Angiopathic Mechanisms on Diabetic Delayed Healing Wounds:Impact and Advances in Therapeutic Agents / 医药导报

The prevalence of diabetes mellitus in China has recently been increasing year by year,and spontaneous skin ulcers in diabetic patients,as one of the most serious complications,often develop on the patient's extremities represented by foot ulcers.Due to the complexity and variety of its pathogenesis,it leads to poor clinical outcomes and difficulty in healing.Thus,pa-tients often face the risk of amputation and death.Therefore,the exploration of mechanisms of the vascular pathogenesis of diabetic delayed-healing wounds and targeted screening of therapeutic agents has become a current research hotspot.Herein,in this paper,we briefly review the role of impaired angiogenesis and vascular dysfunction in diabetic skin ulcers,and the research progress of classical hypoglycemic and natural compounds against vascular lesions is preliminarily summarized to provide a theoretical basis for effective clinical treatment.

The value of fibroblast growth factor 2 and microRNA-206 in predicting postoperative delayed union of closed tibial shaft fractures / 中国基层医药

Objective:To investigate the value of fibroblast growth factor 2 (FGF-2) and microRNA-206 (miR-206) in predicting postoperative delayed union of closed tibial shaft fractures.Methods:The clinical data of 136 patients who underwent closed tibial shaft fracture surgery in Hospital of the 80 th Group Army of Chinese People's Liberation Army Ground Forces from May 2018 to May 2021 were retrospectively analyzed. Eighty-six patients who had delayed union of closed tibial shaft fractures were included in the observation group, and fifty patients who had normal union of closed tibial shaft fractures were included in the control group. Serum FGF-2 level was measured using the enzyme-linked immunosorbent assay, and serum miR-206 expression was detected using the real-time fluorescence polymerase chain reaction. The relationship between FGF-2 expression and miR-206 expression and closed tibial shaft fractures was analyzed. Results:At 1 day, 1, and 4 weeks after surgery, serum FGF-2 level was significantly lower in the observation group than the control group [(14.24 ± 2.15) ng/L vs. (20.36 ± 3.42) ng/L, (21.38 ± 3.27) ng/L vs. (30.45 ± 4.29) ng/L, (23.59 ± 4.36) ng/L vs. (36.67 ± 4.51) ng/L, t = 7.42, 8.42, 16.66, all P < 0.001]. Serum FGF-2 level gradually increased with time in each group. At 1 day after surgery, serum miR-206 expression was significantly lower in the observation group than the control group ( t = 7.50, P < 0.001). At 4 weeks after surgery, serum miR-206 expression was significantly higher in the observation group than the control group ( t = 17.24, P < 0.001). At 1 week after surgery, there was no significant difference in serum miR-206 expression between the two groups ( P > 0.05). Univariate analysis results showed that postoperative infection, FGF-2, and miR-206 were closely related to the delayed union of closed tibial shaft fractures after surgery (all P < 0.05). Multivariate logistic regression analysis results showed that postoperative infection ( OR = 1.93, 95% CI: 1.20-3.07), FGF-2 ( OR = 2.10, 95% CI: 1.31-3.36), miR-206 ( OR = 2.30, 95% CI: 1.35-3.89) were independent risk factors for delayed union of closed tibial shaft fractures after surgery (all P < 0.05). The receiver operating characteristic (ROC) curves plotting serum FGF-2 level and serum miR-206 expression after closed tibial shaft fractures showed that at 4 weeks after surgery, the optimal cut-off value of FGF-2 for predicting delayed union of closed tibial shaft fractures was 29.83 ng/L, with the area under the curve, sensitivity, and specificity of 0.76 (95% CI: 1.23-3.25), 79.34%, and 68.82%, respectively; at 4 weeks after surgery, the optimal cut-off value of miR-206 for predicting delayed union of closed tibial shaft fractures was 0.63, with the area under the curve, sensitivity and specificity of 0.72 (95% CI: 1.10-2.45), 75.33%, and 67.25%, respectively. The area under the curve, the sensitivity, and specificity of combined use of FGF-2 and miR-206 in predicting delayed union of closed tibial shaft fractures were 0.81 (95% CI: 1.35-3.26), sensitivity and specificity were 83.45% and 67.36% respectively. Conclusion:The decrease in serum FGF-2 level and the increase in serum miR-206 expression at 4 weeks after surgery are independent risk factors for delayed union of closed tibial shaft fractures. Combined use of FGF-2 and miR-206 can better predict the delayed union of closed tibial shaft fractures.

