Treatment Of Diabetic Ulcers Research Articles

Photographic tissue characterization applied to relative quantification related to hyperbaric oxygenation of diabetic foot ulceration: technical note

Hyperbaric oxygenation (HBO2) is a successful treatment of diabetic foot ulcerations. Research on the characterization of tissue by ultrasonography (CATUS) or by imaging (CATIM) has grown. We investigated the photographic pCATIM feasibility to quantitate HBO2 effects. Besides, we analyzed pre and post HBO2 treatment photographs quantitatively based on pixel brightnesses of gray-scale imaging versions. Grayscale Medians (GSM) for (1) entire ulceration, (2) inner core, (3) ulceration border, and (4) adjacent skin decreased from 92 to 77, 60 to 56, 105 to 101, and 105 to 90. Entire ulceration post-HBO2 pixel percentages were lower in the 112-153 intervals, 11% vs 29% (p = .0013 by Chi-square), and higher in the 41-111 brightness range, 87% vs 68% (p = .0008). A case report showed quantifiable relative changes detected by pCATIM post HBO2 treatment of diabetic foot ulceration. Further investigation may quantify brightness variabilities and/or specific GSM for ulceration and skin regions.

Formulasi Dan Karakteristik Fisik Sediaan Plester Hidrogel Ekstrak Daun Ciplukan (Physalis angulata L.) Dan Batang Kayu Manis (Cinnamomum burmannii)

Diabetes mellitus is a degenerative disease caused by the damage of beta pancreatic cells. This caused many complication such as diabetic ulcer which left untreated can cause an open wound hard to heal thereby reducing the quality of life. Treatment of diabetic ulcer despite using antidiabetic also using an antibiotic therapy like Mupirocin. In its development, the use of natural ingredients is known to be used as adjuvant therapy for diabetic ulcer such as Ciplukan leaves and Kayu Manis bark. Both of the plant contain phytochemical compound like sinamaldehid, tannin, polyphenol and flavonoid which can work as wound healer. To increase its efficacy then Ciplukan leaves and Kayu Manis bark were formulated as hydrogel patch. Hydrogel patch are known has advantages like better penetration, hygienic and easy to administered Ciplukan (Physalis angulata L.) leaves and Kayu Manis (Cinnamomum burmannii) Bark extracted with maceration technique. The extracts then made into matrix type hydrogel patch with 10% HPMC and 5% PVA as backing patch. The backing patch and extract then placed on a square cast and dried under room temperature for 24 hours. The hydrogel patch then evaluated for physical characteristic including organoleptic aspect, weight uniformity, moisture content and pH. The results showed that Ciplukan leaves and Kayu Manis Bark hydrogel patch have a semi solid consistency, transparent greenish color and distinctive smell. The average pH is 5,5 and have average weight around 1,18 grams. The moisture contens of hydrogel patch is 2,42%. The Ciplukan leaves and Kayu Manis bark is able to formulated into hydrogel patch. The hydrogel patch is showing good appearance and having good properties as topical dosage form. The pH of the hydrogel patch is suitable with pH of the skin and have no intention to irritate the skin. Hydrogel patch also giving a cooling sensations in wound area thus increase patients convenience and acceptability. Keywords: Diabetes mellitus, extract, drug delivery system, hydrogel patch, adjuvant therapy

An uncommon side effect of linezolid: Black hairy tongue

AbstractLinezolid therapy is known to cause black hairy tongue, which is benign and reversible. A 65‐year‐old diabetic male was on treatment for diabetic nonhealing ulcer involving right foot and sole for the past 6 months. Linezolid was started based on the culture and sensitivity of the pus. Patient developed thrombocytopenia and black hairy tongue after 7 days of the drug regimen. Drug was stopped and patient was advised to maintain good oral hygiene, soft tooth brush for brushing and regular mouth wash with lukewarm water. The black hairy tongue completely resolved within a week after stopping the drug. The taste and foreign body sensation on the tongue while swallowing were also improved. The diabetic wound was treated by starting vancomycin after giving a surgical wound debridement by a general surgeon.

