Exactitud diagnóstica de la imagen fotográfica en la granulación de las úlceras diabéticas mediante segmentación / Diagnostic accuracy of photographic imaging in the granulation of diabetic ulcers by segmentation

Introducción: La evaluación del estado de las úlceras por imagen fotográfica se realiza cuando se encuentran los colores rojo y rosado, que corresponden a granulación. Objetivo: Determinar la sensibilidad, especificidad y exactitud de la imagen fotográfica con respecto al estudio histológico en la granulación de úlceras diabéticas. Métodos: El diseño fue una prueba diagnóstica realizada a 29 pacientes diabéticos con 45 úlceras diabéticas no infectadas, en la cual se comparó la observación directa de un área de granulación por imagen fotográfica como prueba diagnóstica en la evaluación referente al estándar por anatomía patológica, a través de una biopsia sacabocado. La imagen fotográfica se obtuvo mediante un Smartphone CATS61 y se analizó a través de la segmentación en colores rojo y negro con el software ImageJ. El estudio lo autorizó un comité de ética. Las estadísticas se realizaron con el software SPSS 22 y EPIDAT 4.4. Resultados: Las úlceras diabéticas presentaron un promedio de 3,03 ± 2,39 cm de largo y 2,26 ± 1,62 cm de ancho; de la úlcera tipo 2 según Wagner en 73,3 por ciento; y de la úlcera tipo A, según la Universidad de Texas en 60 por ciento. Las pruebas de diagnóstico por imagen fotográfica mostraron una sensibilidad, especificidad y exactitud en 90 por ciento, 33,3 por ciento y 61,6 por ciento, respectivamente. Conclusiones: La identificación de la imagen fotográfica y el estudio histológico de las úlceras diabéticas con granulación fueron factibles. La sensibilidad, especificidad y exactitud de la imagen fotográfica resultaron elevada, baja y moderada(AU)

Introduction: The evaluation of the state of the ulcers by photographic image is carried out when the red and pink colors are found, which correspond to granulation. Objective: Determine the sensitivity, specificity and accuracy of the photographic image with respect to the histological study in the granulation of diabetic ulcers. Methods: The design was a diagnostic test performed on 29 diabetic patients with 45 uninfected diabetic ulcers, in which the direct observation of an area of granulation by photographic image was compared as a diagnostic test in the evaluation referring to the standard by pathological anatomy, through a punch biopsy. The photographic image was obtained using a CATS61 Smartphone and analyzed through segmentation in red and black colors with the ImageJ software. The study was authorized by an ethics committee. Statistics were performed with SPSS 22 and EPIDAT 4.4 softwares. Results: Diabetic ulcers presented an average of 3.03 ± 2.39 cm long and 2.26 ± 1.62 cm wide; of type 2 ulcer according to Wagner in 73.3 percent, and type A ulcer, according to the University of Texas at 60 percent. Photographic imaging tests showed sensitivity, specificity and accuracy in 90 percent, 33.3 percent and 61.6 percent, respectively. Conclusions: The identification of the photographic image and the histological study of diabetic ulcers with granulation were feasible. The sensitivity, specificity and accuracy of the photographic image were high, low and moderate(AU)

Clinical Observation on Wagner 2-3 Diabetic Foot Ulcer Treated by TCM External Treatment Scheme for Euriching Pus for Tissue Growth / 中国实验方剂学杂志

ObjectiveTo observe the clinical efficacy and safety of traditional Chinese medicine （TCM） external therapeutic protocol of enriching pus for tissue growth （EPTG） in the treatment of Wagner 2-3 diabetic foot ulcer. MethodThe randomized controlled trial （RCT） design was adopted. Patients receiving basic treatment were divided into the EPTG group and the control group （debridement and change of nano-silver medical antibacterial dressing）. Ulcer healing rate， ulcer area， ulcer depth， TCM symptom score， visual analogue scale（VAS）， transcutaneous partial pressure of oxygen， wound blood flow， inflammatory factors ［C-reactive protein （CRP）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α）］， growth factors ［vascular endothelial growth factor （VEGF）， transforming growth factor-β1 （TGF-β1）， and fibroblast growth factor-β （FGF-β）］， adverse events， and outcome events of the two groups before and after treatment were observed. ResultCompared with the conditions before treatment， the ulcer healing rate， ulcer area， ulcer depth， TCM symptom score， VAS score， transcutaneous partial pressure of oxygen， wound blood flow， CRP， IL-6， TNF-α， VEGF， TGF-β1， and FGF-β were significantly improved （P<0.01）. In terms of the improvement in the ulcer healing rate， ulcer area， ulcer depth， VAS score， transcutaneous partial pressure of oxygen， wound blood flow， CRP， IL-6， TNF-α， VEGF， TGF-β1， and FGF-β， the EPTG group was superior to the control group （P<0.01）. There were no statistically significant differences in adverse events and outcome events between the two groups. ConclusionThe TCM external therapeutic protocol of EPTG is safe and effective in the treatment of Wagner 2-3 diabetic foot ulcer. It can greatly reduce the area and depth of diabetic foot ulcer， improve the ulcer healing rate and TCM symptom score， relieve the pain of patients， and improve the microcirculatory blood supply in the local ulcer. Its mechanism of action may be related to the reduction of the local inflammatory response of the wound and the improvement of the proliferation of fibroblasts and vascular endothelial cells.

