Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic ...Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic management,DFUs,foot lesions,proper care for injuries,diet,and surgery.Certain reasonably priced treatments,such as hyperbaric oxygen and vacuum-assisted closure therapy,are also available for DFUs,along with modern wound care products and techniques.Nonetheless,DF care(cleaning,applying antimicrobial cream when wounded,and foot reflexology),blood glucose monitoring to control diabetes,and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs.Between 50%and 80%of DF infections are preventable.Regardless of the intensity of the lesion,it needs to be treated carefully and checked daily during infection.Tissue regeneration can be aided by cleaning,dressing,and application of topical medicines.The choice of shoes is also important because it affects blood circulation and nerve impulses.In general,regular check-ups,monitoring of the patient’s condition,measuring blood glucose levels,and providing frequent guidance regarding DFU care are crucial.Finally,this important clinical problem requires involvement of multiple professionals to properly manage it.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therape...BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.展开更多
Diabetic foot ulcers(DFUs)represents a significant public health issue,with a rising global prevalence and severe potential complications including amputation.Traditional treatments often fall short due to various lim...Diabetic foot ulcers(DFUs)represents a significant public health issue,with a rising global prevalence and severe potential complications including amputation.Traditional treatments often fall short due to various limitations such as high recurrence rates and extensive resource utilization.This editorial explores the innovative use of acellular fish skin grafts as a transformative approach in DFU management.Recent studies and a detailed case report highlight the efficacy of acellular fish skin grafts in accelerating wound closure,reducing dressing changes,and enhancing patient outcomes with a lower socio-economic burden.Despite their promise,challenges such as limited availability,patient acceptance,and the need for further research persist.Addressing these through more extensive randomized controlled trials and fostering a multidisciplinary treatment approach may optimize DFU care and reduce the global health burden associated with these complex wounds.展开更多
BACKGROUND Pain often predisposes patients with diabetic foot ulcers(DFUs)to negative emotional states,such as anxiety and depression,which can significantly impair treatment outcomes and recovery.However,very few stu...BACKGROUND Pain often predisposes patients with diabetic foot ulcers(DFUs)to negative emotional states,such as anxiety and depression,which can significantly impair treatment outcomes and recovery.However,very few studies have explored the relationship between anxiety,depression,and pain in DFUs,as well as the associated risk factors.AIM To analyze the correlation between anxiety,depression,and pain in patients with DFUs and to identify the associated risk factors.METHODS This study included 106 patients diagnosed with DFUs who were admitted to Tiantai County People’s Hospital between March 2022 and March 2024.The patients’anxiety levels were evaluated using Zung’s self-rating anxiety scale(SAS),depression status was assessed using Zung’s self-rating depression scale(SDS),and pain intensity was assessed using the visual analog scale(VAS).Subsequently,correlations between SAS,SDS,and VAS scores were analyzed.Univariate and multivariate analyses were conducted to explore the risk factors that contributed to anxiety and depression in patients with DFUs.RESULTS Among the 106 patients,39.62%exhibited anxiety and 43.40%presented with depression.Most patients experiencing anxiety or depression exhibited mild symptoms,with no severe cases observed.Compared with asymptomatic patients,those with anxiety or depression had significantly higher VAS scores.Correlation analysis indicated a significant positive relationship between both SAS and SDS scores and the VAS score.Univariate analysis identified sex,age,Wagner’s grade,presence of other complications,and smoking history as factors significantly associated with anxiety and depression.Multivariate analysis further confirmed that younger age,higher Wagner’s grade,and higher VAS scores were independent predictors of anxiety and depression.CONCLUSION This study reveals a significant positive correlation between anxiety,depression,and pain in patients with DFUs.This finding suggests that timely and effective pain intervention may be beneficial in alleviating negative emotions such as anxiety and depression.In addition,younger age(<50 years),higher Wagner’s grade,and higher VAS scores increase the risk of developing anxiety and depression in this patient population.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)are a major complication of diabetes mellitus,and anemia is commonly observed in diabetic patients.However,the relationship between anemia and the risk of developing DFUs remains u...BACKGROUND Diabetic foot ulcers(DFUs)are a major complication of diabetes mellitus,and anemia is commonly observed in diabetic patients.However,the relationship between anemia and the risk of developing DFUs remains unclear.AIM To investigate the relationship between anemia and the risk of DFUs in diabetic patients through a meta-analysis.METHODS A systematic search was conducted across PubMed,Embase,and Web of Science databases to identify studies that reported the co-occurrence of anemia and DFUs in diabetic patients.The primary outcome was an association between anemia and DFU risk,expressed as odds ratios(ORs).Secondary outcomes included the risk of DFU per 1-g/dL decrease in hemoglobin and the difference in hemoglobin le-vels between patients with and without DFU.Statistical analyses were performed using random-effects models to account for heterogeneity.RESULTS Sixteen studies involving 170,949 diabetic patients were included in the analysis.The results indicated a significant association between anemia and an increased risk of DFUs(eight studies,n=166173,OR:2.72,95%CI:1.73–4.25,P<0.001;I2=93%).Subgroup analyses sup-ported consistent findings across various patient characteristics,analytic models,and study quality scores(P for subgroup differences,all>0.05).Additionally,each 1-g/dL decrease in hemoglobin was associated with an excess risk of DFUs(four studies,n=2543,OR:1.65,95%CI:1.21–2.27,P=0.002;I2=68%).Furthermore,diabetic patients with DFUs exhibited significantly lower hemoglobin levels compared to those without DFUs(nine studies,n=3986,mean difference:-2.13 g/dL,95%CI:-2.58 to-1.68,P<0.001;I2=90%).CONCLUSION Anemia can be associated with an increased risk of DFUs in diabetic patients.Monitoring and managing anemia in diabetic population may help mitigate the risk of DFUs,emphasizing the need for early interventions.Further research is required to investigate the underlying mechanisms and potential therapeutic strategies.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)represent a common and serious complication of diabetes,characterized by impaired wound healing and an increased risk of infection.These infections severely impact patient health,n...BACKGROUND Diabetic foot ulcers(DFUs)represent a common and serious complication of diabetes,characterized by impaired wound healing and an increased risk of infection.These infections severely impact patient health,necessitating extensive medical intervention,and increasing the risk of amputation.Vitamin D(VD)plays a critical role in immune regulation and tissue repair.AIM To investigate the effects of VD supplementation on infection rates,wound healing,and immune function in patients with DFUs.METHODS A randomized controlled trial was conducted involving 120 patients with DFUs.Participants were randomly assigned to either a control group(n=60),which received standard care without VD supplementation,or an intervention group(n=60),which received 2000 IU of oral VD3(cholecalciferol)daily for 12 weeks.The primary outcomes included the incidence and severity of infections,whereas the secondary outcomes included wound healing rate,serum 25-hydroxyvitamin D level,levels of immune markers(cathelicidin,interleukin-6 and tumor necrosis factor-α),and adverse events,such as hypercalcemia.RESULTS The incidence of infection was significantly lower in the VD supplementation group(25%)compared with the control group(45%)(P=0.01).Severe infections requiring systemic antibiotics or hospitalization were also less frequent in the VD supplementation group.Wound healing was notably enhanced in the VD supplementation group,with a 60%reduction in ulcer size compared with a 35%reduction in the control group(P<0.01).Serum 25(OH)D level significantly increased in the VD supplementation group(from 16.5 ng/mL to 35.2 ng/mL),confirming the efficacy of VD supplementation.Immune function improved,as demonstrated by a 30%rise in cathelicidin level and a 20%decline in levels of pro-inflammatory cytokines.No adverse effects,including hypercalcemia,were reported.CONCLUSION The VD supplementation effectively reduced infection rate,promoted wound healing,and strengthened immune responses in patients with DFUs.These findings support the incorporation of VD as a safe and effective adjunctive therapy in the clinical management of DFUs.展开更多
