Diabetic Foot Wounds Research Articles

The Efficacy of Negative Pressure Wound Therapy (NPWT) on Healing of Diabetic Foot Ulcers: A Literature Review.

Diabetes mellitus is a complex disorder that requires continuous management to control blood sugar levels and prevent complications. Diabetic foot ulcers (DFU) are the most common complication in diabetic patients. A popular therapy modality with considerable advantages in the management of diabetic foot ulcers today is negative pressure wound therapy (NPWT). This study aimed to review related articles about the efficacy as well as the complications or adverse effects of using NPWT on the healing of DFUs. Searching English databases from PubMed, Ebscohost, Proquest and Science Direct was done to identify relevant citations published between January 2017 and January 2022. A combination of terms was used with the boolean formulation of "negative pressure wound therapy OR NPWT" OR "vacuum-assisted closure or VAC" AND "diabetic foot ulcers OR diabetic foot wound" AND "wound healing" AND "Conventional dressings" and map terms were also used for the subject heading. Some potentially relevant citations of articles from the bibliographies are also reviewed. This study included 8 related articles consisting of 6 RCTs, 1 cohort study and 1 Quasy experimental study. There were various methodological techniques for using NPWT and outcome measures among studies. The results of this literature review showed that NPWT was more efficacious than the other conventional or advanced moist dressings. This therapy revealed a faster healing time with complete wound healing and formation of granulation tissue and reduction in wound size. The complications or adverse effects of NPWT, such as amputation rate, bleeding and pain, were not different from conventional or advanced moist dressings, though. NPWT was more efficacious than other conventional or advanced moist dressings for the healing of DFUs. However, complications or adverse effects of using this therapy showed no significant difference with other conventional or advanced moist dressings.

Application of Lycium Barbarum Polysaccharide Liposome Nanoparticles to Improve the Slow Healing of Refractory Wounds in Diabetic Foot

Refractory wounds in diabetic foot heal slowly. Lycium barbarum polysaccharides has been found to have the effect of lowering blood sugar. At the same time, the role of CXCL12/CXCR4 signaling in the healing process of diabetic foot has attracted much more attention. This study aimed to explore the mechanism by which Lycium barbarum polysaccharide liposome nanoparticles improve slow healing of refractory wounds in diabetic feet through CXCL12/CXCR4 signaling axis. A rat model of diabetic foot trauma was constructed and lipid nanoparticles-Lycium barbarum polysaccharides (LNP-LBP) nanocomposite was prepared and administrated into the rats. During the administration process, wound healing conditions were observed and recorded. HE staining was performed on each group, and inflammatory factors, CXCR4, and podocyte marker protein Nephrin were observed. Compared with control group, the blood sugar levels and inflammatory factor IL-6 levels of mice in the Lycium barbarum polysaccharide liposome nanoparticles group were reduced, and the wound healing speed was significantly accelerated (P < 0.05). LNP-LBP significantly reduced the levels of CXCL12 and CXCR4 in mouse wound tissues (P < 0.05). Moreover, when LNP-LBP and CXCL12/CXCR4 signaling axis inhibitors were used in combination, the wound healing speed was further accelerated and IL-6 levels were significantly increased. LNP-LBP can reduce the blood sugar level of diabetic foot rats, reduce the inflammatory response of diabetic foot wounds and swelling of wound podocytes, promote cell autophagy to speed up metabolism, thereby promoting refractory wounds healing in diabetic foot. The effect is related to inhibiting the expression of CXCL12/CXCR4 signaling.

Development and evaluation of Resveratrol-loaded liposomes in hydrogel-based wound dressing for diabetic foot ulcer.

