Therapeutic Effectiveness of Leukocyte-and Platelet-rich Fibrin for Diabetic Foot Ulcers:A Retrospective Study

Objective Diabetic foot ulcer(DFU)is one of the most serious complications of diabetes.Leukocyte-and platelet-rich fibrin(L-PRF)is a second-generation autologous platelet-rich plasma.This study aims to investigate the clinical effects of L-PRF in patients with diabetes in real clinical practice.Methods Patients with DFU who received L-PRF treatment and standard of care(SOC)from 2018 to 2019 in Tongji Hospital were enrolled.The clinical information including patient characteristics,wound evaluation(area,severity,infection,blood supply),SOC of DFU,and images of ulcers was retrospectively extracted and analyzed.L-PRF treatment was performed every 7±2 days until the ulcer exhibited complete epithelialization or an overall percent volume reduction(PVR)greater than 80%.Therapeutic effectiveness,including overall PVR and the overall and weekly healing rates,was evaluated.Results Totally,26 patients with DFU were enrolled,and they had an ulcer duration of 47.0(35.0,72.3)days.The severity and infection of ulcers varied,as indicated by the Site,Ischemia,Neuropathy,Bacterial Infection,and Depth(SINBAD)scores of 2–6,Wagner grades of 1–4,and the Perfusion,Extent,Depth,Infection and Sensation(PEDIS)scores of 2–4.The initial ulcer volume before L-PRF treatment was 4.94(1.50,13.83)cm3,and the final ulcer volume was 0.35(0.03,1.76)cm3.The median number of L-PRF doses was 3(2,5).A total of 11 patients achieved complete epithelialization after the fifth week of treatment,and 19 patients achieved at least an 80%volume reduction after the seventh week.The overall wound-healing rate was 1.47(0.63,3.29)cm3/week,and the healing rate was faster in the first 2 weeks than in the remaining weeks.Concurrent treatment did not change the percentage of complete epithelialization or healing rate.Conclusion Adding L-PRF to SOC significantly improved wound healing in patients with DFU independent of the ankle brachial index,SINBAD score,or Wagner grade,indicating that this method is appropriate for DFU treatment under different clinical conditions.

Correlation between Surface Area Ratio of Medial to Lateral Tibial Plateau and Knee Alignment in Adults

Objective This study aimed to investigate the correlation between the surface area ratio of medial tibial plateau(MTP)to lateral tibial plateau(LTP)and the mechanical tibiofemoral angle(mTFA).Methods Lower limb computed tomography(CT)images were collected at our hospital.Then,the original CT data were analyzed and reconstructed using medical image processing software.The proximal and distal centres of the femur and tibia were marked.The surface areas of MTP and LTP were identified using image processing software.GraphPad Prism 8.0.2 was used to perform the statistical analysis.Results The surface area ratio of MTP to LTP was significantly correlated with the mTFA in all patients(P<0.0001),male group(P<0.0001),female group(P<0.0001),varus group(P<0.0001),and valgus group(P=0.002).Furthermore,the surface area of MTP and LTP was significantly greater in the male group than in the female group(P<0.0001).There was significant difference in the surface area of the MTP between the varus and valgus groups(P<0.0001).Significant difference was also observed in the surface area ratio of MTP to LTP between the varus and valgus groups(P<0.0001).Conclusion The surface area ratio of MTP to LTP was correlated with the mTFA.Within a certain range,the smaller the mTFA,the greater the surface area ratio of MTP to LTP.For patients undergoing total knee arthroplasty,of whom the surface area of the MTP was basically equal to that of the LTP,it is recommended that the osteotomy should be performed in accordance with mechanical alignment standards,and that a symmetrical tibial plateau prosthesis should be used.For patients whose surface area of MTP is significantly greater than that of the LTP,it is recommended that the osteotomy should be performed in accordance with kinematic alignment standards,and that an anatomical tibial plateau prosthesis should be used.

Autophagy in hepatic progenitor cells modulates exosomal miRNAs to inhibit liver fibrosis in schistosomiasis

Schistosoma infection is one of the major causes of liver fibrosis.Emerging roles of hepatic progenitor cells(HPCs)in the pathogenesis of liver fibrosis have been identified.Nevertheless,the precise mechanism underlying the role of HPCs in liver fibrosis in schistosomiasis remains unclear.This study examined how autophagy in HPCs affects schistosomiasis-induced liver fibrosis by modulating exosomal miRNAs.The activation of HPCs was verified by immunohistochemistry(IHC)and immunofluorescence(IF)staining in fibrotic liver from patients and mice with Schistosoma japonicum infection.By coculturing HPCs with hepatic stellate cells(HSCs)and assessing the autophagy level in HPCs by proteomic analysis and in vitro phenotypic assays,we found that impaired autophagy degradation in these activated HPCs was mediated by lysosomal dysfunction.Blocking autophagy by the autophagy inhibitor chloroquine(CQ)significantly diminished liver fibrosis and granuloma formation in S.japonicum-infected mice.HPC-secreted extracellular vehicles(EVs)were further isolated and studied by miRNA sequencing.miR-1306-3p,miR-493-3p,and miR-34a-5p were identified,and their distribution into EVs was inhibited due to impaired autophagy in HPCs,which contributed to suppressing HSC activation.In conclusion,we showed that the altered autophagy process upon HPC activation may prevent liver fibrosis by modulating exosomal miRNA release and inhibiting HSC activation in schistosomiasis.Targeting the autophagy degradation process may be a therapeutic strategy for liver fibrosis during Schistosoma infection.

Phase formation and crystallization of LiMn_(x)Fe_(1-x)PO_(4)-C olivine material with different Mn^(2+)contents fabricated at lower calcination temperatures

LiMn_(x)Fe_(1-x)PO_(4)-C cathode materials for lithium ion batteries were synthesized via solid-state method using Li_(2)CO_(3),MnCO_(3),NH_(4)H_(2)PO_(4),FePO_(4) and sucrose as starting raw materials,followed by high-temperature reduction-annealing.A series of calcination experiments at different temperatures reveal that Mn^(2+)-containing materials exhibit a lower temperature for olivine phase formation,for example LiMn_(0.5)Fe_(0.5)PO_(4) olivine phase forms at 275℃,while manganese-free crystalline LiFePO_(4) generally forms at the required temperature of 350℃.Increasing Mn^(2+) content is found to enhance crystallization degree of LiMn_(x)Fe_(1-x)PO_(4) material prepared at lower calcination temperatures.X-ray photoelectron spectroscopy(XPS)results confirm that Mn valence state(+2)remains unchanged up to~250℃ when calcined in ambient atmosphere.The above-mentioned beneficial effect of manganese on phase formation and crystallization of olivine can be well attributed to the stable nature of Mn^(2+)and its strong propensity to form olivine phases.