R, Mohammadi-Yeganeh S, Mostafavinia A, Ahmadi H, Omidi H, Rezaei F, Gachkar L, Hamblin MR, Chien S, Bayat M. Photobiomodulation, alone or combined with adipose-derived stem cells, reduces inflammation by modulation of microRNA-146a and interleukin-1ß in a delayed-healing infected wound in diabetic rats. Lasers Med Sci 2023; 38:129. [PMID: 37243832 DOI: 10.1007/s10103-023-03786-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/12/2023] [Indexed: 05/29/2023]
Abstract
Diabetic wounds are categorized by chronic inflammation, leading to the development of diabetic foot ulcers, which cause amputation and death. Herewith, we examined the effect of photobiomodulation (PBM) plus allogeneic diabetic adipose tissue-derived stem cells (ad-ADS) on stereological parameters and expression levels of interleukin (IL)-1ß and microRNA (miRNA)-146a in the inflammatory (day 4) and proliferation (day 8) stages of wound healing in an ischemic infected (with 2×107 colony-forming units of methicillin-resistant Staphylococcus aureus) delayed healing wound model (IIDHWM) in type I diabetic (TIDM) rats. There were five groups of rats: group 1 control (C); group 2 (CELL) in which rat wounds received 1×106 ad-ADS; group 3 (CL) in which rat wounds received the ad-ADS and were subsequently exposed to PBM(890 nm, 80 Hz, 3.5 J/cm2, in vivo); group 4 (CP) in which the ad-ADS preconditioned by the PBM(630 nm + 810 nm, 0.05 W, 1.2 J/cm2, 3 times) were implanted into rat wounds; group 5 (CLP) in which the PBM preconditioned ad-ADS were implanted into rat wounds, which were then exposed to PBM. On both days, significantly better histological results were seen in all experimental groups except control. Significantly better histological results were observed in the ad-ADS plus PBM treatment correlated to the ad-ADS alone group (p<0.05). Overall, PBM preconditioned ad-ADS followed by PBM of the wound showed the most significant improvement in histological measures correlated to the other experimental groups (p<0.05). On days 4 and 8, IL-1 β levels of all experimental groups were lower than the control group; however, on day 8, only the CLP group was different (p<0.01). On day 4, miR-146a expression levels were substantially greater in the CLP and CELL groups correlated to the other groups, on day 8 miR-146a in all treatment groups was upper than C (p<0.01). ad-ADS plus PBM, ad-ADS, and PBM all improved the inflammatory phase of wound healing in an IIDHWM in TIDM1 rats by reducing inflammatory cells (neutrophils, macrophages) and IL-1ß, and increasing miRNA-146a. The ad-ADS+PBM combination was better than either ad-ADS or PBM alone, because of the higher proliferative and anti-inflammatory effects of the PBM+ad-ADS regimen.
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Affiliation(s)
- Fahimeh Ghasemi Moravej
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdollah Amini
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Masteri Farahani
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Samira Mohammadi-Yeganeh
- Department of Biotechnology, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atarodalsadat Mostafavinia
- Department of Anatomical Sciences & Cognitive Neuroscience, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Houssein Ahmadi
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamidreza Omidi
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemehalsadat Rezaei
- College of Pharmacy, University of Kentucky, 789 South Limestone, Lexington, KY, 40536, USA
| | - Latif Gachkar
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Michael R Hamblin
- Laser Research Centre, Faculty of Health Science, University of Johannesburg, Doornfontein, South Africa, and Radiation Biology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Sufan Chien
- Price Institute of Surgical Research, University of Louisville, and Noveratech LLC, Louisville, KY, USA
| | - Mohammad Bayat
- Department of Biology and Anatomical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
- Price Institute of Surgical Research, University of Louisville, and Noveratech LLC, Louisville, KY, USA.
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Zhu Y, Lu J, Wang S, Xu D, Wu M, Xian S, Zhang W, Tong X, Liu Y, Huang J, Jiang L, Guo X, Xie S, Gu M, Jin S, Ma Y, Huang R, Xiao S, Ji S. Mapping intellectual structure and research hotspots in the field of fibroblast-associated DFUs: a bibliometric analysis. Front Endocrinol (Lausanne) 2023; 14:1109456. [PMID: 37124747 PMCID: PMC10140415 DOI: 10.3389/fendo.2023.1109456] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/27/2023] [Indexed: 05/02/2023] Open
Abstract
Background Diabetic foot ulcers (DFUs) are one of the most popular and severe complications of diabetes. The persistent non-healing of DFUs may eventually contribute to severe complications such as amputation, which presents patients with significant physical and psychological challenges. Fibroblasts are critical cells in wound healing and perform essential roles in all phases of wound healing. In diabetic foot patients, the disruption of fibroblast function exacerbates the non-healing of the wound. This study aimed to summarize the hotspots and evaluate the global research trends on fibroblast-related DFUs through bibliometric analysis. Methods Scientific publications on the study of fibroblast-related DFUs from January 1, 2000 to April 27, 2022 were retrieved from the Web of Science Core Collection (WoSCC). Biblioshiny software was primarily performed for the visual analysis of the literature, CiteSpace software and VOSviewer software were used to validate the results. Results A total of 479 articles on fibroblast-related DFUs were retrieved. The most published countries, institutions, journals, and authors in this field were the USA, The Chinese University of Hong Kong, Wound Repair and Regeneration, and Seung-Kyu Han. In addition, keyword co-occurrence networks, historical direct citation networks, thematic map, and the trend topics map summarize the research hotspots and trends in this field. Conclusion Current studies indicated that research on fibroblast-related DFUs is attracting increasing concern and have clinical implications. The cellular and molecular mechanisms of the DFU pathophysiological process, the molecular mechanisms and therapeutic targets associated with DFUs angiogenesis, and the measures to promote DFUs wound healing are three worthy research hotspots in this field.
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Affiliation(s)
- Yushu Zhu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Jianyu Lu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Siqiao Wang
- School of Medicine, Tongji University, Shanghai, China
| | - Dayuan Xu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Minjuan Wu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Shuyuan Xian
- School of Medicine, Tongji University, Shanghai, China
| | - Wei Zhang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xirui Tong
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yifan Liu
- School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Huang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Luofeng Jiang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xinya Guo
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Sujie Xie
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Minyi Gu
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Shuxin Jin
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Yicheng Ma
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
| | - Runzhi Huang
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
- *Correspondence: Runzhi Huang, ; Shizhao Ji, ; Shichu Xiao,
| | - Shichu Xiao
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
- *Correspondence: Runzhi Huang, ; Shizhao Ji, ; Shichu Xiao,
| | - Shizhao Ji
- Department of Burn Surgery, The First Affiliated Hospital of Naval Medical University, Shanghai, China
- Research Unit of Critical Techniques for Treatment of Burns and Combined Burns and Trauma Injury, Chinese Academy of Medical Sciences, Shanghai, China
- *Correspondence: Runzhi Huang, ; Shizhao Ji, ; Shichu Xiao,
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Kim HJ, Kim WJ, Lee HS, Koh YY, Shin YB, Yeo ED. Clinical utility of skin perfusion pressure measurement in diabetic foot wounds: An observational study. Medicine (Baltimore) 2022; 101:e30454. [PMID: 36086746 PMCID: PMC10980428 DOI: 10.1097/md.0000000000030454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 08/01/2022] [Indexed: 11/26/2022] Open
Abstract
The degree of blood vessel stenosis significantly influences diabetic foot treatment. This study aimed to investigate the association between computed tomography angiography (CTA) stenosis and skin perfusion pressure (SPP), which are noninvasive vascular assessments used to evaluate diabetic foot wounds. Forty patients who reported diabetic foot wounds between November 2016 and December 2017 were included in the study. SPPand CTA were performed to evaluate the blood flow, and the rate of decrease in wound size was measured for the wounds corresponding to Meggitt-Wagner grade 1 at the first evaluation and 4-week intervals. The P value of the association between the degree of CTA stenosis and the SPP value was 0.915, and the P value of the association between CTA stenosis and decreasing rate of wound size was .235. There was no statistically significant association between SPP and the decreasing rate of wound size according to the degree of CTA stenosis. The association between SPP value and the decreasing rate of wound size was statistically significant (P < .05). The decreasing rate in diabetic foot wound size was significantly associated with SPP but not with CTA stenosis.
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Affiliation(s)
- Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University, Cheonan Hospital, CheonanRepublic of Korea
| | - Hong Seop Lee
- Department of Orthopaedic Surgery, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Yeong Yoon Koh
- Department of Orthopedic Surgery, VHS Medical Center, Seoul, Republic of Korea
| | - Young Bin Shin
- Department of Orthopedic Surgery, VHS Medical Center, Seoul, Republic of Korea
| | - Eui Dong Yeo
- Department of Orthopedic Surgery, VHS Medical Center, Seoul, Republic of Korea
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Mbela Lusendi F, Matricali GA, Vanherwegen AS, Doggen K, Nobels F. Bottom-up approach to build a 'precision' risk factor classification for diabetic foot ulcer healing. Proof-of-concept. Diabetes Res Clin Pract 2022; 191:110028. [PMID: 35926667 DOI: 10.1016/j.diabres.2022.110028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022]
Abstract
AIMS Diabetic foot ulcers (DFU) have a complex multifactorial pathophysiology. It is crucial to identify essential prognostic variables to streamline therapeutic actions and quality-of-care audits. Although SINBAD and University of Texas (UT), the most frequently used prognostic classification systems, were prospectively validated, not all individual parameters were shown to have consistent associations with healing. In this study, we used a bottom-up approach relying on robust methods to identify independent predictors of DFU healing. METHODS 1,664 DFU patients were included by 34 Belgian diabetic foot clinics (DFCs). Twenty-one patient- and foot-related characteristics were recorded at presentation. Predictors of healing were identified using multivariable Cox proportional hazard regression. Multivariable models were built using backward regression with multiple imputation of missing values and bootstrapping. RESULTS Five essential independent variables were identified: presentation delay, history of minor amputation, ulcer location, surface area and ischemia. This 5 variable-model showed a better performance compared to models based on existing classification systems. CONCLUSIONS A bottom-up approach was used to build a prognostic classification for DFU healing based on large databases. It offers new insights and allows to tailor the classification to certain clinical settings. These 5 parameters could be used as a 'precision classification' for specialized DFCs.
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Affiliation(s)
- Flora Mbela Lusendi
- Health Services Research, Sciensano, Brussel, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | - Giovanni Arnoldo Matricali
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Multidisciplinary Diabetic Foot Clinic, University Hospital Leuven, Leuven, Belgium.
| | | | - Kris Doggen
- Health Services Research, Sciensano, Brussel, Belgium
| | - Frank Nobels
- Multidisciplinary Diabetic Foot Clinic, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.
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9
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Imamura Y, Suzuki K, Saijo H, Tanaka K. Longitudinal physiological remoulding of lower limb skin as a cause of diabetic foot ulcer: a histopathological examination. J Wound Care 2022; 31:S29-S35. [PMID: 36004943 DOI: 10.12968/jowc.2022.31.sup8.s29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Diabetic foot ulcer (DFU) is recognised as a severe complication in patients with type 2 diabetes. With the increasing incidence of diabetes, it represents a major medical challenge. Several models have been proposed to explain its aetiology; however, they have never been assessed by longitudinal histopathological examination, which this study aims to address. METHOD Multiplex-immunofluorescence analysis was carried out with lengthwise serial skin specimens obtained from the medial thigh, lower leg, ankle, dorsum of foot and acrotarsium close to the DFU region of a patient with type 2 diabetes receiving above the knee amputation. RESULTS Proximal-to-distal gradual loss of peripheral nerve was demonstrated, accompanied by compromised capillaries in the superficial papillary plexus and distended CD31-positive capillaries in the dorsum of foot. Neural fibres and capillaries were also significantly compromised in the sweat gland acinus in the ankle and dorsum of foot. Injuries in the superficial papillary plexus, sweat gland acinus, and sweat gland-associated adipose tissues were accompanied by significant infiltration of macrophages. These results indicated that longitudinal impairment of local blood circulation could be the cause of peripheral neuropathy, which initiated ulcer formation. Resultant chronic inflammation, involving sweat gland-associated adipose tissue, gave rise to impairment of wound healing, and thus DFU formation. CONCLUSION Longitudinal histopathological examination demonstrated that impairment of local microvascular circulation (rather than the systemic complication caused by type 2 diabetes) was considered the primary cause of peripheral neuropathy, which initiated ulceration. Together with chronic inflammation in the superficial papillary plexus and sweat gland-associated adipose tissue, it resulted in the development of a DFU. Although this is a study of just one individual's limb, our study provided a unique observation, contributing mechanistic insights into developing novel intervening strategies to prevent and treat DFUs.