Characteristics and Microbiological Profile of Patients with Diabetic Foot Infections in Kuantan, Pahang

@#Introduction: The number of people suffering from diabetic foot infection (DFI) has increased precipitously over the years in Malaysia, owing to increased population, urbanisation, the surge of number of people with obesity and physical inactivity. As one of the most dreaded complications of diabetes mellitus, DFI is associated with high morbidity and mortality. We aim to study the microbiological profile of patients with DFI at a university hospital in Kuantan, Pahang. Materials and methods: This retrospective study was carried out at at Sultan Ahmad Shah Medical Centre @IIUM (SASMEC @IIUM) from 1 January 2018 to 30 April 2019. Patients’ demographic data, types of infection and surgical intervention, and the microbiological profile were obtained from the medical records. Results: A total of 142 causative pathogens were cultured from 130 tissue samples, with an average of 1.09 pathogens per lesion. Majority of the pathogens were gram-negative pathogens (52.8%). Staphylococcus sp. was the most common pathogen isolated (22.5%). This was followed by Streptococcus sp. (10.6%), Pseudomonas sp. (9.2%), Morganella sp. (5.6%), Klebsiella sp. (4.9%), Enterobacter sp. (4.9%), and others. Among the 142 pathogens, there were 9 multidrug-resistant strains observed. Most of the antibiotics were effective against the gram-positive pathogens except benzylpenicillin, tetracyclin, fusidic acid and ciprofloxacin. Meanwhile, cefotaxime, amoxicillin and ampicillin-sulbactam were also not suitable against gramnegative pathogens. Oxacillin and sulfamethoxazole/ trimethoprim can be used as empirical antibiotics against gram-positive pathogens, while vancomycin should be reserved for patients with septic shock or suspected multidrug resistant strain infection. Piperacillin/tazobactam and ceftazidime can be used as empirical antibiotics against gram-negative pathogens. Conclusion: Early initiation of empirical antibiotic(s) is paramount to stymie the infection from getting worse while waiting for the identification of causative pathogens in the management of DFI. This study provides a guide for treating physicians to initiate the most appropriate empirical antibiotic in DFI.

Recomendaciones de manejo del paciente con pie diabético. Curso de instrucción / Management recommendations for diabetic foot patients. Instructional course

El ataque de pie diabético es uno de los desenlaces más fatídicos para el paciente con diabetes, lo que demuestra la importancia del control en una enfermedad que avanza hasta presentar cambios macroscópicos importantes en el miembro inferior. Durante la progresión de la Diabetes, la enfermedad puede derivar en un aumento de la morbilidad e intervenciones invasivas y limitantes para el paciente, de ahí la importancia de la detección e intervención temprana y oportuna de la patología por parte del equipo médico. Estas recomendaciones van dirigida a médicos generales y especialistas en diversas ramas médicas, con el objetivo de enfatizar el cómo se debe realizar el abordaje integral del paciente con pie diabético. Abarcando la prevención, diagnóstico inicial, evaluación de la progresión de la patología, estratificación con las clasificaciones propuestas, y por último el tratamiento según el estadio en el que se encuentre el paciente. Esto con el fin de minimizar desenlaces, intervenciones y complicaciones derivadas de la progresión del pie diabetico. Hablamos de recomendaciones y no de guías debido a la ausencia en un gran número de oportunidades de evidencia científica debidamente estructurada (I y II). Tal vez lo más importante por recalcar en todas estas recomendaciones es recordarle al lector que en los casos de afectación de un pie diabético, siempre se debe tener en cuenta que el pie contralateral también ha estado sometido a la misma enfermedad durante el mismo tiempo y por lo tanto aunque no tenga síntomas se debe considerar igualmente enfermo y se debe examinar también.

