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Bazikian S, Pyun AJ, Zheng H, Padula W, Khan T, Ziegler K, Shin L, Magee GA, Rowe VL, Armstrong DG. Evaluating the impact of an interdisciplinary integrated limb preservation service operating concurrently with a single-specialty service. J Foot Ankle Res 2024; 17:e12013. [PMID: 38613833 DOI: 10.1002/jfa2.12013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/02/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND This study examined the efficacy of an interdisciplinary limb preservation service (LPS) in improving surgical outcomes for diabetic foot ulcer (DFU) patients compared to traditional care. METHODS Data from January 1, 2017 to September 30, 2020 were retrospectively reviewed. An interdisciplinary LPS clinic began on August 1, 2018, coexisting with a preexisting single specialty service. Primary outcomes were major/minor amputation rates and ratios and hospital length of stay. Surgical endpoints pre- and post-LPS launch were compared. RESULTS Among 976 procedures for 731 unique DFU patients, most were male (80.4%) and Hispanic (89.3%). Patient demographics were consistent before and after LPS initiation. Major amputation rates decreased by 45.5% (15.4%-8.4%, p = 0.001), with outpatient procedures increasing over 5-fold (3.3% pre-LPS to 18.7% post-LPS, p < 0.001). Hospital stay reduced from 10.1 to 8.5 days post-LPS (p < 0.001). The major to minor amputation ratio declined from 22.4% to 12.7%. CONCLUSIONS The interdisciplinary LPS improved patient outcomes, marked by fewer major amputations and reduced hospital stays, suggesting the model's potential for broader application.
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Affiliation(s)
- Sebouh Bazikian
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Alyssa J Pyun
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Hanke Zheng
- Department of Pharmaceutical and Health Economics, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - William Padula
- Department of Pharmaceutical and Health Economics, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, Los Angeles, California, USA
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Tanzim Khan
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Kenneth Ziegler
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Laura Shin
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Gregory A Magee
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Vincent L Rowe
- Division of Vascular Surgery and Endovascular Therapy, David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - David G Armstrong
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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Zhao Z, Pang J, Zhao D, Guo N, Guo Y, Kong F, Yang H, Zhao J. Exploring the efficacy of photodynamic antimicrobial chemotherapy on diabetic foot ulcers in rats. J Biophotonics 2024:e202300568. [PMID: 38651324 DOI: 10.1002/jbio.202300568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 02/19/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024]
Abstract
We investigate the efficacy of photodynamic antimicrobial chemotherapy (PACT) and its combination with an antibiotic in the treatment of diabetic foot ulcers (DFUs) in rats using a novel cationic amino acid porphyrin-based photosensitizer. The research findings demonstrate that the combination of novel cationic photosensitizer-mediated PACT and an antibiotic exhibits significant therapeutic efficacy in treating deep ulcers in a rat model of DFUs. Moreover, the PACT + Antibiotic group displays enhanced angiogenesis, improved tissue maturation, and superior wound healing effect. Micro-computed tomography examination showed that the periosteal reaction was most obvious in the PACT + Antibiotic group. The cortical bone volume ratio (BV/TV), the bone mineral density, and trabecular thickness were significantly higher in the PACT + Antibiotic group than in the model group (p < 0.05). The combination of PACT and antibiotic plays a sensitizing therapeutic role, which provides a new idea for the clinical treatment of DFUs.
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Affiliation(s)
- Zhanjuan Zhao
- College of Basic Medicine, Hebei University, Baoding, China
| | - Jinwen Pang
- Department of Medical Imaging, Cangzhou Hospital of Integrated TCM-WM Hebei, Cangzhou, China
| | - Di Zhao
- School of Foreign Languages, Tianjin University of Commerce, Tianjin, China
| | - Ning Guo
- College of Basic Medicine, Hebei University, Baoding, China
| | - Yiman Guo
- College of Clinical Medicine, Hebei University, Baoding, China
| | - Feiyan Kong
- College of Basic Medicine, Hebei University, Baoding, China
| | - Huizhong Yang
- College of Clinical Medicine, Hebei University, Baoding, China
| | - Jianxi Zhao
- Department of Radiology, Affiliated Hospital of Hebei University, Baoding, China
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Cornwell D, Goldstein Z, Chrea B, McLafferty R. Timolol in the treatment of hard-to-heal wounds: a comprehensive review. J Wound Care 2024; 33:243-252. [PMID: 38573903 DOI: 10.12968/jowc.2024.33.4.243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE The aims of this study were to ascertain the effectiveness and safety of the off-label use of topical timolol as an adjunct treatment for hard-to-heal (chronic) wounds. Furthermore, to review and analyse the existing literature regarding the use of topical timolol on wounds of varying aetiologies. METHOD A systematic review of literature in the English language published between May 1961-May 2021 on the application of topical timolol for hard-to-heal wounds in adults was performed. Each research study was evaluated by two reviewers independently. Studies eligible for inclusion in the review were randomised controlled trials (RCTs), clinical trials, observational studies of at least 4 weeks' duration, case series and case studies. Search strategies were performed according to PRISMA guidelines and included MeSH terms and keyword searches. RESULTS An initial 878 articles were identified from a search of PubMed, Ovid Medline, Embase, Cochrane, and SCOPUS. Of these, 699 were reviewed for eligibility, 19 were read in full-text, and 12 were selected for inclusion in the review. In total, two RCTs and 10 observational studies, including five case studies, were analysed. All studies demonstrated efficacy and safety of topical timolol; however, statistical analysis remained limited by lack of blinding and small sample sizes. CONCLUSION This review concludes with all currently available evidence that topical timolol may be considered as an effective and safe adjunct treatment for refractory wounds, primarily venous leg ulcers and diabetic foot ulcers. Given the overall safety, low cost and ease of application of topical timolol, this review provides evidence in favour of off-label use and should prompt further, more rigorous studies.
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Affiliation(s)
- David Cornwell
- Division of Vascular Surgery, Oregon Health and Science University, Portland, OR, US
| | - Zachary Goldstein
- Division of Vascular Surgery, Oregon Health and Science University, Portland, OR, US
| | - Bopha Chrea
- Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, OR, US
| | - Robert McLafferty
- Division of Vascular Surgery, Oregon Health and Science University, Portland, OR, US
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Shen Q, Li B, Chen H, Gao S, Hu Y, Sun Y, Li G. Podiatrist intervention could reduce the incidence of foot ulcers in patients with diabetes: a hospital survey in China. J Wound Care 2024; 33:S25-S32. [PMID: 38573950 DOI: 10.12968/jowc.2024.33.sup4.s25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
OBJECTIVE This study aimed to evaluate the effectiveness of podiatrists in preventing diabetic foot ulcers (DFUs) in China. METHOD The study was a prospective investigation. A total of 300 patients were enrolled from May 2016 to May 2018 in Handan Central Hospital, China. All patients who participated in this study had been diagnosed with type 2 diabetes, according to the International Classification of Diseases (ICD-10). All participants underwent our survey, which included basic patient data and information about DFUs. The patients were followed for one year, during which time they received appropriate intervention from podiatrists, including lifestyle guidance, callus resection, tinea grinding and ingrown nail correction. At the end of the year all the patients were surveyed again. The data before and after the year were statistically compared. RESULTS The results showed that the incidence of DFUs in patients with diabetes was significantly decreased after one year of intervention from podiatrists (20.7% versus 6.7%, p<0.001). Additionally, there was a negative correlation between the number of intervention visits and the number of DFU occurrences (Spearman correlation coefficient: -0.496, p<0.001). Furthermore, we found that 68 patients with a history of DFUs or amputation had an obviously reduced incidence of DFUs after intervention by a podiatrist (89.7% versus 27.9%, p<0.001). We also investigated other foot risk factors in all participants, such as limb neuropathy (76.3%), lower extremity vascular disease (65.7%) and foot paralysis (43.7%). CONCLUSION The results of this study help in understanding the situation of patients with diabetes in China and to prove that standardised podiatrist intervention has an important role in inhibiting the occurrence and development of DFUs.
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Affiliation(s)
- Qian Shen
- School of Foreign Studies of Zhongnan University of Economics and Law; Wuhan, China
| | - Binghui Li
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huating Chen
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Suwen Gao
- Department of Endocrinology, Handan Central Hospital, Handan, China
| | - Yingyue Hu
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Sun
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gongchi Li
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Yang S, Hu L, Zhao Y, Meng G, Xu S, Han R. Prevalence of multidrug-resistant bacterial infections in diabetic foot ulcers: A meta-analysis. Int Wound J 2024; 21:e14864. [PMID: 38619084 PMCID: PMC11017433 DOI: 10.1111/iwj.14864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 03/17/2024] [Accepted: 03/18/2024] [Indexed: 04/16/2024] Open
Abstract
Multidrug-resistant (MDR) bacterial infections have become increasingly common in recent years due to the increased prevalence of diabetic foot ulcers (DFUs). We carried out a meta-analysis aimed at investigating the prevalence of MDR bacteria isolated from DFUs and analysing the risk factors for MDR bacterial infection in patients with DFUs. The PubMed/Medline, Web of Science, Embase, Cochrane Library, Ovid, Scopus, and ProQuest databases were searched for studies published up to November 2023 on the clinical outcomes of MDR bacteria in DFUs. The main outcome was the prevalence of MDR bacteria in DFUs. A total of 21 studies were included, representing 4885 patients from which 2633 MDR bacterial isolates were obtained. The prevalence of MDR bacteria in DFUs was 50.86% (95% confidence interval (CI): 41.92%-59.78%). The prevalence of MDR gram-positive bacteria (GPB) in DFUs was 19.81% (95% CI: 14.35%-25.91%), and the prevalence of MDR gram-negative bacteria (GNB) in DFUs was 32.84% (95% CI: 26.40%-39.62%). MDR Staphylococcus aureus (12.13% (95% CI: 8.79%-15.91%)) and MDR Enterococcus spp. (3.33% (95% CI: 1.92%-5.07%)) were the main MDR-GPB in DFUs. MDR Escherichia coli, MDR Pseudomonas aeruginosa, MDR Enterobacter spp., MDR Klebsiella pneumoniae, and MDR Proteus mirabilis were the main MDR-GNB in DFUs. The prevalence rates were 6.93% (95% CI: 5.15%-8.95%), 6.01% (95% CI: 4.03%-8.33%), 3.59% (95% CI: 0.42%-9.30%), 3.50% (95% CI: 2.31%-4.91%), and 3.27% (95% CI: 1.74%-5.21%), respectively. The clinical variables of diabetic foot ulcer patients infected with MDR bacteria and non-MDR bacteria in the included studies were analysed. The results showed that peripheral vascular disease, peripheral neuropathy, nephropathy, osteomyelitis, Wagner's grade, previous hospitalization and previous use of antibacterial drugs were significantly different between the MDR bacterial group and the non-MDR bacterial group. We concluded that there is a high prevalence of MDR bacterial infections in DFUs. The prevalence of MDR-GNB was greater than that of MDR-GPB in DFUs. MDR S. aureus was the main MDR-GPB in DFUs, and MDR E. coli was the main MDR-GNB in DFUs. Our study also indicated that peripheral vascular disease, peripheral neuropathy, nephropathy, osteomyelitis, Wagner's grade, previous hospitalization, and previous use of antibacterial drugs were associated with MDR bacterial infections in patients with DFUs.
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Affiliation(s)
- Shaoling Yang
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Liye Hu
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Yue Zhao
- Department of OrthopaedicsThe Gucheng County Hospital of Hebei ProvinceGuchengChina
| | - Guangzhe Meng
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Sijia Xu
- Department of EndocrinologyThe Bethune International Peace HospitalShijiazhuangChina
| | - Rui Han
- Department of NeurologyThe First Affiliated Hospital of Hebei Medical UniversityShijiazhuangChina
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Torkaman G, Hoseini-Sanati M, Hedayati M, Mofid M, Iranparvar Alamdari M. Effects of Photobiomodulation Therapy on the Expression of Hypoxic Inducible Factor, Vascular Endothelial Growth Factor, and Its Specific Receptor: A Randomized Control Trial in Patients with Diabetic Foot Ulcer. Photobiomodul Photomed Laser Surg 2024; 42:275-284. [PMID: 38536106 DOI: 10.1089/photob.2023.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
Background: Impaired angiogenesis is a significant factor contributing to delayed healing in diabetic foot ulcers (DFUs) due to inadequate oxygenation. Objective: This study aimed to investigate the impact of photobiomodulation (PBM) using a Ga-As laser on the release of serum hypoxia-inducible factor 1-α (HIF-1α), vascular endothelial growth factor (VEGF), vascular endothelial growth factor receptor-2, and nitric oxide (NO) in diabetic patients with DFUs. Materials and methods: In this double-blind RCT, a total of 30 patients with grade II DFUs were enrolled. The patients were randomly divided into two groups: the PBM (n = 15) and the placebo (n = 15). In the PBM group, a Ga-As laser (904 nm, 2 J/cm2, 90 W) was given for 3 days/week for 4 weeks (11 sessions). In the placebo group, the power was turned off. Both groups received similar standard wound care. Before and after interventions, the levels of serum HIF-1α, VEGF, NO, and sVEGFR-2 were measured. In addition, the percentage decrease in the wound surface area (%DWSA) was measured. Results: Following the intervention, the results revealed that the PBM group had significantly lower levels of VEGF than the placebo group (p = 0.005). The %DWSA was significantly higher in the PBM group compared to the placebo group (p = 0.003). Moreover, VEGF showed a significant negative correlation with %DWSA (p < 0.001). Conclusions: The observed decrease in serum levels of VEGF and an increase in %DWSA, compared to the placebo group, suggests that PBM effectively improves angiogenesis. Furthermore, the significant correlation found between VEGF levels and %DWSA emphasizes the importance of evaluating wound surface in patients as a dependable indicator of enhanced wound angiogenesis. Clinical Trial Registration: NCT02452086.