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Affiliation(s)
- Yoshinobu Imamura
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Keiji Suzuki
- Department of Radiation Medical Sciences, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Hiroto Saijo
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
| | - Katsumi Tanaka
- Department of Plastic and Reconstructive Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
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10
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Mateen S, Kwaadu KY, Ali S. Diagnosis, imaging, and potential morbidities of the hallux interphalangeal joint os interphalangeus. Skeletal Radiol 2022; 51:1143-1151. [PMID: 34704114 DOI: 10.1007/s00256-021-03946-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 10/16/2021] [Accepted: 10/19/2021] [Indexed: 02/02/2023]
Abstract
Hallux pain is a common entity with a differential diagnoses including hallux valgus, hallux limitus/rigidus, and gout and specifically at the interphalangeal joint (IPJ), flexor hallucis longus (FHL) tenosynovitis, and joint arthrosis. An under-recognized source of pain is the os interphalangeus, an ossicle typically located at the plantar aspect of the hallucal interphalangeal joint. This ossicle is radiographically visible in its ossified form in 2-13% of individuals, but can also be present as an ossified or non-ossified nodule in patients. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone in the FHL tendon, it is an ossicle located in the joint capsule of the IPJ and separated from the tendon by a bursa. When the ossicle is absent, the bursa is also absent and the tendon is attached to the joint capsule. Infrequently, the os may be located eccentrically under the first IPJ and reflect persistence of one of the distal phalanx. Rarely, the os interphalangeus may be dorsal to the IPJ. The os interphalangeus is best evaluated on radiographs, ultrasound, and MRI. Pain is a result of altered mechanics with arthrosis or frictional effects with bursitis, tenosynovitis, or intractable plantar keratosis (IPK). The ossicle may also displace into a dislocated IPJ, preventing reduction. The os interphalangeus may be centrally or eccentrically located, and although originally believed to be a sesamoid bone. This has been found within the plantar joint capsule of the distal hallucal interphalangeal joint and separated from the tendon by a bursa. Uncommonly, the location may be plantar eccentric and reflect persistence of one of the ossification centers of the distal phalanx. Although the ossicle can be imaged with standard AP and lateral radiographs in many cases, in those cases of unexplained pain with no radiographically visible ossicle, and the presence of friction blisters, intractable plantar keratosis (IPK), hyper-extension of the IPJ, hallux limitus/rigidus, or metatarsophalangeal joint (MTPJ) arthrodesis, an MRI or CT should be considered to identify a non-ossified fibrocartilaginous node. This is of particular concern in a patient with a history of underling diabetes mellitus or other metabolic disorders associated with diminished pedal sensation where neurotrophic changes place them most at risk for complications associated with excessive plantar pressure. Pain is a result of altered biomechanics with arthrosis, or frictional effects causing bursitis, tenosynovitis, or IPK. The ossicle may also displace into a dislocated IPJ, preventing reduction. In this article, we will describe the anatomy and imaging appearance of the common os interphalangeus variants and associated complications including frictional effects, arthrosis, and IPK and discuss conservative and surgical management of a symptomatic ossicle.
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Affiliation(s)
- Sara Mateen
- Department of Podiatric Surgery, Temple University Hospital Podiatric Surgical Residency Program, 3401 North Broad Street, Philadelphia, PA, 19140, USA.
| | - Kwasi Y Kwaadu
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA, USA
| | - Sayed Ali
- Department of Radiology, Temple University Hospital, Philadelphia, PA, USA
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11
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Mateen S, Skolnik J, Oresanya L, Choi ET, Meyr AJ. Responsiveness and Inter-Rater Reliability of the Pulse Volume Recording Upstroke Ratio (PVRr). J Foot Ankle Surg 2022; 61:486-489. [PMID: 34663552 DOI: 10.1053/j.jfas.2021.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/15/2021] [Accepted: 09/19/2021] [Indexed: 02/03/2023]
Abstract
The objective of this study was to evaluate a measure of the responsiveness and reliability of the pulse volume recording upstroke ratio (PVRr). A database of 389 subjects undergoing lower extremity revascularization was analyzed. Subjects were included in the analysis if they had undergone pedal radiographs, had PVRs performed pre- and postlower extremity revascularization, and had regular pulsatile digital waveforms with a pressure recording on both PVRs. The responsiveness of the PVRr was assessed by means of the postoperative percent change in comparison to the digital pressures. A statistically significant negative correlation was observed (Pearson -0.421; p = .007) indicating that as digital pressures increased, the PVRr decreased. Further, measurement of the reliability of the PVRr was performed on a selection of 10 recordings by 2 residents and 3 board-certified surgeons. The observed intraclass correlation coefficient of measurements was 0.960. Results of this investigation provide evidence in support of the responsiveness and inter-rater reliability in the calculation of the pulse volume recording upstroke ratio.
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Affiliation(s)
- Sara Mateen
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Jennifer Skolnik
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Lawrence Oresanya
- Clinical Assistant Professor, Department of Vascular Surgery, Temple University Hospital, Philadelphia, PA
| | - Eric T Choi
- Clinical Professor and Chair, Department of Vascular Surgery, Temple University Hospital, Philadelphia, PA
| | - Andrew J Meyr
- Clinical Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
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12
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Meyr AJ, Mateen S, Skolnik J, Choi ET. Approximation of the Ankle-Brachial Index in the Setting of Medial Arterial Calcific Sclerosis. J Foot Ankle Surg 2022; 61:314-317. [PMID: 34602348 DOI: 10.1053/j.jfas.2021.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 02/03/2023]
Abstract
The presence of medial arterial calcific sclerosis is known to cause inaccuracy in the interpretation of noninvasive vascular testing. This substantially limits the utility of an important baseline diagnostic test for peripheral arterial disease. Therefore, the objective of this investigation was to derive a method to effectively factor out calcification in the interpretation of the ankle and digital brachial indices. The noninvasive vascular testing results of 160 subjects were stratified into the absence of calcification, mild calcification, moderate calcification, and severe calcification based on plain film radiographic findings of the infrageniculate vessels. Measurements were then performed of the pulse volume recording (PVR) waveforms at brachial, ankle and digital anatomic levels to include PVR wavelength and PVR upstroke length, with a calculation of the ratio of PVR upstroke length to PVR wavelength. These measurements were compared between groups and then correlated to the ankle and digital brachial indices. A significant difference was observed in the PVR upstroke ratio between the 3 anatomic levels (0.1818 vs 0.2622 vs 0.3191; p < .001), but not between the 4 calcification groups (0.2457 vs 0.2363 vs 0.2694 vs 0.2631; p = .242). A significant negative correlation was observed between the PVR upstroke ratio and the ankle brachial index (ABI) (Pearson -0.454; p = .002) with linear regression indicating the relationship is defined by the formula: Effective ankle brachial index = 1.17 - (1.33 × PVR upstroke ratio at ankle level). A significant negative correlation was also observed between the PVR upstroke ratio and the digital brachial index (Pearson -0.553; p < .001) with linear regression indicating the relationship is defined by the formula: Effective toe brachial index = 1.04 - (1.61 × PVR upstroke ratio at digital level). The results of this investigation demonstrate the feasibility of, and provide equations to approximate, the effective ankle brachial and toe brachial indices in the setting of medial arterial calcification.
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Affiliation(s)
- Andrew J Meyr
- Clinical Professor, Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA.
| | - Sara Mateen
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Jennifer Skolnik
- Resident, Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Eric T Choi
- Clinical Professor and Chair, Department of Vascular Surgery, Temple University Hospital, Philadelphia, PA
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13
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Mashaly M, Kheir MAE, Ibrahim M, Khafagy W. Aerobic bacteria isolated from diabetic foot ulcers of Egyptian patients: types, antibiotic susceptibility pattern and risk factors associated with multidrug-resistant organisms. Germs 2022; 11:570-582. [PMID: 35096674 DOI: 10.18683/germs.2021.1292] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 11/22/2021] [Accepted: 11/28/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Diabetic foot infection (DFI) is one of the common diabetic complications. Pathogens causing DFI and their antibiotic susceptibility vary with location. Therefore, empirical antibiotic therapy should be based on the pathogens that are most likely to be present. Aim: To identify the frequent aerobic bacteria causing DFI with detection of their antibiotic susceptibility to help clinicians in our community choose the best empirical antibiotic for DFI. METHODS Swabs were collected from 104 diabetic foot ulcers (DFUs). Aerobic bacterial cultures were done followed by bacterial identification and antibiotic susceptibility testing on VITEK® 2 system. Extended-spectrum beta-lacatamase (ESBL) detection was performed phenotypically and confirmed by multiplex-PCR for bla CTX-M, bla TEM, and bla SHV genes. RESULTS Aerobic bacterial infection was detected in 82/104 (78.8%) of the DFUs. Gram-negative bacilli (GNB) were isolated more frequently (56.1%) than Gram-positive cocci (GPC) (43.9%). The most common single-isolated bacteria were K. pneumoniae (26.8%), S. aureus and coagulase negative staphylococci (22% for each). The only significant independent predictors of DFI with GNB or GPC were long DM duration and frequent hospitalizations, respectively. The most active antibiotics were amikacin, tigecycline and meropenem for GNB, and linezolid and vancomycin for staphylococci. Multidrug-resistance prevalence was 95.1%. ESBL was detected in 52.6% of Enterobacteriaceae; the bla CTX-M gene was the most common (90%), followed by bla TEM (65%) and bla SHV (35%). Peripheral neuropathy was the single independent predictor for DFI with ESBL producers (adjusted OR=15.5). CONCLUSIONS There is a notable local pattern of DFI bacteriology in our community. Our findings could be valuable in developing the future empirical treatment guidelines for DFIs.
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Affiliation(s)
- Mervat Mashaly
- MD, Assistant Professor, Clinical Pathology Department, Clinical Microbiology Unit, Faculty of Medicine, Mansoura University, El Gomhoryia Street, Mansoura, 35516, Egypt
| | - Mohamed Abo El Kheir
- MD, Professor, General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
| | - Mohamed Ibrahim
- MSc student, General Practitioner, Sherbin Central Hospital, Ministry of Health and Population, Mansoura, 35516, Egypt
| | - Wael Khafagy
- MD, Professor, General Surgery Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt
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14
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Abu-Qamar MZ, Kemp V, Whitehead L. The reported external traumas among people with diabetes-related foot ulcers and their outcomes: A systematic review of case reports. Int Wound J 2022; 19:1370-1388. [PMID: 35040251 PMCID: PMC9493236 DOI: 10.1111/iwj.13731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/19/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022] Open
Abstract
The objective of this systematic review was to collate evidence published in case reports on the reported origins of external traumas that contribute to the development of diabetic foot ulcers and their outcomes. The review also aimed to suggest reporting criteria for external traumas contributing to the development of diabetic foot ulcers. The search strategy led to the identification of 1224 articles across six electronic databases. Additional articles were also sourced from other electronic platforms (Google scholar) and the reference lists of the included case reports. Ninety‐four articles met the inclusion criteria and were published between 1989 and 2020. The included case reports were independently assessed for methodological quality using a Joanna Briggs Institute (JBI) checklist. Following the verbatim extraction of data, the JBI three steps approach to “meta‐aggregation” for managing qualitative data was used to synthesise the data on external traumas that contributed to the development of foot ulcers along with the reported outcome. Information on the included case report characteristics was also extracted. The case reports included 155 patients. Average age was 57.2 years with a range from 17 to 86 years. External traumas were mainly experienced in the domestic setting and were categorised into two main categories, mechanical trauma (n = 87, 60%) or burns (n = 58, 40%). The most frequently reported origins of external trauma were contact with a hot surface, animal bites, friction, and puncture wounds. Although healing was the most frequent outcome, a prolonged time was recorded for the ulcers to heal highlighting the importance of prevention. Prevention might not eradicate origins of external trauma 100%, showing the importance of patient and/or family role in monitoring domestic risks, early detection of ulcer and seeking immediate professional care. Foot ulcers need to be reported against standardised criteria considering local characteristics of the ulcer and the individual's general profile.