A Comparative Study between the Use of Negative Pressure Wound Therapy and Silver-Releasing Foam Dressings in the Management of Diabetic Ulcers

AbstractIntroduction Diabetic foot ulcers are one among the most commonly encountered complication of diabetes mellitus tackled by the surgical department worldwide. Negative pressure wound therapy (NPWT) and silver-releasing foam dressings are effective modalities for the treatment of ulcers. This study compares the two treatment modalities.Methods Sixty adult patients admitted with diabetic foot ulcers undergoing NPWT (vacuum-assisted closure [VAC]) or silver-releasing foam dressing (Biatain Ag) treatment were included in the study. Patients undergoing either of the treatment modalities were observed and followed up on a weekly basis prospectively. Wounds were routinely examined for the size of ulcer in area (cm2) and time taken for wound healing. Patients were also assessed qualitatively by means of a questionnaire to find out patient satisfaction and compliance.Results Time taken for wound healing among Biatain Ag group was found to be 24±9.483 days compared with only 19.73±7.575 days in the VAC group. Decrease in size ulcer measured in area was found to be 38.79% in Biatain Ag group, whereas in the VAC group it was found to be 26.56%. Patients were satisfied with both modalities of treatment; however, patient compliance was better for the Biatain Ag Group due to decrease in restriction of mobility and decrease in cost.Conclusion Overall, both modalities of treatment were found to be comparable and can be used with similar efficacy. It can be concluded that silver-releasing foam dressing can act as a beneficial alternative to NPWT in the treatment of diabetic ulcers.

Gene set enrichment analysis and ingenuity pathway analysis to identify biomarkers in Sheng-ji Hua-yu formula treated diabetic ulcers

Ethnopharmacological relevanceSheng-ji Hua-yu (SJHY) formula is a Chinese herbal prescription for diabetic ulcers (DUs) treatment, which can accelerate wound reconstruction and shorten the healing time. However, its mechanism role maintains unclear. Aim of the studyTo elucidate the molecular mechanisms of SJHY application on DUs. Materials and methodsTo begin with, transcriptome sequencing was adopted to identified differentially expression mRNAs among normal ulcers, DUs, and DUs + SJHY treatment in vivo. Liquid chromatography-tandem mass spectrometry was applied for the quality control of SJHY formula. GO and KEGG enrichment analysis were used to identify the mechanisms underlying the therapeutic effect of SJHY formula, and then gene set enrichment analysis and ingenuity pathway analysis were conducted for functional analysis. Further, qPCR detection was performed in vivo for validation. ResultsSJHY administration could regulate the glucose metabolic process, AMPK and HIF-1 pathway to accelerate healing processes of DUs. Besides, CRHR1, SHH, and GAL were identified as the critical targets, and SLC6A3, GRP, FGF23, and CYP27B1 were considered as the upstream genes of SJHY treatment. Combined with animal experiments, the prediction results were validated in DUs mice model. ConclusionsThis study used modular pharmacology analysis to identify the biomarkers of SJHY formula and provide the potential therapeutic targets for DUs treatment as well.

Research Progress on Accurate Syndrome Differentiation and Treatment of Diabetic Ulcer by TCM Internal Treatment

Research Progress on Accurate Syndrome Differentiation and Treatment of Diabetic Ulcer by TCM Internal Treatment

A prospective, randomized, controlled clinical study on the effectiveness of a single‐use negative pressure wound therapy system, compared to traditional negative pressure wound therapy in the treatment of diabetic ulcers of the lower extremities

AbstractA multicenter, phase 4, randomized, comparative‐efficacy study in subjects with lower extremity wounds was carried out to compare wound closure rates, for a single‐use negative pressure wound therapy (s‐NPWT) versus traditional NPWT (t‐NPWT) systems over a 12‐week treatment period. From the initial population of patients with diabetic foot ulcers (DFU) and venous leg ulcers (VLU), we analyzed a subgroup of patients with diabetes mellitus and leg and foot ulcers (either DFUs or VLUs in diabetics), termed, the diabetic lower extremity ulcers (DLEU). In the DLEU group, there were 95 patients in intention‐to‐treat (ITT) and 61 patients in per protocol (PP) populations, respectively. We found a significant difference in favor of s‐NPWT over t‐NPWT in the confirmed wound closures at 12 weeks both in ITT (p < 0.001) and PP populations (p = 0.017). Significantly higher wound closure rates in s‐NPWT group suggest that s‐NPWT should be preferred NPWT option for DLEU.

