Most postoperative reserved "normal" metatarsal stumps of diabetic foot osteomyelitis are infected but have healing potential.

Background: Although the pathology and bacterial status of the "normal" bone stump after operation of diabetic foot osteomyelitis (DFO) are of great significance for the prognosis of foot wounds, there are only a few studies on this topic; hence, it is clinically relevant and urgent to study this topic. Methods: The data of 57 inpatients with DFO from June 2021 to April 2022 were collected, all of whom had DFO in the forefoot and underwent conservative surgery. After the surgical removal of necrotic bone, bone biopsies were taken from the necrotic phalangeal bone and the reserved "normal" metatarsal stump. They were cultured, after which antibiotic susceptibility test and pathological screening were carried out. According to clinical judgment, inpatients' wounds were divided into metatarsal affected group and metatarsal unaffected group. We then compared and analyzed the pathological and bacterial characteristics of preserved "normal" bone stump and its effect on wound healing and prognosis. Results: The poor concordance rate between deep soft tissue culture and infected phalange culture was only 19.3%. The deep soft tissue (72.6%), infected phalange (70.7%), and metatarsal stump (71.4%) were mainly infected with gram-negative Bacillus. The proportion of Enterococcus spp. increased significantly in bone tissue. Acinetobacter baumannii had the highest drug resistance (88%, 22/25). There was no significant difference in several clinical characteristics and wound healing regardless of whether their metatarsal stumps were affected. Most reserved "normal" metatarsal stumps (84.2%, 48/57) were positive by pathological diagnosis and bacterial culture testing; only 15.7% (9/57) samples were truly sterile. Only 8.3% (4/48) of the former patients healed within 6 months; whereas, all the latter (9/9) patients healed within 6 months. However, the majority (89.6%, 43/48) could heal. There was no difference in operations, skin grafting, negative pressure wound therapy, and mortality between the two groups. Conclusion: The most reserved "normal" metatarsal stumps have been invaded by bacteria. However, the majority stumps can be preserved, and the wound will eventually be healed according to the pathological and bacterial culture results.

Erythrocyte Sedimentation Rate Combined With the Probe-to-Bone Test for Fast and Early Diagnosis of Diabetic Foot Osteomyelitis.

This study aimed to investigate the erythrocyte sedimentation rate (ESR) optimal cutoff point in Chinese patients with diabetic foot osteomyelitis (DFO) and to evaluate the screening value of ESR combined with probe-to-bone (PTB) test for a fast diagnosis of DFO in early stage. A total of 204 diabetic inpatients with foot infection were tested for white blood cell count, neutrophil %, C reactive protein, and ESR at admission within 24 hours. All patients were performed PTB test. Patients with DFO (111) were confirmed by bone biopsy, the other patients (86) had only soft tissue infection. Although white blood cell count, neutrophil %, C-reactive protein, and ESR were different between the 2 groups, only area under curve of ESR was 0.832, with the value as a diagnostic indicator. The best cut point of ESR was >43 mm/h; the sensitivity, specificity, positive predictive value (+PV), and negative predictive value (-PV) were 82.9%, 70.5%, 0.78, and 0.77, respectively. ESR combined with PTB test (serial test), the sensitivity, specificity, +PV, -PV, positive likelihood ratio (+LR), and negative LR (-LR) were 63.56%, 98%, 0.97, 0.67, 31.75, and 0.37, respectively. ESR combined with PTB test (parallel test), the sensitivity, specificity, +PV, -PV, +LR, and -LR were 96%, 65.7%, 0.78, 093, 2.8, and 0.06, respectively, combined with PTB test is simple, favorable for application, and can early fast screening patients with DFO in high-risk patients.

Clinical outcomes of toe amputation in patients with type 2 diabetes in Tianjin, China.

The aim of this study is to determine the predictors for reulceration, reamputation and mortality in patients with diabetes following toe amputation, and the impact of activities of daily living on clinical outcomes. This prospective cohort study included 245 patients who had undergone toe amputation (202 healing and 43 non-healing) and was followed for a 5-year period. Data regarding new foot ulceration, reamputation and mortality were recorded, and the patients' activities of daily living were evaluated. The rate of wound healing was 82·4%. The rate of follow-up in the healed group was 91·6%. In years 1, 3 and 5, the cumulative incidence of patients who developed a new foot ulcer was 27·3%, 57·2% and 76·4%, respectively, leading to reamputation in 12·5%, 22·3% and 47·1%, respectively. The cumulative mortality was 5·8%, 15·1% and 32·7% at 1, 3 and 5 years, respectively. Multivariate analysis showed that GHbA1c > 9% (75 mmol/mol) was identified as an independent predictor of impaired wound healing, reulceration and reamputation. An age of >70 years was identified as an independent predictor of reamputation, mortality and impairment of activities of daily living. Despite a satisfactory initial healing rate after the first toe amputation, with the extension course after the toe amputation, the long-term outcomes are not optimistic. In developing countries like China, taking measures to prevent reulceration and reamputation is very important for patients with diabetic foot minor amputations, especially following toe amputation.