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Affiliation(s)
- Ma'en Zaid Abu-Qamar
- Centre for Research in Aged Care, School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Adult Health Nursing, Faculty of Nursing, Mu´tah University, Mu´tah, Jordan
| | - Vivien Kemp
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Lisa Whitehead
- School of Nursing & Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
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15
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Stimulation of Healing of Non-Infected Stagnated Diabetic Wounds by Copper Oxide-Impregnated Wound Dressings. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57101129. [PMID: 34684166 PMCID: PMC8538133 DOI: 10.3390/medicina57101129] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 10/08/2021] [Accepted: 10/15/2021] [Indexed: 12/15/2022]
Abstract
Background and Objective: Copper, a wide spectrum biocide, also plays a key role in angiogenesis and wound healing. Antibacterial wound dressings impregnated with copper oxide microparticles (COD) have been recently cleared by the U.S. FDA and other regulatory bodies for the treatment of acute and chronic wounds, including diabetic wounds. Our objective was to evaluate the capacity of COD in stimulating the healing of non-infected stagnated wounds in diabetic patients initially treated with standard of care (SOC) dressings. Materials and Methods: The trial was divided into the three following phases: 1–2 weeks of screening, during which the patients were treated with SOC dressings; 4 weeks of treatment, during which the COD was applied twice weekly; and 2 weeks of follow-up, during which the patients were again treated with SOC dressings. The wound conditions and sizes were assessed by clinical evaluation and a wound imaging artificial intelligence system. Results: Following 1 month of COD treatment, there was a clear reduction in the mean wound area (53.2%; p = 0.003), an increase in granulation tissue (43.37; p < 0.001), and a reduction in fibrins (47.8%; p = 0.002). In patients with non-weight-bearing wounds, the reduction in wound size was even more dramatic (66.9%; p < 0.001). Conclusions: The results of this study, showing a statistically significant influence of COD on wound healing of hard-to-heal wounds in diabetic patients, strongly supports the notion that copper oxide-impregnated dressings enhance wound healing directly. Further larger controlled studies should be conducted to substantiate our findings.
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16
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Dovell G, Staniszewska A, Ramirez J, Murray I, Ambler GK, Twine CP, Hinchliffe RJ. A systematic review of outcome reporting for interventions to treat people with diabetic foot ulceration. Diabet Med 2021; 38:e14664. [PMID: 34324741 DOI: 10.1111/dme.14664] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Diabetic foot ulceration (DFU) is a challenging clinical problem that affects up to a quarter of patients with diabetes in their lifetime. An agreed set of outcomes for assessing treatments or interventions for DFU has not previously been considered. The aim of this study was to identify outcomes that are reported in clinical studies assessing a treatment or intervention for DFU, to inform the development of a core outcome set (COS). METHODS Systematic literature searches were performed between January 2016 and March 2019. The search strategy was pre-registered with PROSPERO (CRD42019128250). Two authors independently screened abstracts for full text review. Outcomes were extracted from selected papers verbatim and categorized into domains according to established taxonomy. Consistency of outcome reporting was assessed. Overlapping outcomes were merged independently to condense the extracted list of outcomes for use in forthcoming consensus processes. RESULTS Of 4645 abstracts identified, 114 studies met the inclusion criteria. There were 69 randomized studies, 40 prospective studies and 5 protocols. Some 948 outcomes were extracted verbatim. Outcome reporting was consistent for 474 (53%) outcomes. De-duplication left 714 unique verbatim outcomes across 33 domains. Merging of overlapping unique verbatim outcomes established 95 merged outcomes. CONCLUSION This study describes contemporary outcomes reported in studies assessing interventions for DFU. Outcome reporting is considered to be poor as it was consistent in just over half of outcomes extracted. Merging of outcomes has identified 95 outcomes that can be taken forward in the development of a COS.
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Affiliation(s)
- George Dovell
- Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | | | - Jozel Ramirez
- Centre for Surgical Research, University of Bristol, Bristol, UK
| | - Ines Murray
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | - Graeme K Ambler
- Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
| | | | - Robert J Hinchliffe
- Centre for Surgical Research, University of Bristol, Bristol, UK
- Department of Vascular Surgery, North Bristol NHS Trust, Bristol, UK
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17
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Rossboth S, Rossboth B, Schoenherr H, Lechleitner M, Oberaigner W. Risk factors for diabetic foot complications among patients with type 2 diabetes in Austria-A registry-based retrospective cohort study. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00286. [PMID: 34505418 PMCID: PMC8502226 DOI: 10.1002/edm2.286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/23/2021] [Accepted: 06/26/2021] [Indexed: 12/29/2022]
Abstract
Aims Diabetic foot complications, a serious consequence of diabetes mellitus, are associated with a tremendous burden on both individual patients and health care systems. Since prevention strategies may reduce the incidence of this complication, identification of risk factors in large longitudinal studies is essential to optimize early detection and personalized screening of patients at increased risk. Materials and methods We conducted a registry‐based retrospective cohort study using data from 10,688 patients with type 2 diabetes mellitus aged ≥18 years. Cox regression models were used to identify risk factors for foot complications while adjusting for potential confounders. Results We observed 140 diabetic foot complications in our patient cohort. The multivariate Cox regression model revealed neuropathy, peripheral arterial disease and male gender as being positively associated with foot complications. The same effect was detected for nephropathy in the time >10 years after T2DM diagnosis. For higher age at diagnosis and use of insulin, however, a negative association was retrieved. Conclusion Male gender and several diabetes‐related comorbidities were identified as risk factors for subsequent initial foot complications in patients with type 2 diabetes mellitus. These findings suggest that personalized early detection of patients at increased risk might be feasible by using information on demographics, medical history and comorbidities.
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Affiliation(s)
- Sophia Rossboth
- Department of Public Health, Research Unit for Diabetes Epidemiology, Health Services Research and Health Technology Assessment, Medical Informatics and Technology, UMIT-Private University for Health Sciences, Hall i.T., Austria
| | | | - Hans Schoenherr
- Department of Public Health, Research Unit for Diabetes Epidemiology, Health Services Research and Health Technology Assessment, Medical Informatics and Technology, UMIT-Private University for Health Sciences, Hall i.T., Austria.,Department of Internal Medicine, St. Vinzenz Hospital Zams, Zams, Austria
| | | | - Willi Oberaigner
- Department of Public Health, Research Unit for Diabetes Epidemiology, Health Services Research and Health Technology Assessment, Medical Informatics and Technology, UMIT-Private University for Health Sciences, Hall i.T., Austria
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18
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Tuglo LS, Nyande FK, Agordoh PD, Nartey EB, Pan Z, Logosu L, Dei-Hlorlewu AE, Haligah DK, Osafo L, Taful S, Chu M. Knowledge and practice of diabetic foot care and the prevalence of diabetic foot ulcers among diabetic patients of selected hospitals in the Volta Region, Ghana. Int Wound J 2021; 19:601-614. [PMID: 34190402 PMCID: PMC8874051 DOI: 10.1111/iwj.13656] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 05/16/2021] [Indexed: 11/26/2022] Open
Abstract
Diabetic foot ulcers (DFUs) are a common but serious complication of diabetes mellitus (DM). The factors distressing the worth of diabetic foot care (DFC) are knowledge and practice. Foot ulcers are the main cause of amputation and death in people suffering from DM. This study assessed the knowledge and practice of DFC and the prevalence of DFUs and its associated factors among diabetic patients of selected hospitals in the Volta Region, Ghana. A multihospital‐based cross‐sectional study was conducted among 473 patients with DM who were recruited using the systematic sampling method. Data were collected using a validated, pretested, and structured questionnaire, while medical variables were obtained from patient folders and analysed using SPSS version 23. All statistically significant parameters in bivariate analysis were incorporated in the multivariate logistic regression analysis. The results showed that 63% of diabetic patients had good knowledge of DFC, while 49% competently practiced it. A negative correlation was found between knowledge and practice levels of DFC (r = −0.15, P = <.01). The prevalence of DFUs was 8.7% among the studied diabetic patients. Male diabetic patients were 3.4 times more likely to develop DFUs than female diabetic patients (crude odd ratio [cOR] = 3.35; 95% confidence interval [CI] = 1.75‐6.43; P = <.001). Type 1 diabetic patients were five times more likely to develop DFUs than those who had type 2 diabetes (cOR = 5.00; 95% CI = 2.50‐10.00; P = <.001). Diabetic patients who had a family history of diabetes were 4.7 times more likely to develop DFUs than those without family history (adjusted odd ratio [aOR] = 4.66; 95% CI = 1.55‐13.89; P = .006). Those who had diabetes for 5 to 10 years were 3.3 times more likely to develop DFUs than those who had diabetes for less than 5 years (aOR = 3.28; 95% CI = 1.40‐7.67; P = .006). Diabetic patients who had comorbidity were 3.4 times more likely to develop DFUs than those without comorbidity (cOR = 3.35; 95% CI = 1.74‐6.45; P = <.001). The study found that there was good knowledge but poor practices of DFC among patients. Health care providers are expected to better educate patients and emphasise self‐care practices to patients. Health care providers should also give more attention to patients with associated risk factors to avoid further complications and reduce the occurrence of DFUs.
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Affiliation(s)
- Lawrence Sena Tuglo
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, China
| | - Felix Kwasi Nyande
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Percival Delali Agordoh
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Eunice Berko Nartey
- Department of Nutrition and Dietetics, School of Allied Health Sciences, University of Health and Allied Sciences, Ho, Ghana
| | - Zhongqin Pan
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, China
| | - Lydia Logosu
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Atsu Eyram Dei-Hlorlewu
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Desire Koku Haligah
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Linda Osafo
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Simon Taful
- Department of Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Minjie Chu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, China
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19
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Bandeira MA, Dos Santos ALG, Woo K, Gamba MA, de Gouveia Santos VLC. Incidence and Predictive Factors for Amputations Derived From Charcot's Neuroarthropathy in Persons With Diabetes. INT J LOW EXTR WOUND 2021:15347346211025893. [PMID: 34142879 DOI: 10.1177/15347346211025893] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Charcot's neuroarthropathy (CN) is the progressive destruction of the bones and joints of the feet, as a consequence of severe peripheral neuropathy, which predisposes patients to amputations. The purpose of this study was to measure the cumulative incidence of amputations resulting from CN and risk factors among amputated people with diabetes mellitus (DM). This was an epidemiological, observational, and retrospective study of 114 patients with DM who had an amputation involving the lower limbs. Data were collected from 2 specialized outpatient clinics between 2015 and 2019, including socio-demographic and clinical variables (cause of amputation: CN, peripheral arterial disease [PAD], infected ulcers, fracture, osteomyelitis, and others; body mass index [BMI]; 1 or 2 DM, time since DM diagnosis, insulin treatment, glycated hemoglobin; creatinine; smoking and drinking; systemic arterial hypertension, diabetic retinopathy, diabetic kidney disease, diabetic peripheral neuropathy, acute myocardial infarction, PAD, and stroke; characteristics of amputation [level and laterality], in addition to the specific variables related to CN [time of amputation in relation to the diagnosis of CN, diagnosis of CN in the acute phase, and treatment implemented in the acute phase]). We compared socio-demographic and clinical characteristics, including types of amputation, between patients with and without CN. Statistical analyses were performed using the 2 sample t-test or Wilcoxon-Mann-Whitney test, for quantitative variables, and the Pearson's χ2 test or Fisher's exact test for categorical variables. The investigation of the possible association of predictive factors for a CN amputation was carried out through logistic regression. The amputation caused by CN was present in 27 patients with a cumulative incidence of 23.7% in 5 years. There was a statistically significant association between BMI and the occurrence of CN (odds ratio: 1.083; 95% confidence interval: 1.001-1.173; P = .048); higher values of BMI were associated with a higher occurrence of amputations secondary from CN.
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Affiliation(s)
| | | | - Kevin Woo
- 4257Queen's University, Kingston, Ontario, Canada
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20
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Griffiths DA, Kaminski MR. Duration of total contact casting for resolution of acute Charcot foot: a retrospective cohort study. J Foot Ankle Res 2021; 14:44. [PMID: 34130722 PMCID: PMC8204579 DOI: 10.1186/s13047-021-00477-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 04/29/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Charcot neuroarthropathy (Charcot foot) is a highly destructive joint disease of the foot and ankle. If there is delayed diagnosis and treatment, it can lead to gross deformity, instability, recurrent ulceration and/or amputation. Total contact casting (TCC) is a treatment commonly used to immobilise the foot and ankle to prevent trauma, further destruction and preserve the foot structure during the inflammatory phase. At present, there is limited Australian data regarding the duration of TCC treatment for resolution of acute Charcot foot, and whether there are any patient and clinical factors affecting its duration. Therefore, this study aimed to address these deficiencies. METHODS This study presents a retrospective analysis of 27 patients with acute Charcot foot attending for TCC treatment at a high-risk foot service (HRFS) in a large metropolitan health network in Melbourne, Australia. Over a three-year period, data were retrospectively collected by reviewing hospital medical records for clinical, demographic, medical imaging and foot examination information. To explore between-group differences, independent samples t-tests, Mann-Whitney U tests, Chi-square tests, and/or Fisher's exact tests were calculated depending on data type. To evaluate associations between recorded variables and duration of TCC treatment, mean differences, odds ratios (OR) and 95% confidence intervals were calculated. RESULTS Mean age was 57.9 (SD, 12.6) years, 66.7% were male, 88.9% had diabetes, 96.3% had peripheral neuropathy, and 33.3% had peripheral arterial disease. Charcot misdiagnosis occurred in 63.0% of participants, and signs and symptoms consistent with acute Charcot foot were present for a median of 2.0 (IQR, 1.0 to 6.0) months prior to presenting or being referred to the HRFS. All participants had stage 1 Charcot foot. Of these, the majority were located in the tarsometatarsal joints (44.4%) or midfoot (40.7%) and were triggered by an ulcer or traumatic injury (85.2%). The median TCC duration for resolution of acute Charcot foot was 4.3 (IQR, 2.7 to 7.8) months, with an overall complication rate of 5% per cast. Skin rubbing/irritation (40.7%) and asymmetry pain (22.2%) were the most common TCC complications. Osteoarthritis was significantly associated with a TCC duration of more than 4 months (OR, 6.00). Post TCC treatment, 48.1% returned to footwear with custom foot orthoses, 25.9% used a life-long Charcot Restraint Orthotic Walker, and 22.2% had soft tissue or bone reconstructive surgery. There were no Charcot recurrences, however, contralateral Charcot occurred in 3 (11.1%) participants. CONCLUSIONS The median TCC duration for resolution of acute Charcot foot was 4 months, which is shorter or comparable to data reported in the United Kingdom, United States, Europe, and other Asia Pacific countries. Osteoarthritis was significantly associated with a longer TCC duration. The findings from this study may assist clinicians in providing patient education, managing expectations and improving adherence to TCC treatment for acute Charcot neuroarthropathy cases in Australia.