Chitosan alginate nanoparticles as a platform for the treatment of diabetic and non-diabetic pressure ulcers: Formulation and in vitro/in vivo evaluation

Chitosan and alginate are natural bioactive polymers with wound healing properties, in addition to chitosan’s anti-bacterial properties. In this study, these two polymers were combined in a drug-free nanosystem with positive or negative surface charges, for the treatment of non-diabetic and diabetic pressure ulcers. Chitosan alginate nanoparticles (CA NPs) were prepared by a modified ionic gelation method. Interaction between the polymers and formation of the NPs were confirmed by Fourier-Transform infrared spectroscopy, differential scanning calorimetry and transmission electron microscopy. For in vivo study, selected CA NPs with optimum particle size, polydispersity index, positive and negative zeta potential, were evaluated for their pressure ulcers-healing effect using non-diabetic and diabetic rats. Rate of wound closure, histological examination and histomorphometric assessment were used to evaluate the CA NPs’ wound healing potential. Positively and negatively charged CA NPs significantly enhanced wound closure rates, compared to control untreated group. Histological and histomorphometric analysis revealed higher quality and maturation of the formed granulation tissue, less inflammation and higher collagen content with positively charged CA NPs containing higher amount of chitosan. These results suggest that chitosan alginate nanoparticles offer a promising platform for diabetic and non-diabetic wound healing applications.

Evaluation of larval therapy effects on the progression of equine sarcoid

Background: The skin is the largest organ of the body and is of particular importance in the beauty and economic value of the horse. Equine sarcoid disease (ESD) is the most common skin tumor in horses. So far, various methods have been used to treat sarcoidosis, but no fully effective treatment has yet been proposed. The use of larval therapy in the treatment of human diabetic ulcers and horse hoof lesions is spreading. Reports of the use of larval therapy to treat the complications of tumor lesions have been promising.Objectives: This study was performed to evaluate the effect of larval therapy on equine sarcoid lesions. Methods: In this study, 4 cases were diagnosed with sarcoid by clinical examinations and pathological tests, and larval therapy was used to treat sarcoid lesions. To place the larvae on the lesion, the method of implantation in an artificial nest was used. The number of larvae used per square centimeter was about 10 larvae. Result: The result of treatment was satisfactory in 2 cases of horses and even in one case the lesion was largely limited and the emergence of healthy skin began. In the other two cases, no positive result was seen, which was probably due to the extent of the lesion and the instability of the larvae on it. Conclusions: According to the obtained results, it seems that larval therapy is effective for the treatment of sarcoid necrotic lesions, but more studies are needed in this field.

Comparison Between Topical Sucralfate, Topical Platelet-Rich Plasma and Topical Ozonated Virgin Coconut Oil to Enhance Wound Healing in Diabetic Ulcer Mice model

Diabetic ulcer is a serious complication of diabetes mellitus which can lead to further morbidity. Sucralfate, Platelet-rich plasma (PRP) and ozonated virgin coconut oil (VCO) has been shown to provide good clinical outcomes in chronic ulcer healing. This study compares the effectiveness of topical sucralfate, topical PRP and topical ozonated VCO therapy for diabetic ulcer treatment in Wistar mice by observing wound length and vascular endothelial growth factor (VEGF). Ninety Wistar mice with full-thickness ulcer model on the back were divided into 5 groups. Four groups of mice were receiving diabetic induction using streptozotocin injection and were allocated as topical sucralfate (TS), topical PRP (TP), and topical ozonated VCO (TO) group. The remaining diabetic-positive mice were allocated as the diabetic-positive control group (PC) which received standard therapy, and the other non-diabetic mice were allocated as the diabetic-negative control group (NC) which did not receive any therapy. Topical ozonated VCO enhances the wound healing process better with the greatest wound reduction area and highest VEGF expression compared to topical sucralfate and topical PRP. Topical ozonated VCO can potentially accelerate wound healing in diabetic ulcers better than topical sucralfate and topical PRP.

Meta-Analysis of the Effect of Kangfuxin Liquid on Diabetic Patients with Skin Ulcers.