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Affiliation(s)
- Giti Torkaman
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mahsa Hoseini-Sanati
- Physical Therapy Department, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Mehdi Hedayati
- Cellular and Molecular Endocrine Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mofid
- School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
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Xu Y, Geng R, Meng X, Feng Z, Wang X, Zhang G, Bai L. The impact of inflammatory biomarkers on amputation rates in patients with diabetic foot ulcers. Int Wound J 2024; 21:e14827. [PMID: 38522433 PMCID: PMC10961172 DOI: 10.1111/iwj.14827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 02/18/2024] [Accepted: 02/23/2024] [Indexed: 03/26/2024] Open
Abstract
Diabetic Foot Ulcers (DFUs) are a major complication of diabetes, often leading to amputation. Understanding the relationship between haematological inflammatory markers and the incidence of amputation in DFU patients with infectious complications is crucial for improving management and outcomes. This retrospective study, conducted from May 2020 to October 2022, involved 109 patients with DFUs, categorised into amputation (AM) and non-amputation (NAM) groups. Patients were evaluated for various factors, including demographic data, DFU duration, and blood parameters such as haemoglobin A1c (HbA1c), haemoglobin (Hb), albumin (ALB), white blood cell count (WBC), erythrocyte sedimentation rate (ESR), procalcitonin (PCT), C-reactive protein (CRP), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Statistical analyses were performed using independent sample t-tests, Mann-Whitney U test and logistic regression. The univariate analysis showed no significant difference in BMI, DM duration or DFU duration between groups. However, significant differences were noted in PCT, Hb, ESR, ALB, HbA1c and WBC levels, and in inflammatory ratios (NLR, PLR and LMR). Multivariate logistic regression identified CRP, NLR and PLR as independent risk factors for amputation. The study highlights CRP, PLR and NLR as key independent risk factors for amputation in patients with DFUs. These easily obtainable markers from routine blood tests can effectively aid in predicting the risk of osteomyelitis and amputation, enhancing clinical decision making and patient care strategies.
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Affiliation(s)
- Yun Xu
- Ward 1, The Department of EndocrinologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Ruina Geng
- Ward 1, The Department of EndocrinologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Xiangyu Meng
- Ward 1, The Department of EndocrinologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Zhipeng Feng
- The Department of General MedicineThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Xu Wang
- Ward 1, The Department of EndocrinologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Guanying Zhang
- Ward 2, The Department of UrologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
| | - Liwei Bai
- Ward 1, The Department of EndocrinologyThe First Affiliated Hospital of Xinxiang Medical UniversityWeihuiChina
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Zhang L, Lin Y, Huang X, Zhai Z, Wei R, Mo J, Li J, Lu W. Metabolic dysfunction-associated fatty liver disease in the elderly with diabetic foot ulcers: A longitudinal cohort study. Int Wound J 2024; 21:e14586. [PMID: 38102851 PMCID: PMC10961876 DOI: 10.1111/iwj.14586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023] Open
Abstract
This study aimed to explore the association between metabolic-associated fatty liver disease (MAFLD) and ulcer recurrence risk in patients with diabetic foot ulcers (DFUs) through an ambispective longitudinal cohort. From December 2013 to December 2022, a total of 482 inpatients with DFUs (PEDIS grade 3 and above with a severe infection) were eligible for inclusion in this study. This was an ambispective longitudinal cohort study. All participants were followed up every 6 months for 9 years with a median of 36 months. According to whether having MAFLD or not, all subjects were placed into two groups: non-MAFLD (n = 351) and MAFLD (n = 131). The association between MAFLD and ulcer recurrence in patients with DFUs was then evaluated through multivariate Cox regression analysis, stratified analyses and Kaplan-Meier survival analysis. Throughout the follow-up period, out of 482 subjects with DFUs, 68 had ulcer recurrence (14.1%). Three Cox regression models were established for data analyses. In the model I (unadjusted), MAFLD was significantly associated with the ulcer recurrence rate in patients with DFUs (HR = 1.79; 95% CI = 1.097-2.92; p = 0.02). Model II (adjusted model I with gender and age) (HR = 1.781; 95% CI = 1.09-2.912; p = 0.021) and model III (adjusted model II with CVD, duration of diabetes and Cr.) (HR = 1.743; 95% CI = 1.065-2.855; p = 0.027) also showed that MAFLD was significantly related to the ulcer recurrence risk in patients with DFUs, respectively. Stratified analysis indicated that subjects aged ≥60 had a greater risk of ulcer recurrence in MAFLD than in non-MAFLD (HR = 2.31; 95% CI = 1.268-4.206; p = 0.006). Kaplan-Meier survival curve analysis showed that ulcer recurrence rate had a significant association with MAFLD (log-rank, p = 0.018). This study indicated a close association between ulcer recurrence risk and MAFLD in patients with DFUs, especially in the elderly (aged ≥60). Therefore, special attention should be paid to the elderly with both DFUs and MAFLD because they have a higher ulcer recurrence rate than other general populations in routine clinical practice.
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Affiliation(s)
- Liya Zhang
- Department of EndocrinologyShanxi Yingkang Healthcare General HospitalYunchengPeople's Republic of China
| | - Yuanmei Lin
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Xiuxian Huang
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Zhenwei Zhai
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Rongyan Wei
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Jiacheng Mo
- Information Network Center of Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Junjun Li
- Dean's Office of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Wensheng Lu
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical SciencesPeople's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
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Jiang F, Zhang Y, Cheng S, Yang X, Bai M, Zhang M. Quality of evidence supporting the role of hyperbaric oxygen therapy for diabetic foot ulcers. Int Wound J 2024; 21:e14530. [PMID: 38053520 PMCID: PMC10961030 DOI: 10.1111/iwj.14530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023] Open
Abstract
The goal of this overview of systematic reviews (SRs) and meta-analyses (MAs) was to methodically gather, evaluate and summarize the data supporting the use of hyperbaric oxygen therapy (HBOT) to treat diabetic foot ulcers (DFUs). The Cochrane Library, Embase, PubMed, Web of Science and Embase were all searched thoroughly to identify SRs/MAs that qualified. AMSTAR-2 tool, PRISMA checklists and GRADE system were applied by two reviewers independently to assess the methodological quality, reporting and evidence quality of the included SRs/MAs, respectively. Eleven SRs/MAs were enrolled in this overview. According to AMSTAR-2, a very low methodological quality assessment was given to the included SRs/MAs due to the limitations of items 2, 4 and 7. For the PRISMA, the overall quality of reporting is not satisfactory due to missing reporting on protocol, search, as well as additional analysis. The majority of outcomes had low- to moderate-quality evidence, and no high-quality evidence was found to support the role of HBOT for DFUs, according to GRADE. To conclude, the potential of HBOT in treating DFUs is supported by evidence of low to moderate quality. More rigorously designed, high-level studies are needed in the future to determine the evidence for HBOT for DFU, including the timing, frequency and duration of HBOT interventions.
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Affiliation(s)
- Fuxin Jiang
- General Medicine DepartmentXigu Hospital of Lanzhou University Second HospitalLanzhouChina
| | - Yalan Zhang
- The Second Affiliated Hospital of Fujian Medical UniversityQuanzhouChina
| | - Shijin Cheng
- Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Xiaohui Yang
- Tianjin University of Traditional Chinese MedicineTianjinChina
| | - Min Bai
- General Medicine DepartmentXigu Hospital of Lanzhou University Second HospitalLanzhouChina
| | - Ming Zhang
- Endocrinology DepartmentLanzhou University Second HospitalLanzhouChina
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10
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Sang P, Zhao J, Yang H. The efficacy of electroacupuncture in among early diabetic patients with lower limb arteriosclerotic wounds. Int Wound J 2024; 21:e14526. [PMID: 38093499 PMCID: PMC10961040 DOI: 10.1111/iwj.14526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 03/25/2024] Open
Abstract
Diabetic foot ulcers are the prevalent complication of diabetes mellitus, frequently culminating in arteriosclerosis of the lower extremities and consequent development of chronic wounds. The effectiveness of electroacupuncture (EA) as therapeutic intervention for promoting wound healing in this particular group of patients has been comprehensively assessed in this study. A randomized controlled trial involving 380 early diabetic patients with arteriosclerotic lesions of the lower limbs was conducted. Standard wound care plus EA was administered to the treatment group, while standard wound care alone was administered to the control group. The principal outcome assessed was the reduction in lesion size following the 8-week treatment period. Pain scores, recuperation time, and quality of life (QoL) evaluations constituted secondary outcomes. In comparison to the control group, the treatment group exhibited a significantly greater reduction in wound size (p < 0.05). The treatment group exhibited significantly reduced pain scores and significantly higher QoL scores (p < 0.05). The duration of recovery did not vary substantially among the groups (p > 0.05). Electroacupuncture thus appeared to be an effective adjunctive treatment for early diabetic patients with lower limb arteriosclerotic lesions, promoting pain relief and quality of life. Additional investigation is necessary to validate these results and delve into the underlying mechanisms of action.
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Affiliation(s)
- Peng Sang
- Department of AcupunctureHeilongjiang Academy of Chinese Medicine SciencesHarbinHeilongjiangChina
| | - Jiahui Zhao
- Department of AcupunctureHeilongjiang Academy of Chinese Medicine SciencesHarbinHeilongjiangChina
| | - Hui Yang
- Department of AcupunctureHeilongjiang Academy of Chinese Medicine SciencesHarbinHeilongjiangChina
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Talebi HM, Javaheri J, Fakhari MS. Successful treatment of a high-risk diabetic foot ulcer by ozone therapy and collagen powder: A case report. Clin Case Rep 2024; 12:e8728. [PMID: 38562577 PMCID: PMC10983709 DOI: 10.1002/ccr3.8728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 03/12/2024] [Accepted: 03/15/2024] [Indexed: 04/04/2024] Open
Abstract
Key Clinical Message A high risk diabetic foot ulcer is treated by ozone therapy and collagen powder. The goal of this study was to report a high risk case, treated by ozone therapy, and collagen powder. Ozone therapy and collagen powder can improve healing process of diabetic foot ulcers. Abstract This case report presents a successful nonsurgical outpatient approach for managing a high-risk diabetic foot ulcer with tendon exposure in an older adult with uncontrolled diabetes mellitus and severe heart failure. Due to the patient's comorbidities, surgical intervention was not an option, leading to the utilization of ozone therapy, collagen powder, and Phenytoin ointment. The significance of this case lies in the treatment of a high-risk foot ulcer through a nonsurgical approach, considering the patient's uncontrolled diabetes and severe heart failure. Diabetic foot ulcers (DFUs) are debilitating and life-threatening complications, often resulting in amputations, socio-psychological burdens, and lifestyle changes. Conventional treatment methods have shown limited success, necessitating the exploration of new and innovative approaches. The use of ozone therapy has emerged as a potential treatment, but its safety and efficacy in DFUs require further investigation. The positive outcomes observed in this case report suggest that ozone therapy may be a viable option for treating DFUs, and further studies are recommended to evaluate its effectiveness.
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Affiliation(s)
| | - Javad Javaheri
- Department of Health and Community MedicineArak University of Medical SciencesArakMarkazi ProvinceIran
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12
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Lei Y, Jiang P, Tian T. Comparative analysis of surgical and non-surgical wound approaches in diabetic foot ulcer treatment: Meta-analysis and systematic review. Int Wound J 2024; 21:e14601. [PMID: 38158715 PMCID: PMC10961902 DOI: 10.1111/iwj.14601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/08/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Abstract
The assessment for safety and effectiveness of surgical interventions in the management of diabetic foot ulcers (DFUs) in comparison to non-surgical approaches was performed. A comprehensive search was performed across PubMed, MEDLINE, Cochrane Library and EMBASE in order to identify case-control studies, randomized controlled trials (RCTs), observational studies, cohort studies and observational studies pertaining to DFU treatments. Studies conducted in English language and focusing on wound healing rates, recurrence rates, time to healing and complication management met the inclusion criteria. There were six studies included in this meta-analysis. Surgical procedures, such as debridement, revascularization and skin transplantation, demonstrated significantly superior efficacy in promoting wound healing (84%) and shorter duration of healing (6 weeks) in comparison to non-surgical approaches, including off-loading, wound dressings and pharmacological therapies. Surgical interventions for DFUs resulted in a wound recovery rate of 84%, a significantly higher mean rate than non-surgical approaches (60%) that was observed. In addition, it was observed that the surgical group experienced considerably reduced average healing period of 9 weeks, in contrast to the non-surgical group's mean healing period of 12 weeks. Nevertheless, it is imperative to acknowledge that surgical procedures were notably correlated with a heightened occurrence of complications, such as amputations, which transpired in 19% of instances. Surgical interventions for DFUs may provide superior short-term results with regard to healing rates and recovery time, as indicated by this meta-analysis. However, they are additionally correlated with the heightened likelihood of complications. Although non-surgical techniques offered comparatively secure option, they were also less reliable. Individualized treatment modalities should be chosen in consideration of patient-specific factors and comparative advantages and disadvantages.
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Affiliation(s)
- Yu Lei
- Medical Informatization, Information Department of Shanghai Sixth People's HospitalShanghaiChina
| | - Ping Jiang
- Shanghai Palline Data Technology Co., LtdShanghaiChina
| | - Tian Tian
- Shanghai Palline Data Technology Co., LtdShanghaiChina
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13
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Armstrong DG, Orgill DP, Galiano RD, Glat PM, Kaufman JP, Carter MJ, DiDomenico LA, Zelen CM. A purified reconstituted bilayer matrix shows improved outcomes in treatment of non-healing diabetic foot ulcers when compared to the standard of care: Final results and analysis of a prospective, randomized, controlled, multi-centre clinical trial. Int Wound J 2024; 21:e14882. [PMID: 38606794 PMCID: PMC11010253 DOI: 10.1111/iwj.14882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/27/2024] [Indexed: 04/13/2024] Open
Abstract
As the incidence of diabetic foot ulcers (DFU) increases, better treatments that improve healing should reduce complications of these ulcers including infections and amputations. We conducted a randomized controlled trial comparing outcomes between a novel purified reconstituted bilayer membrane (PRBM) to the standard of care (SOC) in the treatment of non-healing DFUs. This study included 105 patients who were randomized to either of two treatment groups (n = 54 PRBM; n = 51 SOC) in the intent to treat (ITT) group and 80 who completed the study per protocol (PP) (n = 47 PRBM; n = 33 SOC). The primary endpoint was the percentage of wounds closed after 12 weeks. Secondary outcomes included percent area reduction, time to healing, quality of life, and cost to closure. The DFUs that had been treated with PRBM healed at a higher rate than those treated with SOC (ITT: 83% vs. 45%, p = 0.00004, PP: 92% vs. 67%, p = 0.005). Wounds treated with PRBM also healed significantly faster than those treated with SOC with a mean of 42 versus 62 days for SOC (p = 0.00074) and achieved a mean wound area reduction within 12 weeks of 94% versus 51% for SOC (p = 0.0023). There were no adverse events or serious adverse events that were related to either the PRBM or the SOC. In comparison to the SOC, DFUs healed faster when treated with PRBM. Thus, the use of this PRBM is an effective option for the treatment of chronic DFUs.