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Affiliation(s)
| | - Michelle R Kaminski
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia. .,Department of Podiatry, St Vincent's Hospital Melbourne, Melbourne, Victoria, 3065, Australia.
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Effects of Custom-Made Insole Materials on Frictional Stress and Contact Pressure in Diabetic Foot with Neuropathy: Results from a Finite Element Analysis. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11083412] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Offloading plantar pressure in a diabetic foot with neuropathy is challenging in conventional clinical practice. Custom-made insole (CMI) materials play an important role in plantar pressure reduction, but the assessment is costly and time-consuming. Finite element analysis (FEA) can provide an efficient evaluation of different insoles on the plantar pressure distribution. This study investigated the effect of CMI materials and their combinations on plantar pressure reduction for the diabetic foot with neuropathy using FEA. The study was conducted by constructing a three-dimensional foot model along with CMI to study the peak contact pressure between the foot and CMI. The softer material (E = 5 MPa) resulted in a better reduction of peak contact pressure compared with the stiffer material (E = 11 MPa). The plantar pressure was well redistributed with softer material compared with the stiffer material and its combination. In addition, the single softer material resulted in reduced frictional stress under the first metatarsal head compared with the stiffer material and the combination of materials. The softer material and its combination have a beneficial effect on plantar pressure reduction and redistribution for a diabetic foot with neuropathy. This study provided an effective approach for CMI material selection using FEA.
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Vergès B, Brands R, Fourmont C, Petit JM, Simoneau I, Rouland A, Legris P, Bouillet B, Chauvet-Gélinier JC. Fewer Type A personality traits in type 2 diabetes patients with diabetic foot ulcer. DIABETES & METABOLISM 2021; 47:101245. [PMID: 33722768 DOI: 10.1016/j.diabet.2021.101245] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/26/2021] [Accepted: 03/01/2021] [Indexed: 12/30/2022]
Abstract
AIM Type A personality-characterized by time urgency, strong drive, and a need for achievement and competitiveness-has been shown to be associated with reduced mortality in patients with diabetes. However, it is not known whether a Type A personality might protect against diabetic foot ulcer (DFU). This prompted our present analysis of the association between Type A personality and DFU. METHODS The Bortner Scale questionnaire was used to assess Type A personality in 386 patients with type 2 diabetes (T2D), including 104 patients also presenting with, and 282 presenting without, DFU. Additional questionnaires were used to assess perceived stress and depression. RESULTS Type A Bortner scores were significantly lower in T2D patients with vs without DFU (166.64 ± 38.76 vs 178.79 ± 36.61, respectively; P = 0.005). In patients with DFU, the prevalence of Type A personality traits was significantly lower than in those without DFU (48% vs 64.5%, respectively; P = 0.005) whereas, in contrast, Type B personality traits (the opposite of Type A) were more prevalent (52% vs 35.5%, respectively; P = 0.005). On multivariate analysis, Type A Bortner scores were negatively associated with DFU (P = 0.008) independently of age, gender, BMI, depression scores or perceived stress. CONCLUSION The Type A personality, characterized by competitiveness and a need for achievement, is significantly less frequently seen in T2D patients with DFU. On the other hand, the Type B personality is much more prevalent in such patients. It may be that the Type B personality, which is characterized by fewer problem-focused coping strategies and a decreased adherence to care, might favour the development of DFU.
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Affiliation(s)
- Bruno Vergès
- CHU Dijon, Department of Endocrinology-Diabetology, Dijon, France; University of Burgundy, INSERM LNC UMR1231, Dijon, France.
| | - Roxane Brands
- CHU Dijon, Department of Endocrinology-Diabetology, Dijon, France
| | - Coralie Fourmont
- CHU Dijon, Department of Endocrinology-Diabetology, Dijon, France
| | - Jean-Michel Petit
- CHU Dijon, Department of Endocrinology-Diabetology, Dijon, France; University of Burgundy, INSERM LNC UMR1231, Dijon, France
| | - Isabelle Simoneau
- CHU Dijon, Department of Endocrinology-Diabetology, Dijon, France; University of Burgundy, INSERM LNC UMR1231, Dijon, France
| | - Alexia Rouland
- CHU Dijon, Department of Endocrinology-Diabetology, Dijon, France; University of Burgundy, INSERM LNC UMR1231, Dijon, France
| | - Pauline Legris
- CHU Dijon, Department of Endocrinology-Diabetology, Dijon, France
| | - Benjamin Bouillet
- CHU Dijon, Department of Endocrinology-Diabetology, Dijon, France; University of Burgundy, INSERM LNC UMR1231, Dijon, France
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Linton C, Searle A, Hawke F, Tehan PE, Chuter V. Nature and extent of outpatient podiatry service utilisation in people with diabetes undergoing minor foot amputations: a retrospective clinical audit. J Foot Ankle Res 2021; 14:6. [PMID: 33435997 PMCID: PMC7805117 DOI: 10.1186/s13047-020-00445-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/26/2020] [Indexed: 11/17/2022] Open
Abstract
Background People with diabetes are at high risk of foot complications that can lead to lower extremity amputations. National standards suggest that early assessment and management by a podiatry led multidisciplinary high-risk foot clinic (HRFC) helps to reduce complications. This review is a retrospective audit of the Central Coast Local Health District (CCLHD) podiatry department service utilisation in people with diabetes who had undergone a minor foot amputation. Methods All people with diabetes who had minor foot amputations in the calendar year 2017 in the CCLHD in New South Wales were identified. Podiatry occasions of service from all podiatry service clinics (e.g. general, orthoses, wound, HRFC) and hospital stays for 12 months prior to, and 12 months, post the minor foot amputation were extracted. Results Data on 74 people with diabetes who underwent 85 minor foot amputations were collected. In the 12-month period leading up to their minor foot amputation less than half, 42% (n=31), of the patients had attended any of the available podiatry service clinics within the CCLHD system. Post-amputation and discharge from hospital there was an overall rise of 26% in numbers attending all CCLHD podiatry- led clinics bringing the total to 68% (51). However, attendance at the HRFC rose by only 2% from 16% (n=12) to 18% n= (13). Conclusion This study shows that there was underutilisation of Podiatry Services in the CCLHD in 2017 with some participants not meeting national treatment guidelines for foot health services. Revision of current referral pathways both prior to, during and following hospitalisation and expanding the multidisciplinary HRFC to accommodate the population by providing more accessible locations has since been undertaken to increase service access. Further provision of education to those highlighted to be at high risk has also been implemented.
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Affiliation(s)
- Clare Linton
- BE130 Health Precinct, Brush Road, Ourimbah, NSW, 2258, Australia. .,Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia. .,School of Health Sciences, Faculty of Health and Medicine, The University of Newcastle, Ourimbah, NSW, Australia.
| | - Angela Searle
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
| | - Fiona Hawke
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
| | - Peta Ellen Tehan
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
| | - Vivienne Chuter
- Central Coast Local Health District, Gosford Hospital, Holden St, Gosford, NSW, Australia
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Liao F, Zhang K, Zhou L, Chen Y, Elliott J, Jan YK. Effect of Different Local Vibration Frequencies on the Multiscale Regularity of Plantar Skin Blood Flow. ENTROPY 2020; 22:e22111288. [PMID: 33287056 PMCID: PMC7712514 DOI: 10.3390/e22111288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
Local vibration has shown promise in improving skin blood flow (SBF). However, there is no consensus on the selection of the best vibration frequency. An important reason may be that previous studies utilized time- and frequency-domain parameters to characterize vibration-induced SBF responses. These parameters are unable to characterize the structural features of the SBF response to local vibrations, thus contributing to the inconsistent findings seen in vibration research. The objective of this study was to provide evidence that nonlinear dynamics of SBF responses would be an important aspect for assessing the effect of local vibration on SBF. Local vibrations at 100 Hz, 35 Hz, and 0 Hz (sham vibration) with an amplitude of 1 mm were randomly applied to the right first metatarsal head of 12 healthy participants for 10 min. SBF at the same site was measured for 10 min before and after local vibration. The degree of regularity of SBF was quantified using a multiscale sample entropy algorithm. The results showed that 100 Hz vibration significantly increased multiscale regularity of SBF but 35 Hz and 0 Hz (sham vibration) did not. The significant increase of regularity of SBF after 100 Hz vibration was mainly attributed to increased regularity of SBF oscillations within the frequency interval at 0.0095–0.15 Hz. These findings support the use of multiscale regularity to assess effectiveness of local vibration on improving skin blood flow.
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Affiliation(s)
- Fuyuan Liao
- Department of Biomedical Engineering, Xi’an Technological University, Xi’an 710021, China;
| | - Keying Zhang
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA; (K.Z.); (L.Z.)
| | - Lingling Zhou
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA; (K.Z.); (L.Z.)
| | - Yanni Chen
- Department of Pediatrics, Xi’an Jiaotong University Health Science Center, Xi’an 710021, China;
| | - Jeannette Elliott
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA;
| | - Yih-Kuen Jan
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA; (K.Z.); (L.Z.)
- Correspondence: ; Tel.: +1-217-300-7253
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25
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Abu-Qamar MZ, Kemp V, Whitehead L. Foot ulcers associated with external trauma among people with diabetes: An integrative review of the origin of trauma and outcomes. Int J Nurs Stud 2020; 114:103822. [PMID: 33248292 DOI: 10.1016/j.ijnurstu.2020.103822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Foot ulcers are common among people with diabetes. These ulcers are caused by a number of factors including trauma. To date, research findings on the origin of external trauma and the outcome of foot ulcers resulting from an external trauma have not been summarised. OBJECTIVE To examine the origin of external trauma that contribute to the development of foot ulcers among people with diabetes and the outcome of such ulcers. DESIGN An integrative review. SETTINGS Hospital/community. PARTICIPANTS Patients with diabetes and foot ulcer. METHOD The Joanna Briggs framework was used to underpin this integrative review. Six different databases (CINAHL +, Medline, SCOPUS, Embase, ProQuest and Web of Science databases) were searched systematically to find research publications reporting traumas that contributed to foot ulcers sustained by people with diabetes. The search was limited to articles published in English. The search revealed 3193 articles that were filtered to 78 articles to be assessed at the full-text level and 45 articles were subsequently included. Quality appraisal was conducted independently by two reviewers, using the Joanna Briggs Institute (JBI) Critical Appraisal tools. Data were extracted into a form developed for the purpose of this review. Narrative synthesis was used to manage the extracted verbatim details on the origin of external trauma contributing to foot ulcers and the outcomes. RESULTS The origins of external trauma were summarised into two domains and further specified into 16 categories. The identified traumas were mainly minor and originated within the home environment. The most commonly reported origins of external trauma were puncture wounds, ill-fitting shoes and self-care practices that caused foot ulcers. Twenty-seven studies reported outcomes following the development of an ulcer. Twenty-two studies reported amputation as an outcome and mortality was reported in 10 studies. It was not clear whether these outcomes were directly related to the foot ulcer or related to other diabetes-related complications. CONCLUSIONS The majority of ulcers occurred in the home environment and were preventable in nature. The assessment of an individual's local context, particularly the home and actions to reduce risk is a priority. The extent of the risks related to external trauma need to be more widely communicated through clinical guidelines and training opportunities for frontline staff. TWEETABLE ABSTRACT The main origins of external foot trauma among people with diabetes were puncture wounds, ill-fitting footwear and self-care practices.
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Affiliation(s)
- Ma'en Zaid Abu-Qamar
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia; Department of Adult Health Nursing, Faculty of Nursing, Mu´tah University, Mu´tah, Jordan.
| | - Vivien Kemp
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia.
| | - Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, 270 Joondalup Drive, Joondalup, WA 6027, Australia.