In this study, we used meta-analysis to comprehensively evaluate the clinical efficacy of Kangfuxin Liquid in the treatment of diabetic patients with skin ulcers. Literature search was performed through PubMed, Web of Science, Embase, China National Knowledge Infrastructure, and Wanfang Data. The retrieval was not limited by language, and the search period was from 2010 to October 12, 2020. Diabetic patients with skin ulcers were treated with Kangfuxin Liquid combined with basic treatment as the treatment group and only basic treatment as the control group. Stata16.0 software was used for system evaluation. A total of 11 studies and 874 patients were included. Meta-analysis showed that 11 studies compared the treatment efficacy between the two groups, and the results showed that the treatment efficacy in the treatment group was significantly higher than that in the control group [OR = 5.38, 95% CI (3.52, 8.24), P < 0.001]. Among them, 9 studies compared the healing time of wounds. The healing time of the treatment group was significantly longer than that of the control group [SMD = −2.13, 95% CI (−2.85, −1.41), P < 0.001]. Five studies compared the length of stay, and the length of stay in the treatment group was shorter than that in the control group [SMD = −3.68, 95% CI (−5.38, −1.97), P < 0.001]. Compared with basic treatment, Kangfuxin Liquid combined with basic treatment has an ideal effect in the treatment of diabetic skin ulcers, which can improve the overall treatment efficiency and shorten the wound rehabilitation time and the length of stay.

Investigating auranofin for the treatment of infected diabetic pressure ulcers in mice and dermal toxicity in pigs

Bacterial infection of pressure ulcers (PUs) are a notable source of hospitalization for individuals with diabetes. This study evaluated the safety profile and efficacy of auranofin to treat diabetic PUs infected with methicillin-resistant Staphylococcus aureus (MRSA). PUs were infected with MRSA in diabetic TALLYHO/JngJ mice and then treated with topical auranofin (2%), topical mupirocin (2%), or oral clindamycin (30 mg/kg) for four days. PUs were harvested post-treatment to enumerate bacterial burden and determine expression of cytokines/growth factors. Landrace cross pigs were exposed topically to auranofin (1%, 2%, and 3%) for 4–14 days and evaluated for signs of localized or systemic toxicity. Auranofin eradicated MRSA in PUs within four days (7.92-log10 reduction) in contrast to mupirocin (2.15-log10 reduction) and clindamycin (0.73-log10 reduction). Additionally, auranofin treatment resulted in decreased expression of pro-inflammatory cytokines and increased expression of biomarkers associated with re-epithelization of wounded tissue, confirmed with histopathologic analysis. No significant histopathologic lesions were present on porcine skin sites exposed to topical auranofin. Additionally, minimal accumulation of plasma gold and no systemic toxicity was observed in pigs exposed to topical auranofin. Auranofin appears to be a potent and safe topical agent to further investigate for treatment of mild-to-moderate MRSA-infected diabetic PUs.

Treatment Of Grade II Diabetic Ulcer with Mindi Leaf Hydrogel (Melia Zadarach L) Against Wound Healing Process

Diabetic ulcers are a chronic complication of Diabetes Mellitus. Modern society prefers non pharmacology as a nursing action because it is far from chemicals. Researchers found that mindi leaves with ingredients that can be used as anti-inflammatory, antidiabetic and antibacterial can be used to treat diabetes which is packaged into a hydrogel for the basic ingredient of modern care (modern dressing).To determine the effectiveness of mindi leaf hydrogel on the wound healing process in patients with grade II diabetic ulcers. True experimental design with pre-test post-test with control group design. Data were collected by taking 40 respondents through stratified random sampling and the hypothesis was tested by using the General Linear Model effectiveness test.Mindi leaf hydrogel significantly accelerated the healing process of grade II ulcers with a value of p=0.000.Treatment of diabetic ulcers with mindi leaf hydrogel is effective in accelerating the wound healing process

KGF Phage Model Peptide Accelerates Cutaneous Wound Healing in a Diabetic Rat Model