Diabetic foot wounds (DFUs) are counted as one of the most common microvascular complications associated with poorly controlled and chronic diabetes mellitus. It confers a serious challenge to clinical practice, surmounting hyperglycemia-induced disturbance in angiogenesis and endothelial dysfunction, with limited fruitful intervention to control the manifestations of DFUs. Resveratrol (RV) can improve endothelial function and has strong pro-angiogenic properties for the treatment of diabetic foot wounds. The present study aims to design an RV-loaded liposome-in-hydrogel system to effectively heal diabetic foot ulcers. A thin-film hydration method was used to prepare RV-loaded liposomes. Liposomal vesicles were assessed, for various characteristics such as particle size, zeta potential, and entrapment efficiency. The best-prepared liposomal vesicle was then incorporated into 1% carbopol 940 gel to develop a hydrogel system. The RV-loaded liposomal gel showed improved skin penetration. To assess the efficacy of the developed formulation, a diabetic foot ulcer animal model was used. The topical application of the developed formulation significantly reduced blood glucose and increased glycosaminoglycans (GAGs) to improve ulcer healing as well as wound closure on day 9. Faster re-epithelization, proliferation of fibroblast, formation of collagen, and reduced inflammatory cell infiltration at the wound site were also noted. Results indicate that RV-loaded liposomes in hydrogel-based wound dressing significantly accelerate wound healing in diabetic foot ulcers by restoring the altered wound healing process in diabetics.

Exploring the mechanism by which aqueous Gynura divaricata inhibits diabetic foot based on network pharmacology, molecular docking and experimental verification

BackgroundTo predict and validate the potential mechanism by which Gynura divaricata (GD) functions in the treatment of diabetic foot (DF).MethodsThe main chemical constituents of GD were identified by reviewing the literature, the traditional Chinese medicine database platform (TCMIP) and the BATMAN-TCM platform. DF disease targets were identified with the GeneCards database, and the compound-target network was constructed by using the intersection of drugs and disease. The STRING platform was used to construct the protein–protein interaction (PPI) network, and Cytoscape 3.7.2 software was used to visualize the results. Moreover, the Metascape database was used for Gene Ontology (GO) enrichment analyses and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Molecular docking of the active ingredients of GD and core protein targets of DF was performed using AutoDock software. Finally, the predicted results were preliminarily verified with experiments.ResultsA total of 140 potential targets of GD were identified and associated with DF. According to the PPI network analysis, GD accelerated DF wound healing, and the mechanism may be related to proteins such as AKT1, TP53, IL6, CASP3, TNF, and VEGFA. GO and KEGG enrichment analyses indicated that GD may play a role in the treatment of diabetic foot by affecting various signaling pathways. Molecular docking results showed that the proteins AKT1, TP53, IL6, CASP3, TNF, and VEGFA were closely associated with the components of GD. The animal experiments showed that GD reduced the levels of IL-6 and TNF-α and increased the mRNA and protein expression of VEGFA in rats with DF.ConclusionsGD regulates multiple targets and multiple pathways to promote wound healing in DF.

Validation of the Ischaemia Severity Scale (ISS) Based on Non-Invasive Vascular Assessments (SEWSS) for Predicting Outcomes of Diabetic Foot Attack.

Assessment of ischaemia severity includes a variety of measures, such as pedal pulse palpation, the ankle/brachial index (ABI), and the toe/brachial index (TBI), but there is a lack of consensus regarding which ischaemia scale is the most effective for determining outcome prognosis. The purpose of this study is to validate the application of the ischaemia severity scale (ISS) in the effective prediction of wound healing, amputations, and mortality for diabetic foot wounds (DFW). This prospective study included 235 consecutive patients graded according to the Saint Elian Wound Score System (SEWSS). The ISS is part of this system, with patients being scored as non-ischaemic (0) or having mild (1), moderate (2), or severe (3) ischaemia. Age, diabetes duration in years, and ulcer size were found to be associated with a longer mean ischaemia of increasing severity. A trend of reduction in the pulse palpation rates (70.4%, 50%, 8.5% to 0%; p < 0.01), ABI (1.1 ± 0.1, 0.86 ± 0.3, 0.68 ± 0.2, 0.47 ± 0.2, p < 0.01), TBI average values (0.90 ± 0.35, 0.62 ± 0.52, 0.50 ± 0.33, 0.10 ± 0.42, p < 0.01), wound healing success (88.7%, 57.7%, 40.7%, 12.9%; p < 0.01), and delay in weeks (Kaplan-Meier: log-rank 44.2, p < 0.01) was observed with increasing values of the ISS (0, 1, 2, and 3). The odds ratio for adverse outcomes increased for each additional level of ischaemia severity. Thus, we demonstrate that the ISS is useful in effectively predicting adverse outcomes for DFW.