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26
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Henshaw FR, Bostan LE, Worsley PR, Bader DL. Evaluating the effects of sedentary behaviour on plantar skin health in people with diabetes. J Tissue Viability 2020; 29:277-283. [PMID: 32943281 DOI: 10.1016/j.jtv.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 08/31/2020] [Accepted: 09/01/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND Diabetes-Related Foot Ulcers (DRFUs) are a common and devastating consequence of Diabetes Mellitus and are associated with high morbidity, mortality, social and economic costs. Whilst peak plantar pressures during gait are implicated cited as a major contributory factor, DRFU occurrence has also been associated with increased periods of sedentary behaviour. The present study was designed aimed to assess the effects of sitting postures on plantar tissue health. METHODS After a period of acclimatisation, transcutaneous oxygen tensions (TCPO2) and inflammatory cytokines (IL-1α and IL-1RA) were measured at the dorsal and plantar aspects of the forefoot before, during and after a 20-min period of seated-weight-bearing in participants with diabetes (n = 11) and no diabetes (n = 10). Corresponding interface pressures at the plantar site were also measured. RESULTS During weight-bearing, participants with diabetes showed increases in tissue ischaemia which were linearly correlated proportional to plantar pressures (Pearson's r = 0.81; p < 0.05). Within the healthy group, no such correlation was evident (p > 0.05). There were also significant increases in post seated weight-bearing values for ratio for IL-1α and IL-1RA, normalised to total protein, post seated weight-bearing in participants with diabetes compared to healthy controls. CONCLUSION This study shows that prolonged sitting may be detrimental to plantar skin health. It highlights the need to further examine the effects of prolonged sitting in individuals, who may have a reduced tolerance to loading in the plantar skin and soft tissues.
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Affiliation(s)
- F R Henshaw
- School of Health Sciences, Western Sydney University, Sydney, Australia.
| | - L E Bostan
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - P R Worsley
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - D L Bader
- Clinical Academic Facility, Faculty of Health Sciences, University of Southampton, Southampton, UK
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Henshaw FR, Reid IB, Spencer AM, Turner DE. Point of care ultrasound imaging as a wound assessment tool in diabetic foot ulcers: a case series. J Wound Care 2020; 29:S28-S34. [DOI: 10.12968/jowc.2020.29.sup8.s28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Foot ulceration is a common and devastating complication of diabetes. Traditionally, diabetic foot ulcers (DFU) are managed by multidisciplinary teams in tertiary hospital settings. Wound management decisions are based largely on visual observations at the point of care, using rudimentary evaluation of superficial tissues, such as wound tracings and photography combined with expert knowledge of the treating practitioners. Imaging based methods of assessment, such as X-ray, magnetic resonance imaging, scintigraphy or computed tomography are able to more comprehensively categorise wounds and to determine whether re-epithelialised wounds are in fact healed. Ultrasound has been advocated by the World Health Organization for the monitoring of chronic diseases and for screening because it is considered low risk, comfortable for patients and low cost. It can be performed in real time at the point of care and using B-mode, Doppler and elastography has the potential to provide clinically meaningful information for monitoring the status of hard-to-heal wounds, but to date this imaging technique has not been exploited in this field. This case series highlights the utility of diagnostic musculoskeletal ultrasound as an adjunct to traditional wound assessment that can provide diagnostically meaningful information to assist in clinical decision making. Future research will be needed to determine if routine incorporation of ultrasound in wound assessment improves patient outcomes.
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Affiliation(s)
- Frances R Henshaw
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Royal North Shore Hospital, North Sydney-Ryde Health Service, St. Leonards, NSW, Australia
| | - Ian B Reid
- Royal North Shore Hospital, North Sydney-Ryde Health Service, St. Leonards, NSW, Australia
| | - Anna M Spencer
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
| | - Deborah E Turner
- School of Health Sciences, Western Sydney University, Campbelltown, NSW, Australia
- Queensland University of Technology, Brisbane, Queensland, Australia
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28
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Lauri C, Glaudemans AW, Campagna G, Keidar Z, Muchnik Kurash M, Georga S, Arsos G, Noriega-Álvarez E, Argento G, Kwee TC, Slart RH, Signore A. Comparison of White Blood Cell Scintigraphy, FDG PET/CT and MRI in Suspected Diabetic Foot Infection: Results of a Large Retrospective Multicenter Study. J Clin Med 2020; 9:jcm9061645. [PMID: 32486304 PMCID: PMC7356770 DOI: 10.3390/jcm9061645] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
Diabetic foot infections (DFIs) represent one of the most frequent and disabling morbidities of longstanding diabetes; therefore, early diagnosis is mandatory. The aim of this multicenter retrospective study was to compare the diagnostic accuracy of white blood cell scintigraphy (WBC), 18F-fluorodeoxyglucose positron emission tomography/computed tomography ((18F) FDG PET/CT), and Magnetic Resonance Imaging (MRI) in patients with suspected DFI. Images and clinical data from 251 patients enrolled by five centers were collected in order to calculate the sensitivity, specificity, and accuracy of WBC, FDG, and MRI in diagnosing osteomyelitis (OM), soft-tissue infection (STI), and Charcot osteoarthropathy. In OM, WBC acquired following the European Society of Nuclear Medicine (EANM) guidelines was more specific and accurate than MRI (91.9% vs. 70.7%, p < 0.0001 and 86.2% vs. 67.1%, p = 0.003, respectively). In STI, both FDG and WBC achieved a significantly higher specificity than MRI (97.9% and 95.7% vs. 83.6%, p = 0.04 and p = 0.018, respectively). In Charcot, both MRI and WBC demonstrated a significantly higher specificity and accuracy than FDG (88.2% and 89.3% vs. 62.5%, p = 0.0009; 80.3% and 87.9% vs. 62.1%, p < 0.02, respectively). Moreover, in Charcot, WBC was more specific than MRI (89.3% vs. 88.2% p < 0.0001). Given the limitations of a retrospective study, WBC using EANM guidelines was shown to be the most reliable imaging modality to differentiate between OM, STI, and Charcot in patients with suspected DFI.
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Affiliation(s)
- Chiara Lauri
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (C.L.); (G.C.)
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands; (A.W.J.M.G.); (T.C.K.); (R.H.J.A.S.)
| | - Andor W.J.M. Glaudemans
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands; (A.W.J.M.G.); (T.C.K.); (R.H.J.A.S.)
| | - Giuseppe Campagna
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (C.L.); (G.C.)
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, 3109601 Haifa, Israel; (Z.K.); (M.M.K.)
| | - Marina Muchnik Kurash
- Department of Nuclear Medicine, Rambam Health Care Campus, 3109601 Haifa, Israel; (Z.K.); (M.M.K.)
| | - Stamata Georga
- 3rd Department of Nuclear Medicine, Aristotle University Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (S.G.); (G.A.)
| | - Georgios Arsos
- 3rd Department of Nuclear Medicine, Aristotle University Medical School, Papageorgiou General Hospital, 56403 Thessaloniki, Greece; (S.G.); (G.A.)
| | - Edel Noriega-Álvarez
- Department of Nuclear Medicine, University Hospital of Ciudad Real, 13005 Ciudad Real, Spain;
| | - Giuseppe Argento
- Radiology Unit, Sant’Andrea University Hospital, 00189 Rome, Italy;
| | - Thomas C. Kwee
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands; (A.W.J.M.G.); (T.C.K.); (R.H.J.A.S.)
| | - Riemer H.J.A. Slart
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands; (A.W.J.M.G.); (T.C.K.); (R.H.J.A.S.)
- Department of Biomedical Photonic Imaging, Faculty of Science and Technology, University of Twente, 7500 Enschede, The Netherlands
| | - Alberto Signore
- Nuclear Medicine Unit, Department of Medical-Surgical Sciences and of Translational Medicine, “Sapienza” University of Rome, 00161 Rome, Italy; (C.L.); (G.C.)
- Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, 9700 Groningen, The Netherlands; (A.W.J.M.G.); (T.C.K.); (R.H.J.A.S.)
- Correspondence: ; Tel.: +39-06-3377-6191
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Lee JH, Yoon JS, Lee HW, Won KC, Moon JS, Chung SM, Lee YY. Risk factors affecting amputation in diabetic foot. Yeungnam Univ J Med 2020; 37:314-320. [PMID: 32370489 PMCID: PMC7606965 DOI: 10.12701/yujm.2020.00129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 04/14/2020] [Indexed: 12/13/2022] Open
Abstract
Background A diabetic foot is the most common cause of non-traumatic lower extremity amputations (LEA). The study seeks to assess the risk factors of amputation in patients with diabetic foot ulcers (DFU). Methods The study was conducted on 351 patients with DFUs from January 2010 to December 2018. Their demographic characteristics, disease history, laboratory data, ankle-brachial index, Wagner classification, osteomyelitis, sarcopenia index, and ulcer sizes were considered as variables to predict outcome. A chi-square test and multivariate logistic regression analysis were performed to test the relationship of the data gathered. Additionally, the subjects were divided into two groups based on their amputation surgery. Results Out of the 351 subjects, 170 required LEA. The mean age of the subjects was 61 years and the mean duration of diabetes was 15 years; there was no significant difference between the two groups in terms of these averages. Osteomyelitis (hazard ratio [HR], 6.164; 95% confidence interval [CI], 3.561−10.671), lesion on percutaneous transluminal angioplasty (HR, 2.494; 95% CI, 1.087−5.721), estimated glomerular filtration rate (eGFR; HR, 0.99; 95% CI, 0.981−0.999), ulcer size (HR, 1.247; 95% CI, 1.107−1.405), and forefoot ulcer location (HR, 2.475; 95% CI, 0.224−0.73) were associated with risk of amputation. Conclusion Osteomyelitis, peripheral artery disease, chronic kidney disease, ulcer size, and forefoot ulcer location were risk factors for amputation in diabetic foot patients. Further investigation would contribute to the establishment of a diabetic foot risk stratification system for Koreans, allowing for optimal individualized treatment.
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Affiliation(s)
| | - Ji Sung Yoon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Hyoung Woo Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Kyu Chang Won
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Sung Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
| | - Seung Min Chung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Yin Young Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
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Allicin alleviates inflammation of diabetic macroangiopathy via the Nrf2 and NF-kB pathway. Eur J Pharmacol 2020; 876:173052. [PMID: 32135124 DOI: 10.1016/j.ejphar.2020.173052] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 02/26/2020] [Accepted: 02/28/2020] [Indexed: 01/04/2023]
Abstract
As diabetic macroangiopathy is becoming increasingly prevalent, it is urgent to explore preventive and therapeutic drugs and study the mechanism. Diabetic mice were induced by intraperitoneal injection of streptozotocin (STZ)for five consecutive days. Diabetic mice were divided into diabetic and allicin groups. After sacrifice, frozen aortic root sections were immunohistochemically stained for nuclear factor erythroid 2-related factor 2 (Nrf2) and inflammation cytokine-tumor necrosis factor α (TNF-α), and the remaining aortic tissues were analyzed by Western blot for the expression of proinflammation genes. In vitro, Nrf2 and inflammatory relative protein expression levels in Human Umbilical Vein Endothelial Cells (HUVECs) were examined. HUVECs proliferation and apoptosis were measured. TNF-α expression was increased in diabetic group compared to that in control group; this effect was alleviated in allicin-treated mice. Inflammation relative protein expression of Vascular Cell Adhesion Molecule 1(VCAM-1), Matrix metalloproteinase 2 (MMP-2), Inducible Nitric Oxide Synthase (iNOS), and monocyte chemotactic protein 1 (MCP-1) was higher in the diabetic group than in the control group; however, allicin treatment inhibited these diabetes-induced increase. In vitro, allicin treatment reversed the hyperglycemia-induced reduction in proliferation, and decreased the apoptosis induced by high glucose. Inflammation relative protein expression was consistent with that in vivo. Additionally, the expression of nuclear factor kappa-B (NF-κB)and Nrf2 was increased in both DM mice and HUVECs; allicin treatment induced a significant reduction in NF-κB level and improvement in Nrf2 level. Allicin alleviates inflammation caused by diabetic macroangiopathy, and the mechanism may occur via increasing Nrf2 and decreasing NF-κB.