Diabetic foot is one of the most fatal outcomes for patients with diabetes; the importance of control in a disease that progresses until presenting important macroscopic changes in the lower limb is absolutely relevant. Along diabetes progression, the disease can lead to increased morbidity and invasive and limiting interventions for the patient, hence the importance of early and timely detection and intervention of the pathology by the medical team. These recommendations are addressed to general practitioners and specialized faculty in various medical branches, emphasizing how a comprehensive approach to the patient with diabetic foot should be carried out. Covering prevention, initial diagnosis, evaluation of the progression of the pathology, stratification with the proposed classifications, and finally the treatment according to the stage in which the patients are, is actually well described herein in order to minimize unsatisfactory outcomes, interventions and complications derived from the progression of diabetic foot. We are talking about recommendations and not guidelines due to the absence in a large number of opportunities of properly structured scientific evidence (I and II). Perhaps, the most important thing to emphasize in all these recommendations is to remind the reader that in cases of treating a diabetic foot, it should always be kept in mind that the contralateral foot is not healthy because it has also been subjected to the same disease, for the same period of time and stressed equally as well. Therefore, even if the contralateral foot does not have symptoms, it should be considered equally ill and should be examined and treated likewise.

Management recommendations for diabetic foot patients. Instructional course / Recomendaciones de manejo del paciente con pie diabético. Curso de instrucción

Diabetic foot is one of the most fatal outcomes for patients with diabetes; the importance of control in a disease that progresses until presenting important macroscopic changes in the lower limb is absolutely relevant. Along diabetes progression, the disease can lead to increased morbidity and invasive and limiting interventions for the patient, hence the importance of early and timely detection and intervention of the pathology by the medical team. These recommendations are addressed to general practitioners and specialized faculty in various medical branches, emphasizing how a comprehensive approach to the patient with diabetic foot should be carried out. Covering prevention, initial diagnosis, evaluation of the progression of the pathology, stratification with the proposed classifications, and finally the treatment according to the stage in which the patients are, is actually well described herein in order to minimize unsatisfactory outcomes, interventions and complications derived from the progression of diabetic foot. We are talking about recommendations and not guidelines due to the absence in a large number of opportunities of properly structured scientific evidence (I and II). Perhaps, the most important thing to emphasize in all these recommendations is to remind the reader that in cases of treating a diabetic foot, it should always be kept in mind that the contralateral foot is not healthy because it has also been subjected to the same disease, for the same period of time and stressed equally as well. Therefore, even if the contralateral foot does not have symptoms, it should be considered equally ill and should be examined and treated likewise.

El ataque de pie diabético es uno de los desenlaces más fatídicos para el paciente con diabetes, lo que demuestra la importancia del control en una enfermedad que avanza hasta presentar cambios macroscópicos importantes en el miembro inferior. Durante la progresión de la Diabetes, la enfermedad puede derivar en un aumento de la morbilidad e intervenciones invasivas y limitantes para el paciente, de ahí la importancia de la detección e intervención temprana y oportuna de la patología por parte del equipo médico. Estas recomendaciones van dirigida a médicos generales y especialistas en diversas ramas médicas, con el objetivo de enfatizar el cómo se debe realizar el abordaje integral del paciente con pie diabético. Abarcando la prevención, diagnóstico inicial, evaluación de la progresión de la patología, estratificación con las clasificaciones propuestas, y por último el tratamiento según el estadio en el que se encuentre el paciente. Esto con el fin de minimizar desenlaces, intervenciones y complicaciones derivadas de la progresión del pie diabetico. Hablamos de recomendaciones y no de guías debido a la ausencia en un gran número de oportunidades de evidencia científica debidamente estructurada (I y II). Tal vez lo más importante por recalcar en todas estas recomendaciones es recordarle al lector que en los casos de afectación de un pie diabético, siempre se debe tener en cuenta que el pie contralateral también ha estado sometido a la misma enfermedad durante el mismo tiempo y por lo tanto aunque no tenga síntomas se debe considerar igualmente enfermo y se debe examinar también.

