Diabetic foot attack(DFA)is the most severe presentation of diabetic foot disease,with the patient commonly displaying severe sepsis,which can be limb or life threatening.DFA can be classified into two main categories...Diabetic foot attack(DFA)is the most severe presentation of diabetic foot disease,with the patient commonly displaying severe sepsis,which can be limb or life threatening.DFA can be classified into two main categories:Typical and atypical.A typical DFA is secondary to a severe infection in the foot,often initiated by minor breaches in skin integrity that allow pathogens to enter and proliferate.This form often progresses rapidly due to the underlying diabetic pathophysiology of neuropathy,microvascular disease,and hyperglycemia,which facilitate infection spread and tissue necrosis.This form of DFA can present as one of a number of severe infective pathologies including pyomyositis,necrotizing fasciitis,and myonecrosis,all of which can lead to systemic sepsis and multiorgan failure.An atypical DFA,however,is not primarily infection-driven.It can occur secondary to either ischemia or Charcot arthropathy.Management of the typical DFA involves prompt diagnosis,aggressive infection control,and a multidisciplinary approach.Treatment can be guided by the current International Working Group on the Diabetic Foot/Infectious Diseases Society of America guidelines on diabetic foot infections,and the combined British Orthopaedic Foot and Ankle Society-Vascular Society guidelines.This article highlights the importance of early recognition,comprehensive management strategies,and the need for further research to establish standardized protocols and improve clinical outcomes for patients with DFA.展开更多
Foot ulcers are common in diabetic patients,have a cumulative lifetime incidence rate as high as 25%and frequently become infected.The spread of infection to soft tissue and bone is a major causal factor for lowerlimb...Foot ulcers are common in diabetic patients,have a cumulative lifetime incidence rate as high as 25%and frequently become infected.The spread of infection to soft tissue and bone is a major causal factor for lowerlimb amputation.For this reason,early diagnosis and appropriate treatment are essential,including treatment which is both local(of the foot)and systemic(metabolic),and this requires coordination by a multidisciplinary team.Optimal treatment also often involves extensive surgical debridement and management of the wound base,effective antibiotic therapy,consideration for revascularization and correction of metabolic abnormalities such as hyperglycemia.This article focuses on diagnosis and management of diabetic foot infections in the light of recently published data in order to help clinicians in identification,assessment and antibiotic therapy of diabetic foot infections.展开更多
Management of diabetic foot ulcers is the biggest challenge to the clinician,as conventional antibiotic therapies and local wound care have their own limitations.They are not effective for control of infections and pr...Management of diabetic foot ulcers is the biggest challenge to the clinician,as conventional antibiotic therapies and local wound care have their own limitations.They are not effective for control of infections and promotion of healing because of cytotoxic effects.In view of cytotoxicity of routinely used topical antiseptic agents,this article focuses on the search of an ideal topical antiseptic agent that is safe and effective in controlling infectious agents and also in promoting the healing process.This review focuses on the use of various acids such as citric,acetic,hyaluronic,and hypochlorous acids as topical agents in diabetic foot infections.This article also focuses on the different roles of acids in the treatment of diabetic foot infections.展开更多
Diabetes-related amputation rates are high in the Caribbean. Many authorities have identified independent risk factors for diabetes-related amputations, but cultural factors remain underappreciated. We coined the term...Diabetes-related amputation rates are high in the Caribbean. Many authorities have identified independent risk factors for diabetes-related amputations, but cultural factors remain underappreciated. We coined the term “Caribbean substitution culture” to describe the attitude of patients with diabetic foot infections in which they refuse to access medical care, instead voluntarily choosing to substitute “bush medicines” or other alternative therapies in the place of conventional treatment. Recognizing that the Caribbean substitution culture is a barrier to effective treatment of diabetic foot infections is the first step in curbing these practices. In this paper, we discuss the issues related to the Caribbean substitution culture, including the demographics of the population at risk, the alternative therapeutic practices and potential public health strategies to combat this practice.展开更多