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Affiliation(s)
- David G. Armstrong
- Division of Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesCaliforniaUSA
| | - Dennis P. Orgill
- Division of Plastic SurgeryBrigham and Women's HospitalBostonMassachusettsUSA
| | - Robert D. Galiano
- Division of Plastic Surgery, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Paul M. Glat
- Surgery and PediatricsDrexel University College of Medicine, St. Christopher's Hospital for ChildrenPhiladelphiaPennsylvaniaUSA
| | - Jarrod P. Kaufman
- Department of Surgery, Temple University School of Medicine and McGowan Institute for Regenerative MedicineUniversity of PittsburghPittsburghPennsylvaniaUSA
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14
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Liang X, Xia Y, Xu Z, Zeng Q, Gao G, He J, Xu D. Treatment of diabetic foot ulcers with external application of Chinese herbal medicine: An overview of overlapping systematic reviews. Int Wound J 2024; 21:e14563. [PMID: 38135909 PMCID: PMC10961878 DOI: 10.1111/iwj.14563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 12/01/2023] [Indexed: 12/24/2023] Open
Abstract
This overview of systematic reviews (SRs) and meta-analysis (MAs) aimed to systematically collate, appraise and synthesize evidence for the treatment of diabetic foot ulcers (DFUs) with the external application of Chinese herbal medicine (CHM). SRs/MAs of external application of CHM for DFUs were collected by searching Cochrane Library, Web of science, CNKI, PubMed, VIP, Embase and Wanfang. Two independent reviewers carried out the literature selection and data extraction. Subsequently, AMSTAR-2 tool, PRISMA, and GRADE system were applied by two reviewers independently to evaluate the methodological quality, reporting quality, and evidence quality of the included studies, respectively. Eight SRs/MAs met the eligibility criteria and were included. According to AMSTAR-2, a very low methodological quality assessment was given to the included SRs/MAs due to the flaws of items 2, 4 and 7. The PRISMA system identified protocol and registration weaknesses, as well as search method weaknesses. With GRADE, no high-quality evidence was identified to support the role of external application of CHM for DFUs, and the quality of evidence for the vast majority of outcomes was rated as low or moderate. In conclusion, low- to moderate-quality evidence supports the promise of external application of CHM for the treatment of DFUs. Due to the limitations of the evidence supporting external application of CHM for DFUs, rigorously designed and larger samples of high-quality studies are needed going forward before broad recommendations can be made.
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Affiliation(s)
- Xiaolun Liang
- The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Yuge Xia
- The Second Affiliated Hospital of Anhui University of Chinese MedicineHefeiChina
| | - Zhirui Xu
- Medical College of Acu‐Moxi and RehabilitationGuangzhou University of Chinese MedicineGuangzhouChina
| | - Qiang Zeng
- The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
| | - Guochuan Gao
- Guangzhou Hospital of Integrated Chinese and Western MedicineGuangzhouChina
| | - Jiangshan He
- The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
- Guangzhou University of Chinese MedicineGuangzhouChina
| | - Danping Xu
- The Eighth Affiliated HospitalSun Yat‐sen UniversityShenzhenChina
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15
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Chen HR, Lu SJ, Wang Q, Li ML, Chen XC, Pan BY. Application of hyperbaric oxygen therapy in diabetic foot ulcers: A meta-analysis. Int Wound J 2024; 21:e14621. [PMID: 38531355 DOI: 10.1111/iwj.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 12/15/2023] [Indexed: 03/28/2024] Open
Abstract
Hyperbaric oxygen therapy (HBOT) has been used in patients with diabetic foot ulcers (DFU) for many years, but its clinical efficacy is still controversial. Therefore, this study explored the efficacy of HBOT applied to DFU by means of meta-analysis. PubMed, Cochrane Library, Embase, CNKI and Wanfang databases were searched, from database inception to October 2023, and published randomised controlled trials (RCTs) of HBOT in DFU were collected. Two investigators independently screened the collected literature, extracted relevant data and assessed the quality of the literature. Review Manager 5.4 software was applied for data analysis. Twenty-nine RCTs with 1764 patients were included. According to the combined results, when compared with conventional treatment, HBOT significantly increased the complete healing rate of DFUs (46.76% vs. 24.46%, odds ratio [OR]: 2.83, 95% CI: 2.29-3.51, p < 0.00001) and decreased the amputation rate (26.03% vs. 45.00%, OR: 0.41, 95% CI: 0.18-0.95, p = 0.04), but the incidence of adverse events was significantly higher in patients (17.37% vs. 8.27%, OR: 2.49, 95% CI: 1.35-4.57, p = 0.003), whereas there was no significant difference in the mortality (6.96% vs. 12.71%, OR: 0.52, 95% CI: 0.21-1.28, p = 0.16). Our results suggest that HBOT is effective in increasing the complete healing rate and decreasing the amputation rate in patients with DFUs, but increases the incidence of adverse events, while it has no significant effect on mortality.
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Affiliation(s)
- Hai-Rong Chen
- Department of General Practice Medicine, Affiliated Haikou Hospital of Xiangya Medical College of Central South University, Haikou, China
| | - Shi-Juan Lu
- Department of Cardiovascular Medicine, Affiliated Haikou Hospital of Xiangya Medical College of Central South University, Haikou, China
| | - Qi Wang
- Department of General Practice Medicine, Affiliated Haikou Hospital of Xiangya Medical College of Central South University, Haikou, China
| | - Ming-Lan Li
- Department of General Practice Medicine, Affiliated Haikou Hospital of Xiangya Medical College of Central South University, Haikou, China
| | - Xun-Chun Chen
- Department of General Practice Medicine, Affiliated Haikou Hospital of Xiangya Medical College of Central South University, Haikou, China
| | - Bi-Yun Pan
- Department of General Practice Medicine, Affiliated Haikou Hospital of Xiangya Medical College of Central South University, Haikou, China
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16
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Baker CL, Seo KS, Park N, Rutter JK, Thornton JA, Pruett SB, Park JY. L-arginine supplementation abrogates hypoxia-induced virulence of Staphylococcus aureus in a murine diabetic pressure wound model. mSphere 2024; 9:e0077423. [PMID: 38426801 PMCID: PMC10964415 DOI: 10.1128/msphere.00774-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/24/2024] [Indexed: 03/02/2024] Open
Abstract
Diabetic foot ulcers (DFUs) are the most common complications of diabetes resulting from hyperglycemia leading to ischemic hypoxic tissue and nerve damage. Staphylococcus aureus is the most frequently isolated bacteria from DFUs and causes severe necrotic infections leading to amputations with a poor 5-year survival rate. However, very little is known about the mechanisms by which S. aureus dominantly colonizes and causes severe disease in DFUs. Herein, we utilized a pressure wound model in diabetic TALLYHO/JngJ mice to reproduce ischemic hypoxic tissue damage seen in DFUs and demonstrated that anaerobic fermentative growth of S. aureus significantly increased the virulence and the severity of disease by activating two-component regulatory systems leading to expression of virulence factors. Our in vitro studies showed that supplementation of nitrate as a terminal electron acceptor promotes anaerobic respiration and suppresses the expression of S. aureus virulence factors through inactivation of two-component regulatory systems, suggesting potential therapeutic benefits by promoting anaerobic nitrate respiration. Our in vivo studies revealed that dietary supplementation of L-arginine (L-Arg) significantly attenuated the severity of disease caused by S. aureus in the pressure wound model by providing nitrate. Collectively, these findings highlight the importance of anaerobic fermentative growth in S. aureus pathogenesis and the potential of dietary L-Arg supplementation as a therapeutic to prevent severe S. aureus infection in DFUs.IMPORTANCES. aureus is the most common cause of infection in DFUs, often resulting in lower-extremity amputation with a distressingly poor 5-year survival rate. Treatment for S. aureus infections has largely remained unchanged for decades and involves tissue debridement with antibiotic therapy. With high levels of conservative treatment failure, recurrence of ulcers, and antibiotic resistance, a new approach is necessary to prevent lower-extremity amputations. Nutritional aspects of DFU treatment have largely been overlooked as there has been contradictory clinical trial evidence, but very few in vitro and in vivo modelings of nutritional treatment studies have been performed. Here we demonstrate that dietary supplementation of L-Arg in a diabetic mouse model significantly reduced duration and severity of disease caused by S. aureus. These findings suggest that L-Arg supplementation could be useful as a potential preventive measure against severe S. aureus infections in DFUs.
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Affiliation(s)
- Carol L. Baker
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Keun Seok Seo
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Nogi Park
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Jaime K. Rutter
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Justin A. Thornton
- Department of Biological Sciences, College of Arts and Sciences, Mississippi State University, Mississippi State, Mississippi, USA
| | - Stephen B. Pruett
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
| | - Joo Youn Park
- Department of Comparative Biomedical Sciences, College of Veterinary Medicine, Mississippi State University, Mississippi State, Mississippi, USA
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17
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Bang FS, Leeberg V, Ding M, Dreyer CH. The effect of VEGF stimulation in diabetic foot ulcers: A systematic review. Wound Repair Regen 2024. [PMID: 38494793 DOI: 10.1111/wrr.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/21/2024] [Accepted: 02/28/2024] [Indexed: 03/19/2024]
Abstract
Diabetic foot ulcers are a common and severe complication of diabetes mellitus, and a risk factor for amputation. Because of the vessel insufficiency in diabetic foot ulcers (DFU), vascular endothelial growth factor (VEGF) that simulates angiogenesis is of interest to promote wound healing. This systematic review evaluates the last 16 years of in-vivo studies with VEGF stimulation as a treatment for DFU, developed based on the last published systematic article. A total of 961 articles were identified through databases in two phases. 947 articles were excluded by exclusion criteria, and four articles met our inclusion criteria and were included. The effects of VEGF on wound healing were analysed in all four studies. In three studies, the VEGF-treated wounds showed statistically faster healing than those not treated with VEGF. In one study, the VEGF-treated wounds revealed a positive trend toward faster healing. Furthermore, all four studies were in favor of using VEGF, but concluded that further research is needed. These studies showed a positive trend towards faster healing and was safe when using VEGF topically on humans. Furthermore, viral particles of VEGF seem to have a systematic effect when a dose exceeding 5.0 × 109 vp pr wound. Future research in using VEGF on DFU should focus on VEGF's relevant dosage, release rate, and specific mechanism. This review inspires further research, and a consistent study design is prerequisite such that results are more homogenic and comparable. Much effort is needed to translate the results into our clinical practice.
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Affiliation(s)
- Frederik S Bang
- Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Veronica Leeberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Ming Ding
- Department of Orthopaedic Surgery and Traumatology, CORI-Centre for Orthopaedic Research and Innovation, Slagelse Hospital, Slagelse, Denmark
| | - Chris H Dreyer
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedic Surgery and Traumatology, CORI-Centre for Orthopaedic Research and Innovation, Slagelse Hospital, Slagelse, Denmark
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18
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Meloni M, Piaggesi A, Uccioli L. From a Spark to a Flame: The Evolution of Diabetic Foot Disease in the Last Two Decades. INT J LOW EXTR WOUND 2024:15347346241238480. [PMID: 38470358 DOI: 10.1177/15347346241238480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
Despite many improvements have been achieved, diabetic foot disease (DFD) remains a clinical, social, and economic burden. In the last years, DFD showed an evolution of its characteristics with an increase of the ischaemic/neuro-ischaemic foot in comparison to the pure neuropathic foot. Simultaneously, there was and increased incidence of concomitant cardiovascular co-morbidities, which influences the higher fragility of patients with DFS. Peripheral arterial disease (PAD) in subjects with diabetic foot seems to show a more aggressive pattern, being more distal and difficult to treat. Untreatable PAD remains the unmet need for clinicians and the main risk factor of major amputation in patients with diabetic foot ulcers. Authors aimed to describe the evolution of diabetic foot patients in the last two decades, describing also the current and future treatment which may improve outcomes in the next generations.
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Affiliation(s)
- Marco Meloni
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Alberto Piaggesi
- Diabetic Foot Section, Department of Endocrinology and Metabolism, University of Pisa, Pisa, Italy
| | - Luigi Uccioli
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy
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19
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Huang X, Li Z, Zhai Z, Wang Q, Wei R, Mo J, Huang J, Lu W. Association Between Metabolic Dysfunction-Associated Fatty Liver Disease and MACCEs in Patients with Diabetic Foot Ulcers: An Ambispective Longitudinal Cohort Study. Diabetes Metab Syndr Obes 2024; 17:1119-1130. [PMID: 38465347 PMCID: PMC10924916 DOI: 10.2147/dmso.s447897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 02/28/2024] [Indexed: 03/12/2024] Open
Abstract
Aim Metabolic dysfunction-related fatty liver disease (MAFLD) is closely related to metabolic disorders. However, the relationship between MAFLD and the prognosis in diabetic foot ulcers (DFUs) remains unclear. This study aimed to explore the association between MAFLD and the risk of major adverse cardiac and cerebral events (MACCEs) in patients with DFUs. Methods 889 inpatients with DFUs (PEDIS/TEXAS mild and above) were included in this study from 2013 to 2023. All participants were placed into non-MAFLD (n = 643) and MAFLD (n = 246) groups and followed up every 6 months for 10.9 years with a median of 63 months through in-person outpatient interviews and family fixed-line telephone visits. The association between MAFLD and the risk of MACCEs was evaluated through Multivariate Cox regression analyses, Stratified analyses and Kaplan-Meier survival analyses. Results Of the 889 subjects, 214 (24.07%) experienced MACCEs. Multivariate Cox regression analysis showed that MAFLD was independently associated with MACCEs (P < 0.001), of which with non-fatal myocardial infarction (P = 0.04), non-fatal stroke (P = 0.047), coronary artery revascularization (P = 0.002), heart failure (P = 0.029), and all-cause mortality (P = 0.021), respectively. The stratified analysis revealed that compared with non-MAFLD (HR=1), DFUs with MAFLD had a 2.64-fold increased risk for MACCEs (P <0.001; P for interaction = 0.001) in peripheral arterial disease (PAD) subgroup. Kaplan-Meier analysis evidenced that the MAFLD group had a higher cumulative incidence of MACCEs (log-rank, all P < 0.05). Conclusion MAFLD is a high-risk factor for MACCEs in patients with DFUs. The findings will remind clinicians to pay more attention to MAFLD in patients with DFUs, especially in patients with DFUs combined with PAD as early as possible in clinical practice and adopt timely effective intervention strategies to prevent the occurrence of MACCEs to improve the clinical prognosis in patients with DFUs.
