自体富血小板凝胶在糖尿病足溃疡的应用

对糖尿病足溃疡患者开展自体富血小板凝胶治疗,分析效果。方法 收集2023.1-2023.12来我院治疗的40例患者进行研究,分组方式:随机平衡,组别对照、实验组,每组20例,对照组:基础治疗,实验组在对照组患者治疗基础上 开展自体富血小板凝胶治疗,明确治疗效果;创口的愈合、患者生活质量、临床指标。结果 实验组患者治疗效果显佳,临床指标显优,创口愈合时间更短,生活质量显佳 (P < 0.05);结论 在针对于糖尿病足溃疡的治疗上,开展自体富血小板凝胶的治疗方式,在促进患者伤口愈合的效果上较佳,患者治疗的费用得到减少,提升其生活质量,值得提倡。

糖尿病足溃疡的临床诊断及治疗

糖尿病足溃疡是糖尿病重要的并发症,也是糖尿病患者致残、致死的重要原因之一,它严重威胁着糖尿病患者的生命质量和寿命,所以越来越引起医务工作者和患者的重视.

糖尿病足部溃疡的外科治疗

目的:探讨糖尿病足部溃疡的外科治疗方法。方法:对我院收治的53例糖尿病足部溃疡患者进行回顾性分析。结果:单纯换药8例(15.09%),清创后换药14例(26.42%),皮片移植5例(9.43%),皮瓣修复8例(15.09%),单纯截趾7例(13.21%),高位截肢11例(20.75%)。一期愈合率为90.57%。结论:糖尿病足部溃疡的外科治疗是挽救肢体的积极手段,配合药物可降低患者的截肢率,改善生活质量。

糖尿病足的预防与护理

目的：探讨糖尿病足的预防及护理。方法：从其发病原因及高危因素方面进行分析并制定出相应的预防及护理。结果：除正规、系统的治疗原发病外，加强糖尿病足的预防和护理，提高患者对疾病及相关知识的认识水平，掌握科学合理的足部保健方法，可使糖尿病足的发生率及截肢率明显下降。结论：因此提高对本病的认识和了解其发病原因和高危因素等，以便对具有糖尿病足危险性的患者进行指导，预防病变发生，并采取相应的措施。

自体骨髓血干细胞移植治疗术治疗糖尿病足2例护理体会

糖尿病患者由于合并神经病变及各种不同程度末梢血管病变而导致下肢感染、溃疡形成和深部组织的破坏,从而形成糖尿病足[1].导致糖尿病截肢的首位原因是足溃疡的不愈合及其并发症.2004年11月-2005年3月,我科收治2例糖尿病足患者,在控制血糖、营养神经、改善微循环及局部清创换药的基础上,通过自体骨髓血干细胞移植治疗术治疗糖尿病足,取得满意结果,现将其中的护理体会报道如下:

足部输液诱发糖尿病足1例

糖尿病足是病程长血糖控制不佳的糖尿病患者在外界因素的刺激下发生的足部病变，是糠尿病的严重并发症，其发生如控制不当，会给患者造成截肢等严重后果。缺血、神经病变感染是导致糖尿病发生的重要原因。但由输液诱发的少见，现报告1例。

真空负压封闭技术在糖尿病足治疗中的应用效果研究

目的研究探讨真空负压封闭技术在糖尿病足治疗中的应用效果，总结其临床治疗经验及临床应用价值。方法选取我院2009年5月-2011年5月糖尿病足的患者52例，随机分为观察组与对照组各26例，对照组采取橡皮务引流治疗，观察组采取真空负压封闭技术治疗，观察对比两组患者的治疗效果。结果观察组显效15例，有效8例，无效3例，总有效率为88．5％；对照组显效12例，有效6例，无效8例，总有效率为69．2％，两组治疗效果对比有显著性差异（p〈0．05），具有统计学意义。两组创面愈合时间、疼痛评分、换药次数、手术次数对比有显著性差异（P〈0．05），具有统计学意义。结论真空负压封闭技术在糖尿病足治疗中的应用效果显著，明显优于采取橡皮务引流治疗，具有重要的临床应用价值。

糖尿病足治疗与护理的进展(综述)

对糖尿病足患者在积极控制血糖、抗感染、改善下肢循环、营养支持及其他对症治疗的基础上,进行局部创面清创、换药,采用胰岛素加敏感抗生素进行湿敷,根据创面的面积、程度,决定局部换药次数,进行处理及卫生宣教。