Diabetic foot ulcers(DFU)are one of the most challenging complications of diabetes.Up to one-third of patients with diabetes mellitus(DM)may suffer from DFUs during their life.DFU is one of the leading causes of morbi...Diabetic foot ulcers(DFU)are one of the most challenging complications of diabetes.Up to one-third of patients with diabetes mellitus(DM)may suffer from DFUs during their life.DFU is one of the leading causes of morbidity in patients with DM.The treatment period is challenging,and the recurrence rate of DFUs is high.Hence,establishing prevention strategies is the most important point to be emphasized.A multidisciplinary approach is necessary in the prevention and treatment of DFUs.Patients at risk should be identified,and prevention measures should be taken based on the risk category.Once a DFU is formed,the appropriate classification and evidence-based treatment interventions should be executed.Glycemic control,diagnosis and treatment of vascular disease,local wound care,diagnosis,and treatment of infection should be addressed along with the proper evaluation and management of general health status.展开更多
Foot infection is a well recognized risk factor for major amputation in diabetic patients. The osteomyelitis is one of the most common expression of diabetic foot infection, being present approximately in present in 1...Foot infection is a well recognized risk factor for major amputation in diabetic patients. The osteomyelitis is one of the most common expression of diabetic foot infection, being present approximately in present in 10%-15% of moderate and in 50% of severe infectious process. An early and accurate diagnosis is required to ensure a targeted treatment and reduce the risk of major amputation. The aim of this review is to report a complete overview about the management of diabetic foot osteomyelitis. Epidemiology, clinical aspects, diagnosis and treatment are widely described according to scientific reccomendations and our experience.展开更多
Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy makin...Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy making the foot prone to injuries from trivial trauma,and local tissue hyperglycaemia favouring infection and delaying the wound healing.DFU have been the leading cause for non-traumatic amputations of part or whole of the limb.Western medicines focus mainly on euglycaemia,antimicrobials,debridement and wound cover with grafts,and off-loading techniques.Advances in euglycaemic control,foot care and footwear,systemic antimicrobial therapy,and overall health care access and delivery,have resulted in an overall decrease in amputations.However,the process of wound care after adequate debridement remains a major cost burden globally,especially in developing nations.This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence.Wound modulation with various dressings and techniques are often a costly affair.Some aspects of the topical therapy with modern/Western medicines are frequently not addressed.Cost of and compliance to these therapies are important as both the wounds and their treatment are“chronic.”Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations,though without adequate clinical base/relevance.Traditional Chinese medicine involves restoring yin-yang balance,regulating the‘chi’,and promoting local blood circulation.Traditional medicines from India have been emphasizing on‘naturally’available products to control wound infection and promote all the aspects of wound healing.There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns.Various natural and plant derived products(e.g.,honey,aloe vera,oils,and calendula)and maggots are also used for wound healing purposes.We believe that patients with a chronic wound are so tired physically,emotionally,and financially that they usually accept native traditional medicine which has the same cultural base,belief,and faith.Many of these products have never been tested in accordance to“evidence-based medicine.”There are usually case reports and experience-based reports about these products.Recently,there have been some trials(in vitro and in vivo)to verify the claims of usage of traditional medicines in management of DFU.Such studies show that these natural products enhance the healing process by controlling infection,stimulating granulation tissue,antimicrobial action,promoting fibroblastic activity and collagen deposition,etc.In this review,we attempt to study and analyse the available literature on results of topical traditional medicines,which are usually advocated in the management of DFU.An integrated and‘holistic’approach of both modern and traditional medicine may be more acceptable to the patient,cost effective,and easy to administer and monitor.This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.展开更多