Chronic Nonhealing Ulcers ‒ Garhwal Region (Etiopathology, Microbiology with Susceptibility, Managements & Outcomes)

Introduction:Chronic nonhealing ulcers, with varied etio-pathologies, are difficult to manage and warrant meticulous, early and prolonged directed treatment to prevent their development and complications.Methods:Patients of chronic ulcers (>3 months’ duration), having undergone surgical management at our Institute, VCSGGMS&RI-UT, between January 2018 –August 2019, numbering one hundred twenty five (N= 125), were included in this concurrent observational study, aimed at identifying implicated microrganism(s) and their antibiotic susceptibility, for promoting wound healing, along with surgical measures Results:Male patients (M:F :: 87:38; 69.6% males) in the “20-50 year” age-group (74; 59.2%), with diabetic ulcers (35;28.0%), burns etc. (21;16.8%) and traumatic ulcers (18;14.4%) etc. predominated in the chronic non-healing state. Gram positive (68; 54.4%) organisms (including Staphylococcus) were the major isolates from the ulcers; organisms showing higher sensitivity to the newer generations/groups of antibiotics. Uncontrolled Diabetes, other prolonged illnesses &/or under-nutrition were important causative factors, requiring their remediations and also debridements ± skin/flap coverage (45; 36.0%) with prolonged course of antibiotics and occasional amputations (18; 14.4%) for adequate treatment.Conclusion:Skilled intensive multidisciplinary effort is essential to achieve satisfactory healing and prevent disfigurement and to limit disability and death (11; 8.8%) among the patients.

Effect of deuterium depleted water combined with platelet-rich plasma on wound healing of diabetic ulcer in rats / 上海交通大学学报（医学版）

Objective: To observe the effect of deuterium depleted water combined with platelet-rich plasma on wound healing of diabetic ulcer in rats, and to explore its possible mechanism. Methods: Male SD rats were randomly divided into two groups, normal control group (group A, n=20) and diabetic group (n=80). Rats in the diabetic group were fed with high-fat diet for 4 weeks, and the rat diabetic ulcer model was replicated by intraperitoneal injection of streptozotocin (STZ) + skin full-thickness resection; then randomly divided into diabetic model group (group B), platelet-rich plasma group (group C), deuterium depleted water group (group D), and deuterium depleted water combined platelet-rich plasma group (group E), with 18 rats for each group. Group A with common feed was fed for 4 weeks after intraperitoneal injection of an equal volume of citric acid-sodium citrate buffer + skin full-thickness resection to replicate the normal ulcer model. The animals were sacrificed after treatment for 3, 7 and 14 d, and the random blood glucose was measured at each corresponding time point. The wound surface and wound margin tissue were taken to observe the wound healing and local histomorphology of each group. The contents of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in the wound tissue of each group were detected by enzyme-linked reaction adsorption method. Results: Random blood glucose in group D and group E was lower than that before intervention. The inflammatory response of the wounds in each diabetic group was slower than that in group A. The granulation ripening effect of group E was faster than that of group B, C, and D. The effect was best in each intervention group, and the neovascularization and fibroblasts appeared earlier and in large quantities. The content of TIMP-1 in group A was significantly higher than that in group B, C, D and E (P<0.05). The content of TIMP-1 in group B was significantly lower than that in group C, D and E (P<0.05). The content of TIMP-1 was significantly higher than that of group C and D (P<0.05). The content of MMP-9 in group B was significantly higher than that in group A, C, D and E (P<0.05). The content of MMP-9 in group E was significantly lower than that in group C and D (P<0.05). Conclusion: Deuterium depleted water can promote the healing of diabetic ulcer wounds. Deuterium depleted water combined with platelet-rich plasma can significantly promote the healing of diabetic ulcer wounds, which may be related to the decrease of random blood glucose, the increase of TIMP-1 and the inhibition of MMP-9 expression.

A Comparative Clinical Study On Application Of Yashada Bhasma Lepa And Jatyadi Ghrita In The Management Of Dushta Vrana W.s.r. Diabetic Ulcer