尿激酶配合氢溴酸山莨菪碱股动脉溶栓对糖尿病足的疗效观察

目的观察股动脉溶栓治疗糖尿病足的临床疗效。方法将40例糖尿病足患者随机分为治疗组和对照组，每组20例，治疗组忠侧股动脉穿刺并滴注尿激酶（2．5×10＾5U）配合氢溴酸山莨菪碱（10mg）溶栓，对照组静脉滴注前列腺素E。注射液（10gg）。结果治疗组糖尿病足的有效率95％，对照组的有效率80％，两组比较差异有显著性（P〈0．05）。足背动脉多普勒检查显示，治疗组治疗后血流速度改善显著优于对照组（P〈0．05）。结论动脉内溶栓治疗糖尿病足具有操作简便、治疗时间短、址效快以及治疗费用低的特点，容易被老年患者接受，可以在老年病医院推广。

Linggui Zhugan Decoction Improves High Glucose-Induced Autophagy in Podocytes

Objective To explore the influence of Linggui Zhugan Decoction(LGZGD) on high glucose induced podocyte autophagy.Methods LGZGD containing serum was prepared by intragastric administation of 4.2 g/kg(low dose), 8.4 g/kg(medium dose), and 12.6 g/kg(high dose) LGZGD into SD rats respectively. MPC5 and AB8/13 podocyte cells were treated with 60 mmol/L glucose to establish diabetic nephropathy podocyte model in vitro. Both podocytes were divided into control group, high glucose group, low dose LGZGD group, medium dose LGZGD group, and high dose LGZGD group, respectively. For the three LGZGD groups, before LGZGD intervention, podocytes were treated with 60 mmol/L glucose for 3 days. After treated with LGZGD containing serum, cells were collected to analyze cell migration using Transwell assay, proliferation using CCK8, apoptosis and cell cycle using flow cytometry, autophagosome formation using transmission electron microscopy, and expression levels of Beclin-1, Atg5, LC3II/I, and P62 proteins using Western blot.Results Compared with the control group, the proliferation and migration of MPC5 and AB8/13 cells in the high glucose group slightly decreased, whereas these parameters restored after intervention with low and medium concentrations of LGZGD, with the medium dose LGZGD having the better effect(P < 0.05). Flow cytometry showed that the medium dose LGZGD group had a significantly lower apoptosis rate(P < 0.05) and higher survival rate(P > 0.05) compared to the high dose LGZGD group. High glucose arrested podocytes in G1 phase, whereas LGZGD shifted podocytes from being predominant in G1 phase to G2 phase. High dose LGZGD significanly reduced high glucose-increased autophagosome formation in both podocytes(P < 0.05). Western blot analysis showed that Beclin-1, Atg5, LC3II/I, and P62 expressions were increased in MPC5 cells treated with high glucose and reversed after adminstration of low and medium doses of LGZGD(P < 0.05).Conclusion LGZGD reduced apoptosis and enhanced autophagy in high glucose treated podocytes via regulating Beclin-1/LC3II/I/Atg5 expression.

Jinhuang powder for the treatment of diabetic foot ulcers:an updated metaanalysis with power analysis and trial sequential analysis

Background:Traditional Chinese Medicines(TCM)had been indicated to benefit for the chronic non-infectious diseases,such as cancers,hypertension,primary dysmenorrheal,etc.Although randomized controlled trials(RCTs)had been conducted,there was still the controversy on the efficacy of Jinhuang powder for diabetic foot ulcers(DFUs).Objective:This systematic review aimed to objectively evaluate the potential of Jinhuang powder for DFUs.Methods:Seven databases(CNKI,Chongqing VIP,Wanfang database,CBM,the Cochrane Library,PubMed and Web of Science)were searched to retrieve RCTs up to December,2016;and the relevant references of the eligible studies were screened.According to the eligible criteria,the literature was screened;data were extracted;and then the methodological quality was assessed.The meta-analysis,power analysis and trial sequential analysis(TSA)were performed by using Meta analyst software(version beta 3.13),Stata 12.0,Power and Precision statistical software package(Biostat)and TSA software(version0.9),respectively.Results:Finally,three RCTs with 198 participants were included.The results of meta-analysis showed that there were statistically significant differences between groups in(1)the cure rate(RR,1.25;95%CI.1.10to1.41;P=0.00)and(2)the wound healing time(SMD,-3.404;95%CI,-5.821 to -0.987;P=0.00).Three trials presented more than 80% power with 0.05α-errors in both outcomes and the power of two meta-analyses to pool different outcomes presented more than 95%.The TSA showed that the summary results were certain.Conclusion:The external application with Jinhuang powder was an effective and cost-effective therapy for DFUs.The power analysis and TSA showed that the efficacy of Jinhuang powder dressing for the treatment of DFUs is conclusive.