The Efficacy of Autologous Platelet-Rich Gel and Traditional Chinese Medicine in Diabetic Foot Treatment: A Parallel Randomized Controlled Clinical Trial

Diabetic foot (DF) is a prevalent metabolic infection. DF wounds are the basis for all cases of nontraumatic lower limb amputations in diabetes. DF care approaches include debridement of wound, pressure relief in the wounded area, proper wound, infection, and ischemia management. However, there is a need for research to develop more effective therapeutic approaches. This study investigated the effectivity and safety of autologous platelet-rich gel combined with conventional treatment and traditional Chinese medicine (TCM) in DF ulcer therapy. Sixty DF ulcer patients were divided into treatment and control groups of 30 patients each. The treatment group involved a combination of autologous platelet-rich gel, conventional treatment, and TCM. The control group was only treated with a combination of conventional therapy and TCM. Laboratory variables, including platelets, hemoglobin (Hb), albumin, and HbA1c, were analyzed and compared between the treatment and the control groups at baseline and endpoint. Healing area, volume, and rates were compared in both groups. Basic patients' data and the wound conditions had no significant difference between the treatment and the control group. The treatment and control groups cure rates were 93.3% vs. 50%, respectively. The healing rate per 2weeks was significantly higher in the treatment than in the control group (0.78±0.05 vs. 0.43±0.04). There was no statistically significant difference in the platelets, Hb, albumin, and HbA1c levels in the treatment and control groups. Autologous platelet-rich gel combined with conventional treatment and TCM is effective and safe for DF ulcer treatment.

Modified poly(L-lysine)-based structures as novel antimicrobials for diabetic foot infections, an in-vitro study

Background: Wound infections occur as sequelae to skin trauma and cause significant hospitalizations, morbidity and mortality. Skin traumas arise more frequently in those with diabetes or cardiovascular disease and in these settings, may be chronic with poorer outcomes including lower limb amputation. Treatment of chronic wound infection is challenging due to antibiotic resistance and biofilm formation by bacteria including S. aureus and P. aeruginosa, which are among the most frequent causative pathogens. Managing these challenging infections requires new molecules and modalities. Methods: We evaluated antimicrobial and anti-biofilm activity of star-shaped poly(L-lysine) (PLL) polymers against S. aureus and P. aeruginosa strains and clinical isolates recovered from wounds including diabetic foot wounds (DFW) in a Dublin Hospital in 2019. A star-shaped PLL polypeptide series, specifically G2(8)PLL 20, G3(16)PLL 10, G4(32)PLL 5 with variation in polypeptide chain length and arm-multiplicity, were compared to a linear peptide, PLL 160 with equivalent number of lysine residues. Results: All PLLs, including the linear polypeptide, were bactericidal at 1μM against S. aureus 25923 and P. aeruginosa PAO1, with log reduction in colony forming units/ml between 2.7-3.6. PLL 160 demonstrated similar killing potency against 20 S. aureus and five P. aeruginosa clinical isolates from DFW, mean log reductions: 3.04 ± 0.16 and 3.96 ± 0.82 respectively after 1 hour incubation. Potent anti-biofilm activity was demonstrated against S. aureus 25923 but for clinical isolates, low to moderate loss of biofilm viability was shown using PLL 160 and G3(16)PLL 10 at 50 μM ( S. aureus) and 200 μM ( P. aeruginosa) with high inter-isolate variability . In the star-shaped architecture, antimicrobial activity was retained with incorporation of 5-mer hydrophobic amino-acid modifications to the arms of the polypeptides (series G3(16)PLL 20-coPLT 5, G3(16)PLL 20-coPLI 5, G3(16)PLL 20-coPLP 5). Conclusion: These polypeptides offer structural flexibility for clinical applications and have potential for further development, particularly in the setting of diabetic foot and other chronic wound infections.