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Affiliation(s)
- Xiuxian Huang
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical Sciences, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Zhengming Li
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical Sciences, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Zhenwei Zhai
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical Sciences, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Qiu Wang
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical Sciences, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Rongyan Wei
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical Sciences, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Jiacheng Mo
- Information Network Center of Guangxi Academy of Medical Sciences, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Jianhao Huang
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical Sciences, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
| | - Wensheng Lu
- Department of Endocrinology and Metabolism of Guangxi Academy of Medical Sciences, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, 530021, People's Republic of China
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Architha T, Juanitaa GR, Vijayalalitha R, Jayasuriya R, Athira G, Balamurugan R, Ganesan K, Ramkumar KM. LncRNA NEAT1/miR-146a-5p Axis Restores Normal Angiogenesis in Diabetic Foot Ulcers by Targeting mafG. Cells 2024; 13:456. [PMID: 38474419 DOI: 10.3390/cells13050456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 03/14/2024] Open
Abstract
Non-healing lesions in diabetic foot ulcers are a significant effect of poor angiogenesis. Epigenetic regulators, mainly lncRNA and miRNA, are recognized for their important roles in disease progression. We deciphered the regulation of lncRNA NEAT1 through the miR-146a-5p/mafG axis in the progression of DFU. A lowered expression of lncRNA NEAT1 was associated with dysregulated angiogenesis through the reduced expression of mafG, SDF-1α, and VEGF in chronic ulcer subjects compared to acute DFU. This was validated by silencing NEAT1 by SiRNA in the endothelial cells which resulted in the transcriptional repression of target genes. Our in silico analysis identified miR-146a-5p as a potential target of lncRNA NEAT1. Further, silencing NEAT1 led to an increase in the levels of miR-146a-5p in chronic DFU subjects. This research presents the role of the lncRNA NEAT1/miR-146a-5p/mafG axis in enhancing angiogenesis in DFU.
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Affiliation(s)
- Tca Architha
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Chengalpattu Dt., Tamil Nadu, India
| | - George Raj Juanitaa
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Chengalpattu Dt., Tamil Nadu, India
| | - Ramanarayanan Vijayalalitha
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Chengalpattu Dt., Tamil Nadu, India
| | - Ravichandran Jayasuriya
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Chengalpattu Dt., Tamil Nadu, India
| | - Gopinathan Athira
- SRM Medical Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur 603 203, Chengalpattu Dt., Tamil Nadu, India
| | - Ramachandran Balamurugan
- SRM Medical Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur 603 203, Chengalpattu Dt., Tamil Nadu, India
| | - Kumar Ganesan
- School of Chinese Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 10 Sassoon Road, Pokfulam, Hong Kong 999077, China
| | - Kunka Mohanram Ramkumar
- Department of Biotechnology, School of Bioengineering, SRM Institute of Science and Technology, Kattankulathur 603 203, Chengalpattu Dt., Tamil Nadu, India
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21
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Hettinger G, Mitra N, Thom SR, Margolis DJ. An Improved Clinical and Genetics-Based Prediction Model for Diabetic Foot Ulcer Healing. Adv Wound Care (New Rochelle) 2024. [PMID: 38258807 DOI: 10.1089/wound.2023.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024] Open
Abstract
Objective: The goal of this investigation was to use comprehensive prediction modeling tools and available genetic information to try to improve upon the performance of simple clinical models in predicting whether a diabetic foot ulcer (DFU) will heal. Approach: We utilized a cohort study (n = 206) that included clinical factors, measurements of circulating endothelial precursor cells (CEPCs), and fine sequencing of the NOS1AP gene. We derived and selected relevant predictive features from this patient-level information using statistical and machine learning techniques. We then developed prognostic models using machine learning approaches and assessed predictive performance. The presentation is consistent with TRIPOD requirements. Results: Models using baseline clinical and CEPC data had an area under the receiver operating characteristic curve (AUC) of 0.73 (0.66-0.80). Models using only single nucleotide polymorphisms (SNPs) of the NOS1AP gene had an AUC of 0.67 (95% confidence interval, CI: [0.59-0.75]). However, models incorporating baseline and SNP information resulted in improved AUC (0.80, 95% CI [0.73-0.87]). Innovation: We provide a rigorous analysis demonstrating the predictive potential of genetic information in DFU healing. In this process, we present a framework for using advanced statistical and bioinformatics techniques for creating superior prognostic models and identify potentially predictive SNPs for future research. Conclusion: We have developed a new benchmark for which future predictive models can be compared against. Such models will enable wound care experts to more accurately predict whether a patient will heal and aid clinical trialists in designing studies to evaluate therapies for subjects likely or unlikely to heal.
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Affiliation(s)
- Gary Hettinger
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nandita Mitra
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Stephen R Thom
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David J Margolis
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
- Department of Dermatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Mancusi R, Nosso G, Pecoraro S, Barricelli M, Russo A. Photodynamic Therapy With RLP068 and 630-nm Red LED Light in Foot Ulcers in Patients With Diabetes: A Case Series. INT J LOW EXTR WOUND 2024; 23:99-103. [PMID: 34693762 DOI: 10.1177/15347346211053403] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The management and healing of lower extremity ulcers have always been a complex health problem because the clinical course is typically chronic, the results are often poor, and the socioeconomic impact is considerable. The healing process of foot ulcers of people with diabetes is further hindered by the concomitant presence of obstructive arterial disease, neuropathy, and foot malformation. It is frequently associated with multiresistant infections and often results in micro/macro amputations. Photodynamic therapy employs a photosensitizer activated by light of a specific wavelength able to generate reactive oxygen species, which initiate further oxidative responses locally with components of the bacteria. The experience of the treatment center for the lower extremity ulcers in 17 persons with diabetes in Acerra (Italy) with photoactivated RLP068, reported here, corroborates the results of the clinical trials and of the previous case reports. In all cases, examined photodynamic therapy with photosensitizer RLP068 and red light at 630 nm was found to reduce lesion area and inflammation and to ensure the decrease of bacterial load, hence reducing treatment times and antibiotics use, improving patient outcomes, and reducing the incidence of amputations. The simultaneous combination of photodynamic therapy with other ancillary physical-based treatments such as therapeutic magnetic resonance or Bio-Electro-Magnetic-Energy-Regulation was observed to be safe, time-saving, and able to lead to faster healing.
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Affiliation(s)
| | | | | | | | - Andrea Russo
- Private Clinic Villa dei Fiori, Acerra, Naples, Italy
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23
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Yang Q, Liu F, Zhao C, Xu X, Wang Y, Zuo W. Effect of Chinese herbal compound dressings in treating patients with diabetic foot ulcers: A meta-analysis. Int Wound J 2024; 21:e14767. [PMID: 38444012 PMCID: PMC10914709 DOI: 10.1111/iwj.14767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 01/26/2024] [Accepted: 01/28/2024] [Indexed: 03/07/2024] Open
Abstract
This meta-analysis aims to systematically investigate the clinical efficacy of Chinese herbal compound dressings in treating patients with diabetic foot ulcers (DFUs). A comprehensive computerised search was conducted in databases including PubMed, Embase, Google Scholar, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases, from database inception to November 2023, to identify randomised controlled trials (RCTs) concerning the use of Chinese herbal compound dressings in patients with DFU. Two researchers independently screened the literature, extracted data, and assessed the quality based on inclusion and exclusion criteria. Data analysis was performed using Stata 17.0 software. Overall, 18 RCTs involving 1405 DFU patients were included. The analysis indicated that compared to the control group, the group treated with Chinese herbal compound dressings had significantly shorter ulcer healing time (standardised mean difference [SMD] = -2.49, 95% confidence interval [CI]: -3.53 to -1.46, p < 0.001), reduced ulcer surface area (SMD = -3.38, 95% CI: -4.67 to -2.09, p < 0.001), and higher healing rates (odds ratio [OR] = 2.24, 95% CI: 1.72-2.92, p < 0.001) as well as overall effectiveness rates (OR = 4.56, 95% CI: 3.10-6.71, p < 0.001). This study demonstrates that the external application of Chinese herbal compound dressings in patients with DFU can significantly shorten the ulcer healing time and improve wound healing rates.
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Affiliation(s)
- Qian Yang
- Department of Traditional Chinese MedicineCangzhou Central HospitalCangzhouHebeiChina
| | - Fei Liu
- Department of CardiologyCangzhou Central HospitalCangzhouHebeiChina
| | - Changxiu Zhao
- Department of HematologyCangzhou Central HospitalCangzhouHebeiChina
| | - Xin Xu
- Department of Traditional Chinese MedicineCangzhou Central HospitalCangzhouHebeiChina
| | - Yaqi Wang
- Department of Traditional Chinese MedicineCangzhou Central HospitalCangzhouHebeiChina
| | - Weiwei Zuo
- Department of EndocrinologyCangzhou Central HospitalCangzhouHebeiChina
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24
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Sanchez A, Hartstein A, Ashry H, Raza M. Use of hypothermically stored amniotic membrane on diabetic foot ulcers: a multicentre retrospective case series. J Wound Care 2024; 33:S16-S23. [PMID: 38457306 DOI: 10.12968/jowc.2024.33.sup3.s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
OBJECTIVE The aim of this retrospective case series was to report on the outcomes of diabetic foot ulcers (DFUs) managed with hypothermically stored amniotic membrane (HSAM). METHOD Deidentified case data of patients who received HSAM were obtained from wound care sites across the US. Data were collected, beginning at the first patient visit to the wound care site (first presentation), at the visit in which the first HSAM application occurred (baseline), and at each subsequent visit over 12 weeks of treatment (follow-up). All patients received standard of care (SoC) between first presentation and baseline. RESULTS Of the 50 patients in the study, 68% were male. Mean age of the entire cohort was 66.7 years. Of the DFUs, 88% were present for <6 months at first presentation. Mean wound area was 3.5cm2, and mean percentage area reduction was -68.3% from first presentation to baseline. The mean number of HSAM applications was 5.5, and mean number of days between applications was 7.5. A >60% area reduction was attained in 96.0% of DFUs, and 78% attained complete wound closure (CWC) by week 12. The median time to CWC was 55 days. CONCLUSION The results of this retrospective case series suggest positive outcomes for DFUs managed with HSAM. A reduction in time to CWC may lead to lesser financial burden and improved quality of life for DFU patients. DECLARATION OF INTEREST The authors have no conflicts of interest.
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Affiliation(s)
| | - Alan Hartstein
- Palm Beach Foot & Ankle, Palm Beach Gardens, FL 33410, US
| | - Hisham Ashry
- Palm Beach Foot & Ankle, Palm Beach Gardens, FL 33410, US
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25
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Mikłosz A, Chabowski A. Efficacy of adipose-derived mesenchymal stem cell therapy in the treatment of chronic micro- and macrovascular complications of diabetes. Diabetes Obes Metab 2024; 26:793-808. [PMID: 38073423 DOI: 10.1111/dom.15375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/23/2023] [Accepted: 11/05/2023] [Indexed: 02/06/2024]
Abstract
Diabetes mellitus is a highly prevalent disease characterized by hyperglycaemia that damages the vascular system, leading to micro- (retinopathy, neuropathy, nephropathy) and macrovascular diseases (cardiovascular disease). There are also secondary complications of diabetes (cardiomyopathy, erectile dysfunction or diabetic foot ulcers). Stem cell-based therapies have become a promising tool targeting diabetes symptoms and its chronic complications. Among all stem cells, adipose-derived mesenchymal stem cells (ADMSCs) are of great importance because of their abundance, non-invasive isolation and no ethical limitations. Characteristics that make ADMSCs good candidates for cell-based therapy are their wide immunomodulatory properties and paracrine activities through the secretion of an array of growth factors, chemokines, cytokines, angiogenic factors and anti-apoptotic molecules. Besides, after transplantation, ADMSCs show great ex vivo expansion capacity and differentiation to other cell types, including insulin-producing cells, cardiomyocytes, chondrocytes, hepatocyte-like cells, neurons, endothelial cells, photoreceptor-like cells, or astrocytes. Preclinical studies have shown that ADMSC-based therapy effectively improved visual acuity, ameliorated polyneuropathy and foot ulceration, arrested the development and progression of diabetic kidney disease, or alleviated the diabetes-induced cardiomyocyte hypertrophy. However, despite the positive results obtained in animal models, there are still several challenges that need to be overcome before the results of preclinical studies can be translated into clinical applications. To date, there are several clinical trials or ongoing trials using ADMSCs in the treatment of diabetic complications, most of them in the treatment of diabetic foot ulcers. This narrative review summarizes the most recent outcomes on the usage of ADMSCs in the treatment of long-term complications of diabetes in both animal models and clinical trials.
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Affiliation(s)
- Agnieszka Mikłosz
- Department of Physiology, Medical University of Bialystok, Bialystok, Poland
| | - Adrian Chabowski
- Department of Physiology, Medical University of Bialystok, Bialystok, Poland
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26
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Orrapin S, Siribumrungwong B. Successful Revascularization, Angiosome Concept, and Multivessel Revascularization: Effects on Wound Healing: An Asian Perspective. INT J LOW EXTR WOUND 2024; 23:12-18. [PMID: 37933151 DOI: 10.1177/15347346231212330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Endovascular treatment for revascularization in patients with chronic limb-threatening ischemia (CLTI), which is commonly found in patients with diabetes mellitus demonstrates a variable result of vessel patency, wound healing rate, and limb salvage rate. The angiosome concept has been adopted to determine the best target arterial path (TAP) for revascularization for wound healing in CLTI patients. Recent publications demonstrated the benefit of angiosome-targeted revascularization to guide the endovascular treatment in patients CLTI. The best TAP under angiosome concept by direct revascularization with at least 2 of 3 below-the-knee arteries runoff to restore in-line pulsatile blood flow to the ischemic tissue shows the best patency and high rate of wound healing. However, the clinical evidence and application of the angiosome concept in daily practice are difficult and not well established. The vascular territories, collateral vessel, wound area, and locations which associated with angiosome are varied. This article review aims to summarize the concept of angiosome-targeted revascularization and multivessel revascularization for application to the real-world practice under the evidence-based data.