The authors have previously demonstrated that one phage-displayed keratinocyte growth factor (KGF) model peptide that can bind to epidermal cells and facilitate cellular proliferation. In this study, the authors investigated the role of phage-displayed KGF model peptide on wound healing in diabetic rats. Full-thickness excisional dorsal wounds were created in the diabetic rats, after which the rats were randomly divided into five groups: negative control group [normal saline (NS)], two KGF control groups which were respectively treated with low-dose KGF (5 ng/mL, K-LD) and high-dose KGF (50 ng/mL, K-HD), and two KGF model-peptide-treated groups which were respectively treated with low-dose model peptide (5 ng/mL, M-LD) and high-dose model peptide (50 ng/mL, M-HD). On day 14 post-injury, wound closure was followed by digital planimetry and wound tissues were harvested for histologic assay and real-time polymerase chain reaction. Wounds treated with model peptide closed markedly faster than negative control wounds and were comparable to KGF treated wounds. Histology and immunohistology results demonstrated significantly higher levels of re-epithelization, granulation tissue formation and vascularization in the model peptide groups. Furthermore, real-time polymerase chain reaction expression of KGFR, collagen I and transforming growth factor-β1 in model peptide groups, were also generally higher than that in negative control group. Phage-displayed KGF peptide promotes wound healing through accelerating re-epithelialization, enhancing dermal regeneration, and inducing angiogenesis. Model peptide possesses the potential to be a promising therapeutic option for the treatment of diabetic ulcers.

Finite element-based method for determining an optimal offloading design for treating and preventing heel ulcers

Diabetic heel ulceration, a serious, destructive, and costly complication of diabetes, is often treated by custom-made offloading footwear. One common offloading device is a custom-made insole designed with a hole under the damaged site that is intended to reduce local mechanical loads on the ulcer. However, current devices do not take into account the increasing loads at the wound peripheries, and quantitative assessments and scientific guidelines for the optimal design of the offloading hole are lacking. Here, we develop a novel method to determine the volumetric exposure to mechanical loading of a human heel, at two volume of interests (VOIs) during walking in 150 different finite-element footwear configurations. We defined the two VOIs as (1) the area of the heel soft tissues typically at high risk of ulceration, and (2) the soft tissues surrounding the high risk area. For all model variants, three hole-geometry parameters were defined: (1) radius, (2) radius of curvature (ROC) and (3) depth. We found two combinations of the offloading parameters which minimize heel loads in both VOIs. The first is with a large offloading radius, large ROC and large depth, whereas the second is with a large offloading radius, large depth but relatively small ROC. Our novel practical scientific analysis method, that takes into account the ulcer site as well as the peripheral area, has the potential to optimize development of offloading solutions by streamlining the examination of their biomechanical efficiency, and thus may revolutionize prevention and treatment of diabetic ulcers at any foot location.

Injectable Desferrioxamine-Laden Silk Nanofiber Hydrogels for Accelerating Diabetic Wound Healing.

Dysangiogenesis and chronic inflammation are two critical reasons for diabetic foot ulcers. Desferrioxamine (DFO) was used clinically in the treatment of diabetic foot ulcers by repeated injections because of its capacity to induce vascularization. Biocompatible carriers that release DFO slowly and facilitate healing simultaneously are preferable options to accelerate the healing of diabetic wounds. Here, DFO-laden silk nanofiber hydrogels that provided a sustained release of DFO for more than 40 days were used to treat diabetic wounds. The DFO-laden hydrogels stimulated the healing of diabetic wounds. In vitro cell studies revealed that the DFO-laden hydrogels modulated the migration and gene expression of endothelial cells, and they also tuned the inflammation behavior of macrophages. These results were confirmed in an in vivo diabetic wound model. The DFO-laden hydrogels alleviated dysangiogenesis and chronic inflammation in the diabetic wounds, resulting in a more rapid wound healing and increased collagen deposition. Both in vitro and in vivo studies suggested potential clinical applications of these DFO-laden hydrogels in the treatment of diabetic ulcers.

The level of evidence of the publications on conservative surgery for the treatment of diabetic forefoot ulcers: A scoping review

ObjectiveThe diabetic foot disease is one of the most serious complications of diabetes causing high rates of amputations, premature deaths and healthcare cost. While standard non-surgical care is the mainstay of treatment of diabetic foot ulcers (DFU), many reports demonstrated that conservative surgery particularly in the forefoot, compared better in terms of clinical outcomes. Nevertheless, the quality of surgical articles dealing with diabetic ulcers of the forefoot is thought to be average. This paper aimed to quantify the level of evidence of the DFU surgical papers published in the literature. Literature surveyPubMed was searched from inception till Feb 2020. All study designs but case reports were accepted for inclusion. Two outcomes were searched for: a) study design and b) level of evidence. The level of evidence of the studies was based on the classification developed by the Oxford Center for Evidence-based Medicine. ResultsIn total, 90 articles were included for analysis. Only 6 studies (6.7%) had a Level 1 level of evidence. One study had a Level 2 (1.1%) and 13 studies (14.4%) a Level 3. The majority of the included studies had a Level 4 of level of evidence with 70 studies (77.8%) being case-series. ConclusionIt is surprising that a disease with such enormous health-related and financial burden did not generate enough interest among surgeons to invest more into high quality research. The findings should incite surgeons to get more involved in the treatment of forefoot diabetic wound and infection. Large comparative prospective high quality trials to assess the available surgical methods are needed.