BACKGROUND Diabetic foot ulcers(DFU)are estimated to affect about 18.6 million people worldwide annually.The pathogenesis of DFU is complex,and the available drugs are not effective.Dl-3-n-butylphthalide(NBP)is a synt...BACKGROUND Diabetic foot ulcers(DFU)are estimated to affect about 18.6 million people worldwide annually.The pathogenesis of DFU is complex,and the available drugs are not effective.Dl-3-n-butylphthalide(NBP)is a synthetic mixture of racemates used in China for the treatment of ischemic stroke.It was initially isolated from the seeds of Apium graveolens Linn,with studies showing its potential role in treating diabetes and its complications.AIM To predict and validate the mechanism by which NBP treats DFU.METHODS Network pharmacological analysis was performed to identify pharmacological targets and signaling pathways mediating the treatment effect of NBP on DFU.In vivo and in vitro experiments were conducted to validate the therapeutic effects and mechanisms of NBP on DFU.RESULTS Network pharmacology analysis identified 26 pharmacological targets of NBP and predicted that NBP could treat DFU partially by modulating apoptosis and vascular signaling pathways.Results from animal experiments showed that NBP significantly improved DFU by increasing neovascularization and fibroblast proliferation.In vitro tests demonstrated that NBP treatment promoted the migration and proliferation of human umbilical vein endothelial cells and human dermal fibroblasts,while inhibiting the apoptosis of human umbilical vein endothelial cells,human dermal fibroblasts,and human keratinocytes cells.CONCLUSION This study found that NBP could treat DFU by decreasing the rate of apoptosis and increasing angiogenesis via the advanced glycation end products-receptor of advanced glycation end products signaling pathway and binding to the heme oxygenase 1,caspase 3,B cell leukemia/lymphoma 2,brain derived neurotrophic factor,and nuclear factor erythroid 2 L2 genes.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)are a significant challenge in diabetic care,and the efficacy of negative pressure wound therapy(NPWT)in treating them remains a subject of continuous investigation.AIM To provide ...BACKGROUND Diabetic foot ulcers(DFUs)are a significant challenge in diabetic care,and the efficacy of negative pressure wound therapy(NPWT)in treating them remains a subject of continuous investigation.AIM To provide a comprehensive meta-analysis of the role of NPWT in the manage-ment of DFUs.METHODS A systematic review was performed based on Preferred Reporting Items for Sys-tematic Reviews and Meta-Analyses guidelines,searching databases like PubMed,Embase,Web of Science,and the Cochrane Library.Randomized clinical trials(RCTs)were included to compare NPWT to other dressings for DFUs.Outcomes measured were wound healing time and rate,granulation tissue formation time,amputation rate,and adverse events.Study quality was evaluated using Coch-rane's risk of bias tool.Analyses utilizedχ2,I2,fixed or random-effects models via Stata v17.RESULTS Of the 1101 identified articles,9 RCTs were selected for meta-analysis.Studies spanned from 2005 to 2020 and originated from countries including the United States,Chile,Pakistan,Italy,India,and Germany.Meta-analysis demonstrated a significant improvement in wound healing rate[risk ratio(RR)=1.46,95%CI:1.22-1.76,P<0.01]and a reduction in amputation rate(RR=0.69,95%CI:0.50-0.96,P=0.006)with NPWT.Furthermore,the time for granulation tissue formation was significantly reduced by an average of 19.54 days.However,the incidence of adverse events did not significantly differ between NPWT and control treatments.CONCLUSION NPWT significantly improves wound healing rates and reduces amputation rates in DFUs.It also hastens the formation of granulation tissue.However,the therapy does not significantly alter the risk of adverse events compared to alternate treatments.展开更多
BACKGROUND Aloe vera has been used as a traditional herbal therapy for wound management and dermatological conditions worldwide for thousands of years.Scientific evidence has confirmed that acemannan,the bioactive com...BACKGROUND Aloe vera has been used as a traditional herbal therapy for wound management and dermatological conditions worldwide for thousands of years.Scientific evidence has confirmed that acemannan,the bioactive compound in aloe vera gel,exhibits significant anti-inflammatory and immunomodulatory properties that enhance tissue regeneration.This case report describes the successful application of an innovative acemannan-enriched glycolipid sphere dressing derived from aloe vera gel in diabetic foot ulcer(DFU)treatment,which achieved a clinically remarkable outcome.CASE SUMMARY An 80-year-old female patient with a 20-year history of type 2 diabetes mellitus experienced recurrent diabetic foot pain for 15 years.She had multiple hospitalizations due to acute infections and poorly controlled hyperglycemia.Long-term treatments included metformin and gliclazide.Upon presentation,she had a nonhealing wound on her left dorsal foot,diagnosed as a severe DFU(Texas classification:Grade II,stage D).She declined amputation and opted for conservative treatment.The medical team applied an acemannan-enriched glycolipid sphere dressing five times daily to the left calf and foot,avoiding the wound area.Frequency was reduced to three times daily after scab formation.Weight-bearing on the injured foot was avoided.Through in-person and online consultations,the team managed her lifestyle and diet,emphasizing natural foods.After 5 months,the DFU healed without significant scarring or functional loss.No recurrence was observed during the 2-year follow-up.Acemannan-enriched glycolipid sphere dressings promote DFU healing.This suggests the potential of these dressings for treating other refractory wounds.展开更多
BACKGROUND Shifting from the inflammatory to the proliferative phase represents a pivotal step during managing diabetic foot ulcers(DFUs);however,existing medical interventions remain insufficient.MicroRNAs(miRs)highl...BACKGROUND Shifting from the inflammatory to the proliferative phase represents a pivotal step during managing diabetic foot ulcers(DFUs);however,existing medical interventions remain insufficient.MicroRNAs(miRs)highlight notable capacity for accelerating the repair process of DFUs.Previous research has demonstrated which miR-122-5p regulates matrix metalloproteinases under diabetic conditions,thereby influencing extracellular matrix dynamics.AIM To investigate the impact of miR-122-5p on the transition from the inflammatory to the proliferative stage in DFU.METHODS Analysis for miR-122-5p expression in skin tissues from diabetic ulcer patients and mice was analyzed using quantitative real-time polymerase chain reaction(qRT-PCR).A diabetic wound healing model induced by streptozotocin was used,with mice receiving intradermal injections of adeno-associated virus-DJ encoding empty vector or miR-122.Skin tissues were retrieved at 3,7,and 14 days after injury for gene expression analysis,histology,immunohistochemistry,and network studies.The study explored miR-122-5p’s role in macrophage-fibroblast interactions and its effect on transitioning from inflammation to proliferation in DFU healing.RESULTS High-throughput sequencing revealed miR-122-5p as crucial for DFU healing.qRT-PCR showed significant upregulation of miR-122-5p within diabetic skin among DFU individuals and mice.Western blot,along with immunohistochemical and enzyme-linked immunosorbent assay,demonstrating the upregulation of inflammatory mediators(hypoxia inducible factor-1α,matrix metalloproteinase 9,tumor necrosis factor-α)and reduced fibrosis markers(fibronectin 1,α-smooth muscle actin)by targeting vascular endothelial growth factor.Fluorescence in situ hybridization indicated its expression localized to epidermal keratinocytes and fibroblasts in diabetic mice.Immunofluorescence revealed enhanced increased presence of M1 macrophages and reduced M2 polarization,highlighting its role in inflammation.MiR-122-5p elevated inflammatory cytokine levels while suppressing fibrotic activity from fibroblasts exposed to macrophage-derived media,highlighting its pivotal role in regulating DFU healing.CONCLUSION MiR-122-5p impedes cutaneous healing of diabetic mice via enhancing inflammation and inhibiting fibrosis,offering insights into miR roles in human skin wound repair.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free ant...BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free anterolateral thigh(ALT)perforator flap is a promising reconstructive method;however,diabetic vasculopathy challenges optimal perfusion.This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.AIM To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs,thereby providing insights to improve surgical outcomes.METHODS This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024.Patients were categorized into normal(n=50)and abnormal(n=50)blood perfusion groups based on intraoperative perfusion assessments.Data on demographics,clinical characteristics,vascular status,metabolic control,and preoperative laboratory parameters were collected.Statistical analyses,including univariate and multivariate logistic regression,were conducted to identify significant predictive factors for perfusion outcomes.RESULTS Old age,high body mass index,long diabetes duration,and presence of diabetic peripheral neuropathy were associated with impaired perfusion.Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin(HbA1c),creatinine,triglycerides,and partial pressure of carbon dioxide.Conversely,high hemoglobin,albumin,and prealbumin levels and partial pressure of oxygen(PaO_(2))were protective.Multivariate analysis identified diabetes duration,HbA1c,PaCO_(2),PaO_(2),and albumin as independent predictors of perfusion,underscoring the roles of metabolic control and vascular health.CONCLUSION Optimizing metabolic control,vascular health,and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)present a significant healthcare challenge attributable to their high rates of disability and the limitations of applied traditional nursing approaches.Effective management is crit...BACKGROUND Diabetic foot ulcers(DFUs)present a significant healthcare challenge attributable to their high rates of disability and the limitations of applied traditional nursing approaches.Effective management is critical for uneventful health outcomes.AIM To investigate the effects of multidisciplinary team(MDT)nursing interventions and blood glucose control on the negative emotions and satisfaction of DFUhealing patients.METHODS This retrospective cohort study included 115 patients with DFUs,divided into MDT and blood glucose control intervention group(n=60)and standard care control group(n=55).The comparison factors were wound area,new granulation tissue coverage area,wound healing rate,2-hour postprandial blood glucose level,fasting plasma glucose level,Hamilton Anxiety Scale score,Hamilton Depression Scale score,and nursing satisfaction.RESULTS After 4 weeks,the average wound area reduced from 22.04±6.48 cm^(2)to 11.96±3.63 cm^(2)(P<0.05).New granulation tissue coverage area reached 52.85±18.39 cm^(2) for the intervention group and 28.39±9.94 cm^(2)(P<0.05)in the control group,respectively.The healing rate was significantly higher in the intervention group than in the control group(91.7%vs 76.4%,P<0.05).Fasting plasma glucose decreased more sharply in the intervention group(from 8.36±0.98 mmol/L to 6.91±1.23 mmol/L)than in the control group(8.41±1.05 mmol/L to 7.81±1.27 mmol/L),with the intervention group maintaining significantly lower levels(P<0.05).The intervention group demonstrated a significantly greater reduction in 2-hour postprandial blood glucose levels(11.35±2.67 mmol/L to 7.52±1.38 mmol/L)compared to the control group(11.61±3.01 mmol/L to 8.72±1.63 mmol/L;P<0.05).Hamilton Anxiety Scale and Hamilton Depression Scale scores were significantly lower in the intervention group(P<0.05).Patient satisfaction with nursing was 93.33%and 74.55%in the intervention and control groups,respectively(P<0.05).CONCLUSION MDT combined with blood glucose control enhanced healing rates and positively influenced emotional well-being and satisfaction among patients.This strategy holds potential for application in clinical practice.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)are a severe complication of diabetes and a leading cause of lower limb amputation due to impaired wound healing.Adipose-derived mesenchymal stem cells(ADSCs)have emerged as a prom...BACKGROUND Diabetic foot ulcers(DFUs)are a severe complication of diabetes and a leading cause of lower limb amputation due to impaired wound healing.Adipose-derived mesenchymal stem cells(ADSCs)have emerged as a promising therapeutic option for DFUs because of their angiogenic,immunomodulatory,and regenerative properties.However,studies on the molecular mechanisms and regulatory pathways of ADSCs in DFUs are limited.AIM To investigate the dose-response relationship,the optimal administration route,persistence,and molecular mechanisms of ADSCs in DFU healing.METHODS In this study,human ADSCs were isolated and cultured,and their differentiation potential was characterized.A DFU mouse model was established to evaluate the dose-dependent effects and persistence of ADSCs administered subcutaneously or intramuscularly.Wound closure rate,angiogenesis,inflammation,and collagen deposition were assessed in the ADSC-treated and model groups.Additionally,in vitro experiments using human dermal fibroblasts and endothelial cells were conducted to elucidate the molecular mechanisms underlying ADSC-mediated wound healing.RESULTS ADSC treatment significantly enhanced wound closure,promoted angiogenesis,modulated inflammatory responses,and accelerated tissue regeneration in the DFU model.Notably,the therapeutic efficacy and retention of ADSCs were influenced by both dosage and administration route,with subcutaneous injection of 5×105 ADSCs yielding the most favorable outcomes,particularly when injected into the feet,which resulted in prolonged retention.In vitro experiments further revealed that ADSCs exert their therapeutic effects via multiple mechanisms,including phosphatidylinositol 3-kinase signaling pathway activation to enhance vascular endothelial growth factor secretion,thereby promoting angiogenesis and modulating the Notch signaling pathway in DFUs to suppress inflammation and facilitate tissue regeneration.CONCLUSION ADSCs effectively promote DFU healing and have clinical potential as a treatment for chronic non-healing diabetic wounds.These findings provide a foundation for optimizing ADSC-based therapies for treating DFUs.展开更多
BACKGROUND Chronic nonhealing wounds,such as diabetic foot ulcer(DFU),suffer from delayed healing.Identifying effective biomarkers or targets is crucial for managing these refractory wounds.While N7-methylguanosine(m7...BACKGROUND Chronic nonhealing wounds,such as diabetic foot ulcer(DFU),suffer from delayed healing.Identifying effective biomarkers or targets is crucial for managing these refractory wounds.While N7-methylguanosine(m7G)methylation is important in RNA modification,its connection to chronic nonhealing wounds is poorly understood.AIM To assess the potential m7G biomarkers in DFU and their underlying molecular mechanisms.METHODS Differential expression analysis and weighted gene coexpression network analysis identified key genes in DFU.Hub genes were determined through m7G-DFU intersection,and gene set enrichment analysis was conducted.Diagnostic potential of hub genes was assessed using receiver operating characteristic curves.The hub gene’s expression(decapping scavenger enzyme,DCPS)was confirmed using quantitative reverse transcription polymerase chain reaction and immunofluorescence.In vitro,normal human epidermal keratinocyte models were knocked down for DCPS,and the function was assessed through flow cytometry,western blotting,immunofluorescence,Transwell assays,and scratch assays.RESULTS Weighted gene coexpression network analysis and differential expression analysis revealed links between DFU datasets and methylation processes,identifying hub gene DCPS as a candidate biomarker.Notably,its diagnostic value was confirmed with a test set and receiver operating characteristic curve,achieving an area under the curve of 0.98 and 0.99.Quantitative reverse transcription polymerase chain reaction and immunofluorescence analyses showed significantly reduced expression of DCPS in the wound skin of DFU patients and streptozotocin-induced diabetic mice,indicating its role as a regulatory factor of m7G in diabetic wounds.Mechanistically,in vitro studies showed that DCPS knockdown significantly reduced cyclin-dependent kinase 6 and cyclin D1 expression,disrupted the epithelial cell cycle,inhibited cell proliferation and migration,and increased apoptosis rates.CONCLUSION DCPS was identified as a promising DFU biomarker and therapeutic target,regulating m7G to affect cell cycle,proliferation,and epithelial cell migration during DFU wound healing.展开更多
BACKGROUND Diabetic foot ulcer(DFU)is a serious and destructive complication of diabetes,which has a high amputation rate and carries a huge social burden.Early detection of risk factors and intervention are essential...BACKGROUND Diabetic foot ulcer(DFU)is a serious and destructive complication of diabetes,which has a high amputation rate and carries a huge social burden.Early detection of risk factors and intervention are essential to reduce amputation rates.With the development of artificial intelligence technology,efficient interpretable predictive models can be generated in clinical practice to improve DFU care.AIM To develop and validate an interpretable model for predicting amputation risk in DFU patients.METHODS This retrospective study collected basic data from 599 patients with DFU in Beijing Shijitan Hospital between January 2015 and June 2024.The data set was randomly divided into a training set and test set with fivefold cross-validation.Three binary variable models were built with the eXtreme Gradient Boosting(XGBoost)algorithm to input risk factors that predict amputation probability.The model performance was optimized by adjusting the super parameters.The pre-dictive performance of the three models was expressed by sensitivity,specificity,positive predictive value,negative predictive value and area under the curve(AUC).Visualization of the prediction results was realized through SHapley Additive exPlanation(SHAP).RESULTS A total of 157(26.2%)patients underwent minor amputation during hospitalization and 50(8.3%)had major amputation.All three XGBoost models demonstrated good discriminative ability,with AUC values>0.7.The model for predicting major amputation achieved the highest performance[AUC=0.977,95%confidence interval(CI):0.956-0.998],followed by the minor amputation model(AUC=0.800,95%CI:0.762-0.838)and the non-amputation model(AUC=0.772,95%CI:0.730-0.814).Feature importance ranking of the three models revealed the risk factors for minor and major amputation.Wagner grade 4/5,osteomyelitis,and high C-reactive protein were all considered important predictive variables.CONCLUSION XGBoost effectively predicts diabetic foot amputation risk and provides interpretable insights to support person-alized treatment decisions.展开更多
