Efficacy of Huangma Ding or autologous platelet-rich gel for the diabetic lower extremity arterial disease patients with foot ulcers

BACKGROUND Diabetes foot is one of the most serious complications of diabetes and an important cause of death and disability,traditional treatment has poor efficacy and there is an urgent need to develop a practical treatment method.AIM To investigate whether Huangma Ding or autologous platelet-rich gel(APG)treatment would benefit diabetic lower extremity arterial disease(LEAD)patients with foot ulcers.METHODS A total of 155 diabetic LEAD patients with foot ulcers were enrolled and divided into three groups:Group A(62 patients;basal treatment),Group B(38 patients;basal treatment and APG),and Group C(55 patients;basal treatment and Huangma Ding).All patients underwent routine follow-up visits for six months.After follow-up,we calculated the changes in all variables from baseline and determined the differences between groups and the relationships between parameters.RESULTS The infection status of the three groups before treatment was the same.Procalcitonin(PCT)improved after APG and Huangma Ding treatment more than after traditional treatment and was significantly greater in Group C than in Group B.Logistic regression analysis revealed that PCT was positively correlated with total amputation,primary amputation,and minor amputation rates.The ankle-brachial pressure and the transcutaneous oxygen pressure in Groups B and C were greater than those in Group A.The major amputation rate,minor amputation rate,and total amputation times in Groups B and C were lower than those in Group A.CONCLUSION Our research indicated that diabetic foot ulcers(DFUs)lead to major amputation,minor amputation,and total amputation through local infection and poor microcirculation and macrocirculation.Huangma Ding and APG were effective attreating DFUs.The clinical efficacy of Huangma Ding was better than that of autologous platelet gel,which may be related to the better control of local infection by Huangma Ding.This finding suggested that in patients with DFUs combined with coinfection,controlling infection is as important as improving circulation.

Protein Supplementation for the Prevention and Management of Sarcopenia in the Elderly

Sarcopenia is common in patients with many physiological or pathological conditions, especially in aging people. Nutrition plays an important role in the prevention and treatment of sarcopenia. Sarcopenia is often related to insufficient protein intake in the elderly. Muscle protein synthesis occurs mainly through mTORC1 pathway, and degradation occurs by ubiquitination-mediated pathways. This review summarizes the growing body of evidence, including substantial clinical trials, which increasing the protein intake can serve as the basis for preventing and managing muscle loss in patients with sarcopenia. Supplementation of essential amino acids (EAA), branched chain amino acids (BCAA), and especially leucine-rich whey protein may promote muscle protein synthesis by activating the mTORC1 signaling pathway, and may inhibit protein degradation by decreasing ubiquitin-mediated degradation. Taking in sufficient energy and protein and engaging in active exercise are the main methods of stimulating muscle protein synthesis and preventing or managing sarcopenia. Therefore, it is necessary to strengthen research on the use of protein supplements for not only elderly patients, but also those with tumor cachexia and other diseases related to sarcopenia.