Color therapy in treatment of diabetic neuroand angiopathy and ulcers of low extremities

Color therapy in treatment of diabetic neuroand angiopathy and ulcers of low extremities

Study of Biofilm Formation and Antibiotic Resistance Pattern of Bacteria Isolated from Diabetic Foot Ulcers in H&amp;#244;pital de R&amp;#233;f&amp;#233;rence Saint Joseph, Kinshasa, Democratic Republic of Congo

Foot infections resulting from biofilm producers and multi-drug resistant organisms is one of the most important complications of diabetes mellitus, as it can impede the wound healing process. This study was carried out in order to determine the antibiotic resistance pattern and the biofilm production in diabetic foot ulcers isolates. Clinical samples were collected from patients suffering from diabetic foot ulcers by using sterile swabs. Antibiotic susceptibility test was done using disk diffusion method on Mueller Hinton Agar. Biofilm formation was assessed by Crystal Violet Staining Method. Staphylococcus aureus isolates were resistant to ofloxacin (83.3%), ciprofloxacin (75.0%), trimethoprim-sulphamethoxazole (75.0%), and gentamicin (58.8%) but very sensitive to oxacillin (100.0%) and vancomycin (91.7%). Pseudomonas aeruginosa isolates showed resistance to the commonly used antibiotics such as ofloxacin, cefotaxime, ampicillin (81.8%), ceftazidime and imipenem (72.7%). The majority of bacteria studied were biofilm producers. This study showed that bacteria isolated from diabetic foot ulcers were biofilm producers and presented resistance to commonly used antibiotics. Knowledge on antibiotic sensitivity pattern and biofilm phenotype of the isolates will be helpful in determining the drugs for the treatment of diabetic ulcers.

Basing on microRNA-mRNA analysis identifies microRNA in exosomes associated with wound repair of diabetic ulcers

The diabetic ulcer is one of the serious complications of diabetes. In this study, we aimed to establish an exosomal microRNA (miRNA)-targeted messenger RNA (mRNA) regulatory network for screening new biomarkers for diabetic ulcer treatment. For this purpose, exosomes were extracted from bone marrow stem cells (BMSCs) collected from diabetic ulcer patients and healthy adults. The miRNAs in exosomes was detected by high-throughput sequencing analysis. The Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis of the differential miRNAs were performed. The miRNA-mRNA regulatory network between candidate miRNAs and their target genes were constructed by Cytoscape software basing on mRNA expression profiles data of diabetic ulcer patients from Gene Expression Omnibus (GEO). GO and KEGG analyses of the core genes were performed. A total of 63 differential expressed miRNAs in BMSCs exosomes were identified between diabetic ulcer patients and healthy adults. The GO analysis of miRNAs showed that it was mainly related to signal transduction and intercellular transport, and KEGG analysis showed that it was related to the vascular endothelial growth factor (VEGF) signaling pathway. The core genes of the miRNA-mRNA network were thioredoxin interacting protein (TXNIP), cell division cycle 14A (CDC14A), cache domain containing 1 (CACHD1), interferon-induced protein 44 like (IFI44L), late cornified envelope 1AL (CE1A), leucine-rich repeats and immunoglobulin-like domains 2 (LRIG2), palmdelphin (PALMD) and serine and arginine-rich splicing factor 11 (SRSF11). GO analysis of the core genes was related to platelet-derived growth factor receptor signaling pathway. The KEGG analysis of the core genes was related to the cell cycle and nucleotide-binding oligomerization domain (NOD)-like receptor signaling pathway. A potential miRNA-mRNA regulatory network provides a comprehensive understanding of the molecular mechanisms and promising new targets such as miR-130a-5p, SESN2, LRIG2, and CDC14A for the wound repair of diabetic ulcers.