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Affiliation(s)
- Saritphat Orrapin
- Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
- Thammasat University-Center of Excellence for Diabetic Foot care (TU-CDC), Thammasat University Hospital, Pathum Thani, Thailand
| | - Boonying Siribumrungwong
- Vascular Surgery Division, Department of Surgery, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
- Center of Excellence in Applied Epidemiology, Faculty of Medicine, Thammasat University Hospital, Thammasat University, Pathum Thani, Thailand
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27
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Viswanathan V, Govindan S, Selvaraj B, Rupert S, Kumar R. A Clinical Study to Evaluate Autofluorescence Imaging of Diabetic Foot Ulcers Using a Novel Artificial Intelligence Enabled Noninvasive Device. INT J LOW EXTR WOUND 2024; 23:169-176. [PMID: 34617810 DOI: 10.1177/15347346211047098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetic foot ulcers, with worldwide prevalence ranging from 12%-25%, are an important cause of nontraumatic lower limb amputation. Evidence-based assessment of early infection can help the clinician provide the right first line treatment thus helping improve the wound closure rate. Illuminate®, a novel point of care device working on multispectral autofluorescence imaging, helps in the rapid identification and classification of bacteria. This study was aimed to evaluate the diagnostic accuracy of the device in detecting bacterial gram type against standard culture methods. A total of 178 patients from a tertiary care center for diabetes was recruited and 203 tissue samples were obtained from the wound base by the plastic surgeon. The device was handled by the trained investigator to take wound images. The tissue samples were taken from the color-coded infected region as indicated by the device's Artificial Intelligence algorithm and sent for microbial assessment. The results were compared against the Gram type inferred by the device and the device was found to have an accuracy of 89.54%, a positive predictive value of 86.27% for detecting Gram-positive bacteria, 80.77% for Gram-negative bacteria, and 91.67% for no infection. The negative predictive value corresponded to 87.25% for Gram-positive, 92% for Gram-negative, and 96.12% for no infection. The Results exhibited the accuracy of this novel autofluorescence device in identifying and classifying the gram type of bacteria and its potential in significantly aiding clinicians towards early infection assessment and treatment.
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Affiliation(s)
- Vijay Viswanathan
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu
| | - Senthil Govindan
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu
| | - Bamila Selvaraj
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Chennai, Tamil Nadu
| | - Secunda Rupert
- Stem Cell Research Centre, Government Stanley Medical College & Hospital, Chennai, Tamil Nadu
| | - Raghul Kumar
- Adiuvo Diagnostics Private Limited, Chennai, Tamil Nadu
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28
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Alomairi AA, Alhatlani RA, Alharbi SM, Alqurain ZJ, Alanazi IZ, Alanazi SA, Alkhmis Z, Samandar AF, Arif S. Assessing the Application and Effectiveness of Human Amniotic Membrane in the Management of Venous and Diabetic Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Cureus 2024; 16:e56659. [PMID: 38646232 PMCID: PMC11032220 DOI: 10.7759/cureus.56659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2024] [Indexed: 04/23/2024] Open
Abstract
This study aimed to assess the efficacy of human amniotic membranes (HAM) in treating venous and diabetic ulcers, which often pose challenges in healing. A systematic review and meta-analysis were conducted, evaluating 10 relevant studies involving 633 participants. Findings revealed that HAM treatment significantly accelerated ulcer closure, demonstrating over 90% complete healing compared to standard care. Despite moderate heterogeneity among studies, the results strongly suggested the effectiveness and safety of HAM therapy for venous and diabetic leg ulcers. Further research with larger study cohorts is recommended to bolster the existing evidence supporting HAM in managing these challenging wounds.
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Affiliation(s)
- Abeer A Alomairi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Rama A Alhatlani
- College of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Qassim, SAU
| | | | | | | | | | - Zainab Alkhmis
- Medicine and Surgery, King Faisal University, Alhasa, SAU
| | - Alaa F Samandar
- College of Medicine, Umm AlQura University - Al-Qunfudah Branch, Mecca, SAU
| | - Sultan Arif
- Department of Plastic Surgery and Burn Unit, Security Force Hospital, Riyadh, SAU
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29
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Erel V, Nasirian A, Gu Y, Lavery L, Wijesundara MBJ. Development of Cyclic Pressure Offloading Insole for Diabetic Foot Ulcer Prevention. INT J LOW EXTR WOUND 2024:15347346241234825. [PMID: 38419569 DOI: 10.1177/15347346241234825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Introduction. The likelihood of developing a diabetic foot ulcer (DFU) during one's lifetime for individuals with diabetes mellitus is around 19% to 34%. Continuous and repetitive loading on soft tissues are the major causative factors for DFU. This paper introduces an air cell array insole designed for cyclically offloading pressure from plantar regions to reduce repetitive stress and loading on foot. Materials and Methods. The insole comprises an air cell array insole and a pneumatic control unit. The interface pressure was evaluated in static and dynamic conditions at 3 different air cell internal pressures (6.9, 10.3, and 13.8 kPa). Plantar interface pressure was measured using a commercial pressure system, and data were analyzed using paired t test. Average interface pressure and peak pressure (PP) were studied to evaluate the functionality and effectiveness of the insole. Results. The analysis of static pressure data revealed that cyclic offloading significantly (p < .05) reduced PP in 4 tested cells corresponding to big toe, metatarsal heads, and heel areas with the maximum mean difference of 12.9 kPa observed in big toe region. Similarly, dynamic pressure data analysis showed that cyclic offloading significantly (p < .05) reduced PP in these areas, with the highest mean PP reduction of 36.98 kPa in the big toe region. Discussion. Results show the insole's capability to reduce plantar pressure through cyclic offloading. Internal pressure of air cells significantly affects the overall pressure reduction and must be chosen based on the user's weight. Conclusion. Results confirm that the insole with offloading capabilities has the potential to reduce the risk of developing DFUs by alleviating the plantar stress during both static and dynamic conditions.
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Affiliation(s)
- Veysel Erel
- Biomedical Technology Division, The University of Texas at Arlington Research Institute Fort Worth, Arlington, TX, USA
| | - Aida Nasirian
- Biomedical Technology Division, The University of Texas at Arlington Research Institute Fort Worth, Arlington, TX, USA
| | - Yixin Gu
- Biomedical Technology Division, The University of Texas at Arlington Research Institute Fort Worth, Arlington, TX, USA
| | - Larry Lavery
- Department of Plastic Surgery, UT Southwestern Medical Center Dallas, Dallas, TX, USA
| | - Muthu B J Wijesundara
- Biomedical Technology Division, The University of Texas at Arlington Research Institute Fort Worth, Arlington, TX, USA
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30
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Shiraishi M, Lee H, Kanayama K, Moriwaki Y, Okazaki M. Appropriateness of Artificial Intelligence Chatbots in Diabetic Foot Ulcer Management. INT J LOW EXTR WOUND 2024:15347346241236811. [PMID: 38419470 DOI: 10.1177/15347346241236811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Type 2 diabetes is a significant global health concern. It often causes diabetic foot ulcers (DFUs), which affect millions of people and increase amputation and mortality rates. Despite existing guidelines, the complexity of DFU treatment makes clinical decisions challenging. Large language models such as chat generative pretrained transformer (ChatGPT), which are adept at natural language processing, have emerged as valuable resources in the medical field. However, concerns about the accuracy and reliability of the information they provide remain. We aimed to assess the accuracy of various artificial intelligence (AI) chatbots, including ChatGPT, in providing information on DFUs based on established guidelines. Seven AI chatbots were asked clinical questions (CQs) based on the DFU guidelines. Their responses were analyzed for accuracy in terms of answers to CQs, grade of recommendation, level of evidence, and agreement with the reference, including verification of the authenticity of the references provided by the chatbots. The AI chatbots showed a mean accuracy of 91.2% in answers to CQs, with discrepancies noted in grade of recommendation and level of evidence. Claude-2 outperformed other chatbots in the number of verified references (99.6%), whereas ChatGPT had the lowest rate of reference authenticity (66.3%). This study highlights the potential of AI chatbots as tools for disseminating medical information and demonstrates their high degree of accuracy in answering CQs related to DFUs. However, the variability in the accuracy of these chatbots and problems like AI hallucinations necessitate cautious use and further optimization for medical applications. This study underscores the evolving role of AI in healthcare and the importance of refining these technologies for effective use in clinical decision-making and patient education.
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Affiliation(s)
- Makoto Shiraishi
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Haesu Lee
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Koji Kanayama
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Yuta Moriwaki
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
| | - Mutsumi Okazaki
- Department of Plastic and Reconstructive Surgery, The University of Tokyo Hospital, Tokyo, Japan
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31
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Lu Y, Zhao D, Cao G, Yin S, Liu C, Song R, Ma J, Sun R, Wu Z, Liu J, Wu P, Wang Y. Research progress on and molecular mechanism of vacuum sealing drainage in the treatment of diabetic foot ulcers. Front Surg 2024; 11:1265360. [PMID: 38464666 PMCID: PMC10920358 DOI: 10.3389/fsurg.2024.1265360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 01/05/2024] [Indexed: 03/12/2024] Open
Abstract
Diabetic foot ulcers (DFUs) are common chronic wounds and a common complication of diabetes. The foot is the main site of diabetic ulcers, which involve small and medium-sized arteries, peripheral nerves, and microcirculation, among others. DFUs are prone to coinfections and affect many diabetic patients. In recent years, interdisciplinary research combining medicine and material science has been increasing and has achieved significant clinical therapeutic effects, and the application of vacuum sealing drainage (VSD) in the treatment of DFUs is a typical representative of this progress, but the mechanism of action remains unclear. In this review, we integrated bioinformatics and literature and found that ferroptosis is an important signaling pathway through which VSD promotes the healing of DFUs and that System Xc-GSH-GPX4 and NAD(P)H-CoQ10-FSP1 are important axes in this signaling pathway, and we speculate that VSD is most likely to inhibit ferroptosis to promote DFU healing through the above axes. In addition, we found that some classical pathways, such as the TNF, NF-κB, and Wnt/β-catenin pathways, are also involved in the VSD-mediated promotion of DFU healing. We also compiled and reviewed the progress from clinical studies on VSD, and this information provides a reference for the study of VSD in the treatment of DFUs.
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Affiliation(s)
- Yongpan Lu
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, China
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Dejie Zhao
- Department of Vascular Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, China
| | - Guoqi Cao
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Siyuan Yin
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chunyan Liu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Ru Song
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Jiaxu Ma
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Rui Sun
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhenjie Wu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, Shandong Provincial Qianfoshan Hospital, Shandong University, Jinan, China
| | - Jian Liu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Peng Wu
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Yibing Wang
- Jinan Clinical Research Center for Tissue Engineering Skin Regeneration and Wound Repair, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
- Department of Plastic Surgery, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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32
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Primous NR, Elvin PT, Carter KV, Andrade HL, La Fontaine J, Shibuya N, Biguetti CC. Bioengineered Skin for Diabetic Foot Ulcers: A Scoping Review. J Clin Med 2024; 13:1221. [PMID: 38592047 PMCID: PMC10932123 DOI: 10.3390/jcm13051221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 04/10/2024] Open
Abstract
Diabetic foot ulcers (DFUs) pose a significant threat to individuals with diabetes mellitus (DM), such as lower limb amputation and severe morbidity. Bioengineered skin substitutes (BSS) are alternatives to traditional interventions for treating DFUs, but their efficacy compared to standard wound care (SWC) or other treatment types, such as allografts, remains unknown. A scoping review of human studies was conducted to identify current approaches in the treatment of DFUs using BSS as compared with other treatment options. Systematic searches in PubMed, Cochrane Library, and Web of Science were conducted to identify comparative studies that enrolled 10 or more patients and evaluated wound healing outcomes (closure, time-to-healing, and area reduction). Database searches isolated articles published from 1 December 2012 to 1 December 2022 and were conducted in accordance with PRISMA-ScR guidelines. The literature search yielded 1312 articles, 24 of which were included for the qualitative analysis. Findings in these studies demonstrated that BSS outperformed SWC in all measured outcomes, suggesting that BSS may be a superior treatment for DFUs. Of the 24 articles, 8 articles compared human amniotic membrane allografts (hAMA) to BSS. Conflicting evidence was observed when comparing BSS and hAMA treatments, highlighting the need for future research.
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Affiliation(s)
- Nathaniel R. Primous
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
| | - Peter T. Elvin
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
- Department of Biomedical Engineering, University of Texas at Dallas, Dallas, TX 75080, USA
| | - Kathleen V. Carter
- Library, School of Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA;
| | - Hagner L. Andrade
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
| | - Javier La Fontaine
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
| | - Naohiro Shibuya
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
| | - Claudia C. Biguetti
- Department of Podiatric Medicine, Surgery and Biomechanics, School of Podiatric Medicine, University of Texas Rio Grande Valley, Harlingen, TX 78550, USA; (N.R.P.); (P.T.E.); (H.L.A.); (J.L.F.); (N.S.)
- Department of Biomedical Engineering, University of Texas at Dallas, Dallas, TX 75080, USA
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Jiang X, Zeng YE, Li C, Wang K, Yu DG. Enhancing diabetic wound healing: advances in electrospun scaffolds from pathogenesis to therapeutic applications. Front Bioeng Biotechnol 2024; 12:1354286. [PMID: 38375451 PMCID: PMC10875055 DOI: 10.3389/fbioe.2024.1354286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/17/2024] [Indexed: 02/21/2024] Open
Abstract
Diabetic wounds are a significant subset of chronic wounds characterized by elevated levels of inflammatory cytokines, matrix metalloproteinases (MMPs), and reactive oxygen species (ROS). They are also associated with impaired angiogenesis, persistent infection, and a high likelihood of hospitalization, leading to a substantial economic burden for patients. In severe cases, amputation or even mortality may occur. Diabetic foot ulcers (DFUs) are a common complication of diabetes, with up to 25% of diabetic patients being at risk of developing foot ulcers over their lifetime, and more than 70% ultimately requiring amputation. Electrospun scaffolds exhibit a structural similarity to the extracellular matrix (ECM), promoting the adhesion, growth, and migration of fibroblasts, thereby facilitating the formation of new skin tissue at the wound site. The composition and size of electrospun scaffolds can be easily adjusted, enabling controlled drug release through fiber structure modifications. The porous nature of these scaffolds facilitates gas exchange and the absorption of wound exudate. Furthermore, the fiber surface can be readily modified to impart specific functionalities, making electrospinning nanofiber scaffolds highly promising for the treatment of diabetic wounds. This article provides a concise overview of the healing process in normal wounds and the pathological mechanisms underlying diabetic wounds, including complications such as diabetic foot ulcers. It also explores the advantages of electrospinning nanofiber scaffolds in diabetic wound treatment. Additionally, it summarizes findings from various studies on the use of different types of nanofiber scaffolds for diabetic wounds and reviews methods of drug loading onto nanofiber scaffolds. These advancements broaden the horizon for effectively treating diabetic wounds.