Diabetes is a chronic disease that is considered one of the most stubborn global health problems that continues to defy the efforts of scientists and physicians.The prevalence of diabetes in the global population cont...Diabetes is a chronic disease that is considered one of the most stubborn global health problems that continues to defy the efforts of scientists and physicians.The prevalence of diabetes in the global population continues to grow to alarming levels year after year,causing an increase in the incidence of diabetes complications and health care costs all over the world.One major complication of diabetes is the high susceptibility to infections especially in the lower limbs due to the immunocompromised state of diabetic patients,which is considered a definitive factor in all cases.Diabetic foot infections continue to be one of the most common infections in diabetic patients that are associated with a high risk of serious complications such as bone infection,limb amputations,and life-threatening systemic infections.In this review,we discussed the circumstances associated with the high risk of infection in diabetic patients as well as some of the most commonly isolated pathogens from diabetic foot infections and the related virulence behavior.In addition,we shed light on the different treatment strategies that aim at eradicating the infection.展开更多
Objective: To investigate the therapeutic effect and clinical value of red light therapy combined with insulin therapy on wound in type 2 diabetic foot (DF) rats. Methords: Wistar rats were injected intraperitoneally ...Objective: To investigate the therapeutic effect and clinical value of red light therapy combined with insulin therapy on wound in type 2 diabetic foot (DF) rats. Methords: Wistar rats were injected intraperitoneally with medium-dose high-fat and high-fat streptozotocin and carefully controlled at room temperature. The type 2 diabetes mellitus Wistar rats were reproved with high glucose and high fat streptozotocin (STZ) Foot involvement in the establishment of type 2 diabetic foot rat model. The rats were randomly divided into three groups: metformin 0.140 g/kg group, red light therapy group combined with insulin treatment group, model group, blank control group (30 d after intragastric administration of rats), further observation of each group of rat wounds Healing rate, insulin, blood glucose and blood lipid and vascular endothelial activity factors such as laboratory changes. Results: The observation of red light therapy combined with insulin treatment group was the most obvious, the difference was statistically significant, significantly promoted wound healing in DF rats, increased healing rate, increased insulin sensitivity (NO) and nitric oxide synthase (NOS) were increased in the serum of rats. The insulin resistance and platelet aggregation rate of the DF model rats were significantly higher than those of the control group, and the insulin sensitivity index (ISI) , Blood glucose, blood lipid, blood viscosity and endothelin (ET) and other active factors were significantly reduced. Conclusion: (1) treatment of red light therapy can improve blood rheology, improve glucose and lipid metabolism, improve insulin sensitivity, Vascular endothelial cell activation and so on to improve the wound healing rate of DF wound in rats. (2) The treatment of red light therapy is effective, safe and high in clinical application.展开更多
Diabetes mellitus,a chronic disease of metabolism,is characterized by a disordered production or cellular utilization of insulin.Diabetic foot disease,which comprises the spectrum of infection,ulceration,and gangrene,...Diabetes mellitus,a chronic disease of metabolism,is characterized by a disordered production or cellular utilization of insulin.Diabetic foot disease,which comprises the spectrum of infection,ulceration,and gangrene,is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients.The aim of this study is to provide an evidence-based overview of diabetic foot complications.Due to neuropathy,diabetic foot infections can occur in the form of ulcers and minor skin lesions.In patients with diabetic foot ulcers,ischemia and infection are the main causes of non-healing ulcers and amputations.Hyperglycemia compromises the immune system of individuals with diabetes,leading to persistent inflammation and delayed wound healing.In addition,the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance.As a further complicating factor,the warning signs and symptoms of diabetic foot problems can easily be overlooked.Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis;accordingly,the risk of these complications in people with diabetes should be assessed annually.Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections,if peripheral arterial disease is present,revascularization should be considered to prevent limb amputation.A multidisciplinary approach to the prevention,diagnosis,and treatment of diabetic patients,including those with foot ulcers,is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.展开更多
背景:研究表明,核苷酸结合寡聚化结构域样受体蛋白3(nucleotide binding oligomerization domain like receptor protein 3,NLRP3)炎性小体、白细胞介素18和白细胞介素1β均可以通过诱发炎症级联反应释放炎症因子、影响代谢应激、损伤...背景:研究表明,核苷酸结合寡聚化结构域样受体蛋白3(nucleotide binding oligomerization domain like receptor protein 3,NLRP3)炎性小体、白细胞介素18和白细胞介素1β均可以通过诱发炎症级联反应释放炎症因子、影响代谢应激、损伤内皮细胞等参与糖尿病足溃疡的发生、发展,可以为早期感染提供参考。目的:进一步探讨外周血单核细胞NLRP3炎性小体、白细胞介素18和白细胞介素1β水平对糖尿病足溃疡皮瓣修复术后早期感染的预测价值。方法:选取糖尿病足溃疡患者147例,根据术后1周内发生感染的情况分为感染组与非感染组,Logistic回归分析外周血单核细胞NLRP3炎性小体、白细胞介素18和白细胞介素1β水平与术后早期感染的关系,并评估预测价值。结果与结论:①147例糖尿病足溃疡患者术后1周内发生感染35例(23.8%),分离致病菌47株,含革兰阳性菌25株(53.19%);革兰阴性菌22株(46.81%)。②单因素分析显示,Wagner分级、是否合并糖尿病肾病、手术时间、外周血NLRP3、Caspase-1及ASC的mRNA、白细胞介素18、白细胞介素1β水平均是影响术后早期感染的危险因素(均P<0.05)。③多因素分析提示,Wagner分级、NLRP3、Caspase-1及ASC的mRNA、高白细胞介素18、白细胞介素1β均是影响术后早期感染的独立危险因素(均P<0.05)。④ROC曲线结果显示,NLRP3、Caspase-1及ASC的mRNA、白细胞介素18、白细胞介素1β对糖尿病足溃疡患者术后早期感染的区分效能曲线下面积(AUC)分别为0.823,0.705,0.676,0.811和0.853,联合预测效能AUC为0.915。⑤结果说明,糖尿病足溃疡患者主要是受到革兰阳性菌的影响,且外周血单核细胞NLRP3炎性小体、白细胞介素18和白细胞介素1β水平是影响术后早期感染的独立危险因素,上述指标的联合预测效能更优,值得进一步深入研究。展开更多