Microneedle(MN)patches could be a promising treatment for diabetic foot ulcers that plague thousands of people worldwide.While reducing skin resistance or increasing driving force can accelerate the efficiency of tran...Microneedle(MN)patches could be a promising treatment for diabetic foot ulcers that plague thousands of people worldwide.While reducing skin resistance or increasing driving force can accelerate the efficiency of transdermal drug delivery with conventional MN patches,it can create toxic chemical residues or require the help of additional devices.Herein,a thermo-responsive microneedles patch(TMN)with high biocompatibility without additional equipment is proposed.The TMN consisted of a bilayer microneedles composed of sodium alginate(SA)-g-poly(N-isopropylacrylamide)layer(SA-g-PNIPAM)loaded with sucrose octasulfate sodium salt(SOS)and hyaluronic acid layer and a polycaprolactone/chitosan nanofiber membrane loading with tetracycline hydrochloride(TH)and SOS.PNIPAM accelerates drug release by extruding the drug through a volumetric phase transition in response to temperature changes,and TH and SOS promote wound healing by inhibiting bacterial growth and promoting vascular regeneration and epithelial formation.The results showed that the drug release of TMN was significantly faster,with the drug release rate of more than 80% in the 10th h,and the antibacterial rate of TMN could reach 800%.In addition,TMN had good biocompatibility and good healing effects in vivo,which may be helpful for the design of multifunctional dressings in the future.展开更多
BACKGROUND Negative pressure wound therapy(NPWT)is a potential treatment for diabetic foot ulcers(DFUs),although the mechanisms underlying its effectiveness remain unclear.This study posits that NPWT may improve wound...BACKGROUND Negative pressure wound therapy(NPWT)is a potential treatment for diabetic foot ulcers(DFUs),although the mechanisms underlying its effectiveness remain unclear.This study posits that NPWT may improve wound healing by promoting angiogenesis and activating the nuclear factor erythroid 2-related factor 2(Nrf2)/Kelch-like epichlorohydrin-associated protein 1(Keap1)signaling pathway,which is crucial for the body’s defense against oxidative stress.The hypothesis indicates that enhancing antioxidant defenses through NPWT may positively affect the healing process.There are still limited data on the roles of Nrf2,its downstream signaling molecules,and angiogenesis markers in patients undergoing NPWT.AIM To study the mechanism of NPWT in DFUs.METHODS This study included a total of 40 hospitalized patients with DFUs from Xuzhou Central Hospital,who were divided into Control group(n=21)and NPWT group(n=19).The levels of Nrf2 and Keap1 were analyzed in the granulation tissue 7 days after treatment.The wound condition,erythrocyte sedimentation rate(ESR),procalcitonin(PCT),interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),vascular endothelial growth factor(VEGF),basic fibroblast growth factor(b-FGF),cluster of differentiation 31(CD31),and levels of oxidative stress[malondialdehyde(MDA),superoxide dismutase(SOD),catalase(CAT),and total antioxidant capacity(T-AOC)]were analyzed before and 7 days after treatment by the Mann-Whitney U test.RESULTS The NPWT group demonstrated significant improvements in wound healing compared to the control group after 7 days of treatment.The levels of ESR,PCT,IL-6,and TNF-αwere significantly reduced in the NPWT group compared to the control group(P<0.05),while the levels of CD31,VEGF,and b-FGF showed significant increases(P<0.05).The NPWT group exhibited notable elevations in the levels of Nrf2 and its downstream targets(SOD,CAT,and T-AOC),accompanied by decreases in the levels of Keap1 and MDA(P<0.05).CONCLUSION NPWT may contribute to the healing of DFUs by potentially reducing levels of oxidative stress.Its effects could possibly be enhanced through the action of Nrf2.展开更多
Background: Confusion often arises in caring for diabetic foot infections and ulcers, especially with antimicrobials;we aim to shed light on this entity and alert healthcare workers to its stewardship. Methods: Record...Background: Confusion often arises in caring for diabetic foot infections and ulcers, especially with antimicrobials;we aim to shed light on this entity and alert healthcare workers to its stewardship. Methods: Records were reviewed between February 2016 and September 2023. Data for patients diagnosed with diabetes and foot ulcers, infected or not, were examined following ICD 9 search terms. Records for patients were included if they were prediabetic/diabetic adults with foot ulcers, more than 18 years old, and on antidiabetic treatment. Patients were excluded if they insulin resistant, with normal HgbA1c levels, wheel-chair dependent, bed-bound, non-diabetic patients, diabetic patients who had vascular lower limb surgery earlier to ulcers, diabetic patients who had aortocoronary bypass, deep venous thrombosis within six months, malignancy, and severe clinical depression. A modified IWGDF/IDSA guidelines definitions for DFI and DFU was considered. Statistical analysis was done using R programming. Statistical methods were employed as appropriate, and a significant P-value was considered for P Results: Most characteristics were well balanced between DFI and DFU, on imaging osteomyelitis and tissue swelling were significantly more in DFI. Endovascular radiological procedures showed angiograms to be considerably more in DFI, while angioplasty was more in DFU, in addition to smoking. Bacteremia was uncommon, and swab cultures were mostly polymicrobial in both ulcers;no clear association with blood bacteria was detected with the polymicrobial growth, though few were concordant. Antimicrobials prescribed for both ulcers were not statistically different except for carbapenems, which were more in DFI (P Conclusion: Attention should be paid to best practices while caring for diabetic ulcers. These include swab culture interpretations, the use of antimicrobials, and plan management according to DFI or DFU to utilize either local care or combination with antimicrobials.展开更多
In this editorial,we comment on an article by Liao et al published in the current issue of the World Journal of Diabetes.We focus on the clinical significance of tibial transverse transport(TTT)as an effective treatme...In this editorial,we comment on an article by Liao et al published in the current issue of the World Journal of Diabetes.We focus on the clinical significance of tibial transverse transport(TTT)as an effective treatment for patients with diabetic foot ulcers(DFU).TTT has been associated with tissue regeneration,improved blood circulation,reduced amputation rates,and increased expression of early angiogenic factors.Mechanistically,TTT can influence macrophage polarization and growth factor upregulation.Despite this potential,the limitations and conflicting results of existing studies justify the need for further research into its optimal application and development.These clinical implications highlight the efficacy of TTT in recalcitrant DFU and provide lasting stimuli for tissue re-generation,and blood vessel and bone marrow improvement.Immunomodu-lation via systemic responses contributes to its therapeutic potential.Future studies should investigate the underlying molecular mechanisms to enhance our understanding and the efficacy of TTT.This manuscript emphasizes the potential of TTT in limb preservation and diabetic wound healing and suggests avenues for preventive measures against limb amputation in diabetes and peripheral artery disease.Here,we highlight the clinical significance of the TTT and its importance in healing DFU to promote the use of this technique in tissue regeneration.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)are one of the most severe and popular complications of diabetes.The persistent non-healing of DFUs is the leading cause of amputation,which causes significant mental and financial...BACKGROUND Diabetic foot ulcers(DFUs)are one of the most severe and popular complications of diabetes.The persistent non-healing of DFUs is the leading cause of amputation,which causes significant mental and financial stress to patients and their families.Macrophages are critical cells in wound healing and perform essential roles in all phases of wound healing.However,no studies have been carried out to systematically illustrate this area from a scientometric point of view.Although there have been some bibliometric studies on diabetes,reports focusing on the investigation of macrophages in DFUs are lacking.AIM To perform a bibliometric analysis to systematically assess the current state of research on macrophage-related DFUs.METHODS The publications of macrophage-related DFUs from January 1,2004,to December 31,2023,were retrieved from the Web of Science Core Collection on January 9,2024.Four different analytical tools:VOSviewer(v1.6.19),CiteSpace(v6.2.R4),HistCite(v12.03.07),and Excel 2021 were used for the scientometric research.RESULTS A total of 330 articles on macrophage-related DFUs were retrieved.The most published countries,institutions,journals,and authors in this field were China,Shanghai Jiao Tong University of China,Wound Repair and Regeneration,and Aristidis Veves.Through the analysis of keyword co-occurrence networks,historical direct citation networks,thematic maps,and trend topics maps,we synthesized the prevailing research hotspots and emerging trends in this field.CONCLUSION Our bibliometric analysis provides a comprehensive overview of macrophage-related DFUs research and insights into promising upcoming research.展开更多
基金Supported by the King Salman Center for Disability Research,No.KSRG-2023-407.
