Efficacy of Biomechanics-based Decompression Therapy in Managing Recurrent Diabetic Plantar Ulcers.

OBJECTIVE: The objective of this study is to assess the efficacy of decompression nursing based on biomechanical principles in managing recurrent diabetic plantar ulcers. METHODS: Sixty-seven patients experiencing recurrent diabetic plantar ulcers who sought medical attention at Huadong Hospital Affiliated to Fudan University between January 2021 and December 2022 were selected as participants for this study. The participants underwent biomechanics-based decompression nursing. We compared pre-intervention and post-intervention data to assess the differences in relevant observational indexes. RESULTS: Post-intervention, patients showed significant improvements in foot comfort scores and adherence to pressure reduction behavior compared with their pre-intervention status, with statistical significance (P < 0.05). The intervention was effective in 41 cases (61.19%), with 18 cases (26.87%) showing improvement and 8 cases (11.94%) deemed ineffective, culminating in an overall efficacy rate of 88.06%. All 67 patients achieved complete ulcer healing within an average duration of 58.63 ± 18.13 days, without any recorded recurrences. CONCLUSION: Biomechanics-based decompression nursing demonstrates effective facilitation of wound healing, yielding expeditious recovery, enhanced comfort, and a reduced incidence of recurrence.

Survey of factors related to diabetic foot pruritus in the elderly in Shanghai.

The objective of the study is to explore the status quo of foot pruritus and related factors in elderly diabetics and provide a reference for targeted preventive measures. The study involved a survey using a self-designed foot pruritus assessment scale to understand the status quo of foot pruritus among 411 cases of elderly diabetics from 5 communities in Shanghai. The morbidity rate of foot pruritus in elderly diabetics in the community was 20.1%. Good self-management behaviour was the protective factor, while diabetic peripheral neuropathy, hyperlipidemia, and dry skin were risk factors (all P < 0.05). The incidence of foot pruritus in elderly diabetics was high and influenced by several factors. We recommend that self-management behaviour of patients be improved. Additionally, screening and interventions to address hyperlipidemia, diabetic peripheral neuropathy, and dry skin should be conducted regularly to prevent diabetic foot ulcers.

Histone deacetylase 6 promotes skin wound healing by regulating fibroblast migration and differentiation in aged mice.

Skin wound healing tends to slow down with aging, which is detrimental to both minor wound recovery in daily life and the recovery after surgery. The aim of current study was to explore the effect of histone deacetylase 6 (HDAC6) on wound healing during aging. Cultured human dermal fibroblasts (HDFs) and mouse full-thickness skin wound model were used to explore the functional changes of replicative senescent dermal fibroblasts and the effect of aging on skin wound healing. Scratch wound healing assay revealed significantly decreased migration speed of senescent HDFs, and BrdU incorporation assay indicated their considerably retardant proliferation. The protein expression levels of collagen and HDAC6 were significantly decreased in both senescent HDFs and skin tissues from aged mice. HDAC6 activity inhibition with highly selective inhibitor tubastatin A (TsA) or HDAC6 knockdown with siRNA decreased the migration speed of HDFs and considerably suppressed fibroblast differentiation induced by transforming growth factor-ß1 (TGF-ß1), which suggests the involvement of HDAC6 in regulating fundamental physiological activities of dermal fibroblasts. In vivo full-thickness skin wound healing was significantly delayed in young HDAC6 knockout mice when compared with young wild type mice. In addition, the wound healing was significantly slower in aged wild type mice than that in young wild type mice, and became even worse in aged HDAC6 knockout aged mice. Compared to the aged wild type mice, aged HDAC6 knockout mice exhibited delayed angiogenesis, reduced collagen synthesis, and decreased collagen deposition in skin wounds. Together, these results suggest that delayed skin wound healing in aged mice is associated with impaired fibroblast function. Adequate expression and activity of HDAC6 are required for fibroblasts migration and differentiation.

Impact of lower limb muscle strength on walking function beyond aging and diabetes.