Nursing students’knowledge and attitude toward diabetic ulcer care and their contributing factors in Indonesia

Objective:The prevalence of diabetic foot ulcer in Indonesia is far greater than the global prevalence.Nursing students are expected to have good knowledge and positive attitudes regarding diabetic ulcer care in order to deliver high-quality wound care during clinical practice.This study aimed to assess nursing students’knowledge and attitudes toward diabetic ulcer care and to investigate the factors related to them.Methods:A cross-sectional study was conducted on 396 academic and clinical phases in three nursing schools in Indonesia from September 2021 to February 2022.Participants completed a survey including a questionnaire about knowledge and attitudes regarding diabetic ulcer care.The data were analyzed using a Chi-square test and multivariate logistic regression analysis.Results:The results show that 43.2%(171/396)of nursing students had inadequate knowledge of diabetic ulcer care.However,88.9%(352/396)had a favorable attitude toward the topic.Nursing students lacked knowledge about the characteristics of diabetic ulcers,diabetic neuropathy,wound infection,and adjunctive therapy for diabetic ulcers,and many of them believe that diabetic ulcer care is too timeconsuming to carry out.Students in the clinical phase of their studies had significantly better knowledge than those in the academic phase(aOR=9.99,95%CI 4.96e20.08,P<0.001).Male nursing students were significantly less likely to have positive attitude toward the topic than female students(aOR=0.42,95%CI 0.19e0.96,P=0.048),and students accustomed to sharing with peers as a source of knowledge had better attitudes than those who were not(aOR=2.76,95%CI 1.40e5.41,P=0.003).Conclusion:Findings show that almost half of the nursing students have insufficient knowledge of diabetic ulcer care.Curriculum developers and educators need to improve the curriculum regarding diabetic wound care and provide strategic programs to improve students’knowledge and attitudes based on the factors discovered in this study.

COMPARATIVE STUDY OF FIBRONECTIN GENE EXPRESSION IN TISSUES FROM HYPERTROPHIC SCARS AND DIABETIC FOOT ULCERS

Objective.To explore the expression characteristic of fibronectin gene in hypertr ophic scars and diabetic ul-cer tissues.Methods.The biopsies from normal skins,hypertrophic scars and diabetic foot ulc ers were taken.The tech-nique of quantitative polymerase ch ain reaction(PCR)was used to evaluate the gene express ion of fibronectin in the above biopsies.Results.Fibronectin gene expression was enhanced in hypertrophic scars and decreased in diabetic foot ul-cers compared with that in normal ski ns.Quantitative comparison showed about 2-fold increase of fibronectin mR-NA level in hypertrophic scars and ab out 3-fold decrease of fibronectin mRNA level in diabetic ulcers as com-pared with that in normal skins.Conclusions.Fibronectin gene expression is influenced by the tissue environment.Di fferent expression and synthesis of fibronectin may cause d ifferent outcomes in wound healing.

Continuing episodes of pain in recurrent acute pancreatitis: Prospective follow up on a standardised protocol with drugs and pancreatic endotherapy

AIM To assess the outcomes of drug therapy(DT)followed by pancreatic endotherapy for continuing painful episodes in recurrent acute pancreatitis.METHODS DT comprised of pancreatic enzymes and antioxidants failing which,endotherapy(ET;pancreatic sphincterotomy and stent placement)was done.The frequency of pain,its visual analogue score(VAS),quality of life(Qo L),serum C peptide and faecal elastase were compared between baseline and after 1 year of follow up in all patients and in the two subgroups on DT and ET.Response was defined as at least 50%reduction in the severity of pain to below a score of 5.RESULTS Of the thirty nine patients analysed,21(53.9%)responded to DT and 18(46.1%)underwent ET.The VAS for pain(7.0±2.0 vs 1.3±2.5,P<0.001)and the number of days with pain per month decreased[1.0(1.0,2.0)vs 1.0(0.0,1.0),P<0.001],and the Qo L scores[55.0(44.0,66.0)vs 38.0(32.00,51.00),P<0.01]improved significantly during follow up.Similar significant improvements were seen in patients in the subgroups of DT and ET except for Qo L in ET.The serum C-peptide(P=0.001)and FE(P<0.001)levels improved significantly in the entire group and in the two subgroups of patients except for the C peptide levels in patients on DT.CONCLUSION A standardised protocol of DT,followed by ET decreased the intensity and frequency of pain in recurrent acute pancreatitis,enhanced Qo L and improved pancreatic function.