In recent years,as living standards have continued to improve,the number of diabetes patients in China,along with the incidence of complications associated with the disease,has been increasing.Among these complication...In recent years,as living standards have continued to improve,the number of diabetes patients in China,along with the incidence of complications associated with the disease,has been increasing.Among these complications,diabetic foot disease is one of the main causes of disability and death in diabetic patients.Due to the differences in economy,culture,religion and level of medical care available across different regions,preventive and treatment methods and curative results for diabetic foot vary greatly.In multidisciplinary models built around diabetic foot,the timely assessment and diagnosis of wounds and appropriate methods of prevention and treatment with internal and external surgery are key to clinical practice for this pathology.In 2019,under the leadership of the Jiangsu Medical Association and Chinese Diabetes Society,the writing group for the Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease(2020 edition)was established with the participation of scholars from the specialist areas of endocrinology,burn injury,vascular surgery,orthopedics,foot and ankle surgery and cardiology.Drawing lessons from diabetic foot guidelines from other countries,this guide analyses clinical practices for diabetic foot,queries the theoretical basis and grades and gives recommendations based on the characteristics of the pathology in China.This paper begins with assessments and diagnoses of diabetic foot,then describes treatments for diabetic foot in detail,and ends with protections for high-risk feet and the prevention of ulcers.This manuscript covers the disciplines of internal medicine,surgical,nursing and rehabilitation and describes a total of 50 recommendations that we hope will provide procedures and protocols for clinicians dealing with diabetic foot.展开更多
文摘Diabetic foot attack(DFA)is the most severe presentation of diabetic foot disease,with the patient commonly displaying severe sepsis,which can be limb or life threatening.DFA can be classified into two main categories:Typical and atypical.A typical DFA is secondary to a severe infection in the foot,often initiated by minor breaches in skin integrity that allow pathogens to enter and proliferate.This form often progresses rapidly due to the underlying diabetic pathophysiology of neuropathy,microvascular disease,and hyperglycemia,which facilitate infection spread and tissue necrosis.This form of DFA can present as one of a number of severe infective pathologies including pyomyositis,necrotizing fasciitis,and myonecrosis,all of which can lead to systemic sepsis and multiorgan failure.An atypical DFA,however,is not primarily infection-driven.It can occur secondary to either ischemia or Charcot arthropathy.Management of the typical DFA involves prompt diagnosis,aggressive infection control,and a multidisciplinary approach.Treatment can be guided by the current International Working Group on the Diabetic Foot/Infectious Diseases Society of America guidelines on diabetic foot infections,and the combined British Orthopaedic Foot and Ankle Society-Vascular Society guidelines.This article highlights the importance of early recognition,comprehensive management strategies,and the need for further research to establish standardized protocols and improve clinical outcomes for patients with DFA.
基金Supported by Institut National de la SantéEt de la Recherche Médicale,the French Speaking Association for Diabetes and Metabolic Diseases(ALFEDIAM grant)the University of Montpellier 1,the Languedoc-Roussillon Area(Chercheur d'avenir Grant) and the City of Nmes
文摘Foot ulcers are common in diabetic patients,have a cumulative lifetime incidence rate as high as 25%and frequently become infected.The spread of infection to soft tissue and bone is a major causal factor for lowerlimb amputation.For this reason,early diagnosis and appropriate treatment are essential,including treatment which is both local(of the foot)and systemic(metabolic),and this requires coordination by a multidisciplinary team.Optimal treatment also often involves extensive surgical debridement and management of the wound base,effective antibiotic therapy,consideration for revascularization and correction of metabolic abnormalities such as hyperglycemia.This article focuses on diagnosis and management of diabetic foot infections in the light of recently published data in order to help clinicians in identification,assessment and antibiotic therapy of diabetic foot infections.