Modified poly(L-lysine)-based structures as novel antimicrobials for diabetic foot infections, an in-vitro study.

Background: Wound infections occur as sequelae to skin trauma and cause significant hospitalizations, morbidity and mortality. Skin traumas arise more frequently in those with diabetes or cardiovascular disease and in these settings, may be chronic with poorer outcomes including lower limb amputation. Treatment of chronic wound infection is challenging due to antibiotic resistance and biofilm formation by bacteria including S. aureus and P. aeruginosa, which are among the most frequent causative pathogens. Managing these challenging infections requires new molecules and modalities. Methods: We evaluated antimicrobial and anti-biofilm activity of star-shaped poly(L-lysine) (PLL) polymers against S. aureus and P. aeruginosa strains and clinical isolates recovered from wounds including diabetic foot wounds (DFW) in a Dublin Hospital in 2019. A star-shaped PLL polypeptide series, specifically G2(8)PLL 20, G3(16)PLL 10, G4(32)PLL 5 with variation in polypeptide chain length and arm-multiplicity, were compared to a linear peptide, PLL 160 with equivalent number of lysine residues. Results: All PLLs, including the linear polypeptide, were bactericidal at 1μM against S. aureus 25923 and P. aeruginosa PAO1, with log reduction in colony forming units/ml between 2.7-3.6. PLL 160 demonstrated similar killing potency against 20 S. aureus and five P. aeruginosa clinical isolates from DFW, mean log reductions: 3.04 ± 0.16 and 3.96 ± 0.82 respectively after 1 hour incubation. Potent anti-biofilm activity was demonstrated against S. aureus 25923 but for clinical isolates, low to moderate loss of biofilm viability was shown using PLL 160 and G3(16)PLL 10 at 50 μM ( S. aureus) and 200 μM ( P. aeruginosa) with high inter-isolate variability . In the star-shaped architecture, antimicrobial activity was retained with incorporation of 5-mer hydrophobic amino-acid modifications to the arms of the polypeptides (series G3(16)PLL 20-coPLT 5, G3(16)PLL 20-coPLI 5, G3(16)PLL 20-coPLP 5). Conclusion: These polypeptides offer structural flexibility for clinical applications and have potential for further development, particularly in the setting of diabetic foot and other chronic wound infections.

The role of rehabilitation in the management of diabetic foot wounds.

Diabetes is one of the most common health problems worldwide. Diabetic foot wounds (DFWs) are hazardous complications of the disease. Patients are often referred to rehabilitation facilities at later stages of the diabetic complications, particularly after amputation surgery. There are potential benefits of rehabilitation practices in preventing and managing DFWs. Therefore, rehabilitation needs to be more involved in the management of DFWs and should be in all stages of diabetic care. In this review, we discuss literature data to bring rehabilitation perspective to the multidisciplinary management of DFWs.

Degrees of Arterial Stenosis and Other Factors Related with Diabetic Foot Wound Severity

Background: Few studies have addressed which blood vessels are affected by arterial stenosis in patients with diabetic foot (DF) and the severity thereof. Furthermore, whether the severity of arterial stenosis is significantly correlated to DF severity was yet to be established. We analyzed the association between the severity of arterial stenosis and DF wound severity, along with a variety of relevant factors.Methods: Seventy-one cases hospitalized with DF were evaluated. To assess the degree of arterial stenosis of the five major arteries of the lower extremity (femoral, popliteal, anterior tibial, posterior tibial and peroneal artery), we performed computed tomography angiography, and quantified arterial stenosis using Bollinger scores. We then assessed DF severity and calculated self-reported wound scores. We also analyzed factors that can affect DF severity and the degree of arterial stenosis in the lower extremities.Results: There was no significant association between the mean total Bollinger score and wound severity. Albumin, protein, and Bollinger scores of femoral arteries showed significant association with wound severity, and age and ankle-brachial index (ABI) showed significant association with mean total Bollinger scores (P<0.05). Albumin and Bollinger scores of femoral arteries had significant association with wound severity, and age and ABI showed significant association with mean total Bollinger scores (P<0.05).Conclusion: There was no significant association between the degree of vascular obstruction and the severity of DF. Our results indicate that surgeons should consider the other factors above to ensure appropriate management of patients with DF and assess the prognosis.