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Zhu X, Wu FL, Zhu T, Liao F, Ren Y, Jan YK. Effects of Preconditioning Local Vibrations on Subsequent Plantar Skin Blood Flow Response to Walking. INT J LOW EXTR WOUND 2020; 20:143-149. [DOI: 10.1177/1534734620905744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Weight-bearing exercise such as walking may increase risk of foot ulcers in people with diabetes mellitus (DM) because of plantar ischemia due to repetitive, high plantar pressure. Applications of local vibrations on plantar tissues as a preconditioning intervention before walking may reduce plantar tissue ischemia during walking. The objective of this study was to explore whether preconditioning local vibrations reduce reactive hyperemia after walking. A double-blind, repeated-measures, and crossover design was tested in 10 healthy participants without DM. The protocol included 10-minute baseline, 10-minute local vibrations (100 Hz or sham), 10-minute walking, and 10-minute recovery periods. The order of local vibrations was randomly assigned. Skin blood flow (SBF) was measured over the first metatarsal head during baseline and recovery periods. SBF responses were characterized as peak SBF, total SBF, and recovery time of reactive hyperemia. SBF was expressed as a ratio of recovery to baseline SBF to quantify the changes. Peak SBF in the vibration protocol (6.98 ± 0.87) was significantly lower than the sham control (9.26 ± 1.34, P < .01). Total SBF in the vibration protocol ([33.32 ± 7.98] × 103) was significantly lower than the sham control ([48.09 ± 8.9] × 103, P < .05). The recovery time in the vibration protocol (166.08 ± 32.71 seconds) was not significantly different from the sham control (223.53 ± 38.85 seconds, P = .1). Local vibrations at 100 Hz could reduce walking-induced hyperemic response on the first metatarsal head. Our finding indicates that preconditioning local vibrations could be a potential preventive intervention for people at risk for foot ulcers.
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Affiliation(s)
- Xiaotong Zhu
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Fu-Lien Wu
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Ting Zhu
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Fuyuan Liao
- Xi’an Technological University, Xi’an, Shaanxi, China
| | | | - Yih-Kuen Jan
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Beihang University, Beijing, China
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32
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Mineoka Y, Ishii M, Hashimoto Y, Yamashita A, Nakamura N, Fukui M. Platelet to lymphocyte ratio correlates with diabetic foot risk and foot ulcer in patients with type 2 diabetes. Endocr J 2019; 66:905-913. [PMID: 31217392 DOI: 10.1507/endocrj.ej18-0477] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Diabetic foot ulcer is a major complication in patients with diabetes. Platelet-lymphocyte ratio (PLR) has been reported to have a predictive effect to some diabetic complications in recent years. However, it has not been fully elucidated about the relationship between diabetic foot risk or diabetic foot ulcer and PLR in patients with type 2 diabetes. Therefore, we aimed to evaluate this relationship. In this cross-sectional study, we evaluated the relationships between patient's diabetic foot risk with the criteria of the International Working Group on the Diabetic Foot (IWGDF) and prevalent foot ulcer, and PLR in 453 consecutive patients with type 2 diabetes. Propensity score analysis was used to adjust the difference of covariates; age, sex, duration of diabetes, body mass index (BMI), HbA1c, current smoking, hypertension, dyslipidemia, neuropathy, PAD, foot deformity and history of foot ulcers. PLR was higher in patients with high risk diabetic foot or foot ulcer (117 ± 40 vs. 107 ± 31, p = 0.003 and 148 ± 65 vs. 113 ± 56, p < 0.001). A receiver-operating characteristic curve demonstrated that PLR of 130.6 constitutes the cut-off value for prevalent foot ulcer with sensitivity 0.85 and specificity 0.70. Multivariate logistic regression analysis revealed that PLR was positively correlated with prevalent foot ulcer (odds ratio, 1.02; 95% confidence interval 1.01-1.04, p = 0.003) after adjusted for several variables with propensity score analysis. Our results demonstrated that PLR can be a marker for high risk diabetic foot and diabetic foot ulcer in patients with type 2 diabetes.
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Affiliation(s)
- Yusuke Mineoka
- Department of Internal Medicine, Otsu City Hospital, Otsu, Japan
| | - Michiyo Ishii
- Department of Internal Medicine, Otsu City Hospital, Otsu, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Aki Yamashita
- Department of Nursing, Otsu City Hospital, Otsu, Japan
| | - Naoto Nakamura
- Department of Internal Medicine, Saiseikai Kyoto Hospital, Nagaoka, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Current Therapeutic Strategies in Diabetic Foot Ulcers. Medicina (B Aires) 2019; 55:medicina55110714. [PMID: 31731539 PMCID: PMC6915664 DOI: 10.3390/medicina55110714] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/16/2019] [Accepted: 10/21/2019] [Indexed: 01/07/2023] Open
Abstract
Diabetic foot ulcers (DFUs) are the fastest growing chronic complication of diabetes mellitus, with more than 400 million people diagnosed globally, and the condition is responsible for lower extremity amputation in 85% of people affected, leading to high-cost hospital care and increased mortality risk. Neuropathy and peripheral arterial disease trigger deformities or trauma, and aggravating factors such as infection and edema are the etiological factors for the development of DFUs. DFUs require identifying the etiology and assessing the co-morbidities to provide the correct therapeutic approach, essential to reducing lower-extremity amputation risk. This review focuses on the current treatment strategies for DFUs with a special emphasis on tissue engineering techniques and regenerative medicine that collectively target all components of chronic wound pathology.
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Morey M, O'Gaora P, Pandit A, Hélary C. Hyperglycemia acts in synergy with hypoxia to maintain the pro-inflammatory phenotype of macrophages. PLoS One 2019; 14:e0220577. [PMID: 31415598 PMCID: PMC6695165 DOI: 10.1371/journal.pone.0220577] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 07/18/2019] [Indexed: 12/21/2022] Open
Abstract
Diabetic foot ulcers (DFUs) are characterized by a chronic inflammation state which prevents cutaneous wound healing, and DFUs eventually lead to infection and leg amputation. Macrophages located in DFUs are locked in an pro-inflammatory phenotype. In this study, the effect of hyperglycemia and hypoxia on the macrophage phenotype was analyzed. For this purpose, a microarray was performed to study the gene expression profile of macrophages cultivated in a high glucose concentration. Hyperglycemia upregulated the expression of pro-inflammatory cytokines such as TNF-α, IL-1, IL-6, chemokines and downregulated the expression of two receptors involved in phagocytosis (CD 36 and Class B scavenger type I receptors). In addition, eleven anti-apoptotic factors were upregulated whereas three pro-apoptotic genes were downregulated. Subsequently, the contribution of hypoxia and hyperglycemia to chronic inflammation and their potential synergistic effect was evaluated on activated THP-1 derived macrophages. A long term post activation effect (17 hours) was only observed on the upregulation of pro-inflammatory cytokines when hypoxia was combined with a high glucose concentration. In contrast, hyperglycemia and hypoxia did not have any effect on wound healing molecules such as TGF-β1. Taken together, the results show that hyperglycemia acts in synergy with hypoxia to maintain a chronic inflammation state in macrophages.
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Affiliation(s)
- Mangesh Morey
- CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
| | - Peadar O'Gaora
- UCD School of Biomedical and Biomolecular Science, University College Dublin, Belfield, Dublin, Ireland
| | - Abhay Pandit
- CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
- * E-mail: (AP); (CH)
| | - Christophe Hélary
- CÚRAM, Centre for Research in Medical Devices, National University of Ireland Galway, Galway, Ireland
- Sorbonne Université, CNRS, Collège de France, Laboratoire de Chimie de la Matière Condensée de Paris,place Jussieu, Paris, France
- * E-mail: (AP); (CH)
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Pérez-Panero AJ, Ruiz-Muñoz M, Cuesta-Vargas AI, Gónzalez-Sánchez M. Prevention, assessment, diagnosis and management of diabetic foot based on clinical practice guidelines: A systematic review. Medicine (Baltimore) 2019; 98:e16877. [PMID: 31464916 PMCID: PMC6736276 DOI: 10.1097/md.0000000000016877] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/26/2019] [Accepted: 07/25/2019] [Indexed: 02/06/2023] Open
Abstract
AIM Diabetic foot complications are the main reason for hospitalization and amputation in people with diabetes and have a prevalence of up to 25%. Clinical practice guidelines are recommendations based on evidence with the aim of improving health care. The main aim of this study was to carry out a systematic review of the levels of the evaluation and treatment strategies that appear in the clinical practice guidelines focus on diabetic foot or diabetes with diabetic foot section. Another objective of this study was to perform an analysis of the levels of evidence in support of the recommendations made by the selected clinical practice guidelines. METHODS A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and a quality assessment by the Appraisal of Guidelines for Research and Evaluation (AGREE II) were performed. The databases checked were "NICE", "Cinahl", "Health Guide", "RNAO", "Sign", "PubMed", "Scopus" and "NCG". The search terms included were "diabetic foot", "guideline(s)", "practice guideline(s)" and "diabetes." RESULTS Twelve articles were selected after checked inclusion criteria and quality assessment. A summary and classification of the recommendations was completed. CONCLUSIONS The heterogeneity of levels of evidence and grades of recommendation of the CPGs included regarding the management, approach and treatment of DF makes it difficult to interpret and assume them in clinical practice in order to select the most correct procedures. Despite this and according to the detailed study of the guidelines included in this work, it can be concluded that the highly recommendable interventions for DF management are debridement (very high level of evidence and strongly recommended), foot evaluation (moderate level of evidence and fairly recommended) and therapeutic footwear (moderate level of evidence and fairly recommended).
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Affiliation(s)
| | | | - Antonio I. Cuesta-Vargas
- Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos 29071, Málaga, Spain
| | - Manuel Gónzalez-Sánchez
- Department of Physiotherapy, University of Málaga, Arquitecto Francisco Peñalosa, s/n. Ampliación campus de Teatinos 29071, Málaga, Spain
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Hasenstein TA, Greene T, Van JC, Meyr AJ. Soft Tissue Reconstruction with Diabetic Foot Tissue Loss. Clin Podiatr Med Surg 2019; 36:425-440. [PMID: 31079608 DOI: 10.1016/j.cpm.2019.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Although substantial advances have been made in treatment of diabetic foot disease with respect to patient education, preventative measures, early intervention, and prophylactic procedures, most surgical interventions for this condition are reactionary. Patients still primarily present to emergency departments with acute infections and tissue necrosis. The surgical intervention for this results in soft tissue deficit, often with partial foot amputation, through excisional debridement of pathologic tissue. Minimizing this initial soft tissue loss, with subsequent reconstruction of the defect, forms the focus of this article with a detailed anatomic assessment of structures at risk in the forefoot, midfoot and rearfoot.
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Affiliation(s)
- Todd A Hasenstein
- Temple University Hospital Podiatric Surgical Residency Program, 8th at Race Street, Philadelphia, PA 19107, USA
| | - Timothy Greene
- Temple University Hospital Podiatric Surgical Residency Program, 8th at Race Street, Philadelphia, PA 19107, USA
| | - Jennifer C Van
- Department of Surgery, Temple University School of Podiatric Medicine, 8th at Race Street, Philadelphia, PA 19107, USA
| | - Andrew J Meyr
- Department of Surgery, Temple University School of Podiatric Medicine, 8th at Race Street, Philadelphia, PA 19107, USA.
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Kirsner R, Dove C, Reyzelman A, Vayser D, Jaimes H. A prospective, randomized, controlled clinical trial on the efficacy of a single-use negative pressure wound therapy system, compared to traditional negative pressure wound therapy in the treatment of chronic ulcers of the lower extremities. Wound Repair Regen 2019; 27:519-529. [PMID: 31087729 PMCID: PMC6852528 DOI: 10.1111/wrr.12727] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 04/24/2019] [Accepted: 05/09/2019] [Indexed: 12/27/2022]
Abstract
Multicenter, phase‐4, randomized, comparative‐efficacy study in patients with VLUs or DFUs comparing for noninferiority the percentage change in target ulcer dimensions (area, depth, and volume) a single‐use negative pressure wound therapy (s‐NPWT) system versus traditional NPWT (t‐NPWT) over a 12‐week treatment period or up to confirmed healing. Baseline values were taken at the randomization visit. Randomized by wound type and size, 164 patients with non‐infected DFUs and VLUs were included. The ITT population was composed of 161 patients (101 with VLUs, 60 with DFUs) and 115 patients completed follow‐up (64 in the s‐NPWT group and 51 in the t‐NPWT group) (PP population). The average age for all patients was 61.5 years, 36.6% were women, and treatment groups were statistically similar at baseline. Primary endpoint analyses on wound area reduction demonstrated statistically significant reduction in favor of s‐NPWT (p = 0.003) for the PP population and for the ITT population (p < 0.001). Changes in wound depth (p = 0.018) and volume (p = 0.013) were also better with s‐NPWT. Faster wound closure was observed with s‐NPWT (Cox Proportional Hazards ratio (0.493 (0.273, 0.891); p = 0.019) in the ITT population. Wound closure occurred in 45% of patients in the s‐NPWT group vs. 22.2% of patients in the t‐NPWT group (p = 0.002). Median estimate of the time to wound closure was 77 days for s‐NPWT. No estimate could be provided for t‐NPWT due to the low number of patients achieving wound closure. Device‐related AEs were more frequent in the t‐NPWT group (41 AEs from 29 patients) than in the s‐NPWT group (16 AEs from 12 patients). The s‐NPWT system met noninferiority and achieved statistical superiority vs. t‐NPWT in terms of wound progression toward healing over the treatment period. When NPWT is being considered for the management of challenging VLUs and DFUs, s‐NPWT should be considered a first choice over other types of NPWT.