The effect of foot bath of Chinese medicine combined with acupoint injection for diabetic peripheral neuropathy:a meta analysis

Objective:The aim of this systematic review was to assess the effect of foot bath of Chinese medicine combined with acupoint injection(FBCMCAI)on patients with diabetic peripheral neuropathy(DPN).Methods:Databases such as Cochrane Library,Pubmed,Web Of Science,China Biology Medicine(CBM),CNKI,VIP and WANFANG DATA were electronically searched to collect the randomized controlled trials(RCTs)(up to October 2016).According to the inclusion and exclusion criteria,literature about effects of FBCMCAI in the treatment of DPN were screened and data were extracted.Literature quality evaluation was appliced by Cochrane Reviewer Handbook 5.1.0.A random or a fixed effects model was used to analyze outcomes by RevMan 5.3 software.Subgroup analysis,sensitivity analysis,and orientation description were performed if necessary.Results:11 randomized controlled trials with a total of 927 patients were included.Meta analysis results revealed that the efficacy of FBCMCAI for DPN was significantly superior to the control treatment(OR=5.07,95%CI:3.23-7.94,Z=7.08,P<0.00001).Besides,there was an increase in motor conduction velocity of peroneal nerve(SMD=1.08,95%CI:0.66-1.48,Z=5.30,P<0.00001),motor conduction velocity of tibial nerve(SMD=1.08,95%CI:0.58-1.58,Z=4.22,P<0.0001)and motor conduction velocity of median nerve(SMD=0.46,95%CI:0.23-0.68,Z=3.96,P<0.0001)in FBCMCAI groups.For another,there was also an increase in sensory motor conduction velocity of the motor nerve(SMD=0.80,95%CI:0.54-1.05,Z=6.06,P<0.00001)and sensory motor conduction velocity of median nerve(SMD=0.66,95%CI:0.38-0.93,Z=4.73,P<0.00001)in the FBCMCAI groups.Symptoms score was significantly reduced after FBCMCAI treatment(WMD=-4.21,95%CI[-4.95,-3.48],Z=11.25,P<0.00001).Conclusion:FBCMCAI may have significant therapeutic efficacy for the treatment of DPN.Diabetic neurologic symptoms and nerve conduction velocities can be improved under FBCMCAI treatment.In-depth research and high quality randomized controlled trials on the efficacy of FBCMCAI are necessary.

Clinical observation on tuina plus foot bath with Chinese medicine for diabetic foot in early stage

Objective:To observe the clinical effect of tuina plus foot bath with Chinese medicine for patients with diabetic foot (DF) in early stage.Methods:A total of 70 patients with early-stage DF were randomly allocated by the random number table into two groups,with 35 cases in each group.Patients in the control group received conventional medication,while patients in the observation group received tuina plus foot bath with Chinese medicine on the basis of conventional medication.The clinical efficacy was compared after 2 courses of treatment.Results:After treatment,intra-group comparisons of ankle-brachial index (ABI) showed statistical significance in both groups (both P<0.05).The curative rate was 83.3% in the observation group,with the total effective rate of 96.7%,versus 29.4% and 76.5% in the control group,respectively,and the between-group comparisons showed statistical significance (both P<0.05),indicating a better effect in the observation group.Conclusion:Tuina plus foot bath with Chinese medicine has a good therapeutic effect for DF patients in early stage.

Elevated skin autofluorescence is strongly associated with foot ulcers in patients with diabetes: a cross-sectional, observational study of Chinese subjects

Objective: This study was designed to evaluate the association between skin autofluorescence (AF), an indicator of advanced glycation end-products (AGEs), and foot ulcers in subjects with diabetes. Methods: In this study, 195 Chinese diabetic subjects were examined. Their feet were examined regardless of whether an ulcer was present or not. Skin AF was measured with an AGE reader. Demographic characteristics and blood data were recorded. Results: The mean values of skin AF were 2.29±0.47 for subjects without foot ulcers, and 2.80±0.69 for those with foot ulcers, a significant difference (P<0.05). Skin AF was strongly correlated with age and duration of diabetes. After adjusting for these factors, multivariate logistic regression showed that skin AF was independently associated with foot ulcerations. Conclusions: Skin AF is independently associated with diabetic foot ulcerations. It might be a useful screening method for foot ulceration risk of diabetic patients.