National expert consensus on the application of negative pressure wound therapy in the treatment of diabetic foot wounds (2021 version)

Diabetic foot has a high rate of disability and mortality. Negative pressure wound therapy (NPWT) is one of the effective techniques in treating diabetic foot wounds, but the non-standard use of it often leads to infections, bleeding, necrosis and other complications, which seriously affects the outcome. In 2020, Tissue Repair of Burns and Trauma Committee, Cross-Straits Medicine Exchange Association organized experts from department of burns, department of orthopedics, department of vascular surgery, department of endocrinology, department of wound repair, and other departments engaged in the treatment of diabetic foot to discuss and write the "expert consensus on the application of negative pressure wound therapy in the treatment of diabetic foot wounds". This consensus is based on evidence-based medicine and combined with the latest clinical research progress, aiming to form a standardized plan for the treatment of diabetic foot wounds with NPWT, which can be used as a reference for clinicians, so as to promote the improvement of clinical diagnosis and treatment of diabetic foot.

Randomized research on the mechanism of local oxygen therapy promoting wound healing of diabetic foot based on RNA-seq technology.

High purity oxygen therapy has good clinical efficacy in the treatment of diabetic foot (DF), but its mechanism of promoting wound healing has been unclear. Patients with DF were randomly divided into an experimental group and a control group. The experimental group was given local oxygen therapy (LOT) by a micro-oxygen therapy instrument, which administered uninterrupted >95% pure oxygen for 24 h at a flow rate of 3 mL/h. Six skin samples from the experimental group before and after treatment underwent RNA sequencing (RNA-seq), and the differentially expressed genes (DEGs) were screened. The clinical results showed that the mean wound healing time of the experimental group was 26 days (P<0.05); the healing area of the experimental group was 3.1-15.3 cm3 , with a mean of 8.8 cm3 , and that of the control group was 2.4-10.4 cm3 (P<0.05). LOT promoted the healing of DF wounds mainly through the tumor necrosis factor (TNF) signaling pathway and the apoptosis pathway. According to our results, LOT can promote DF healing mainly by inhibiting the local oxidative stress reaction of wound skin and by inhibiting the inflammatory and apoptotic pathways. The molecular markers and pathways screened warrant further study.

Influence of Microbiota on Diabetic Foot Wound in Comparison with Adjacent Normal Skin Based on the Clinical Features.

Diabetic foot ulcer (DFU) is a complication experienced by diabetic patients and does not heal well in an altered wound environment. Although diverse microbes in DFU were detected, little is known about their influences on diabetic foot wound (DFW) and the association with the skin microbiota in normal tissue from the same patients according to clinical features. We aimed to analyze the microbiota in normal skin and DFW tissue from the same subject and predict their roles based on clinical features. We analyzed the microbiota in normal skin and DFW tissue from the same subject and compared the associated members of microbiota with clinical parameters. The diversity of skin microbiota was higher than that of DFW tissues, along with compositional differences. In addition, different microbes were associated with clinical features. The proportions of Bacteroidetes, Prevotella, Peptoniphilus, Porphyromonas, and Dialister were higher in the severe groups than of the mild groups, whereas that of Firmicutes was lower in the severe groups. According to wound severity, the microbiota could be related to inflammation, damaging host cell membrane, and pathogenicity through lipopolysaccharide biosynthesis, cellular antigens, and protein digestion metabolism. The predicted DFW microbiota functions according to systemic diabetic status defined by ESRD and HbA1c, differed from those presented by wound severity. Results indicate that the microbiota in normal skin is related to the colonizing microbes in DFW tissue according to clinical features and the different microbes can play important roles in DFW prognosis. This information can be applied to prevent and manage DFW by modulating the microbiota.

Efficacy of Autologous Platelet-Rich Gel for Diabetic Foot Wound Healing: A Meta-Analysis of 15 Randomized Controlled Trials.