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Affiliation(s)
- Robert Kirsner
- Chairman and Harvey Blank Professor, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | | | - Alex Reyzelman
- Associate Professor, Department of Medicine, California School of Podiatric Medicine at Samuel Merritt University, Co-Director UCSF Center for Limb Preservation, San Francisco, CA
| | - Dean Vayser
- Scripps Clinic Medical Group, Department of Orthopedics/Foot & Ankle Center, Chief, Wound Care Division, San Diego, CA
| | - Henry Jaimes
- Global Senior Medical Director-Wounds Smith and Nephew, London, UK
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Grillon A, Argemi X, Gaudias J, Ronde-Ousteau C, Boeri C, Jenny JY, Hansmann Y, Lefebvre N, Jehl F. Bone penetration of daptomycin in diabetic patients with bacterial foot infections. Int J Infect Dis 2019; 85:127-131. [PMID: 31096056 DOI: 10.1016/j.ijid.2019.05.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/06/2019] [Accepted: 05/07/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Daptomycin has shown clinical efficacy in diabetic foot infections (DFI). However, only limited data are available on its bone penetration in this particular population. The aim of this study was to determine daptomycin bone concentrations in patients with DFI undergoing surgery after multiple daptomycin infusions and to determine bone daptomycin inhibitory quotients (IQs) for the predominant gram-positive species involved in DFI. METHODS Fourteen adult patients hospitalized with DFI treated with daptomycin and requiring surgical bone debridement and amputation were included in this single-centre prospective study. Daptomycin concentrations in serum and bone were determined by HPLC at steady state. Bone IQs were then calculated according to different minimum inhibitory concentrations (MICs; range 0.25-4mg/l) that are representative of the main MICs for Staphylococcus aureus, coagulase-negative staphylococci (CoNS), and Enterococcus sp populations. RESULTS Residual and peak concentrations varied from 4.5mg/l to 39.9mg/l and from 31.8mg/l to 110.9mg/l, respectively. Bone daptomycin concentrations at the moment of surgery varied from 1.2mg/l to 17mg/l. Up to a MIC of 1mg/l, which is the epidemiological cut-off value (ECOFF) and breakpoint value for S. aureus and CoNS, all bone daptomycin IQs were positive. The highest bone IQs were observed with Staphylococcus species. Calculated bone IQs for Enterococcus species were often weak at MIC values near the ECOFF. CONCLUSIONS Daptomycin penetrates bone well in patients treated for DFI. At an initially recommended dosage of 6mg/kg, bone concentrations are likely to be effective against staphylococcal infections and infections due to low-MIC Enterococcus.
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Affiliation(s)
- Antoine Grillon
- Hôpitaux Universitaires, Institut de Bactériologie, Strasbourg, France; Virulence Bactérienne Précoce, Université de Strasbourg, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg France.
| | - Xavier Argemi
- Virulence Bactérienne Précoce, Université de Strasbourg, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg France; Hôpitaux Universitaires, Maladies Infectieuses et Tropicales, Strasbourg, France
| | - Jeannot Gaudias
- Hôpitaux Universitaires, Centre de Chirurgie Orthopédique et de la Main (CCOM), Strasbourg, France
| | - Cécile Ronde-Ousteau
- Hôpitaux Universitaires, Centre de Chirurgie Orthopédique et de la Main (CCOM), Strasbourg, France
| | - Cyril Boeri
- Hôpitaux Universitaires, Centre de Chirurgie Orthopédique et de la Main (CCOM), Strasbourg, France
| | - Jean-Yves Jenny
- Hôpitaux Universitaires, Centre de Chirurgie Orthopédique et de la Main (CCOM), Strasbourg, France
| | - Yves Hansmann
- Virulence Bactérienne Précoce, Université de Strasbourg, CHRU de Strasbourg, Fédération de Médecine Translationnelle de Strasbourg, Strasbourg France; Hôpitaux Universitaires, Maladies Infectieuses et Tropicales, Strasbourg, France
| | - Nicolas Lefebvre
- Hôpitaux Universitaires, Maladies Infectieuses et Tropicales, Strasbourg, France
| | - François Jehl
- Hôpitaux Universitaires, Institut de Bactériologie, Strasbourg, France
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Endothelial cell-derived small extracellular vesicles suppress cutaneous wound healing through regulating fibroblasts autophagy. Clin Sci (Lond) 2019; 133:CS20190008. [PMID: 30988132 DOI: 10.1042/cs20190008] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/27/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023]
Abstract
Diabetic foot ulcer is a life-threatening clinical problem in diabetic patients. Endothelial cell-derived small extracellular vesicles (sEVs) are important mediators of intercellular communication in the pathogenesis of several diseases. However, the exact mechanisms of wound healing mediated by endothelial cell-derived sEVs remain unclear. sEVs were isolated from human umbilical vein endothelial cells (HUVECs) pretreated with or without advanced glycation end products (AGEs). The roles of HUVEC-derived sEVs on the biological characteristics of skin fibroblasts were investigated both in vitro and in vivo We demonstrate that sEVs derived from AGEs-pretreated HUVECs (AGEs-sEVs) could inhibit collagen synthesis by activating autophagy of human skin fibroblasts. Additionally, treatment with AGEs-sEVs could delay the wound healing process in Sprague-Dawley (SD) rats. Further analysis indicated that miR-106b-5p was up-regulated in AGEs-sEVs and importantly, in exudate-derived sEVs from patients with diabetic foot ulcer. Consequently, sEV-mediated uptake of miR-106b-5p in recipient fibroblasts reduces expression of extracellular signal-regulated kinase 1/2 (ERK1/2), resulting in fibroblasts autophagy activation and subsequent collagen degradation. Collectively, our data demonstrate that miR-106b-5p could be enriched in AGEs-sEVs, then decreases collagen synthesis and delays cutaneous wound healing by triggering fibroblasts autophagy through reducing ERK1/2 expression.
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Dutra LMA, Melo MC, Moura MC, Leme LAP, De Carvalho MR, Mascarenhas AN, Novaes MRCG. Prognosis of the outcome of severe diabetic foot ulcers with multidisciplinary care. J Multidiscip Healthc 2019; 12:349-359. [PMID: 31118658 PMCID: PMC6506632 DOI: 10.2147/jmdh.s194969] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 02/20/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Approximately 2–4% of individuals worldwide with diabetes mellitus have foot ulcers. This study aims to assess the factors affecting the outcomes of severe foot ulcers in diabetic individuals. Methods: An analytical prospective cohort study was conducted from March 1st, 2015, to March 1st, 2017. A total of 34 individuals was selected. The study included patients with foot ulcers below the ankle who were at risk of amputation. All tests used a <5% level of significance and confidence interval of 95%. A Pearson’s chi-squared test and binary multiple regression were performed to assess the factors related to healing. Results: Only 11.7% of the individuals required amputation; ulcers classified as 2/B according to the University of Texas Diabetic Foot Ulcer Classification System healed before the 1/B ulcers. Neuropathic ulcers were the most prevalent (58.8%); 61.8% healed after 1 year. Most of the individuals were overweight, 47.1% had reduced glomerular filtration rates, and 78.8% had glycated hemoglobin >7%. Body mass index and osteomyelitis were the two significant variables in logistic regression. Conclusions: In this study, osteomyelitis was the main complication related to the risk of amputation, and elevated body mass index and osteomyelitis were the significant factors that induced a slower healing time.
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Affiliation(s)
| | - Manuela Costa Melo
- Departament of Nursing, Higher School of Health Sciences, Brasília, Federal District, Brazil
| | - Mirian Conceição Moura
- Department of Medicine, Higher School of Sciences and Hospital of the Secretary of Health of the Federal District, Clinical Neurophysiologist, Brasília, Federal District, Brazil
| | | | - Marta Rodrigues De Carvalho
- Department of Medicine, Higher School of Sciences and Hospital of the Secretary of Health of the Federal District, Clinical Neurophysiologist, Brasília, Federal District, Brazil
| | - Andre Neves Mascarenhas
- Department of Endocrinology, Regional Hospital of Asa Norte, Brasília, Federal District, Brazil
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Abstract
Diabetic foot ulcerations (DFUs) represent a major medical, social, and economic problem. Therapeutic options are restricted due to a poor understanding of the pathogenic mechanisms. The Notch pathway plays a pivotal role in cell differentiation, proliferation, and angiogenesis, processes that are profoundly disturbed in diabetic wounds. Notch signaling is activated upon interactions between membrane-bound Notch receptors (Notch 1-4) and ligands (Jagged 1-2 and Delta-like 1, 3, 4), resulting in cell-context-dependent outputs. Here, we report that Notch1 signaling is activated by hyperglycemia in diabetic skin and specifically impairs wound healing in diabetes. Local inhibition of Notch1 signaling in experimental wounds markedly improves healing exclusively in diabetic, but not in nondiabetic, animals. Mechanistically, high glucose levels activate a specific positive Delta-like 4 (Dll4)-Notch1 feedback loop. Using loss-of-function genetic approaches, we demonstrate that Notch1 inactivation in keratinocytes is sufficient to cancel the repressive effects of the Dll4-Notch1 loop on wound healing in diabetes, thus making Notch1 signaling an attractive locally therapeutic target for the treatment of DFUs.
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Kurup R, Ansari AA, Singh J. A review on diabetic foot challenges in Guyanese perspective. Diabetes Metab Syndr 2019; 13:905-912. [PMID: 31336544 DOI: 10.1016/j.dsx.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 12/19/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND Diabetes mellitus signifies a major public health threat worldwide. Type 2 diabetes has been reported as the fourth leading cause of death and has affected 15.5% of the adult population in Guyana, South America. Diabetes has also led to major lower extremity amputation at the only referral public hospital in Guyana. Diabetic foot and related complications are known to be multifactorial. CONCLUSION In this review, we highlight the information on the diabetic foot and related complications with an emphasis on Guyanese background.
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Affiliation(s)
- Rajini Kurup
- Faculty of Health Sciences, University of Guyana, Georgetown, South America, Guyana.
| | - Abdullah Adil Ansari
- Faculty of Health Sciences, University of Guyana, Georgetown, South America, Guyana.
| | - Jaipaul Singh
- School of Pharmacy and Forensic and Investigative Sciences, University of South Lancashire, Preston, Lancashire, United Kingdom.
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Luck J, Rodi T, Geierlehner A, Mosahebi A. Allogeneic Skin Substitutes Versus Human Placental Membrane Products in the Management of Diabetic Foot Ulcers: A Narrative Comparative Evaluation of the Literature. INT J LOW EXTR WOUND 2019; 18:10-22. [DOI: 10.1177/1534734618818301] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Outcomes following standard wound care (SWC) for diabetic foot ulcers (DFUs) remain suboptimal. Supplementing SWC with tissue engineered allogeneic cellular wound therapies represents an emerging treatment strategy. This review aimed to evaluate the efficacy and safety of allogeneic skin substitutes and human placental membrane allografts in the management of DFUs. Ovid MEDLINE and Embase databases were searched from inception to October 2017. Any randomized controlled trial (RCT) with an allogeneic skin substitute or placental membrane allograft intervention group was included. Our primary outcome measure was the proportion of completely healed ulcers. Secondary outcome measures included time to complete wound healing and local adverse event rates. Each study was assessed for risk of bias and the quality of evidence was appraised using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Moderate quality evidence from 11 included RCTs demonstrated that both allogeneic cellular approaches improve the proportion of completely healed ulcers at 6 and 12 weeks. One RCT showed that a placental membrane allograft was superior to an allogeneic skin substitute, although this has yet to be repeated in other studies. The addition of allogeneic cellular wound products to SWC improves DFU outcomes. Further studies are required to conclusively establish if placental membrane allografts are superior to allogeneic skin substitutes.