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Affiliation(s)
- Xuewen Jiang
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai, China
| | - Yu-E Zeng
- Department of Neurology, Ruijin Hospital Lu Wan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chaofei Li
- Department of General Surgery, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ke Wang
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai, China
| | - Deng-Guang Yu
- School of Materials and Chemistry, University of Shanghai for Science and Technology, Shanghai, China
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Zhou S, Hu X, Wang Y, Fei W, Sheng Y, Que H. The Global Prevalence of Methicillin-Resistant Staphylococcus Aureus in Patients with Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Diabetes Metab Syndr Obes 2024; 17:563-574. [PMID: 38333763 PMCID: PMC10849909 DOI: 10.2147/dmso.s446911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
Objective Diabetic foot ulcer (DFU) frequently leads to infections, with infected DFUs being a common cause of amputation. Infection by methicillin-resistant Staphylococcus aureus (MRSA) notably increases the necessity for amputation and surgical debridement in affected individuals. Consequently, determining the prevalence and trends of MRSA in patients with DFU is of critical importance. This study aimed to assess the global prevalence and to identify trends in the occurrence of MRSA in tissue or wound swab samples from DFU patients. Methods We conducted a comprehensive literature search across PubMed, Embase, Scopus, and Ovid, spanning from the inception of these databases to July 2023, imposing no language restrictions. The inclusion criteria required that the studies report on 30 or more patients with DFU. Additionally, we categorized our analysis based on geographic region, publication date, and the economic status of the patient's domicile. Our primary endpoint was to ascertain the prevalence of MRSA in DFUs. This systematic review has been registered at (https://www.crd.york.ac.uk/prospero/), with the identifier CRD 42023444360. Results Our analysis encompassed 40 studies involving 12,924 patients across 20 countries. We found that the overall prevalence of MRSA in DFU was 17% (95% Confidence Interval [CI] 0.14-0.20). Regional prevalence varied significantly: in South America, it was 61% (95% CI 0.46-0.76), in North America 20% (95% CI 0.12-0.27), in Europe 19% (95% CI 0.14-0.25), in Africa 13% (95% CI 0.06-0.20), and in other subgroups 11% (95% CI 0.08-0.15). The prevalence of MRSA in DFUs also differed according to the economic status of the countries: 19% (95% CI 0.15-0.23) in high-income countries, 24% (95% CI 0.1-0.37) in upper-middle-income countries, 11% (95% CI 0.07-0.15) in lower-middle-income countries, and 20% (95% CI 0.13-0.27) in low-income countries. Notably, there has been a decline in MRSA prevalence, from 25% before 2010 to 9% thereafter. Conclusion This meta-analysis reveals a decreasing yet still significant global prevalence of MRSA in DFUs. This trend has important implications for antimicrobial resistance and underscores the need for developing targeted programs focusing on infection prevention and exploring alternative therapeutic strategies.
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Affiliation(s)
- Siyuan Zhou
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiaojie Hu
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yunfei Wang
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Wenting Fei
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yuqin Sheng
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Huafa Que
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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Sun H, Si S, Liu X, Geng H, Liang J. Evaluation of a new low-cost negative pressure wound therapy in the treatment of diabetic foot ulcers. J Wound Care 2024; 33:xli-xlvii. [PMID: 38324422 DOI: 10.12968/jowc.2024.33.sup2a.xli] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To investigate the effectiveness of a new and low-cost negative pressure wound therapy (LC-NPWT) in the treatment of diabetic foot ulcers (DFUs). METHOD In this retrospective cohort study, patients from our inpatient clinic with Wagner grade 3 DFUs were given LC-NPWT or conventional wound dressings. The primary outcome was the wound healing rates. Complete wound healing, defined as complete re-epithelialisation of the wound, was recorded during the two months of follow-up. The definition of complete epidermis of the wound was that the skin was closed (100% re-epithelialisation), with no drainage or dressing. The secondary outcomes were the number of inpatient days and surgical procedures, and outcomes after hospital discharge. The wound score from the Bates-Jensen wound assessment tool and the levels of the inflammation factors procalcitonin (PCT), C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were compared between the two groups. The Kaplan-Meier survival estimate was used to examine the cumulative wound healing rate. RESULTS The study cohort comprised 41 patients. The two-month wound healing rate was higher in patients in the LC-NPWT group than in the control group (15/21 (71.4%) versus 8/20 (40.0%), respectively; p=0.043). At the end of the two-month follow-up period, the cumulative wound healing rate was higher in the LC-NPWT group than in the control group (p=0.032). Patients in the LC-NPWT group had fewer inpatient days (19.3±3.84 versus 25.05±4.81; p<0.001) and shorter duration of antibiotic use (32.14±3.89 days versus 36.10±5.80 days; p=0.014) than those who received conventional wound dressings. There were significant improvements in mean wound score between the LC-NPWT group and the control group (p<0.001). After one week of treatment, the blood levels of PCT (0.03±0.30ng/ml versus 0.07±0.08ng/ml; p=0.039), CRP (14.55±13.40mg/l versus 24.71±18.10mg/l; p=0.047) and ESR (42.05±29.29mm/h versus 61.65±22.42mm/h; p=0.021) were lower in patients who received LC-NPWT than those who received conventional wound dressings. CONCLUSION LC-NPWT is effective in the treatment of DFUs and provides a cheaper alternative for patients with DFUs that could potentially alleviate the economic distress these patients endure.
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Affiliation(s)
- Haojie Sun
- Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated XuZhou Hospital of Medical College of Southeast University, Jiangsu 221009, China
| | - Shanwen Si
- Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
| | - Xuekui Liu
- Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated XuZhou Hospital of Medical College of Southeast University, Jiangsu 221009, China
| | - Houfa Geng
- Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical College, The Affiliated XuZhou Hospital of Medical College of Southeast University, Jiangsu 221009, China
| | - Jun Liang
- Xuzhou Medical University, Xuzhou, Jiangsu 221000, China
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Platini H, Adammayanti KA, Maulana S, Putri PMK, Layuk WG, Lele JAJMN, Haroen H, Pratiwi SH, Musthofa F, Mago A. The Potential of Autologous Platelet-Rich Plasma Gel for Diabetic Foot Ulcer Care Among Older Adults: A Systematic Review and Meta-Analysis. Ther Clin Risk Manag 2024; 20:21-37. [PMID: 38288358 PMCID: PMC10823873 DOI: 10.2147/tcrm.s433033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 01/22/2024] [Indexed: 01/31/2024] Open
Abstract
Introduction Poorly controlled diabetes mellitus can lead to the development of diabetic foot ulcers (DFU), which is a frequent complication in patients. However, several diabetes management guidelines for older adults do not mention the occurrence of DFUs. Nowadays, Autologous Platelet-Rich Gel (APG) is being used for treating diabetic ulcers. APG is an innovative platelet-derived product with many advantages, such as being low-cost, easy to produce, and readily available materials. Additionally, it does not lead to any rejection reaction. Objective This study aims to assess the safety and efficacy of APG as a novel treatment of DFU compared with standard treatment in older adult patients. Methods Randomized Controlled Trials (RCTs) were searched using PubMed, Cochrane, Google Scholar, Wiley, and PlosOne. The keywords have been arranged using the Boolean operator, including autologous platelet-rich gel, DFU, and elderly. The data was screened by inclusion and exclusion criteria. The final inclusion study was analyzed and synthesized by tabulation, clusterization, contextual and thematic approach, and assessed for risk of bias using ROB 2.0. Meta-analysis was conducted by using Review Manager 5.4 and the Mantel Haenszel method. Results Eight RCTs with 598 patients were eligible for the present analysis. Compared with standard care/conventional treatment, APG could significantly improve the healing wound in patients with diabetic foot ulcers (Relative risk (RR) 1.32, 95% confidence interval (CI) 1.22-1.57, p < 0.0001), shortened the healing time (Mean difference [MD] -16.97 days (95% CI: -32.64 to -1.29; p < 0.00001), shortened the length of hospital stay (MD= -20.11, 95% CI: -38.02, -2.20; p = 0.03), and amputation rate (MD= 0.36, 95% CI: 0.16, 0.84; p = 0.02). Conclusion APG treatment can better treat DFU in terms of duration of healing, wound healing, length of hospital stay, and amputation prevention than the standard treatment.
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Affiliation(s)
- Hesti Platini
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Keyzha Amartya Adammayanti
- Clinical Clerkship Program, Faculty of Medicine, Universitas Kristen Indonesia (UKI), UKI Hospital East Jakarta, Special Capital Region, Indonesia
| | - Sidik Maulana
- Master of Nursing Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Putu Moradha Kharisma Putri
- Clinical Clerkship Program, Faculty of Medicine, Universitas Kristen Indonesia (UKI), UKI Hospital East Jakarta, Special Capital Region, Indonesia
| | - Welly Grivin Layuk
- Clinical Clerkship Program, Faculty of Medicine, Universitas Kristen Indonesia (UKI), UKI Hospital East Jakarta, Special Capital Region, Indonesia
| | | | - Hartiah Haroen
- Department of Community Health Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Sri Hartati Pratiwi
- Department of Medical-Surgical Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
| | - Faizal Musthofa
- Nursing Internship Program, Faculty of Nursing, Universitas Padjadjaran, Sumedang, West Java, Indonesia
- West Sapphire Medical-Surgical Ward, Santosa Bandung Central, Bandung, West Java, Indonesia
| | - Arpit Mago
- Department of Clinical Medicine, Jawaharlal Nehru Medical College, Belagavi, India
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Pyrgioti EE, Karakousis ND, Georgakopoulos PN, Karagiannakis DS, Papanas N. Folic Acid and Diabetic Foot Ulcers. INT J LOW EXTR WOUND 2024:15347346241226677. [PMID: 38233029 DOI: 10.1177/15347346241226677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Diabetic foot ulcers (DFUs) remain a major cause of morbidity. This narrative mini-review aimed to investigate the potential role of folic acid (FA) in DFUs. Individuals with DFUs exhibit lower levels of FA and lower daily intake, compared to those without DFUs. There is preliminary evidence that FA administration may contribute to improved DFUs healing. In this context, regular evaluation of dietary FA intake may prove important towards reduction or even prevention of DFUs. However, data are still limited and further research is required to enable definitive conclusions and any recommendations.
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Affiliation(s)
| | - Nikolaos D Karakousis
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
| | | | - Dimitrios S Karagiannakis
- Academic Department of Gastroenterology, Laiko General Hospital, Medical School of National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Papanas
- Diabetes Centre-Diabetic Foot Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
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Sun H, Heng H, Liu X, Geng H, Liang J. Evaluation of the healing potential of short-term ozone therapy for the treatment of diabetic foot ulcers. Front Endocrinol (Lausanne) 2024; 14:1304034. [PMID: 38292773 PMCID: PMC10825947 DOI: 10.3389/fendo.2023.1304034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/22/2023] [Indexed: 02/01/2024] Open
Abstract
Background The availability of research on short-term ozone therapy for diabetic foot ulcers (DFUs) is limited, and even when it is accessible, it mainly comprises of basic analysis conducted during long-term ozone therapy. This study was to evaluate the efficacy of short-term ozone therapy in promoting wound healing in DFUs. Methods A retrospective analysis was conducted on 89 patients with type 2 diabetes complicated by DFUs. The patients were divided into two groups: ozone therapy group (n=41) and control group (n=48). Wound condition, change of bacterial types, changes in inflammatory indicators (erythrocyte sedimentation rate [ESR], C-reactive protein [CRP], and procalcitonin [PCT]), vascular endothelial growth factor (VEGF), cytokines [Interleukin 6 (IL-6) and tumor necrosis factor-α(TNF-α)], and oxidative stress levels (superoxide dismutase [SOD], malondialdehyde [MDA], and total antioxidant capacity [T-AOC]) were observed pre-treatment and after 1 week. After a 12-week of follow-up, wound healing rate, amputation rate, inpatient day, duration of antibiotics, reinfection rate, incidence of new ulcers, readmission rate, and reoperation rate, and cumulative wound healing rate using Kaplan-Meier curves were assessed. Results After 1 week of treatment, the ozone therapy group showed higher VEGF, SOD, and T-AOC levels compared to the control group (P<0.05), while CRP, PCT, ESR, IL-6, TNF-α, MDA levels and bacterial types were lower (P<0.05). The ozone therapy group had a higher wound healing rate after a 12-week follow-up (P<0.05). Kaplan-Meier curves indicated a higher cumulative wound healing rate in the ozone therapy group (P<0.05). Additionally, the ozone therapy group had lower inpatient day, duration of antibiotics, reinfection rate, and readmission rate compared to the control group (P<0.05). Conclusion Short-term ozone therapy is effective in promoting wound healing in DFUs by reducing inflammation, increasing growth factor levels, improving oxidative stress status, shortening healing time, and improving long-term prognosis. These findings suggest the potential of short-term ozone therapy as a valuable treatment modality for DFUs.
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Affiliation(s)
| | | | | | - Houfa Geng
- Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
| | - Jun Liang
- Xuzhou Central Hospital, Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
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Makeri D, Eilu E, Odoki M, Agwu E. A Systematic Review of the Microbial Landscape of Diabetic Foot Ulcers in Uganda. Infect Drug Resist 2024; 17:143-151. [PMID: 38234374 PMCID: PMC10793123 DOI: 10.2147/idr.s446838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/10/2024] [Indexed: 01/19/2024] Open
Abstract
Background Diabetes is a growing health concern globally. Poorly managed diabetes may result in diabetic foot ulcers (DFU), which can become a source of chronic infection known as diabetic foot infections. The increasing trend of diabetes in Uganda speaks to the potential for diabetic foot ulcers which may eventually become infected and their attendant impact on the quality of life of diabetic patients. This review assesses the microbial diversity of DFUs in Uganda, aiming to guide treatment and identify research gaps. Main Body of the Abstract We searched PubMed, Scopus and Embase for studies conducted in Uganda that reported isolating microorganisms from diabetic foot ulcers. Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA), we included two eligible studies that reported isolating 122 bacteria spread across eleven (11) species using swab samples and conventional culture methods. Significant isolates included World Health Organization priority pathogens including: Enterobacter specie, Staphylococcus aureus, Klebsiella pneumoniae, and Acinetobacter specie. Methicillin resistant Staphylococcus aureus (MRSA) constituted 33.3% of Staphylococci species and 26% of all bacterial isolates while extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella specie constituted 14.29% of total microbial isolates. Most bacteria showed susceptibility to Imipenem, Vancomycin, Ciprofloxacin, and Clindamycin, but resistance to Cotrimoxazole and Ampicillin was noted. Short Conclusion We conclude that data on the microbiology of DFUs in Uganda is scarce; however, the bioburden of DFUs in the country is similar to those in other parts of the world, and MRSA poses a challenge to antibiotic therapy. Consequently, the continued use of swab samples and conventional culture and sensitivity methods may limit the isolation, identification, and presentation of other important isolates. We recommend characterization of bacterial isolates to better understand their genetic makeup, and the development of a national guideline for managing diabetic foot infections.