文摘Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic management,DFUs,foot lesions,proper care for injuries,diet,and surgery.Certain reasonably priced treatments,such as hyperbaric oxygen and vacuum-assisted closure therapy,are also available for DFUs,along with modern wound care products and techniques.Nonetheless,DF care(cleaning,applying antimicrobial cream when wounded,and foot reflexology),blood glucose monitoring to control diabetes,and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs.Between 50%and 80%of DF infections are preventable.Regardless of the intensity of the lesion,it needs to be treated carefully and checked daily during infection.Tissue regeneration can be aided by cleaning,dressing,and application of topical medicines.The choice of shoes is also important because it affects blood circulation and nerve impulses.In general,regular check-ups,monitoring of the patient’s condition,measuring blood glucose levels,and providing frequent guidance regarding DFU care are crucial.Finally,this important clinical problem requires involvement of multiple professionals to properly manage it.
基金Hubei Province Top Medical Youth Talent Program,Wuhan Knowledge Innovation Special Basic Research Project,No.2023020201020558Clinical Research Project of Affiliated Hospital of Guangdong Medical University,No.LCYJ2021B004 and No.LCYJ2019B010Science and Technology Plan Project of Zhanjiang,No.2022A01191.
文摘BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.
基金Supported by the Zhejiang Medical Technology Project,No.2022RC009 and No.2024KY645.
文摘Diabetic foot ulcers(DFUs)represents a significant public health issue,with a rising global prevalence and severe potential complications including amputation.Traditional treatments often fall short due to various limitations such as high recurrence rates and extensive resource utilization.This editorial explores the innovative use of acellular fish skin grafts as a transformative approach in DFU management.Recent studies and a detailed case report highlight the efficacy of acellular fish skin grafts in accelerating wound closure,reducing dressing changes,and enhancing patient outcomes with a lower socio-economic burden.Despite their promise,challenges such as limited availability,patient acceptance,and the need for further research persist.Addressing these through more extensive randomized controlled trials and fostering a multidisciplinary treatment approach may optimize DFU care and reduce the global health burden associated with these complex wounds.
文摘BACKGROUND Pain often predisposes patients with diabetic foot ulcers(DFUs)to negative emotional states,such as anxiety and depression,which can significantly impair treatment outcomes and recovery.However,very few studies have explored the relationship between anxiety,depression,and pain in DFUs,as well as the associated risk factors.AIM To analyze the correlation between anxiety,depression,and pain in patients with DFUs and to identify the associated risk factors.METHODS This study included 106 patients diagnosed with DFUs who were admitted to Tiantai County People’s Hospital between March 2022 and March 2024.The patients’anxiety levels were evaluated using Zung’s self-rating anxiety scale(SAS),depression status was assessed using Zung’s self-rating depression scale(SDS),and pain intensity was assessed using the visual analog scale(VAS).Subsequently,correlations between SAS,SDS,and VAS scores were analyzed.Univariate and multivariate analyses were conducted to explore the risk factors that contributed to anxiety and depression in patients with DFUs.RESULTS Among the 106 patients,39.62%exhibited anxiety and 43.40%presented with depression.Most patients experiencing anxiety or depression exhibited mild symptoms,with no severe cases observed.Compared with asymptomatic patients,those with anxiety or depression had significantly higher VAS scores.Correlation analysis indicated a significant positive relationship between both SAS and SDS scores and the VAS score.Univariate analysis identified sex,age,Wagner’s grade,presence of other complications,and smoking history as factors significantly associated with anxiety and depression.Multivariate analysis further confirmed that younger age,higher Wagner’s grade,and higher VAS scores were independent predictors of anxiety and depression.CONCLUSION This study reveals a significant positive correlation between anxiety,depression,and pain in patients with DFUs.This finding suggests that timely and effective pain intervention may be beneficial in alleviating negative emotions such as anxiety and depression.In addition,younger age(<50 years),higher Wagner’s grade,and higher VAS scores increase the risk of developing anxiety and depression in this patient population.
基金Supported by General Program of Hainan Natural Science Foundation,No.824MS143.
文摘BACKGROUND Diabetic foot ulcers(DFUs)are a major complication of diabetes mellitus,and anemia is commonly observed in diabetic patients.However,the relationship between anemia and the risk of developing DFUs remains unclear.AIM To investigate the relationship between anemia and the risk of DFUs in diabetic patients through a meta-analysis.METHODS A systematic search was conducted across PubMed,Embase,and Web of Science databases to identify studies that reported the co-occurrence of anemia and DFUs in diabetic patients.The primary outcome was an association between anemia and DFU risk,expressed as odds ratios(ORs).Secondary outcomes included the risk of DFU per 1-g/dL decrease in hemoglobin and the difference in hemoglobin le-vels between patients with and without DFU.Statistical analyses were performed using random-effects models to account for heterogeneity.RESULTS Sixteen studies involving 170,949 diabetic patients were included in the analysis.The results indicated a significant association between anemia and an increased risk of DFUs(eight studies,n=166173,OR:2.72,95%CI:1.73–4.25,P<0.001;I2=93%).Subgroup analyses sup-ported consistent findings across various patient characteristics,analytic models,and study quality scores(P for subgroup differences,all>0.05).Additionally,each 1-g/dL decrease in hemoglobin was associated with an excess risk of DFUs(four studies,n=2543,OR:1.65,95%CI:1.21–2.27,P=0.002;I2=68%).Furthermore,diabetic patients with DFUs exhibited significantly lower hemoglobin levels compared to those without DFUs(nine studies,n=3986,mean difference:-2.13 g/dL,95%CI:-2.58 to-1.68,P<0.001;I2=90%).CONCLUSION Anemia can be associated with an increased risk of DFUs in diabetic patients.Monitoring and managing anemia in diabetic population may help mitigate the risk of DFUs,emphasizing the need for early interventions.Further research is required to investigate the underlying mechanisms and potential therapeutic strategies.
基金Supported by Natural Science Foundation of Henan Province,No.202300410396the Young Talents Promotion Project of Henan Province,No.2021HYTP043.
文摘BACKGROUND Diabetic foot ulcers(DFUs)represent a common and serious complication of diabetes,characterized by impaired wound healing and an increased risk of infection.These infections severely impact patient health,necessitating extensive medical intervention,and increasing the risk of amputation.Vitamin D(VD)plays a critical role in immune regulation and tissue repair.AIM To investigate the effects of VD supplementation on infection rates,wound healing,and immune function in patients with DFUs.METHODS A randomized controlled trial was conducted involving 120 patients with DFUs.Participants were randomly assigned to either a control group(n=60),which received standard care without VD supplementation,or an intervention group(n=60),which received 2000 IU of oral VD3(cholecalciferol)daily for 12 weeks.The primary outcomes included the incidence and severity of infections,whereas the secondary outcomes included wound healing rate,serum 25-hydroxyvitamin D level,levels of immune markers(cathelicidin,interleukin-6 and tumor necrosis factor-α),and adverse events,such as hypercalcemia.RESULTS The incidence of infection was significantly lower in the VD supplementation group(25%)compared with the control group(45%)(P=0.01).Severe infections requiring systemic antibiotics or hospitalization were also less frequent in the VD supplementation group.Wound healing was notably enhanced in the VD supplementation group,with a 60%reduction in ulcer size compared with a 35%reduction in the control group(P<0.01).Serum 25(OH)D level significantly increased in the VD supplementation group(from 16.5 ng/mL to 35.2 ng/mL),confirming the efficacy of VD supplementation.Immune function improved,as demonstrated by a 30%rise in cathelicidin level and a 20%decline in levels of pro-inflammatory cytokines.No adverse effects,including hypercalcemia,were reported.CONCLUSION The VD supplementation effectively reduced infection rate,promoted wound healing,and strengthened immune responses in patients with DFUs.These findings support the incorporation of VD as a safe and effective adjunctive therapy in the clinical management of DFUs.
基金Supported by General Project of Xuzhou Science and Technology Bureau,No.KC22070.