Introduction: Wounds and their management are fundamental to the practice of surgery. In surgery of trauma, wound is frequently a primary pathology. In elective surgery, it is through the wound that access is obtained to deal with the underlying pathology. In both situations surgeon’s task is to minimize the adverse effects of wound, remove or repair damaged structures and harness the process of wound healing to restore function. Objectives: The study is aimed to know the comparative efficacy of Yashada Bhasma Lepa and Jatyadi Ghrita in the management of Dushta Vrana. Method: Clinically diagnosed 30 patients of Dushta Vrana were randomly divided into two groups, each group consisting of 15 Patients. First (A group) is treated by Yashada Bhasma Lepa and second (B group) is treated by Jatyadi Ghrita for 21 days. Result: On the basis of assessment criteria and on the overall result of treatment the patients of Yashada Bhasma Lepa group showed better relief when compared to Jatyadi Ghrita. Interpretation: Yashada Bhasma Lepa having the properties of Tikta, Kashaya, Katu, Rasa predominance thus had action of Kapha Pitta Shamana, Netra Roga, Pandu, Bahumootra Roga, Kasa, Swasa, Rajayakshma, Ratrisweda, Vranasrava Avarodaka,Prameha, Sankochakara.etc. Thus this help for Shodhanaand Ropana. Conclusion: Yashada Bhasma Lepa has provided better relief in maximum signs and symptoms of the patients of Dushta Vrana, in comparison to Jatyadi Ghrita. Its overall effects were also better in comparison to Yashada Bhasma Lepawith Jatyadi Ghrita and dressing reduces the infection.

Antimicrobial Efficacy of Penicillium amestolkiae elv609 Extract Treated Cotton Fabric for Diabetic Wound Care

Diabetes mellitus is a chronic disorder which affects millions of population worldwide. Global estimates published in 2010 reported the world diabetic prevalence as 6.4%, affecting 285 million adults. Foot ulceration and wound infection are major forms of disabilities arising from diabetic diseases. This study was aimed to develop a natural antimicrobial finishing on medical grade textile that meets American Association of Textiles Chemists and Colorists (AATCC) standard. The textile samples were finished with the ethanolic extract of Penicillium amestolkiae elv609, an endophytic fungus isolated from Orthosiphon stamineus Benth (common name: cat's whiskers). Endophyte is defined as microorganism that reside in the living plant tissue, without causing apparent disease symptom to the host. The antimicrobial efficacy of the ethanolic extract of P. minioluteum was tested on clinical pathogens isolated from diabetic wound. The extract exhibited significant inhibitory activity against 4 bacteria and 1 yeast with the minimal inhibitory concentration ranged from 6.25 to 12.5 mg/mL. The results indicate different susceptibility levels of the test microorganism to the ethanolic extract. However, the killing activity of the extract was concentration-dependent. The finished medical textile showed excellent antimicrobial efficacy on AATCC test assays. All the microbial cultures treated with the textile sample displayed a growth reduction of 99.9% on Hoheinstein Challenge Test. The wash durability of the finished textile was found good even after 50 washes with commercial detergent. Besides, the gas chromatography mass spectrometry analysis showed that 6-octadecenoic acid and diethyl phthalate were the main bioactive constituents of the extract. In conclusion, the developed medical textile showed good antimicrobial efficacy on laboratory tests. This work can be extended to in vivo trials for developing healthcare textile products for antimicrobial applications.

Effect of recombined human epidermal growth factor combined with alprostadil on Wnt/β-catenin signal pathway in rats with diabetic ulcer / 中国糖尿病杂志

Objective To explore the effect of recombined Human epidermal growth factor (rhEG) combined with alprostadilon Wnt/β-Catenin signal pathway in rats with diabetic ulcer. Methods Rats with diabetic ulcer were randomly divided into four groups :control group ,rhEG group ,epidermal group and combined treatment group. Ulcer skin was smeared by normalsaline in control group ,and by rhEG in rhEG group. Epidermal was administered from caudal vein in epidermal group.Combined treatment group was treated by rhEG and epidermal at the same time. The healing status were observed. The proteinand mRNA expression of Wnt-1 ,β-Catenin and GSK-3β were measured 14 days after treatment. Results The healing rates in combined treatment group were (9.76 ± 2.37 )% ,(35.74 ± 3.65 )% ,(51.37 ± 4.16)% and (84.42 ± 5.35 )% respectivelyin 6th , 10th and 14th day after treatment , which were significantly higher than in rhEG group and epidermal group (P<0.05). The mRNA levels of Wnt-1 ,β-Catenin and GSK-3βin combined treatment group were (1.42 ± 0.19) ,(1.56 ± 0.21) and (0.95 ± 0.15) after treatment for 14 days ,which were significantly higher than in rhEG group and epidermal group (P<0.05). Protein levels of Wnt-1 ,β-Catenin and GSK-3βin combined treatment group were (1.17 ± 0.16) , (1.38 ± 0.18 ) and (0.81 ± 0.13 ) after treatment for 14 days ,which were significantly higher than in rhEG group and epidermal group ( P < 0.05 ). Conclusion rhEG combined with epidermal can significantly accelerate the healing of diabetic ulcer ,and can regulatethe Wnt/β-Catenin signal pathway by increasing the expression of Wnt-1 ,β-Catenin and GSK-3β.