Percutaneous piercing cortical bone at fracture ends and local injection of autologous concentrated bone marrow aspirate and platelet rich plasma for treatment of delayed fracture union / 中华创伤骨科杂志

Objective To evaluate the clinical efficacy of percutaneous piercing cortical bone at fracture ends and local injection of autologous concentrated bone marrow aspirate (cBMA) and platelet rich plasma (PRP) in the treatment of delayed fracture union.Methods A retrospective study was performed on the clinical data of 34 patients with delayed fracture union who had been treated at Department of Orthopaedics,Luoyang Zhenggu Hospital of Henan Province from April 2014 to February 2017.They were 26 males 8 females,aged from 18 to 63 years (average,36.7 years).There were 15 femoral,11 tibial,5 humerus and 3 ulnar fractures.According to the Weber-Crech classification,14 cases belonged to the type of rich blood supply-active end hypertrophy and 20 to the type of poor blood supply and malnutrition.There were 28 closed and 6 open fractures.Of this cohort,21 cases had their primary fixation,7 had revision once,4 had revision twice,and 2 had revision more than thrice;19 cases had intramedullary fixation,12 had plate fixation and 3 had external fixation.Autologous iliac bone grafting was performed previously in 19 cases.Kirschner wire was used under fluoroscopy to pierce percutaneously the cortical bone at fracture ends;bone marrow blood and peripheral venous blood were collected to prepare autologous cBMA and PRP which were to be injected locally at the fracture ends after mixture.At the last follow-up,the patients were evaluated by visual analogue scale (VAS),SF-36 health survey summary scores and modified Radiographic Union Score for Tibia (RUST).Results The patients were followed up for 12 to 42 months (average,21.5 months).Thirty-one patients healed after surgery,yielding a healing rate of 91.2％.The healing time averaged 5.3 months (from 4 to 10 months).No patient reported such complications as infection or neurovascular injury.At the last follow-up,the VAS scores of the 34 patients were 1.3 ± 0.6 points,significantly lower than the preoperative 5.4 ± 3.6 points (P ＜ 0.05);the postoperative SF-36 scores 74.8 ± 16.5 points,significantly increased than the preoperative 44.8 ± 15.6 scores (P ＜ 0.05);the RUST scores 3.3 ± 0.4 points,significantly higher than the preoperative 1.6 ± 0.8 points (P ＜ 0.05).Conclusions Minimally invasive percutaneous piercing of K-wire on the cortical bone at the fracture ends may result in fluid leakage and restart bone healing process.At the same time,local injection of autologous cBMA and PRP may increase the number and concentration of local bone marrow mesenchymal stem cells and growth factors,promoting fracture healing.

SERIAL OSTEORADIONECROSIS ON BOTH SIDES OF MANDIBLE: A CASE REPORT

Delayed Healing and Reason Analysis of Obstetric Abdomen Vertical Cut and Preventive Nursing Countermeasure / 中华医院感染学杂志

OBJECTIVE To analyze the reason for delayed healing of obstetric abdomen vertical cut and discuss the preventive nursing countermeasure.METHODS The discharged cases during Jul 2005 Jun 2006 and the inpatient cases during Jul 2006 to Jun 2007 were observed and monitored and at the same time the preventive nursing countermeasure was provided and the statistic of clinic material of two years was analyzed.RESULTS A satisfying effect has been made by taking objective monitoring and preventive nursing countermeasure the rate of delayed healing of obstetric abdomen vertical cut been reduced from the original 2.75% to the current 0.93%.CONCLUSIONS The key to prevent the delayed healing of obstetric abdomen vertical cut is prevention.Taking objective monitoring and preventive nursing countermeasure play an importment role in promoting healing of obstetric abdomen vrtical cut.