文摘BACKGROUND Diabetic foot ulcers(DFU)are estimated to affect about 18.6 million people worldwide annually.The pathogenesis of DFU is complex,and the available drugs are not effective.Dl-3-n-butylphthalide(NBP)is a synthetic mixture of racemates used in China for the treatment of ischemic stroke.It was initially isolated from the seeds of Apium graveolens Linn,with studies showing its potential role in treating diabetes and its complications.AIM To predict and validate the mechanism by which NBP treats DFU.METHODS Network pharmacological analysis was performed to identify pharmacological targets and signaling pathways mediating the treatment effect of NBP on DFU.In vivo and in vitro experiments were conducted to validate the therapeutic effects and mechanisms of NBP on DFU.RESULTS Network pharmacology analysis identified 26 pharmacological targets of NBP and predicted that NBP could treat DFU partially by modulating apoptosis and vascular signaling pathways.Results from animal experiments showed that NBP significantly improved DFU by increasing neovascularization and fibroblast proliferation.In vitro tests demonstrated that NBP treatment promoted the migration and proliferation of human umbilical vein endothelial cells and human dermal fibroblasts,while inhibiting the apoptosis of human umbilical vein endothelial cells,human dermal fibroblasts,and human keratinocytes cells.CONCLUSION This study found that NBP could treat DFU by decreasing the rate of apoptosis and increasing angiogenesis via the advanced glycation end products-receptor of advanced glycation end products signaling pathway and binding to the heme oxygenase 1,caspase 3,B cell leukemia/lymphoma 2,brain derived neurotrophic factor,and nuclear factor erythroid 2 L2 genes.
基金Supported by the National Natural Science Foundation of China,No.82202454 and No.81873934the Wang Zhengguo Trauma Medicine Fund(Growth Factor Revival Plan)No.SZYZ-TR-09+1 种基金the Shandong Provincial Natural Science Foundation Youth Fund,No.ZR2020QH168the Jinan Science and Technology Plan Project,No.202225065。
文摘BACKGROUND Diabetic foot ulcers(DFUs)are a significant challenge in diabetic care,and the efficacy of negative pressure wound therapy(NPWT)in treating them remains a subject of continuous investigation.AIM To provide a comprehensive meta-analysis of the role of NPWT in the manage-ment of DFUs.METHODS A systematic review was performed based on Preferred Reporting Items for Sys-tematic Reviews and Meta-Analyses guidelines,searching databases like PubMed,Embase,Web of Science,and the Cochrane Library.Randomized clinical trials(RCTs)were included to compare NPWT to other dressings for DFUs.Outcomes measured were wound healing time and rate,granulation tissue formation time,amputation rate,and adverse events.Study quality was evaluated using Coch-rane's risk of bias tool.Analyses utilizedχ2,I2,fixed or random-effects models via Stata v17.RESULTS Of the 1101 identified articles,9 RCTs were selected for meta-analysis.Studies spanned from 2005 to 2020 and originated from countries including the United States,Chile,Pakistan,Italy,India,and Germany.Meta-analysis demonstrated a significant improvement in wound healing rate[risk ratio(RR)=1.46,95%CI:1.22-1.76,P<0.01]and a reduction in amputation rate(RR=0.69,95%CI:0.50-0.96,P=0.006)with NPWT.Furthermore,the time for granulation tissue formation was significantly reduced by an average of 19.54 days.However,the incidence of adverse events did not significantly differ between NPWT and control treatments.CONCLUSION NPWT significantly improves wound healing rates and reduces amputation rates in DFUs.It also hastens the formation of granulation tissue.However,the therapy does not significantly alter the risk of adverse events compared to alternate treatments.
文摘BACKGROUND Aloe vera has been used as a traditional herbal therapy for wound management and dermatological conditions worldwide for thousands of years.Scientific evidence has confirmed that acemannan,the bioactive compound in aloe vera gel,exhibits significant anti-inflammatory and immunomodulatory properties that enhance tissue regeneration.This case report describes the successful application of an innovative acemannan-enriched glycolipid sphere dressing derived from aloe vera gel in diabetic foot ulcer(DFU)treatment,which achieved a clinically remarkable outcome.CASE SUMMARY An 80-year-old female patient with a 20-year history of type 2 diabetes mellitus experienced recurrent diabetic foot pain for 15 years.She had multiple hospitalizations due to acute infections and poorly controlled hyperglycemia.Long-term treatments included metformin and gliclazide.Upon presentation,she had a nonhealing wound on her left dorsal foot,diagnosed as a severe DFU(Texas classification:Grade II,stage D).She declined amputation and opted for conservative treatment.The medical team applied an acemannan-enriched glycolipid sphere dressing five times daily to the left calf and foot,avoiding the wound area.Frequency was reduced to three times daily after scab formation.Weight-bearing on the injured foot was avoided.Through in-person and online consultations,the team managed her lifestyle and diet,emphasizing natural foods.After 5 months,the DFU healed without significant scarring or functional loss.No recurrence was observed during the 2-year follow-up.Acemannan-enriched glycolipid sphere dressings promote DFU healing.This suggests the potential of these dressings for treating other refractory wounds.
基金Supported by the National Natural Science Foundation of China,No.82274528.
文摘BACKGROUND Shifting from the inflammatory to the proliferative phase represents a pivotal step during managing diabetic foot ulcers(DFUs);however,existing medical interventions remain insufficient.MicroRNAs(miRs)highlight notable capacity for accelerating the repair process of DFUs.Previous research has demonstrated which miR-122-5p regulates matrix metalloproteinases under diabetic conditions,thereby influencing extracellular matrix dynamics.AIM To investigate the impact of miR-122-5p on the transition from the inflammatory to the proliferative stage in DFU.METHODS Analysis for miR-122-5p expression in skin tissues from diabetic ulcer patients and mice was analyzed using quantitative real-time polymerase chain reaction(qRT-PCR).A diabetic wound healing model induced by streptozotocin was used,with mice receiving intradermal injections of adeno-associated virus-DJ encoding empty vector or miR-122.Skin tissues were retrieved at 3,7,and 14 days after injury for gene expression analysis,histology,immunohistochemistry,and network studies.The study explored miR-122-5p’s role in macrophage-fibroblast interactions and its effect on transitioning from inflammation to proliferation in DFU healing.RESULTS High-throughput sequencing revealed miR-122-5p as crucial for DFU healing.qRT-PCR showed significant upregulation of miR-122-5p within diabetic skin among DFU individuals and mice.Western blot,along with immunohistochemical and enzyme-linked immunosorbent assay,demonstrating the upregulation of inflammatory mediators(hypoxia inducible factor-1α,matrix metalloproteinase 9,tumor necrosis factor-α)and reduced fibrosis markers(fibronectin 1,α-smooth muscle actin)by targeting vascular endothelial growth factor.Fluorescence in situ hybridization indicated its expression localized to epidermal keratinocytes and fibroblasts in diabetic mice.Immunofluorescence revealed enhanced increased presence of M1 macrophages and reduced M2 polarization,highlighting its role in inflammation.MiR-122-5p elevated inflammatory cytokine levels while suppressing fibrotic activity from fibroblasts exposed to macrophage-derived media,highlighting its pivotal role in regulating DFU healing.CONCLUSION MiR-122-5p impedes cutaneous healing of diabetic mice via enhancing inflammation and inhibiting fibrosis,offering insights into miR roles in human skin wound repair.
文摘BACKGROUND Diabetic foot ulcers(DFUs)in patients with type 2 diabetes(T2D)are associated with heightened risks of infection and amputation and thus require effective surgical interventions to enhance outcomes.Free anterolateral thigh(ALT)perforator flap is a promising reconstructive method;however,diabetic vasculopathy challenges optimal perfusion.This study analyzes factors influencing intraoperative blood perfusion in ALT flap repair for DFUs.AIM To identify key factors affecting intraoperative blood perfusion during free ALT perforator flap repair in patients with T2D and DFUs,thereby providing insights to improve surgical outcomes.METHODS This retrospective case-control study included 100 patients with T2D who underwent ALT flap repair at our institution between June 2016 and June 2024.Patients were categorized into normal(n=50)and abnormal(n=50)blood perfusion groups based on intraoperative perfusion assessments.Data on demographics,clinical characteristics,vascular status,metabolic control,and preoperative laboratory parameters were collected.Statistical analyses,including univariate and multivariate logistic regression,were conducted to identify significant predictive factors for perfusion outcomes.RESULTS Old age,high body mass index,long diabetes duration,and presence of diabetic peripheral neuropathy were associated with impaired perfusion.Abnormal perfusion was correlated with poor ankle-brachial index and elevated glycated hemoglobin(HbA1c),creatinine,triglycerides,and partial pressure of carbon dioxide.Conversely,high hemoglobin,albumin,and prealbumin levels and partial pressure of oxygen(PaO_(2))were protective.Multivariate analysis identified diabetes duration,HbA1c,PaCO_(2),PaO_(2),and albumin as independent predictors of perfusion,underscoring the roles of metabolic control and vascular health.CONCLUSION Optimizing metabolic control,vascular health,and nutritional status was crucial to enhance intraoperative blood perfusion in diabetic patients undergoing ALT perforator flap repair for DFUs.