Surgical treatment of diabetic leg ulcer / 中华内分泌外科杂志

Objective To investigate the effect of staging treatment for diabetic leg ulcer by vacuum sealing drainage surgery (VSD) combined with perforator flap.Methods From Aug.2013 to Aug.2015,21 patients (in glycemic stability) with diabetic leg ulcer received the sustained VSD suction after a thorough debridement at the first phase and used perforator flap to repair the wound at second phase.Results After a thorough debridement and the sustained VSD suction,all the wounds were repaired with perforator flaps at the second phase.Postoperative flaps of 19 cases survived completely.Postoperative flaps of 2 cases appeared 1/4-1/5 area necrosis of distal flap and healed well after clear debridement.All patients were followed up in glycemic stability and all the flaps survived well without complications such as osteomyelitis and soft tissue infection.Conclusion Based on glycemic stability,VSD combined perforator flap in treatment of diabetic leg ulcers can control the infection and wound closure,which is worthy of clinical application and promotion.

Effects of Qizhi Jiangtang capsule on dermal ulcer in type 2 diabetic rats / 中国中药杂志

The effect of Qizhi Jiangtang vapsule (QJC) on degree of dermal ulcer cicatrization in 2 type diabetic rats was studied. Except the rats for blank group, other male Wistar rats were used to establish type 2 diabetic model by feeding with high sugar and high fat diet for four weeks and intraperitonally injecting with 30 mg•kg⁻¹ streptozotocin (STZ). After that, the rats were divided into balanced groups according to blood sugar, and received corresponding drugs for treatment for 8 weeks. At the end of week 8, 2 cm diameter circular incision was done on the back of rats. After that, the rats were administered continuously for10 days. Area of ulcer surface was detected every two days. After the last administration, wound granulation tissues were cut down to conduct pathological examination and detect the expression of VEGF, PI3K, p-ERK protein in wound tissues. The results showed that compared with the model group, after application of Qizhi Jiangtang capsule (2.24 g•kg⁻¹), the wound was significantly reduced on day 6 and day 10 of wound formation; inflammation reaction on ulcer surface was significantly reduce; Qizhi Jiangtang capsule can increase VEGF expression in the wound tissues of diabetic rats, and inhibit ERK phosphorylation. It can be concluded that Qizhi Jiangtang capsule can promote skin ulcer healing for diabetes rats, and its mechanism may be related to regulating the expression of VEGA and p-ERK proteins.

Study of diabetic ulcer with surgical complications of diabetes, their outcome and management modalities in 72 cases studied in Navi Mumbai.

Background: Diabetes and its long term major complications include septic, vascular (either micro vascular or macro vascular) and neuropathic lesions which affect the various anatomical regions of the body. Majority of admissions to surgical wards is due to these surgical complications of diabetes. So this is a study of these surgical complications of diabetes, their outcome and management modalities. Methods: This “Clinical study of surgical complications of diabetes” consists of a study of minimum of 50 or more cases admitted to surgical wards of Dr. D Y Patil hospital & research centre, from June 2010 to Oct 2012. A series of 72 cases were compiled for this study during this period. This study is to know more about the mode of presentation, clinical features and outcome of management of surgical complication of diabetes mellitus. Results: In present study, 30 cases were conservatively managed with meticulous debridement. 13 cases underwent incision & drainage and came for regular follow-up. 10 cases underwent disarticulation of toes. Four patients underwent below knee amputations whereas 8 patients underwent above knee amputations and 7 patients needed split skin grafting for covering of raw area. Conclusions: Patients on irregular medication usually from age group 51-60 majorly male who undergo trauma (lower limb >>upper limb) are prone to diabetic ulcer complication. Mortality in these patients is due to complications. Conservative management is the mainstay of this condition followed by I & D and finally amputation.

Expression changes of Wnt/β-catenin signaling pathway in diabetic ulcer / 中国病理生理杂志

AIM:To observe the effect of Wnt/β-catenin signaling pathway on diabetic ulcer.METHODS:Diabetic animal model was established in the female Wistar rats by intraperitoneal injection of low-dose streptozotocin fol-lowing high-fat diet feeding.A circular wound was made on the dorsum of the rats in both control group and diabetic group. The condition of wound healing was recorded and the structures of the wound tissues were observed by HE staining in the 2 groups at 3, 7 and 14 d after wounding.The expression ofβ-catenin, GSK-3βand Rspo-3 at mRNA and protein levels in the wound tissues was detected by RT-PCR and ELISA.RESULTS:In diabetic group, the wound healing rate was lower (P<0.05), and the inflammatory cells, fibroblast cells and new capillaries in the wound tissues were fewer than those in control group.The expression of β-catenin and Rspo-3 at mRNA and protein levels in the wound tissues in control group was significantly higher than those in diabetic group, and the expression of GSK-3βwas exactly the opposite (P<0.05). CONCLUSION:The down-regulation of Wnt/β-catenin probably resultes from the decreased level of Rspo-3, which may be one of the reasons for delaying the diabetic ulcer healing.