文摘Management of diabetic foot ulcers is the biggest challenge to the clinician,as conventional antibiotic therapies and local wound care have their own limitations.They are not effective for control of infections and promotion of healing because of cytotoxic effects.In view of cytotoxicity of routinely used topical antiseptic agents,this article focuses on the search of an ideal topical antiseptic agent that is safe and effective in controlling infectious agents and also in promoting the healing process.This review focuses on the use of various acids such as citric,acetic,hyaluronic,and hypochlorous acids as topical agents in diabetic foot infections.This article also focuses on the different roles of acids in the treatment of diabetic foot infections.
文摘Diabetes-related amputation rates are high in the Caribbean. Many authorities have identified independent risk factors for diabetes-related amputations, but cultural factors remain underappreciated. We coined the term “Caribbean substitution culture” to describe the attitude of patients with diabetic foot infections in which they refuse to access medical care, instead voluntarily choosing to substitute “bush medicines” or other alternative therapies in the place of conventional treatment. Recognizing that the Caribbean substitution culture is a barrier to effective treatment of diabetic foot infections is the first step in curbing these practices. In this paper, we discuss the issues related to the Caribbean substitution culture, including the demographics of the population at risk, the alternative therapeutic practices and potential public health strategies to combat this practice.
基金supported by the Society of Endocrinology and Metabolism of Turkey
文摘Diabetic foot ulcers(DFU)are one of the most challenging complications of diabetes.Up to one-third of patients with diabetes mellitus(DM)may suffer from DFUs during their life.DFU is one of the leading causes of morbidity in patients with DM.The treatment period is challenging,and the recurrence rate of DFUs is high.Hence,establishing prevention strategies is the most important point to be emphasized.A multidisciplinary approach is necessary in the prevention and treatment of DFUs.Patients at risk should be identified,and prevention measures should be taken based on the risk category.Once a DFU is formed,the appropriate classification and evidence-based treatment interventions should be executed.Glycemic control,diagnosis and treatment of vascular disease,local wound care,diagnosis,and treatment of infection should be addressed along with the proper evaluation and management of general health status.
文摘Foot infection is a well recognized risk factor for major amputation in diabetic patients. The osteomyelitis is one of the most common expression of diabetic foot infection, being present approximately in present in 10%-15% of moderate and in 50% of severe infectious process. An early and accurate diagnosis is required to ensure a targeted treatment and reduce the risk of major amputation. The aim of this review is to report a complete overview about the management of diabetic foot osteomyelitis. Epidemiology, clinical aspects, diagnosis and treatment are widely described according to scientific reccomendations and our experience.