基金Supported by the Zhejiang Provincial Science and Technology Plan for Traditional Chinese Medicine,No.2025ZL594Municipal-Level Science and Technology Plan Project of Zhejiang Province,No.2023ZD039.
文摘BACKGROUND Diabetic foot ulcers(DFUs)present a significant healthcare challenge attributable to their high rates of disability and the limitations of applied traditional nursing approaches.Effective management is critical for uneventful health outcomes.AIM To investigate the effects of multidisciplinary team(MDT)nursing interventions and blood glucose control on the negative emotions and satisfaction of DFUhealing patients.METHODS This retrospective cohort study included 115 patients with DFUs,divided into MDT and blood glucose control intervention group(n=60)and standard care control group(n=55).The comparison factors were wound area,new granulation tissue coverage area,wound healing rate,2-hour postprandial blood glucose level,fasting plasma glucose level,Hamilton Anxiety Scale score,Hamilton Depression Scale score,and nursing satisfaction.RESULTS After 4 weeks,the average wound area reduced from 22.04±6.48 cm^(2)to 11.96±3.63 cm^(2)(P<0.05).New granulation tissue coverage area reached 52.85±18.39 cm^(2) for the intervention group and 28.39±9.94 cm^(2)(P<0.05)in the control group,respectively.The healing rate was significantly higher in the intervention group than in the control group(91.7%vs 76.4%,P<0.05).Fasting plasma glucose decreased more sharply in the intervention group(from 8.36±0.98 mmol/L to 6.91±1.23 mmol/L)than in the control group(8.41±1.05 mmol/L to 7.81±1.27 mmol/L),with the intervention group maintaining significantly lower levels(P<0.05).The intervention group demonstrated a significantly greater reduction in 2-hour postprandial blood glucose levels(11.35±2.67 mmol/L to 7.52±1.38 mmol/L)compared to the control group(11.61±3.01 mmol/L to 8.72±1.63 mmol/L;P<0.05).Hamilton Anxiety Scale and Hamilton Depression Scale scores were significantly lower in the intervention group(P<0.05).Patient satisfaction with nursing was 93.33%and 74.55%in the intervention and control groups,respectively(P<0.05).CONCLUSION MDT combined with blood glucose control enhanced healing rates and positively influenced emotional well-being and satisfaction among patients.This strategy holds potential for application in clinical practice.
基金Supported by The Zhongguancun National Independent Innovation Demonstration Zone Industrial Ecosystem Cultivation Project,No.20220468089.
文摘BACKGROUND Diabetic foot ulcers(DFUs)are a severe complication of diabetes and a leading cause of lower limb amputation due to impaired wound healing.Adipose-derived mesenchymal stem cells(ADSCs)have emerged as a promising therapeutic option for DFUs because of their angiogenic,immunomodulatory,and regenerative properties.However,studies on the molecular mechanisms and regulatory pathways of ADSCs in DFUs are limited.AIM To investigate the dose-response relationship,the optimal administration route,persistence,and molecular mechanisms of ADSCs in DFU healing.METHODS In this study,human ADSCs were isolated and cultured,and their differentiation potential was characterized.A DFU mouse model was established to evaluate the dose-dependent effects and persistence of ADSCs administered subcutaneously or intramuscularly.Wound closure rate,angiogenesis,inflammation,and collagen deposition were assessed in the ADSC-treated and model groups.Additionally,in vitro experiments using human dermal fibroblasts and endothelial cells were conducted to elucidate the molecular mechanisms underlying ADSC-mediated wound healing.RESULTS ADSC treatment significantly enhanced wound closure,promoted angiogenesis,modulated inflammatory responses,and accelerated tissue regeneration in the DFU model.Notably,the therapeutic efficacy and retention of ADSCs were influenced by both dosage and administration route,with subcutaneous injection of 5×105 ADSCs yielding the most favorable outcomes,particularly when injected into the feet,which resulted in prolonged retention.In vitro experiments further revealed that ADSCs exert their therapeutic effects via multiple mechanisms,including phosphatidylinositol 3-kinase signaling pathway activation to enhance vascular endothelial growth factor secretion,thereby promoting angiogenesis and modulating the Notch signaling pathway in DFUs to suppress inflammation and facilitate tissue regeneration.CONCLUSION ADSCs effectively promote DFU healing and have clinical potential as a treatment for chronic non-healing diabetic wounds.These findings provide a foundation for optimizing ADSC-based therapies for treating DFUs.
基金Supported by National Natural Science Foundation of China,No.82370903Noncommunicable Chronic Diseases-National Science and Technology Major Project,No.2023ZD0509400 and No.2023ZD0509402+1 种基金2023 Key Disciplines on Public Health Construction of Chongqing,the Natural Science Foundation of Chongqing Municipal Science and Technology Bureau,No.cstc2024ycjh-bgzxm0014Major Project of Science and Technology Research Program of Chongqing Education Commission of China,No.KJZD-M202400102.
文摘BACKGROUND Chronic nonhealing wounds,such as diabetic foot ulcer(DFU),suffer from delayed healing.Identifying effective biomarkers or targets is crucial for managing these refractory wounds.While N7-methylguanosine(m7G)methylation is important in RNA modification,its connection to chronic nonhealing wounds is poorly understood.AIM To assess the potential m7G biomarkers in DFU and their underlying molecular mechanisms.METHODS Differential expression analysis and weighted gene coexpression network analysis identified key genes in DFU.Hub genes were determined through m7G-DFU intersection,and gene set enrichment analysis was conducted.Diagnostic potential of hub genes was assessed using receiver operating characteristic curves.The hub gene’s expression(decapping scavenger enzyme,DCPS)was confirmed using quantitative reverse transcription polymerase chain reaction and immunofluorescence.In vitro,normal human epidermal keratinocyte models were knocked down for DCPS,and the function was assessed through flow cytometry,western blotting,immunofluorescence,Transwell assays,and scratch assays.RESULTS Weighted gene coexpression network analysis and differential expression analysis revealed links between DFU datasets and methylation processes,identifying hub gene DCPS as a candidate biomarker.Notably,its diagnostic value was confirmed with a test set and receiver operating characteristic curve,achieving an area under the curve of 0.98 and 0.99.Quantitative reverse transcription polymerase chain reaction and immunofluorescence analyses showed significantly reduced expression of DCPS in the wound skin of DFU patients and streptozotocin-induced diabetic mice,indicating its role as a regulatory factor of m7G in diabetic wounds.Mechanistically,in vitro studies showed that DCPS knockdown significantly reduced cyclin-dependent kinase 6 and cyclin D1 expression,disrupted the epithelial cell cycle,inhibited cell proliferation and migration,and increased apoptosis rates.CONCLUSION DCPS was identified as a promising DFU biomarker and therapeutic target,regulating m7G to affect cell cycle,proliferation,and epithelial cell migration during DFU wound healing.
文摘BACKGROUND Diabetic foot ulcer(DFU)is a serious and destructive complication of diabetes,which has a high amputation rate and carries a huge social burden.Early detection of risk factors and intervention are essential to reduce amputation rates.With the development of artificial intelligence technology,efficient interpretable predictive models can be generated in clinical practice to improve DFU care.AIM To develop and validate an interpretable model for predicting amputation risk in DFU patients.METHODS This retrospective study collected basic data from 599 patients with DFU in Beijing Shijitan Hospital between January 2015 and June 2024.The data set was randomly divided into a training set and test set with fivefold cross-validation.Three binary variable models were built with the eXtreme Gradient Boosting(XGBoost)algorithm to input risk factors that predict amputation probability.The model performance was optimized by adjusting the super parameters.The pre-dictive performance of the three models was expressed by sensitivity,specificity,positive predictive value,negative predictive value and area under the curve(AUC).Visualization of the prediction results was realized through SHapley Additive exPlanation(SHAP).RESULTS A total of 157(26.2%)patients underwent minor amputation during hospitalization and 50(8.3%)had major amputation.All three XGBoost models demonstrated good discriminative ability,with AUC values>0.7.The model for predicting major amputation achieved the highest performance[AUC=0.977,95%confidence interval(CI):0.956-0.998],followed by the minor amputation model(AUC=0.800,95%CI:0.762-0.838)and the non-amputation model(AUC=0.772,95%CI:0.730-0.814).Feature importance ranking of the three models revealed the risk factors for minor and major amputation.Wagner grade 4/5,osteomyelitis,and high C-reactive protein were all considered important predictive variables.CONCLUSION XGBoost effectively predicts diabetic foot amputation risk and provides interpretable insights to support person-alized treatment decisions.