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Affiliation(s)
| | - Timo Rodi
- Royal Free Hospital, Hampstead, London, UK
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Zhang C, Zhu Y, Lu S, Zhong W, Wang Y, Chai Y. Platelet-Rich Plasma with Endothelial Progenitor Cells Accelerates Diabetic Wound Healing in Rats by Upregulating the Notch1 Signaling Pathway. J Diabetes Res 2019; 2019:5920676. [PMID: 31559315 PMCID: PMC6735213 DOI: 10.1155/2019/5920676] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/15/2019] [Indexed: 12/28/2022] Open
Abstract
Diabetic wounds, as a kind of refractory wound, are very difficult to heal. Both endothelial progenitor cell (EPC) transplantation and platelet-rich plasma (PRP) can improve diabetic wound healing to some extent. However, PRP application cannot provide reparative cells, while EPC transplantation cannot replenish the required growth factors for wound healing. Thus, when applied alone, neither of these factors is sufficient for effective wound healing. Furthermore, the proliferation, differentiation, and fate of the transplanted EPCs are not well known. Therefore, in this study, we examined the efficacy of combined PRP application with EPC transplantation in diabetic wound healing. Our results indicated that PRP application improved EPC proliferation and migration. The Notch signaling pathway plays a key role in the regulation of the proliferation and differentiation of stem cells and angiogenesis in wound healing. The application of PRP upregulated the Notch pathway-related gene and protein expression in EPCs. Furthermore, experiments with shNotch1-transfected EPCs indicated that PRP enhanced the function of EPCs by upregulating the Notch1 signaling pathway. In vivo studies further indicated that the combination of PRP and EPC transplantation increased neovascularization, reduced wound size, and improved healing in rat wound models. Thus, PRP application can provide the necessary growth factors for wound healing, while EPC transplantation offers the required cells, indicating that the combination of both is a potent novel approach for treating diabetic wounds.
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Affiliation(s)
- Cheng Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Rd. 600, Shanghai 200233, China
| | - Yu Zhu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Rd. 600, Shanghai 200233, China
| | - Shengdi Lu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Rd. 600, Shanghai 200233, China
| | - Wanrun Zhong
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Rd. 600, Shanghai 200233, China
| | - Yanmao Wang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Rd. 600, Shanghai 200233, China
| | - Yimin Chai
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Yishan Rd. 600, Shanghai 200233, China
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Sanz-Corbalán I, Lázaro-Martínez JL, García-Morales E, Molines-Barroso R, Álvaro-Afonso F, García-Álvarez Y. Advantages of early diagnosis of diabetic neuropathy in the prevention of diabetic foot ulcers. Diabetes Res Clin Pract 2018; 146:148-154. [PMID: 29287839 DOI: 10.1016/j.diabres.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/13/2017] [Accepted: 12/21/2017] [Indexed: 12/18/2022]
Abstract
AIMS To evaluate the utility of the sudomotor function test (SFT) as a clinical tool in the Risk Stratification System of diabetic patients and to demonstrate the earlier detection of the risk of developing diabetic foot ulcers (DFU) compared to the standard clinical tests. METHODS Prospective follow-up study on 263 patients enrolled consecutively over 3.5 years. Diabetic patients without active DFU were classified according to the International Working Group Risk Stratification System (RSS) and categorized according to the results of the Semmes-Wenstein Monofilament (SWM) and biothesiometer measurements or the SFT. The main outcome evaluated was the development of DFU. RESULTS Median follow-up was 42 [38-44] months. Sixty patients (22.8%) developed DFU after a median of 6.2 [3-17] months. Ten patients that were included in the no-risk group (group 0) based on the SWM and biothesiometer results developed DFU. Thus the sensitivity of this approach was 83.33% and the specificity was 50.47%. Based on the SFT results, all patients that developed DFU were included in the correct risk group. This approach had 100% sensitivity and 31.53% specificity. Regarding the diagnostic accuracy of the two Methods, the respective AUC values were 0.776 (95% CI 0.702-0.849) and 0.816 (95% CI 0.757-0.874). CONCLUSIONS SFT improved RSS in diabetic patients in a specialized diabetic foot unit. SFT categorized patients correctly according to the risk of developing DFU.
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Kopf S, Groener JB, Kender Z, Fleming T, Bischoff S, Jende J, Schumann C, Ries S, Bendszus M, Schuh-Hofer S, Treede RD, Nawroth PP. Deep phenotyping neuropathy: An underestimated complication in patients with pre-diabetes and type 2 diabetes associated with albuminuria. Diabetes Res Clin Pract 2018; 146:191-201. [PMID: 30389624 DOI: 10.1016/j.diabres.2018.10.020] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/27/2018] [Accepted: 10/24/2018] [Indexed: 01/19/2023]
Abstract
AIMS The aim of the study was to assess whether quantitative-sensory-testing could be used to evaluate prevalence and predictors of diabetic neuropathy (DPNP) in patients with pre-diabetes and type 2 diabetes. METHODS Twenty-eight pre-diabetics and 108 patients with type 2 diabetes were evaluated using neuropathy-deficit-score (NDS), neuropathy-symptom-score (NSS), nerve-conduction-studies (NCS), short-QST-protocol to examine small fibers and the comprehensive QST-battery (long-QST) according to the German Research Network on Neuropathic Pain protocol. RESULTS Long-QST revealed a DPNP-prevalence of 71% in pre-diabetics and 95% in patients with type 2 diabetes, while according to NDS it was only 11% and 63%, and NCS missed 58% of patients with DPNP. Small and medium fibers were similarly affected in both groups, while large fiber deficits were significantly more common in type 2 diabetes (p < 0.01). Complete loss of function in all fibers was significantly higher in patients with type 2 diabetes than in pre-diabetics (26% vs. 11%, p < 0.05). Hyperalgesia was slightly increased in pre-diabetes than in type 2 diabetes (57% vs. 43%, p = n.s.). However, NSS only showed significant associations with large fiber deficits. Logistic regression analyses revealed that age (OR 1.14[1.05/1.24]) and albuminuria (OR 12.8[1.52/107.3]) were independent predictors for the presence of DPNP. CONCLUSIONS DPNP is much more prevalent in patients with pre-diabetes and type 2 diabetes and clinical routine tests may miss the majority of affected patients. Age and albuminuria, but not HbA1c, appear to be significantly associated with DPNP. CLINICAL TRIAL REGISTRATION NCT03022721.
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Affiliation(s)
- Stefan Kopf
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - Jan B Groener
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Zoltan Kender
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Thomas Fleming
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Sandra Bischoff
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany
| | - Johann Jende
- University Hospital of Heidelberg, Department of Neuroradiology, Heidelberg, Germany
| | | | | | - Martin Bendszus
- University Hospital of Heidelberg, Department of Neuroradiology, Heidelberg, Germany
| | - Sigrid Schuh-Hofer
- Medical Faculty Mannheim, Department of Neurophysiology, University of Heidelberg, Mannheim, Germany
| | - Rolf-Detlef Treede
- Medical Faculty Mannheim, Department of Neurophysiology, University of Heidelberg, Mannheim, Germany
| | - Peter P Nawroth
- University Hospital of Heidelberg, Department of Internal Medicine 1 and Clinical Chemistry, Heidelberg, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Joint Heidelberg-ICD Translational Diabetes Program, Helmoltz-Zentrum, Munich, Germany
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Jiménez S, Rubio JA, Álvarez J, Lázaro-Martínez JL. Análisis de las reulceraciones en una unidad multidisciplinar de pie diabético tras la implementación de un programa de cuidado integrado del pie. ENDOCRINOL DIAB NUTR 2018; 65:438.e1-438.e10. [DOI: 10.1016/j.endinu.2018.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/16/2018] [Accepted: 03/21/2018] [Indexed: 01/13/2023]
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Cardenas V, Seo K, Sheth S, Meyr AJ. Prevalence of Lower-Extremity Arterial Calcification in Patients with Diabetes Mellitus Complicated by Foot Disease at an Urban US Tertiary-Care Center. J Am Podiatr Med Assoc 2018; 108:267-271. [PMID: 30156894 DOI: 10.7547/16-075] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND We sought to determine the prevalence of lower-extremity arterial calcification in a cohort of patients with diabetes and associated foot pathology receiving inpatient treatment at an urban US tertiary health-care system. METHODS The primary outcome measure was defined as either radiographic evidence of vessel calcification or noninvasive vascular testing that resulted in any reporting of vessel noncompressibility or an ankle-brachial index greater than 1.1. Radiographic evidence of vessel calcification was defined as radiodense calcification in the proximal first intermetatarsal space (deep plantar perforating artery), anterior ankle (anterior tibial artery), or posterior ankle (posterior tibial artery) on dorsoplantar and lateral foot projections. RESULTS Of the 367 individuals included in the study, 359 underwent radiography, with radiographic evidence of calcification in 192 (53.5%). Noninvasive vascular testing was performed on 265 participants, with any reporting of noncompressibility or an ankle-brachial index greater than 1.1 observed in 153 (57.7%). Ninety-four participants (25.6%) demonstrated evidence of arterial calcification on the radiographs and noninvasive testing, meaning that 251 participants (68.4%) demonstrated evidence of arterial calcification on at least one test, including 63.6% of participants classified as black/African American race, 65.4% as white race, and 78.3% as Hispanic/Latino ethnicity. CONCLUSIONS The results of this investigation increase the body of knowledge with respect to the evaluation and treatment of diabetic foot disease and may lead to future investigations on the topic of lower-extremity arterial calcification.
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Affiliation(s)
- Vanessa Cardenas
- Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Kyung Seo
- Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Shyam Sheth
- Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA
| | - Andrew J. Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA
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The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing better than direct angiosome perfusion in diabetic foot wounds. J Vasc Surg 2018; 68:1473-1481. [PMID: 29803684 DOI: 10.1016/j.jvs.2018.01.060] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/31/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Previous studies show conflicting results in wound healing outcomes based on angiosome direct perfusion (DP), but few have adjusted for wound characteristics in their analyses. We have previously shown that the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification correlates with wound healing in diabetic foot ulcers (DFUs) treated by a multidisciplinary team. The aim of this study was to compare WIfI classification vs DP and pedal arch patency as predictors of wound healing in patients presenting with DFU and peripheral arterial disease. METHODS We performed a retrospective review of a prospectively maintained database of all patients with peripheral arterial disease presenting to our multidisciplinary DFU clinic who underwent angiography. An angiosome was considered directly perfused if the artery feeding the angiosome was revascularized or was completely patent. Wound healing time at 1 year was compared on the basis of DP vs indirect perfusion, Rutherford pedal arch grade, and WIfI classification using univariable statistics and Cox proportional hazards models. RESULTS Angiography was performed on 225 wounds in 99 patients (mean age, 63.3 ± 1.2 years; 62.6% male; 53.5% black) during the entire study period. There were 33 WIfI stage 1, 33 stage 2, 51 stage 3, and 108 stage 4 wounds. DP was achieved in 154 wounds (68.4%) and indirect perfusion in 71 wounds (31.6%). On univariable analysis, WIfI classification was significantly associated with improved wound healing (57.2% for WIfI 3/4 vs 77.3% for WIfI 1/2; P = .02), whereas DP and pedal arch patency were not (both, P ≥ .08). After adjusting for baseline patient and wound characteristics, WIfI stage remained independently predictive of wound healing (WIfI 3/4: hazard ratio [HR], 0.77; 95% confidence interval [CI], 0.67-0.88), whereas DP (HR, 0.82; 95% CI, 0.55-1.21) and pedal arch grade (HR, 0.85; 95% CI, 0.70-1.03) were not. CONCLUSIONS In our population of patients treated by a multidisciplinary diabetic foot service, the Society for Vascular Surgery WIfI classification system was a stronger predictor of diabetic foot wound healing than DP or pedal arch patency. Our results suggest that a measure of wound severity should be included in all future studies assessing wound healing as an outcome, as differences in patients' wound characteristics may be a strong contributor to the variation of angiosome-directed perfusion results previously observed.
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Abstract
Although there are various types of therapeutic footwear currently used to treat diabetic foot ulcers (DFUs), recent literature has enforced the concept that total-contact casts are the benchmark.Besides conventional clinical tests and imaging modalities, advanced MRI techniques and high-sensitivity nuclear medicine modalities present several advantages for the investigation of diabetic foot problems.The currently accepted principles of DFU care are rigorous debridement followed by modern wound dressings to provide a moist wound environment. Recently, hyperbaric oxygen and negative pressure wound therapy have aroused increasing attention as an adjunctive treatment for patients with DFUs.For DFU, various surgical treatments are currently available, including resection arthroplasty, metatarsal osteotomies and metatarsal head resections.In the modern management of the Charcot foot, surgery in the acute phase remains controversial and under investigation. While conventional fixation techniques are frequently insufficient to keep alignment postoperatively, superconstruct techniques could provide a successful fixation.Retrograde intramedullary nailing has been a generally accepted method of achieving stability. The midfoot fusion bolt is a current treatment device that maintains the longitudinal columns of the foot. Also, Achilles tendon lengthening remains a popular method in the management of Charcot foot. Cite this article: EFORT Open Rev 2018;3 DOI: 10.1302/2058-5241.3.170073.
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Affiliation(s)
- Önder İ. Kılıçoğlu
- Department of Orthopaedics and Traumatology, İstanbul University, Istanbul Faculty of Medicine, Turkey
| | - Mehmet Demirel
- Department of Orthopaedics and Traumatology, İstanbul University, Istanbul Faculty of Medicine, Turkey
| | - Şamil Aktaş
- Department of Underwater and Hyperbaric Medicine, İstanbul University, Istanbul Faculty of Medicine, Turkey
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