OBJECTIVE: This study was performed to investigate the influence of lower limb muscle strength on the walking function of advanced-age patients with diabetes. METHODS: In this cross-sectional descriptive study, data were collected from 202 advanced-age patients with diabetes. All patients completed questionnaires, the one-leg stance test, the timed up-and-go test, the 30-s sit-to-stand test, and plantar pressure platform measurements. The patients were divided in two groups according to their lower limb muscle strength: those with declining muscle strength and those with normal muscle strength. RESULTS: Walking function was significantly abnormal in the patients with declining lower limb muscle strength. The gait trajectories were abnormal, mainly with respect to a shortage of driving force. CONCLUSION: The lower limb muscle strength can affect the static balance and dynamic balance in advanced-age patients with declining lower limb muscle strength.

Investigation and analysis of lower extremity arterial disease in hospitalized elderly type 2 diabetic patients.

BACKGROUND: The risk of lower extremity arterial disease (LEAD) is increased in diabetic patients. LEAD in diabetic patients occurs earlier and is often more severe and diffuse; however, it is largely underdiagnosed and untreated. The purposes of this study were to investigate and analyze LEAD situation of hospitalized elderly type 2 diabetic patients. METHODS: The ankle-brachial index (ABI) was used to screen LEAD in hospitalized elderly type 2 diabetic patients. The patients were divided into 5 groups based on the screening results: non-LEAD group and LEAD group; the LEAD group was divided into mild stenosis group, moderate stenosis group, and severe stenosis group. RESULTS: The percentage of patients who had LEAD was 43%. Significant difference in age, diabetes duration, peak velocity, microalbuminuria, and vibratory sensory neuropathy was observed between patients with and without LEAD; regression analysis showed that urinary albumin and vibratory sensory neuropathy were independent risk factors for LEAD. Significant difference in age, body mass index (BMI), peak velocity, urinary albumin, and high-density lipoprotein cholesterol (HDL-C) was observed between mild stenosis group, moderate stenosis group, and severe stenosis group; regression analysis showed that urinary albumin, BMI, and HDL-C were independent risk factors for accelerating vascular stenosis. CONCLUSIONS: The incidence of LEAD in hospitalized elderly type 2 diabetic patients is high; age, diabetes duration, peak velocity, BMI, urinary microalbumin, vibratory sensory neuropathy, and HDL-C are the major risk factors for LEAD. Active control of risk factors is helpful to reduce or delay LEAD.

[Quantitative and qualitative analysis of total bacteria and ammonia-oxidizing bacteria in Buji River in wet season].

Microbial community structure and biomass in river water can reflect the situation of water quality in some extent. Nitrogen removal was mainly achieved by the nitrification and denitrification processes, and ammonia oxidation catalyzed by ammonia-oxidizing bacteria (AOB) is the first and rate-limiting step of nitrification. To explore the AOB community structure and biomass in nitrogen polluted river, water samples were collected from Buji River (Shenzhen) in wet season. Quantification of 16S rRNA copy numbers of total bacteria and AOB were performed by real-time PCR, and the microbial community structures were studied by denaturing gradient gel electrophoresis (DGGE). The results showed that the number of total bacterial 16S rRNA changed from 4.73 x 10(10) - 3.90 x 10(11) copies x L(-1) in the water samples. The copy numbers of AOB varied from 5.44 x 10(6) - 5.96 x 10(8)copies x L(-1). Redundancy discrimination analysis (RDA) showed that the main factors affecting the structure and the numbers of bacteria were different. For total bacteria, nitrate influenced the biomass significantly (P < 0.05) while nitrogen and heavy metals (Mn and Zn) were the main factors affecting the microbial community structures (P < 0.05). For AOB, ammonia and Zn were the main factors influencing the biomass while ammonia nitrogen and heavy metals (Mn and Zn) were the main factors affecting the microbial community structures. 16S rDNA sequences from the water samples indicated that the bacteria generally belonged to Epsilon-Proteobacteria, Gamma-Proteobacteria, Beta-Proteobacteria, and Delta-Proteobacteria. Nitrosomonas sp. and Nitrosospira sp. were the main AOB. Cluster analysis showed that water pollution in downstream resulted in evident difference in microbial community structure between upstream and downstream water samples.