Effects of embryonic fibroblasts on the aging-related phenotypes and dysfunction of diabetic ulcer fibro-blasts / 中华内分泌外科杂志

Objective To observe the effects of human embryonic fibroblasts ( FBs ) on the biological characteristics of diabetic FBs in vitro , and to explore the possible therapeutic mechanism on diabetic ulcers . Methods Diabetic FBs were isolated and cultured with embryonic FBs (experimental group), adult FBs(control group 1)and alone(control group 2)in transwell chambers.Diabetic FBs growth curves in the coculture systems were described.The cell shape was observed by microscopy with HE staining .On the 4th and 7th day of cocul-ture, diabetic FBs were isolated to measure the expression levels of hydroxyproline and transforming growth factor -beta 1(TGF-β1)in the supernatant of monoculture .The cell senescense was displayed by β-galactosidase histo-chemical staining on the 3th, 5th and 7th day of coculture.Eight patients with diabetic foot ulcers who were can-didates for embryonic FBs constructs after failed traditional treatment were included in the study .The pre and post self-control study was conducted by observing the wound healing process before and after embryonic FBs treat -ment.Results Diabetic FBs in the experimental coculture system displayed more typical pattern and faster grow -ing rate.The level of hydroxyproline and TGF-β1 in the supernatant of diabetic FBs monoculture was significantly higher in the experimental group than in the control group after treated 4 or 7 days ( hydroxyproline:4 d, 7 d :compared with control group 1:P=0.023,P=0.007;compared with control group 2: P=0.007, P=0.003;TGF-β1 4 d, 7 d:compared with control group 1:P=0.000, P=0.000;compared with control group 2: P=0.000, P=0.000).The expression of SA-β-gal tended to be more apparent in control group 1 and 2 than in the experimental group on the 3rd,5th,and 7th day.All of the 8 cases with diabetic ulcers were cured by using em-bryonic FBs constructs .Conclusion Embryonic FBs can promote the proliferation of diabetic FBs , correct cell senescence and increase the production of hydroxyproline and TGF-β1,which maybe enhance the process of dia-betic wound healing .

Analysis of bacterial spectrum in diabetes ulcer / 中华内分泌外科杂志

Objective To evaluate the features of bacterial spectrum and drug resistance in diabetic ulcer.Methods Excretion specimen of diabetic ulcer from 130 patients admitted into our hospital from Mar.2010 to Sep.2011 were collected for bacterial culture and drug sensitivity test.28 antibiotics were chosen from 35commonly used antibiotics to test antibiotic sensitivity to decide whether the antibiotic was sensitive (S),intermediate sensitive (I),or resistant (R).Results 19 strains were isolated from 130 cases.Staphylococcus aureus with 14.62 ％ (19 cases)rated the first,followed by escherichia coli with 13.85％ (18 cases),proteus mirabilis with 13.08％ (17 cases),staphylococcus epidermidis with 12.31％ (16 cases),enterococcus faecalis with 12.31％ (16 cases),acinetobacter baumannii with 10.77％ (14 cases).Antibiotics with high sensitivity to Gram-positive bacteria were tigecycline and vancomycin while with high sensitivity to Gram-negative bacteria were imipenem and amikacin.Conclusions Bacteria of diabetic ulcer are commonly resistant to antibiotics.It is of great importance for clinical rational drug use to know the distribution and resistance of commonly encountered bacteria.