Objectives: The meta-analysis was performed to summarize the available evidence and determine the healing effectiveness of autologous platelet-rich gel (APG) on diabetic foot (DF) wounds. Approach: PubMed and The Cochrane Library and CNKI databases were searched to identify prior randomized controlled trials. Methodological qualities of included studies were assessed using Cochrane Handbook for Systematic Reviews of Intervention. Healing rate was considered the primary outcome; the secondary outcomes included healing time and adverse events. Results: Fifteen studies involving a total of 827 subjects were analyzed in the meta-analysis. Considering the primary outcome, the average healing rate in APG group was 85.8% and ranged from 68.4% to 100%. Relatively, the control group was 57.4% and ranged from 18.2% to 75.0%. Eligible studies were compared with a fixed effects model (I 2 = 0.0%, p = 0.496), indicating a higher healing rate with APG (risk ratio [RR] 1.44, 95% confidence interval [CI]: 1.32-1.57, z = 8.50, p < 0.001). The leave-one-out sensitivity analysis is robust. Considering the secondary outcomes, APG therapy needed less time (weighted mean difference -10.75 days, 95% CI: -11.67 to 8.86 days, z = 14.34, p < 0.001) and had fewer adverse events (RR 0.44, 95% CI: 0.25-0.76, z = 2.94, p = 0.003). Innovation: APG therapy is an innovative and effective approach to promote DF wound healing and reduce healing time and adverse events. Conclusion: The meta-analysis demonstrates that APG therapy has a positive effect on the treatment of DF wounds. However, additional well-designed and high-quality studies are needed to reach a conclusion with more confidence.

Predictors for Amputation in Patients with Diabetic Foot Wound

PurposeDiabetic foot wound (DFW) is known as a major contributor of nontraumatic lower extremity amputation. We aimed to evaluate overall amputation rates and risk factors for amputation in patients with DFW.Materials and MethodsFrom January 2014 to December 2017, 141 patients with DFW were enrolled. We determined rates and risk factors of major amputation in DFW and in DFW with peripheral arterial occlusive disease (PAOD). In addition, we investigated rates and predictors for amputation in diabetic foot ulcer (DFU).ResultsThe overall rate of major amputation was 26.2% in patients with DFW. Among 141 DFWs, 76 patients (53.9%) had PAOD and 29 patients (38.2%) of 76 DFWs with PAOD underwent major amputation. Wound state according to Wagner classification, congestive heart failure, leukocytosis, dementia, and PAOD were the significant risk factors for major amputation. In DFW with PAOD, Wagner classification grades and leukocytosis were the predictors for major amputation. In addition, amputation was performed for 28 patients (38.4%) while major amputation was performed for 5 patients (6.8%) of 73 DFUs. Only the presence of osteomyelitis (OM) showed significant difference for amputation in DFU.ConclusionThis study represented that approximately a quarter of DFWs underwent major amputation. Moreover, over half of DFW patients had PAOD and about 38.2% of them underwent major amputation. Wound state and PAOD was major predictors for major amputation in DFW. Systemic factors, such as CHF, leukocytosis, and dementia were identified as risk factors for major amputation. In terms of DFU, 38.4% underwent amputation and the presence of OM was a determinant for amputation.

Effects of vacuum sealing combined with NovaBay on improving diabetic foot wound healing

Objective To explore the effects of vacuum sealing combined with NovaBay on improving diabetic foot wound healing, and to offer new insights and methods for treating chronic aporetic wounds. Methods Totally 130 patients with diabetic foot ulcer admitted in the Second Affiliated Hospital of Zhejiang Chinese Medical University between November 2015 and November 2016 were randomly and equally divided into two groups. Patients in the treatment group received 5 ml NovaBay for twice a day on the basis of vacuum sealing drainage (VSD) , and received drainage 5 min after treatment with NovaBay, while patients in the control group received vacuum sealing drainage with 5 ml 0.9% sodium chloride solution for twice a day, and received drainage 5 min after treatment of sodium chloride solution. The intervention time of the patients in both groups were 12 days, with NovaBay and ducts replaced every 3 days. The patients in the two groups were evaluated with Pressure Ulcer Scale for Healing (PUSH) and the coverage rate of granulation tissue was calculated 0, 6, and 12 days after the intervention. And the positive rate of bacteria was tested at the end of the intervention. Results The PUSH scores of the patients in the two groups decreased as time went by, indicating that the wound healing was effective (P<0.001) . The coverage rate of granulation tissue rose with time, and that of the patients in the treatment group rose more obviously (P<0.001) . 12 days after the intervention, the patients in the treatment group (4.62%) showed a lower positive rate of bacteria (P<0.001) than the patients in the control group (47.70%) . Conclusions Vacuum sealing combined with NovaBay shows remarkable effects in cleaning infection of chronic and aporetic wounds, thus a new and effective way to improve the growth of granulation tissue and wound healing. Key words: Diabetic foot; Vacuum sealing; Liquid dressing; Wound healing