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Affiliation(s)
- Danladi Makeri
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
| | - Emmanuel Eilu
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
| | - Martin Odoki
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
- Department of Microbiology and Immunology, School of Medicine, King Ceasor University, Kampala, Uganda
- Department of Applied Sciences, School of Sciences, Nkumba University, Entebbe, Uganda
| | - Ezera Agwu
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Ishaka, Uganda
- Department of Microbiology and Parasitology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
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Maia A, Saraiva M, Costa L, Carvalho AC, Freitas C, Amaral C, Coelho A, Carvalho R. Leg dystrophic calcification as a consequence of chronic diabetic foot infection: a case report. J Wound Care 2024; 33:66-71. [PMID: 38197282 DOI: 10.12968/jowc.2024.33.1.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Foot ulceration and infection is associated with a substantial increase in morbidity and mortality in patients with diabetes. We present a clinical case of recurrent diabetic foot infection with an atypical clinical evolution. A 58-year-old male patient with type 1 diabetes and a history of bilateral Charcot foot neuroarthropathy was followed at our Diabetic Foot Clinic for an unhealed plantar foot ulcer for >1.5 years with recurrent episodes of infection. He was admitted to hospital due to foot ulcer reinfection with sepsis and ipsilateral lower limb cellulitis. The foot infection was found to be associated with an underlying abscess in the anterior compartment of the leg, with a cutaneous fistulous course with extensive alterations of an inflammatory nature. Exudate from the lesion was drained and tissue biopsied, revealing Serratia marcescens and Klebsiella oxytoca with dystrophic calcification (DC). Surgical excision of dystrophic tissue with debridement of the fistulous tracts was performed. The excised material corroborated the presence of fibroadipose connective tissue with marked DC, as well as areas of mixed inflammation compatible with a chronic infectious aetiology. Targeted long-term antibiotic therapy was implemented, for a total of six weeks, with a favourable clinical evolution and complete closure of the lesion at the final follow-up. DC results from calcium deposition in degenerated tissues without evidence of systemic mineral imbalance and is a potential cause of non-healing ulcers. Few cases of DC have been reported in diabetic foot patients and its treatment remains challenging and controversial. A longer follow-up period is necessary to verify the effectiveness of our approach.
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Affiliation(s)
- Ariana Maia
- Diabetic Foot Unit, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Miguel Saraiva
- Diabetic Foot Unit, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Luís Costa
- Diabetic Foot Unit, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Division of Orthopedics and Traumatology, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - André Couto Carvalho
- Diabetic Foot Unit, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Cláudia Freitas
- Diabetic Foot Unit, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Cláudia Amaral
- Diabetic Foot Unit, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - André Coelho
- Division of Pathological Anatomy, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Rui Carvalho
- Diabetic Foot Unit, Centro Hospitalar e Universitário do Porto, Porto, Portugal
- Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário do Porto, Porto, Portugal
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Huang Y, Wang D, Zhang W, Yuan X, Li K, Zhang Y, Zeng M. Identification of hub genes and pathways associated with cellular senescence in diabetic foot ulcers via comprehensive transcriptome analysis. J Cell Mol Med 2024; 28:e18043. [PMID: 37985432 PMCID: PMC10805497 DOI: 10.1111/jcmm.18043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 10/20/2023] [Accepted: 10/25/2023] [Indexed: 11/22/2023] Open
Abstract
This research aimed to find important genes and pathways related to cellular senescence (CS) in diabetic foot ulcers (DFU) and to estimate the possible pathways through which CS affects diabetic foot healing. The GSE80178 dataset was acquired from the Gene Expression Omnibus (GEO) database, containing six DFU and three diabetic foot skin (DFS) samples. The limma package was used to identify differentially expressed genes (DEGs). At the same time, DEGs associated with CS (CS-DEGs) were found using the CellAge database. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted on the CS-DEGs. A protein-protein interaction (PPI) network was built using the String database, and the cytoHubba plug-in within Cytoscape helped identify hub genes. Lastly, the miRNA-TF-mRNA regulatory network for these hub genes was established. In total, 66 CS-DEGs were obtained. These genes mainly focus on CS, Kaposi sarcoma-associated herpesvirus infection and Toll-like receptor signalling pathway. Eight hub genes were identified to regulate cell senescence in DFU, including TP53, SRC, SIRT1, CCND1, EZH2, CXCL8, AR and CDK4. According to miRNA-TF-mRNA regulatory network, hsa-mir-132-3p/SIRT1/EZH2 axis is involved in senescence cell accumulation in DFU.
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Affiliation(s)
- Yike Huang
- Department of EmergencyThe First Affiliated Hospital of Chengdu Medical CollegeChengduChina
| | - Dongqing Wang
- Department of EmergencyThe First Affiliated Hospital of Chengdu Medical CollegeChengduChina
| | - Wen Zhang
- School of Clinical Medicine, Chengdu Medical CollegeChengduChina
- Department of Medical LaboratoryXindu District People’ s Hospital of ChengduChengduChina
| | - Xue Yuan
- Department of PediatricsChongqing Bishan Area Women and Children HospitalChongqingChina
| | - Ke Li
- Department of EmergencyThe First Affiliated Hospital of Chengdu Medical CollegeChengduChina
| | - Yuanyuan Zhang
- Department of Medical LaboratoryXindu District People’ s Hospital of ChengduChengduChina
| | - Mingqiang Zeng
- Department of EmergencyThe First Affiliated Hospital of Chengdu Medical CollegeChengduChina
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Burhan A, Arofiati F, Da Silva VA, Sebayang SM. Effect of Ankle Brachial Index (ABI) and Compression Therapy on Diabetic Foot Ulcer Healing. Curr Diabetes Rev 2024; 20:e310323215277. [PMID: 37005544 DOI: 10.2174/1573399819666230331083420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 12/13/2022] [Accepted: 01/17/2023] [Indexed: 04/04/2023]
Abstract
PURPOSE Knowing the effect of compression therapy on the value of the Ankle Brachial Index in the healing process of Diabetic Foot Ulcer. DESIGN This study used a quasi-experimental method with pretest-posttest with control group design with purposive sampling and non-equivalent control groups for eight weeks of treatment. SUBJECTS AND SETTING Patients diagnosed with Diabetic Foot Ulcer have and have Peripheral Artery Disease, patient characteristics are homogenized, age >18 years, wound care every three days, Ankle Brachial Index values between 0.6-1.3 mmHg, research three clinics in Indonesia in February 2021. METHODS The population with Diabetic Foot Ulcer was screened by inclusion criteria with Ankle Brachial Index and Bates-Jensen Wound Assessment Tool instruments, a total of n=140; in the study, thirteen samples were excluded, the intervention group was given Compression Therapy n= 68, and the control group was compression stockings for eight weeks n=59, the data were statistically analyzed non-parametric test using Wilcoxon and Mann-Whitney U. RESULTS Statistical analysis showed that the mean difference in paired group means was 26.4%. Meanwhile, in the mean analysis, the difference in the post-test healing of diabetic foot ulcers was 2.83%; p=0.000 and improvement of peripheral microcirculation was 33.02%; p=0.000 in the eighth week. Thus, compression therapy intervention in diabetic foot ulcer patients can improve peripheral microcirculation and increase Diabetic Foot Ulcers healing compared to the control group. CONCLUSION Compression therapy tailored to the patient's needs and according to standard operating procedures can improve peripheral microcirculation, so that blood flow in the legs becomes normal; it can speed up the healing process of Diabetic Foot Ulcers.
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Affiliation(s)
- Asmat Burhan
- School of Nursing, Health Faculty, University of Harapan Bangsa, Banyumas, Indonesia
| | - Fitri Arofiati
- Lecture Master of Nursing Post Graduate Study Universitas Muhammadiyah Yogyakarta, Karihan, Indonesia
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Okur KT, Ozan F, Kahraman M, Melez M, Ünlü ÖC, Altun İ. Assessment of the risk factors determining the prognosis of major and minor limb amputations in patients with diabetic foot ulcers. ADV CLIN EXP MED 2024; 33:21-30. [PMID: 37212776 DOI: 10.17219/acem/163240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/21/2023] [Accepted: 04/13/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND Diabetes mellitus (DM) is a major global health problem, and its incidence is growing. Depending on this increase, the number of diabetes-related complications will also rise. OBJECTIVES This study aimed to determine the risk factors associated with major and minor amputations resulting from diabetes. MATERIAL AND METHODS Patients diagnosed with diabetic foot complications (n = 371) and hospitalized between January 2019 and March 2020 were retrospectively evaluated using information obtained from the database of Diabetic Foot Wound Clinic. Examination of the data identified 165 patients for inclusion in the study, who were stratified into major amputation (group 1, n = 32), minor amputation (group 2, n = 66) and non-amputation (group 3, n = 67) groups. RESULTS Of the 32 patients who underwent major amputations, 84% had a below-knee amputation, 13% had an above-knee amputation and 3% had knee disarticulation. At the same time, 73% of 66 patients who underwent minor amputation had a single-finger amputation, 17% had a multiple-finger amputation, 8% had a transmetatarsal amputation, and 2% had Lisfranc amputation. Laboratory results showed high acute phase protein and low albumin (ALB) levels in patients from group 1 (p < 0.05). Although Staphylococcus aureus was found to be the most common infectious agent, Gram-negative pathogens were dominant (p < 0.05). Also, there was a significant cost difference between the groups (p < 0.05). Furthermore, those aged over 65 had a high Wagner score, high Charlson Comorbidity Index (CCI), long diabetic foot ulcer (DFU) duration, and high white blood cell (WBC) count, all of which were risk factors for major amputation (p < 0.05). CONCLUSIONS This study demonstrated an increased Wagner staging and incidence of peripheral neuropathy (PN) and peripheral arterial disease (PAD) in major amputation patients. In addition, the rate of distal vessel involvement was high in major amputation patients, with elevated acute phase proteins and low ALB levels crucial in laboratory findings.
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Affiliation(s)
- Kürşat Tuğrul Okur
- Department of Orthopaedics and Traumatology, Kayseri City Hospital, Turkey
| | - Fırat Ozan
- Department of Orthopaedics and Traumatology, Kayseri City Hospital, Turkey
| | - Murat Kahraman
- Department of Orthopaedics and Traumatology, Kayseri City Hospital, Turkey
| | - Muhammed Melez
- Department of Orthopaedics and Traumatology, Kayseri City Hospital, Turkey
| | - Ömer Can Ünlü
- Department of Orthopaedics and Traumatology, Kayseri City Hospital, Turkey
| | - İbrahim Altun
- Department of Orthopaedics and Traumatology, Kayseri City Hospital, Turkey
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Huang X, Han J, Nong Y, Sun J, Wang Q, Zhai Z, Mo J, Huang J, Lu W. Triglyceride-glucose index is strongly associated with all-cause mortality in elderly females with diabetic foot ulcers: A 9-year follow-up study. Int Wound J 2024; 21:e14344. [PMID: 37555254 PMCID: PMC10777761 DOI: 10.1111/iwj.14344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
This study aims to explore the association between the triglyceride-glucose (TyG) index and all-cause mortality in patients with diabetic foot ulcers (DFUs) through an ambispective cohort study. A total of 555 inpatients with DFUs were qualified to participate in the trial study from 2013 to 2022. Throughout a median 63-month period, all subjects were followed up every 6 months. According to the three quantiles of the TyG index, participants were divided into three groups: low-level (≤8.75, n = 185), moderate-level (8.76-9.33, n = 185) and high-level (≥9.34, n = 185). The association between the TyG index and all-cause mortality in patients with DFUs was then assessed. During the follow-up period, out of 555 patients with DFUs, 116 died (20.9%). After adjusting for confounding factors, the TyG index was positively associated with all-cause mortality in patients with DFUs (HR = 1.733; 95% CI = 1.341-2.241; p < 0.001). Compared with the low-level TyG index, the moderate-level TyG index (HR = 1.685; 95% CI = 1.011-2.810; p = 0.045) and the high-level TyG index (HR = 2.769; 95% CI = 1.678-4.568; p < 0.001) were positively correlated with all-cause mortality in patients with DFUs. Additionally, in subgroup analysis, both females (HR = 1.905; 95% CI = 1.250-2.904; p = 0.003), males (HR = 1.729; 95% CI = 1.240-2.409; p = 0.001), younger (<65 years old) (HR = 1.467; 95% CI = 1.008-2.135; p = 0.046) and elderly (≥ 65) (HR = 1.933; 95% CI = 1.339-2.791; p < 0.001) showed a positive correlation between TyG index and all-cause mortality rate in patients with DFUs. Furthermore, in the high-level TyG index group compared, males (HR = 2.699; 95% CI = 1.457-4.998) and participants aged <65 years (HR = 2.031; 95% CI = 0.972-4.242), with the TyG index level increase by 1.0, the risk for all-cause mortality increased 3.277-fold in females (HR = 4.277; 95% CI = 1.645-11.124) and 1.909-fold in elderly aged ≥65 years (HR = 2.909; 95% CI = 1.486-5.695), respectively. Kaplan-Meier survival curve analysis showed that the higher the TyG index level, the higher risk of all-cause mortality in patients with DFUs (log-rank, all p < 0.001). Briefly, this study implies a strong positive correlation between the TyG index and all-cause mortality in patients with DFUs, especially in older women. Therefore, special attention should be paid to elderly females with DFUs because they have a higher TyG index level and risk of all-cause mortality than other populations in daily clinical practice.