Lateral Arm Free Flap for Small Sized Diabetic Foot Ulcer around Toes

The purpose of this study was to present the clinical analysis of the results of lateral arm free flap for small sized and infected diabetic foot ulcer around toes. From May 2006 to December 2007, Seven patients were included in our study. Average age was 52.8 years, six were males and one was female. All had infected diabetic foot ulcer and had exposures of bone or tendon structures. Ulcers were located around great toe in four patients, 4th toe in one and 5th toe in two. Three patients had osteomyelitis of metatarsal or phalanx. After appropriate control of infection by serial wound debridement and intravenous antibiotics, lateral arm flap was applied to cover remained soft tissue defects. Posterior radial collateral artery of lateral arm flap was reanastomosed to dorsalis pedis artery of recipient foot by end to side technique in all cases in order to preserve already compromised artery of diabetic foot. All flaps were designed over lateral epicondyle to get longer pedicle and averaged pedicle length was 8 cm. Two cases were used as a sensate flap to achieve protective sensation of foot. All flaps survived and provided satisfactory coverage of soft tissue defects on diabetc foot ulcers. All patients could achieve full weight-bearing ambulation. No patients has had recurrence of infection, ulceration and further toe amputations. There were three complications, a delayed wound healing of flap with surrounding tissue, a partial peripheral loss of flap and a numbness of forearm below donor site. All patients were satisfied with their clinical results, especially preserving their toes and could return to the previous activity levels. Lateral arm free flap could be recommend for infected diabetic foot ulcers around toes, to preserve toes, coverage of soft tissue defect and control of infection with low donor site morbidity.

Case Reports of Diabetic Foot Successfully Treated with Kigi-kenchu-to with Additional Ingredients / 日本東洋医学雑誌

We report on three patients suffering from diabetic foot successfully treated with. Kigi-kenchu-to with additional ingredients.<br>Case 1 was a 68-year-old female with diabetes mellitus and rheumatoid arthritis The bilateral foot sole ulcers present were diagnosed as diabetic gangrene. Her condition had not improved, in spite of Western medical treatment. The ulcers of bilateral foot improved, however, after administration of Kigi-kenchu-to-ka-bushi, while rheumatoid indices also became negative.<br>Case 2 was a 66-year-old male with diabetes mellitus and a history of subarachnoidal hemorrhage. Kigi-kenchu-to-ka-bushi medication, in this instance, caused recurring ulcers of the big toe to disappear.<br>Case 3 was a 72-year-old male. Gangrene of bilateral toes set in, during treatment of diabetic nephropathy. And even though the toes were amputated, recovery was delayed because of poor blood flow to the feet. After administration of Kigi-kenchu-to-ka-hanbi, granulation formation progressed and the patient's outlook improved.<br>We consider that Kigi-kenchu-to, with additional ingredients, may serve as an effective cure for diabetic foot.

Reconstruction of Diabetic Foot Ulcers by Regional Flap Surgery / 대한정형외과학회잡지

PURPOSE: The purpose of this study was to evaluate the value of regional flap surgery for diabetic foot ulcers combined with infection or bone and tendon exposure. MATERIALS AND METHODS: We reviewed eight patients, nine cases of diabetic foot ulcers, which were treated by regional flap surgery. There were two Wagner's grade 2 ulcers and six Wagner's grade 3 ulcers. We performed four reversed sural artery neurocutaneous flaps, two lateral supramalleolar flaps, two medial plantar artery flaps and one first dorsal metatarsal artery flap. RESULTS: Seven of nine flaps completely survived after regional flap surgery. One partial and one complete flap necrosis occurred. One partially necrotized flap needed an additional skin graft. One completely necrotized flap needed free rectus abdominis myocutaneous flap surgery. There were two new ulcers, which were treated by free flap surgery. No patient needed amputation above the ankle joint. CONCLUSION: Satisfactory results were obtained by regional flap surgery for diabetic foot ulcers. Regional flap surgery is regarded as an effective treatment modality for diabetic foot ulcer combined with bone and tendon exposure with infection.

Hyperbaric Oxygen Therapy In Orthopaedic Surgery / 대한정형외과학회잡지

Hyperbaric oxygen therapy (HBO), which in Korea is used chiefly for CO poisoning, can be used in many disorders in orthopaedic field through the action of increasing oxygen tension of peripheral tissue, Since June 1986, when the multiplace hyperbaric chamber was built in our hospital, we have experienced 197 cases of HBO in orthopaedic field and we are to analyze the result of treatment and suggest reasonable indications. The outline of results are as follows ;1. Crushing injuries and wounds caused or accompanied by circulatory disturbance were most frequent among the 197 cases we've experienced, and received 17.5 times of HBO on average. 2. Discernible effectiveness was found in split thickness skin graft, diabetic ulcer and Buerger's disease as compared to the control group. 3. Otalgia was the most common side effect, but not severe. 4. From the above results, it is thought that HBO has fair range of indications in orthopaedic field and is worth using as an adjuvant means to surgery.