基金supported by the Joint Funds of National Natural Science Foundation of China(No.U22A20162)the Natural Science Foundation of Hebei Province of China(No.C2021202002)+1 种基金the National Natural Science Foundation of China(No.52271245),the Natural Science Foundation of Tianjin(No.21JCQNJC01280)the financial support from the Danish Council for Independent Research(9040-00219B),European Union’s Horizon 2020 research and innovation program under the Marie Skłodowska-Curie grant agreement ENSIGN(Project ID:101086226),L4DNANO(Project ID:101086227).
文摘Microneedle(MN)patches could be a promising treatment for diabetic foot ulcers that plague thousands of people worldwide.While reducing skin resistance or increasing driving force can accelerate the efficiency of transdermal drug delivery with conventional MN patches,it can create toxic chemical residues or require the help of additional devices.Herein,a thermo-responsive microneedles patch(TMN)with high biocompatibility without additional equipment is proposed.The TMN consisted of a bilayer microneedles composed of sodium alginate(SA)-g-poly(N-isopropylacrylamide)layer(SA-g-PNIPAM)loaded with sucrose octasulfate sodium salt(SOS)and hyaluronic acid layer and a polycaprolactone/chitosan nanofiber membrane loading with tetracycline hydrochloride(TH)and SOS.PNIPAM accelerates drug release by extruding the drug through a volumetric phase transition in response to temperature changes,and TH and SOS promote wound healing by inhibiting bacterial growth and promoting vascular regeneration and epithelial formation.The results showed that the drug release of TMN was significantly faster,with the drug release rate of more than 80% in the 10th h,and the antibacterial rate of TMN could reach 800%.In addition,TMN had good biocompatibility and good healing effects in vivo,which may be helpful for the design of multifunctional dressings in the future.
文摘BACKGROUND Negative pressure wound therapy(NPWT)is a potential treatment for diabetic foot ulcers(DFUs),although the mechanisms underlying its effectiveness remain unclear.This study posits that NPWT may improve wound healing by promoting angiogenesis and activating the nuclear factor erythroid 2-related factor 2(Nrf2)/Kelch-like epichlorohydrin-associated protein 1(Keap1)signaling pathway,which is crucial for the body’s defense against oxidative stress.The hypothesis indicates that enhancing antioxidant defenses through NPWT may positively affect the healing process.There are still limited data on the roles of Nrf2,its downstream signaling molecules,and angiogenesis markers in patients undergoing NPWT.AIM To study the mechanism of NPWT in DFUs.METHODS This study included a total of 40 hospitalized patients with DFUs from Xuzhou Central Hospital,who were divided into Control group(n=21)and NPWT group(n=19).The levels of Nrf2 and Keap1 were analyzed in the granulation tissue 7 days after treatment.The wound condition,erythrocyte sedimentation rate(ESR),procalcitonin(PCT),interleukin 6(IL-6),tumor necrosis factor alpha(TNF-α),vascular endothelial growth factor(VEGF),basic fibroblast growth factor(b-FGF),cluster of differentiation 31(CD31),and levels of oxidative stress[malondialdehyde(MDA),superoxide dismutase(SOD),catalase(CAT),and total antioxidant capacity(T-AOC)]were analyzed before and 7 days after treatment by the Mann-Whitney U test.RESULTS The NPWT group demonstrated significant improvements in wound healing compared to the control group after 7 days of treatment.The levels of ESR,PCT,IL-6,and TNF-αwere significantly reduced in the NPWT group compared to the control group(P<0.05),while the levels of CD31,VEGF,and b-FGF showed significant increases(P<0.05).The NPWT group exhibited notable elevations in the levels of Nrf2 and its downstream targets(SOD,CAT,and T-AOC),accompanied by decreases in the levels of Keap1 and MDA(P<0.05).CONCLUSION NPWT may contribute to the healing of DFUs by potentially reducing levels of oxidative stress.Its effects could possibly be enhanced through the action of Nrf2.
文摘Background: Confusion often arises in caring for diabetic foot infections and ulcers, especially with antimicrobials;we aim to shed light on this entity and alert healthcare workers to its stewardship. Methods: Records were reviewed between February 2016 and September 2023. Data for patients diagnosed with diabetes and foot ulcers, infected or not, were examined following ICD 9 search terms. Records for patients were included if they were prediabetic/diabetic adults with foot ulcers, more than 18 years old, and on antidiabetic treatment. Patients were excluded if they insulin resistant, with normal HgbA1c levels, wheel-chair dependent, bed-bound, non-diabetic patients, diabetic patients who had vascular lower limb surgery earlier to ulcers, diabetic patients who had aortocoronary bypass, deep venous thrombosis within six months, malignancy, and severe clinical depression. A modified IWGDF/IDSA guidelines definitions for DFI and DFU was considered. Statistical analysis was done using R programming. Statistical methods were employed as appropriate, and a significant P-value was considered for P Results: Most characteristics were well balanced between DFI and DFU, on imaging osteomyelitis and tissue swelling were significantly more in DFI. Endovascular radiological procedures showed angiograms to be considerably more in DFI, while angioplasty was more in DFU, in addition to smoking. Bacteremia was uncommon, and swab cultures were mostly polymicrobial in both ulcers;no clear association with blood bacteria was detected with the polymicrobial growth, though few were concordant. Antimicrobials prescribed for both ulcers were not statistically different except for carbapenems, which were more in DFI (P Conclusion: Attention should be paid to best practices while caring for diabetic ulcers. These include swab culture interpretations, the use of antimicrobials, and plan management according to DFI or DFU to utilize either local care or combination with antimicrobials.
基金Supported by Grants of the Korea Research Foundation,an NRF Grant Funded by the Korea Government,No.NRF-2023R1A2C3003717.
文摘In this editorial,we comment on an article by Liao et al published in the current issue of the World Journal of Diabetes.We focus on the clinical significance of tibial transverse transport(TTT)as an effective treatment for patients with diabetic foot ulcers(DFU).TTT has been associated with tissue regeneration,improved blood circulation,reduced amputation rates,and increased expression of early angiogenic factors.Mechanistically,TTT can influence macrophage polarization and growth factor upregulation.Despite this potential,the limitations and conflicting results of existing studies justify the need for further research into its optimal application and development.These clinical implications highlight the efficacy of TTT in recalcitrant DFU and provide lasting stimuli for tissue re-generation,and blood vessel and bone marrow improvement.Immunomodu-lation via systemic responses contributes to its therapeutic potential.Future studies should investigate the underlying molecular mechanisms to enhance our understanding and the efficacy of TTT.This manuscript emphasizes the potential of TTT in limb preservation and diabetic wound healing and suggests avenues for preventive measures against limb amputation in diabetes and peripheral artery disease.Here,we highlight the clinical significance of the TTT and its importance in healing DFU to promote the use of this technique in tissue regeneration.
基金Supported by the Science and Technology Planning Project of Guangzhou,No.2024A03J1132the Foundation of Guangdong Provincial Medical Science and Technology,No.B2024038.
文摘BACKGROUND Diabetic foot ulcers(DFUs)are one of the most severe and popular complications of diabetes.The persistent non-healing of DFUs is the leading cause of amputation,which causes significant mental and financial stress to patients and their families.Macrophages are critical cells in wound healing and perform essential roles in all phases of wound healing.However,no studies have been carried out to systematically illustrate this area from a scientometric point of view.Although there have been some bibliometric studies on diabetes,reports focusing on the investigation of macrophages in DFUs are lacking.AIM To perform a bibliometric analysis to systematically assess the current state of research on macrophage-related DFUs.METHODS The publications of macrophage-related DFUs from January 1,2004,to December 31,2023,were retrieved from the Web of Science Core Collection on January 9,2024.Four different analytical tools:VOSviewer(v1.6.19),CiteSpace(v6.2.R4),HistCite(v12.03.07),and Excel 2021 were used for the scientometric research.RESULTS A total of 330 articles on macrophage-related DFUs were retrieved.The most published countries,institutions,journals,and authors in this field were China,Shanghai Jiao Tong University of China,Wound Repair and Regeneration,and Aristidis Veves.Through the analysis of keyword co-occurrence networks,historical direct citation networks,thematic maps,and trend topics maps,we synthesized the prevailing research hotspots and emerging trends in this field.CONCLUSION Our bibliometric analysis provides a comprehensive overview of macrophage-related DFUs research and insights into promising upcoming research.
