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Objective To investigate the clinical features and risk factors of diabetic foot recurrence infection in diabetes mellitus (DM) patients.Methods A total of 158 patients with diabetic foot infection from January 2014 to December 2017 admitted to the First Affiliated Hospital of Xiamen University were selected in the study.There were 90 patients with diabetic foot recurrence.The clinical data of patients with recurrent infection and non-recurrent infection were compared and analyzed.Multivariate logistic regression was used to analyze the risk factors associated with recurrent infection of diabetic foot.Results Ninety patients with recurrent infection of diabetic foot were cultured with 108 strains of pathogens,of which Gram-positive (G +),Gram-negative (G-),and other pathogens accounted for 54.63 ％ (59 strains),39.81％ (43 strains),5.56％ (6 strains),respectively.The differences in disease duration,age,white blood cell count,hs-CRP,hemoglobin,fibrinogen,albumin levels,and Wanger grade 4 to 5 ratio,peripheral vascular lesions of the lower extremities,recent use of antibiotics and the healing time of ulcers in patients of diabetic foot recurrence and non-recurrent infections were statistically significant (t =6.003,6.132,3.144,4.322,4.513,11.179,7.164,x2 =4.269,8.613,25.083,23.298,all P ＜ 0.05).Multivariate analysis showed that the independent risk factors for diabetic foot recurrence were peripheral vascular lesions of the lower extremities,recent use of antimicrobial agents,ulcer healing time more than 65 days (x2 =5.134,4.807,10.512,all P ＜ 0.05).Conclusion The results show that patients with ulcer healing time more than 65 days,vascular lesions around the lower extremities,and diabetic foot who recently used antibiotics have a higher risk of recurrent infections.Close observation should be made to take early precautionary measures based on the patients'own condition.
ABSTRACT
Objective@#To investigate the clinical features and risk factors of diabetic foot recurrence infection in diabetes mellitus (DM) patients.@*Methods@#A total of 158 patients with diabetic foot infection from January 2014 to December 2017 admitted to the First Affiliated Hospital of Xiamen University were selected in the study.There were 90 patients with diabetic foot recurrence.The clinical data of patients with recurrent infection and non-recurrent infection were compared and analyzed.Multivariate logistic regression was used to analyze the risk factors associated with recurrent infection of diabetic foot.@*Results@#Ninety patients with recurrent infection of diabetic foot were cultured with 108 strains of pathogens, of which Gram-positive(G+ ), Gram-negative(G-), and other pathogens accounted for 54.63%(59 strains), 39.81%(43 strains), 5.56%(6 strains), respectively.The differences in disease duration, age, white blood cell count, hs-CRP, hemoglobin, fibrinogen, albumin levels, and Wanger grade 4 to 5 ratio, peripheral vascular lesions of the lower extremities, recent use of antibiotics and the healing time of ulcers in patients of diabetic foot recurrence and non-recurrent infections were statistically significant(t=6.003, 6.132, 3.144, 4.322, 4.513, 11.179, 7.164, χ2=4.269, 8.613, 25.083, 23.298, all P<0.05). Multivariate analysis showed that the independent risk factors for diabetic foot recurrence were peripheral vascular lesions of the lower extremities, recent use of antimicrobial agents, ulcer healing time more than 65 days(χ2=5.134, 4.807, 10.512, all P<0.05).@*Conclusion@#The results show that patients with ulcer healing time more than 65 days, vascular lesions around the lower extremities, and diabetic foot who recently used antibiotics have a higher risk of recurrent infections.Close observation should be made to take early precautionary measures based on the patients' own condition.
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<p><b>OBJECTIVE</b>To observe the effects of conditioned medium from keloid fibroblasts under hypoxia on angiogenesis, and to investigate the role of hypoxic microenvironment in invasive growth of keloid.</p><p><b>METHODS</b>Primary keloid fibroblasts and human umbilical endothelial cells (HUVEC) were cultured as conventional method. Keloid fibroblasts were cultured either in a hypoxic incubator (2% O2) for 48 h or in a normoxic incubator (20% O2) as control. Then those cell culture mediums were collected and mixed with endothelial cell medium by the proportion of 1:1 as conditioned medium. The mRNA and secreted protein of pro-angiogenic factors such as vascular endothelial growth factor (VEGF), angiopoietin-1 (Ang-1) and periostin of keloid fibroblasts under hypoxia were detected by real time PCR and ELISA. The proliferation, migration and invasion, tube formation of HUVEC cultured with conditioned medium were evaluated by CCK-8 assay, Transwell assay and matrigel tube formation assay, respectively.</p><p><b>RESULTS</b>Hypoxia increased the expression of VEGF, Ang-1 and periostin in both mRNA (increased by 75%, 43% and 118% respectively, P < 0.05) and secreted protein (increased by 30.2%, 14.2% and 19.5% respectively, P < 0.05) levels; the proliferations of HUVEC in hypoxic conditioned medium in 1, 2 and 3 d were 0.67 +/- 0.07, 0.84 +/- 0.09 and 1.08 +/- 0.10 respectively, which were higher compared to those in control group (0.52 +/- 0.08, 0.72 +/- 0.10 and 0.91 + 0.14, P < 0.05); the numbers of migration, invasion and tube formation of HUVEC were (73.2 +/- 8.9), (56.3 +/- 12.5), (9.66 +/- 1.96) cells/HP, which were higher compared to those in control group [(59.0 +/- 8.0), 35.5 +/- 8.5), (6.5 +/- 1.87) cells/HP, P < 0.05].</p><p><b>CONCLUSIONS</b>Hypoxia increases the expression of pro-angiogenic factors of keloid fibroblasts, and its conditioned medium under hypoxia could promote angiogenesis. The results suggest hypoxic microenvironment may play a significant role in the invasive growth of keloid by inducing angiogenesis.</p>