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Affiliation(s)
- Xiuxian Huang
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Jiaxia Han
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Yuechou Nong
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Jingxia Sun
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Qiu Wang
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Zhenwei Zhai
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Jiacheng Mo
- Information Network Center of Guangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Jianhao Huang
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
| | - Wensheng Lu
- Department of Endocrinology and MetabolismGuangxi Academy of Medical Sciences and the People's Hospital of Guangxi Zhuang Autonomous RegionNanningPeople's Republic of China
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Leiva K, Trinidad A, Gonzalez I, Espinosa A, Zwick T, Levine JE, Rodriguez MA, Lev-Tov H, Wu W, Kirsner RS, Godavarty A. Development of a Tissue Oxygenation Flow-Based Index Toward Discerning the Healing Status in Diabetic Foot Ulcers. Adv Wound Care (New Rochelle) 2024; 13:22-33. [PMID: 37060195 PMCID: PMC10654646 DOI: 10.1089/wound.2022.0170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/09/2023] [Indexed: 04/16/2023] Open
Abstract
Objective: The objective of this study is to characterize breath-hold (BH)-induced oxygenation changes in diabetic foot ulcers (DFUs) and develop an oxygenation flow index (OFI) to discern nonhealing from healing DFUs. Approach: The imaging approach utilizes an innovative BH stimulus that induces vasoconstriction and measures for altering oxygenation flow in and around the tissues of DFUs and controls. The modified Beer-Lambert law was utilized to calculate hemoglobin-based spatiotemporal oxygenation maps in terms of oxygen saturation. Results: We found controls had synchronous BH-induced oxygenation changes across the dorsal (OFI: 29.0%) and plantar (OFI: 57.6%) aspects of the foot. Nonhealing DFUs, however, had less synchronous BH-induced oxygenation changes (OFI <28%). In addition, two complicated healing DFU cases, or cases with underlying issues or poor long-term healing outcomes, were observed to have OFIs <28%. Innovation: An OFI was developed to differentiate nonhealing DFUs from healing DFUs using a single, noncontact, near-infrared optical scanner for spatiotemporal oxygenation monitoring. The OFI has potential to provide immediate feedback on the microcirculation in DFUs, through hemoglobin-based oxygenation parameters. Conclusion: A preliminary threshold (OFI <28%) could differentiate nonhealing and complicated DFUs from healing DFUs. The overall oxygenation flow pattern was less synchronous (or the OFI value reduced) in the nonwound areas of the feet that were nonhealing. In other words, the reduced OFI value (<28%) in the entire foot, excluding the wound region is a possible indicator that the wound may not heal.
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Affiliation(s)
- Kevin Leiva
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, Florida, USA
| | - Alexander Trinidad
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, Florida, USA
| | - Isabella Gonzalez
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, Florida, USA
| | - Aliette Espinosa
- Dr. Phillip Frost Department of Dermatology, UM Wound Care Center, University of Miami, Miami, Florida, USA
| | - Thomas Zwick
- Dr. Phillip Frost Department of Dermatology, UM Wound Care Center, University of Miami, Miami, Florida, USA
| | - Jason Edward Levine
- Dr. Phillip Frost Department of Dermatology, UM Wound Care Center, University of Miami, Miami, Florida, USA
| | - Magaly Adelaida Rodriguez
- Dr. Phillip Frost Department of Dermatology, UM Wound Care Center, University of Miami, Miami, Florida, USA
| | - Hadar Lev-Tov
- Dr. Phillip Frost Department of Dermatology, UM Wound Care Center, University of Miami, Miami, Florida, USA
| | - Wensong Wu
- Department of Mathematics and Statistics, Florida International University, Miami, Florida, USA
| | - Robert S. Kirsner
- Dr. Phillip Frost Department of Dermatology, UM Wound Care Center, University of Miami, Miami, Florida, USA
| | - Anuradha Godavarty
- Optical Imaging Laboratory, Department of Biomedical Engineering, Florida International University, Miami, Florida, USA
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Magruder ML, Yao VJH, Rodriguez AN, Ng MK, Piuzzi NS, Mont MA. History of Diabetic Foot Ulcer is Associated With Increased Risk of Prosthetic Joint Infection and Sepsis After Total Joint Arthroplasty. J Arthroplasty 2024; 39:250-254. [PMID: 37536397 DOI: 10.1016/j.arth.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 04/12/2023] [Accepted: 07/13/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND Diabetic foot ulcers (DFUs) are common sequelae of diabetes mellitus. Currently, the effect of DFUs on total joint arthroplasty (TJA) outcomes is sparsely evaluated. This study investigated whether DFU patients undergoing TJA increases risk of (1) prosthetic joint infections (PJI), (2) surgical site infections (SSI), (3) sepsis, (4) readmissions, and (5) revisions. METHODS Using PearlDiver, a retrospective query from January 1, 2010 to October 31, 2020 was performed. DFU patients undergoing total knee arthroplasty (TKA) and total hip arthroplasty (THA) were included and 1:5 propensity score matched with controls using age, sex, body mass index, and various comorbidities (33,155 TKA patients [DFU = 5,529; control = 27,626]; 17,146 THA patients [DFU = 2,862; control = 14,284]). Outcomes included rates of PJI, SSI, sepsis, readmissions, and revisions. Multivariate logistical regressions calculated odds ratios (ORs), 95% confidence intervals, and P values (P < .001 as significance threshold). RESULTS DFU increased risk of sepsis within 90 days of TKA (OR 4.59; P < .001) and THA (OR 4.87; P < .001). DFU did not increase risk of PJI at 90 days for TKA (OR 0.8; P = .1) or THA (OR 0.85; P = .34) but did by 2 years post-TKA (OR 1.51; P < .001) and THA (OR 1.55; P < .001). Risk of SSI increased in DFU cohort following TKA and THA at 90 days and 2 years and at 90-day readmissions and 2-year revisions. CONCLUSION DFU patients undergoing TJA demonstrated increased risk of postoperative sepsis and PJI. Furthermore, DFU patients demonstrated an increased risk of SSI, readmissions, and revisions. Providers should counsel DFU patients about postoperative risks.
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Affiliation(s)
- Matthew L Magruder
- Department of Orthopaedic Surgery, Maimonidies Medical Center, Brooklyn, New York
| | - Vincent J H Yao
- Sophie Davis Biomedical Education Program at the CUNY School of Medicine, New York, New York
| | - Ariel N Rodriguez
- Department of Orthopaedic Surgery, Maimonidies Medical Center, Brooklyn, New York
| | - Mitchell K Ng
- Department of Orthopaedic Surgery, Maimonidies Medical Center, Brooklyn, New York
| | - Nicolas S Piuzzi
- Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Michael A Mont
- Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore, Baltimore, Maryland
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Chen L, Shen S, Wang S. LncRNA SNHG16 Knockdown Promotes Diabetic Foot Ulcer Wound Healing via Sponging MiR-31-5p. TOHOKU J EXP MED 2023; 261:283-289. [PMID: 37704416 DOI: 10.1620/tjem.2023.j078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Diabetic foot ulcers are caused by nerve abnormalities and vascular lesions in the distal lower limbs of diabetic patients. However, the causes of diabetic foot ulcers are diverse and the treatment process is complex. Therefore, understanding the pathogenesis of diabetic foot ulcers through lncRNA and formulating effective means are the key to the cure of patients. Tissues were collected from 76 diabetic foot ulcer patients and 50 non-diabetic patients undergoing traumatic amputation. Human dermal fibroblasts (HDFs) were induced by high glucose to obtain diabetic foot ulcer cell model. The lncRNA SNHG16 (SNHG16) and miR-31-5p expression in tissues and cells was detected by real-time quantitative reverse transcription PCR (RT-qPCR). Cell Counting Kit-8 (CCK-8) and Transwell assays were used to evaluate the biological behavior of the cells, and the association between SNHG16 and miR-31-5p was explored by luciferase reporting assay. SNHG16 was distinctly expressed in diabetic foot ulcer tissue samples, while miR-31-5p was decreased. In vitro cell function assays confirmed that the proliferation level was inhibited in the constructed diabetic foot ulcer cell model (HG group), as was the migration and invasion ability. After transfection with silencing SNHG16, the biological behavior of the cells was promoted. Mechanistically, SNHG16 sponge miR-31-5p regulated disease progression. Recovery experiments revealed that miR-31-5p inhibitor counteracted the effect of silencing SNHG16 on cell viability. SNHG16 knockdown may regulate the biological function of cells by targeting miR-31-5p to promote wound healing and ameliorate the condition of diabetic foot ulcer patients.
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Affiliation(s)
- Lifen Chen
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University
| | - Shuyi Shen
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University
| | - Songyu Wang
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University
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Carro GV, Noli ML, Rodriguez MG, Ticona M, Fuentes M, Llanos MDLÁ, Caporaso F, Marciales G, Turco SLE. Plantar Thermography in High-Risk Patients With Diabetes Mellitus Compared to Nondiabetic Individuals. INT J LOW EXTR WOUND 2023:15347346231218034. [PMID: 38112384 DOI: 10.1177/15347346231218034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
Diabetic foot (DF) is one of the most devastating complications of diabetes mellitus (DM). Infrared thermography has been studied for its potential in early diagnosis and preventive measures against DF ulcers, although its role in the management and prevention of DF complications remains uncertain. The objective of this study was to determine the average temperatures of different points of the plantar foot using infrared thermography in patients with DM and history of DF (DFa group, at the highest risk of developing foot ulcers) and compare them to people without DM (NoDM group). One hundred and twenty-three feet were included, 63 of them belonged to DFa Group and the other 60 to NoDM Group. The average temperature in the NoDM Group was 27.4 (26.3-28.5) versus 28.6 (26.8-30.3) in the DFa Group (p = .002). There were differences between both groups in temperatures at the metatarsal heads and heels, but not in the arch. Average foot temperatures did not relate to sex, ankle-brachial index, and age, and had a mild correlation with daily temperature (Spearman 0.51, p < .001). Data provided in our study could be useful in establishing a parameter of normal temperatures for high-risk patients. This could serve as a foundational framework for future research and provide reference values, not only for preventative purposes, as commonly addressed in most studies, but also to assess the applicability of thermography in clinical scenarios particularly when one foot cannot serve as a reference, suspected osteomyelitis of the remaining bone, or instances of increased temperature in specific areas which may necessitate adjustments to the insoles in secondary prevention.
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Affiliation(s)
| | - María Laura Noli
- Diabetic Foot Unit, Hospital Nacional Prof A. Posadas. El Palomar, Argentina
| | | | - Miguel Ticona
- Diabetic Foot Unit, Hospital Nacional Prof A. Posadas. El Palomar, Argentina
| | - Mariana Fuentes
- Diabetic Foot Unit, Hospital Nacional Prof A. Posadas. El Palomar, Argentina
| | | | - Federico Caporaso
- Diabetic Foot Unit, Hospital Nacional Prof A. Posadas. El Palomar, Argentina
| | - Guillermo Marciales
- Diabetic Foot Unit, Hospital Nacional Prof A. Posadas. El Palomar, Argentina
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Chen R, Deng H, Zou L. Analysis of Bulk Transcriptome Sequencing Data and in vitro Experiments Reveal SIN3A as a Potential Target for Diabetic Foot Ulcer. Diabetes Metab Syndr Obes 2023; 16:4119-4132. [PMID: 38145255 PMCID: PMC10740743 DOI: 10.2147/dmso.s439924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 12/06/2023] [Indexed: 12/26/2023] Open
Abstract
Background Diabetic foot ulcers (DFUs) represent a severe complication of diabetes associated with reduced quality of life, lower limb amputations, hospitalizations, increased incidence, and mortality. Importantly, a significant number of pathogenic genes remain unexplored in DFUs. Methods A series of bioinformatics analyses were performed on publicly available bulk transcriptome sequencing datasets GSE134431 and GSE80178 to explore the transcriptomic changes in DFUs and select core genes for in vitro functional validation. In a focused examination, the differential expression analysis unveiled distinctions in gene expression patterns between DFUs and non-ulcerated diabetic skin tissues. Enriched functional annotations of differentially expressed genes were explored using the DAVID online tool. Protein-protein interaction analysis was conducted to investigate interactions among differentially expressed genes and select core genes. Knockdown or overexpression of core genes in HaCaT keratinocytes was performed to assess their impact on cell proliferation and migration. Results Ten core genes were identified. Cell Counting Kit-8 (CCK-8) and scratch assays demonstrated that downregulation of the core gene SIN3A significantly inhibited the migration and proliferation of HaCaT keratinocytes, while overexpression of SIN3A reversed the high-glucose-induced suppression of HaCaT cell viability and migration. Conclusion SIN3A expression is downregulated in DFUs. In vitro, SIN3A promotes the proliferation and migration of HaCaT keratinocytes, suggesting it may be a potential therapeutic target for DFUs.
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Affiliation(s)
- Ran Chen
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Haibo Deng
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
| | - Lijun Zou
- Department of Wound Repair Surgery, Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, People’s Republic of China
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Ning P, Liu Y, Kang J, Cao H, Zhang J. Comparison of healing effectiveness of different debridement approaches for diabetic foot ulcers: a network meta-analysis of randomized controlled trials. Front Public Health 2023; 11:1271706. [PMID: 38146472 PMCID: PMC10749485 DOI: 10.3389/fpubh.2023.1271706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 11/21/2023] [Indexed: 12/27/2023] Open
Abstract
Objectives The choice of the debridement method is very important for the healing of diabetic foot ulcers (DFUs), but the relative effectiveness of different debridement methods in the healing of DFUs remains unclear. This study conducted a network meta-analysis of the relative healing effectiveness of different debridement methods in patients with DFUs. Methods We performed a literature search in PubMed, Embase, and Cochrane Library from database inception up to 30 June 2023 for screening randomized controlled trials on the healing effectiveness of debridement in DFUs. Outcome measures included ulcer healing rate and ulcer area reduction rate. The Cochrane Risk Bias Tool, version 2.0, was used to assess the risk of bias in the included trials. R software was used for performing statistical analysis and GraphPad Prism was used for image plotting. Results A total of 19 randomized controlled trials were included, and 900 patients with DFUs were assessed in this analysis. The proteolytic fraction from the latex of Vasconcellea cundinamarcensis (P1G10) in enzymatic debridement showed the best ulcer healing rate (SURCA = 0.919) when compared with the standard of care (SOC) group, with a mean difference (MD) and 95% confidence interval (CI) of 1.40 (0.57, 2.36). Kiwifruit extract demonstrated the best effect on the ulcer area reduction rate (SURCA = 0.931), when compared with that in the SOC group, with an MD and 95% CI of 0.47 (0.27, 0.66). Conclusion Enzymatic debridement was superior to other debridement methods in terms of ulcer healing rate and ulcer area reduction rate in patients with DFUs. However, as the quality of the included trials is low, enzymatic debridement can be used as a candidate debridement method in addition to sharp-based debridement in clinical practice. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023441715.
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Affiliation(s)
| | | | | | - Hongyi Cao
- Department of Endocrine and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Geriatric Diseases Institute of Chengdu, Chengdu, China
| | - Jiaxing Zhang
- Department of Endocrine and Metabolism, Chengdu Fifth People’s Hospital (The Second Clinical Medical College, Affiliated Fifth People’s Hospital of Chengdu University of Traditional Chinese Medicine), Geriatric Diseases Institute of Chengdu, Chengdu, China
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