Expression of matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in different bacterial colonization diabetic wound tissues

Objective To observe the expression levels of matrix metalloproteinase (MMP)-9 and tissue inhibitor of metalloproteinase (TIMP)-1 in different bacterial colonization diabetic wound. Methods Included patients were divided into four groups: group A, 19 patients with diabetic foot wound, including group A1, 7 patients with bacterial growth on the wound, and group A2, 12 patients without bacterial growth on the wound; group B, 6 diabetic patients; group C, 7 normal controls. Skin tissues in all four groups were taken surigically. Bacterial culture and counting were done in group A. The MMP-9 and TIMP-1 gene expression in skin tissue was detected by real-time fluorescent quantitative polymerase chain reaction (FQ-PCR), and Western blotting was used to detect the expression of MMP-9 and TIMP-1 proteins. Results The relative expression of MMP-9 in groups A1, A2, B and C was 1.136±0.116, 0.601±0.080, 0.391±0.088 and 0.134±0.057 respectively (P=0.000 for all). The relative expression levels of TIMP-1 in groups A1, A2, B and C were 1.013±0.086, 2.570±0.845, 4.878±0.829 and 7.294±1.551 respectively (P=0.000 for all). The results from Western blotting were consistent with those from RT-PCR. Conclusion Hyperglycemia altered the expression of MMP-9 and TIMP-1 in the skin tissue. Heavy bacterial colonization in diabetic wound increased the expression of MMP-9, and decreased the TIMP-1 expression, which may disturb the balance of MMP-9/TIMP-1, affecting wound healing. Key words: Diabetes; Wound; Bacteria; Matrix metalloproteinase; Tissue inhibitorof metalloproteinase

Diabetic Foot Wounds: Which Patients are More Prone to Tetanus?

Background Patients who have diabetes and chronic wounds are more prone to tetanus than the other populations. The prevalence of diabetes among patients diagnosed with tetanus was 15%, nearly three times the average expected prevalence of diabetes in the United States. In this study, we aimed to evaluate the tetanus immunization status of the patients with diabetic foot wounds (DFW) and to determine the factors, which may predict to immunity against tetanus.Methods Patients who admitted to outpatient clinics with DFW were included between 1 January and 31 December 2016. Tetanus antibody levels were measured by a commercial Clostridium tetani 5S IgG ELISA kit. Antibody levels below 0.1 IU/ml were defined as “No reliable protection” and levels above 0.1 IU/ml were defined as “Reliable protection”. A questionnaire applied to all patients for detailed diabetes and vaccinating history about tetanus.ResultsNinety-one patients were enrolled to the study, 66 (72.5%) of them were male and 25 (%27.5) of them were female. Mean age was 62 ± 11 years. Sixty-five (71.4%) of the patients had no reliable protection while 26 (28.6%) of them had reliable protection. Tetanus IgG titers were decreasing by the age (Figure). Univariate analysis results between the immune and non-immune groups were demonstrated in Table: In the logistic regression analysis, only patients’ age was found statistically significant predictive factor for immunity against tetanus (OR: 1,114 95% CI: 1,047–1,185).Conclusion We found that elderly patients with DFW have very low rate of immunization against tetanus. Therefore, tetanus vaccination should be given particularly to the elderly patients with DFW without any serological control. Characteristics Immune patients (n = 26) None-immune patients (n = 65) P Age (year)(Mean ± SD)53.3 ± 12.165.1 ± 8.6 0.0001 Age of diabetes (year) (Mean ± SD)12.6 ± 8.116.4 ± 8.1 0.043 GEND ER Male, n (%)21 (31.8)45 (68.2)0.265 Female, n (%)5 (20)20 (80) Residency status Urban, n (%)24 (34.3)46 (65.7) 0.028 Rural, n (%)2 (9.5)19 (90.5) Educational status Primary–Secondary School, n (%)20 (24.7)61 (75.3) 0.029 High School-University, n (%)6 (60)4 (40) Knowledge about vaccination history Full covered, n (%)3 (50)3 (50)0.461 Not covered, n (%)4 (30.8)9 (69.2) Unknown, n (%)19 (26.4)53 (73.6)Disclosures All authors: No reported disclosures.