文摘Diabetic foot infections and diabetic foot ulcers(DFU)cause significant suffering and are often recurring.DFU have three important pathogenic factors,namely,microangiopathy causing local tissue anoxia,neuropathy making the foot prone to injuries from trivial trauma,and local tissue hyperglycaemia favouring infection and delaying the wound healing.DFU have been the leading cause for non-traumatic amputations of part or whole of the limb.Western medicines focus mainly on euglycaemia,antimicrobials,debridement and wound cover with grafts,and off-loading techniques.Advances in euglycaemic control,foot care and footwear,systemic antimicrobial therapy,and overall health care access and delivery,have resulted in an overall decrease in amputations.However,the process of wound care after adequate debridement remains a major cost burden globally,especially in developing nations.This process revolves around two basic concerns regarding control/eradication of local infection and promotion of faster healing in a chronic DFU without recurrence.Wound modulation with various dressings and techniques are often a costly affair.Some aspects of the topical therapy with modern/Western medicines are frequently not addressed.Cost of and compliance to these therapies are important as both the wounds and their treatment are“chronic.”Naturally occurring agents/medications from traditional medicine systems have been used frequently in different cultures and nations,though without adequate clinical base/relevance.Traditional Chinese medicine involves restoring yin-yang balance,regulating the‘chi’,and promoting local blood circulation.Traditional medicines from India have been emphasizing on‘naturally’available products to control wound infection and promote all the aspects of wound healing.There is one more group of chemicals which are not pharmaceutical agents but can create acidic milieu in the wound to satisfy the above-mentioned basic concerns.Various natural and plant derived products(e.g.,honey,aloe vera,oils,and calendula)and maggots are also used for wound healing purposes.We believe that patients with a chronic wound are so tired physically,emotionally,and financially that they usually accept native traditional medicine which has the same cultural base,belief,and faith.Many of these products have never been tested in accordance to“evidence-based medicine.”There are usually case reports and experience-based reports about these products.Recently,there have been some trials(in vitro and in vivo)to verify the claims of usage of traditional medicines in management of DFU.Such studies show that these natural products enhance the healing process by controlling infection,stimulating granulation tissue,antimicrobial action,promoting fibroblastic activity and collagen deposition,etc.In this review,we attempt to study and analyse the available literature on results of topical traditional medicines,which are usually advocated in the management of DFU.An integrated and‘holistic’approach of both modern and traditional medicine may be more acceptable to the patient,cost effective,and easy to administer and monitor.This may also nevertheless lead to further improvement in quality of life and decrease in the rates of amputations for DFU.
文摘Diabetes is a chronic disease that is considered one of the most stubborn global health problems that continues to defy the efforts of scientists and physicians.The prevalence of diabetes in the global population continues to grow to alarming levels year after year,causing an increase in the incidence of diabetes complications and health care costs all over the world.One major complication of diabetes is the high susceptibility to infections especially in the lower limbs due to the immunocompromised state of diabetic patients,which is considered a definitive factor in all cases.Diabetic foot infections continue to be one of the most common infections in diabetic patients that are associated with a high risk of serious complications such as bone infection,limb amputations,and life-threatening systemic infections.In this review,we discussed the circumstances associated with the high risk of infection in diabetic patients as well as some of the most commonly isolated pathogens from diabetic foot infections and the related virulence behavior.In addition,we shed light on the different treatment strategies that aim at eradicating the infection.
文摘Objective: To investigate the therapeutic effect and clinical value of red light therapy combined with insulin therapy on wound in type 2 diabetic foot (DF) rats. Methords: Wistar rats were injected intraperitoneally with medium-dose high-fat and high-fat streptozotocin and carefully controlled at room temperature. The type 2 diabetes mellitus Wistar rats were reproved with high glucose and high fat streptozotocin (STZ) Foot involvement in the establishment of type 2 diabetic foot rat model. The rats were randomly divided into three groups: metformin 0.140 g/kg group, red light therapy group combined with insulin treatment group, model group, blank control group (30 d after intragastric administration of rats), further observation of each group of rat wounds Healing rate, insulin, blood glucose and blood lipid and vascular endothelial activity factors such as laboratory changes. Results: The observation of red light therapy combined with insulin treatment group was the most obvious, the difference was statistically significant, significantly promoted wound healing in DF rats, increased healing rate, increased insulin sensitivity (NO) and nitric oxide synthase (NOS) were increased in the serum of rats. The insulin resistance and platelet aggregation rate of the DF model rats were significantly higher than those of the control group, and the insulin sensitivity index (ISI) , Blood glucose, blood lipid, blood viscosity and endothelin (ET) and other active factors were significantly reduced. Conclusion: (1) treatment of red light therapy can improve blood rheology, improve glucose and lipid metabolism, improve insulin sensitivity, Vascular endothelial cell activation and so on to improve the wound healing rate of DF wound in rats. (2) The treatment of red light therapy is effective, safe and high in clinical application.