Identification of high-risk groups of charcot foot in the people with diabetic foot neuropathic ulcerations

Objective To identify high-risk groups of Charcot foot(CN) in the people with diabetic foot neuropathic ulcerations(NU). Methods Twenty cases patients with CN who were diagnosed in General Hospital of the Chinese People Air Force from June 2008 to June 2013 and 58 patients with diabetic neuropathic ulcer who were hospitalized from January 2010 to December 2011 and followed up until June 2014 without foot deformity were retrospectively analyzed.All patient's general condition, examination and laboratory results, diabetic chronic complications, complication, diabetes distribution of foot ulcers, and plain features. Results There were no statistically significant differences in terms of patients' average age, sex ratio, proportion of smokers, BMI, HbA1c, blood lipid, dorsalis pedis artery diameter and diabetic nephropathy (Ⅲ-Ⅳ period), chronic kidney disease stage 3 above, proliferation diabetic retinal pathological changes, the prevalence of coronary heart disease between the two groups(P>0.05). Compared with NU group, patients with single high proportion(40.00%(8/20) vs.10.34%(6/58)), Short duration of diabetes((12.37±5.64) years vs.(14.27±8.04) years), Feet long numbness(6(5, 9) years vs.4(2, 20) years), low rate of hardening of the arteries narrow(ABI<0.9)( 0(0/20) vs.39.66%(13/58)), high recurrent diabetic foot ulcer prevalence(70.00%(14/20) vs.25.86%(15/58)), more patients with diabetes mellitus autonomic neuropathy(75.00%(15/20) vs.39.66%(23/58)), less combined with hypertension(25.00%(5/20) vs.58.62%(34/58)), the differences were significant(t orχ2=6.981, 2.259, 4.068, 3.887, 12.405, 7.436, 6.724; P<0.05). Diabetic foot wound distribution on mesopodium of CN group and NU group was 36.84%(7/19), 6.90%(4/58) respectively, the difference was significant(χ2=11.443, P=0.003). Diabetic foot amputation rate(Wanger 4, 5 grade) of CN group and NU group was 44.44%(4/9), 6.90%(2/29) respectively, the difference was significant(χ2=4.732, P=0.020). Conclusion The characteristics of high-risk groups of diabetics Charcot foot in the people with diabetic foot neuropathic ulcerations are middle aged, no foot of ischemia, combine the diabetic autonomic neuropathy and the feet always with recurrent ulcers. Key words: Diabetic foot ulcer; Diabetic peripheral neuropathy; Neuropathic ulcer; Charcot foot

Clinical application and nursing of maggot debridement therapy in the refractry wounds

Objective To investigate the clinical application and nursing of maggot debridement therapy in the diabetic foot , pressure ulcer and other refractory wounds .Methods Eleven patients with refractory wounds were selected .We used maggot debridement therapy for wound debridement , and implemented considerate clinical care and psychological care for their respective basic diseases .Results The mean healing time of the refractory wounds was （25.0 ±3.8） days.The patients received scientific and considerate nursing and accepted the biological debridement therapy psychologically .Conclusions For the treatment of chronic refractory wounds , maggot debridement therapy is an effective , economical and safe method . Key words: Nursing; Larva; Debridement; Refractory wound; Clinical application