文摘Diabetes mellitus,a chronic disease of metabolism,is characterized by a disordered production or cellular utilization of insulin.Diabetic foot disease,which comprises the spectrum of infection,ulceration,and gangrene,is one of the most severe complications of diabetes and is the most common cause of hospitalization in diabetic patients.The aim of this study is to provide an evidence-based overview of diabetic foot complications.Due to neuropathy,diabetic foot infections can occur in the form of ulcers and minor skin lesions.In patients with diabetic foot ulcers,ischemia and infection are the main causes of non-healing ulcers and amputations.Hyperglycemia compromises the immune system of individuals with diabetes,leading to persistent inflammation and delayed wound healing.In addition,the treatment of diabetic foot infections is challenging due to difficulty in accurate identification of pathogenic microorganisms and the widespread issue of antimicrobial resistance.As a further complicating factor,the warning signs and symptoms of diabetic foot problems can easily be overlooked.Issues associated with diabetic foot complications include peripheral arterial disease and osteomyelitis;accordingly,the risk of these complications in people with diabetes should be assessed annually.Although antimicrobial agents represent the mainstay of treatment for diabetic foot infections,if peripheral arterial disease is present,revascularization should be considered to prevent limb amputation.A multidisciplinary approach to the prevention,diagnosis,and treatment of diabetic patients,including those with foot ulcers,is of the utmost importance to reduce the cost of treatment and avoid major adverse consequences such as amputation.
文摘背景:研究表明,核苷酸结合寡聚化结构域样受体蛋白3(nucleotide binding oligomerization domain like receptor protein 3,NLRP3)炎性小体、白细胞介素18和白细胞介素1β均可以通过诱发炎症级联反应释放炎症因子、影响代谢应激、损伤内皮细胞等参与糖尿病足溃疡的发生、发展,可以为早期感染提供参考。目的:进一步探讨外周血单核细胞NLRP3炎性小体、白细胞介素18和白细胞介素1β水平对糖尿病足溃疡皮瓣修复术后早期感染的预测价值。方法:选取糖尿病足溃疡患者147例,根据术后1周内发生感染的情况分为感染组与非感染组,Logistic回归分析外周血单核细胞NLRP3炎性小体、白细胞介素18和白细胞介素1β水平与术后早期感染的关系,并评估预测价值。结果与结论:①147例糖尿病足溃疡患者术后1周内发生感染35例(23.8%),分离致病菌47株,含革兰阳性菌25株(53.19%);革兰阴性菌22株(46.81%)。②单因素分析显示,Wagner分级、是否合并糖尿病肾病、手术时间、外周血NLRP3、Caspase-1及ASC的mRNA、白细胞介素18、白细胞介素1β水平均是影响术后早期感染的危险因素(均P<0.05)。③多因素分析提示,Wagner分级、NLRP3、Caspase-1及ASC的mRNA、高白细胞介素18、白细胞介素1β均是影响术后早期感染的独立危险因素(均P<0.05)。④ROC曲线结果显示,NLRP3、Caspase-1及ASC的mRNA、白细胞介素18、白细胞介素1β对糖尿病足溃疡患者术后早期感染的区分效能曲线下面积(AUC)分别为0.823,0.705,0.676,0.811和0.853,联合预测效能AUC为0.915。⑤结果说明,糖尿病足溃疡患者主要是受到革兰阳性菌的影响,且外周血单核细胞NLRP3炎性小体、白细胞介素18和白细胞介素1β水平是影响术后早期感染的独立危险因素,上述指标的联合预测效能更优,值得进一步深入研究。
基金The National Natural Science Foundation of China(grant number:81770810)。
文摘In recent years,as living standards have continued to improve,the number of diabetes patients in China,along with the incidence of complications associated with the disease,has been increasing.Among these complications,diabetic foot disease is one of the main causes of disability and death in diabetic patients.Due to the differences in economy,culture,religion and level of medical care available across different regions,preventive and treatment methods and curative results for diabetic foot vary greatly.In multidisciplinary models built around diabetic foot,the timely assessment and diagnosis of wounds and appropriate methods of prevention and treatment with internal and external surgery are key to clinical practice for this pathology.In 2019,under the leadership of the Jiangsu Medical Association and Chinese Diabetes Society,the writing group for the Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease(2020 edition)was established with the participation of scholars from the specialist areas of endocrinology,burn injury,vascular surgery,orthopedics,foot and ankle surgery and cardiology.Drawing lessons from diabetic foot guidelines from other countries,this guide analyses clinical practices for diabetic foot,queries the theoretical basis and grades and gives recommendations based on the characteristics of the pathology in China.This paper begins with assessments and diagnoses of diabetic foot,then describes treatments for diabetic foot in detail,and ends with protections for high-risk feet and the prevention of ulcers.This manuscript covers the disciplines of internal medicine,surgical,nursing and rehabilitation and describes a total of 50 recommendations that we hope will provide procedures and protocols for clinicians dealing with diabetic foot.