[Effects of chemerin on the proliferation of 3T3-L1 adipocytes].

OBJECTIVE: To explore the effects of chemerin on the proliferation of 333-Li preadipocytes and elucidate its possible mechanism. METHODS: Recombinant lentivirus-mediated silencing or over-expression of chemerin gene were constructed in 3T3-L1 cells. The proliferation of 3T3-L1 cells was examined by the assays of methyl thiazolyl tetrazolium (MTT) and 5-bromo-2-deoxyuridine (BrdU) incorporation. The expressions of chemerin, ERK1, ERK2 and cyclinD1 in 3T3-L1 cells were detected by real-time reverse transcriptase-polymerase chain reaction (RT-PCR). The protein levels of chemerin, ERK1/2 and p-ERK1/2 were detected by Western blot. RESULTS: MT and BrdU results showed that absorbance (A) value and BrdU incorporation increased in chemerin over-expression group compared with over-expression control group [1. 09 ± 0. 08 vs 0. 90 ± 0. 09, (126. 5 ± 14. 6)% vs (100. 0 ± 7. 0) %, both P <0. 05]. The increase of A value and BrdU incorporation in chemerin over-expression group could be inhibited by PD98059, a blocker of ERK1/2 signal pathway. A value (0. 91 ± 0. 13) and BrdU incorporation [(104. 3 ± 10. 7)%] decreased compared with over-expression group (P <0. 05). They also decreased in chemerin gene silencing group compared to silencing control group [ 0. 72 ± 0. 11 vs 0. 90 ± 0. 09, (77. 6 ± 11. 8) % vs ( 99. 7 ± 6. 3) %, both P < 0. 05]. Quantitative real-time PCR revealed that over-expression group had a higher expression in chemerin, ERK, ERK2 and cyclinDl than over-expression control group (2. 77 ± 0. 31 vs 1. 01 ± 0. 12, 1. 39 ± 0. 19 vs 0. 76 ± 0. 30, 1. 46 ± 0. 14 vs 0. 88 ± 0. 14, 1. 44 ± 0. 17 vs 1. 03 0. 15, all P <0. 05). Chemerin gene silencing group had lower expressions of chemerin, ERKI, ERK2 and cyclinD1 than silencing control group (0. 35 ± 0. 12 vs 1. 25 ± 0. 31, 0. 64 ± 0. 15 vs 1. 03 ± 0. 14, 0. 56 ± 0. 10 vs 1. 06 ± 0. 29, 0. 66 ± 0. 13 vs 1. 09 0. 19, all P <0. 05). Western blot showed that the expressiond of chemerin, ERK1/2 and p-ERK1/2 increased in chemerin over-expression group versus over-expression control group (2. 18 ± 0. 32 vs 1. 18 ± 0. 14, 1. 37 ± 0. 05 vs 0. 97 ± 0. 12, 1. 06 ± 0. 09 vs 0. 56 ± 0. 08, all P < 0. 05). The expressiond of chemerin, ERK1/2 and p-ERK1/2 decreased in chemerin gene silencing group versus silencing control group (1. 00 ± 0. 07 vs 1. 40 ± 0. 17, 0. 87 ± 0. 15 vs 1. 20 ± 0. 12, 0. 49 ± 0. 07 vs 0. 91 ± 0. 11, all P < 0. 05). CONCLUSIONS: Chemerin may promote the proliferation of 3T3-L1 cells. And it may be achieved via an up-regulated expression of ERK1/2.

Can We Stop Antibiotic Therapy When Signs and Symptoms Have Resolved in Diabetic Foot Infection Patients?

The study aimed to investigate whether we can stop antibiotic therapy when signs and symptoms have resolved in diabetic foot infection (DFI) patients with different grades of peripheral arterial disease (PAD) and those without PAD, and to determine whether the severity of PAD and infection has an effect on antibiotic therapy duration. A prospective randomized controlled trial of DFI patients was carried out. Patients were randomized into 2 groups when signs and symptoms had resolved: continuing antibiotics group (CAG) and discontinuing antibiotics group (DAG). The recurrence and clinical outcomes were recorded. The recurrence rate of mild infection with mild/moderate PAD was similar in the 2 groups. Compared with CAG, the recurrence rate of mild infection with severe PAD was higher in DAG (P = .030), also for moderate/severe infection with PAD (mild/moderate [P = .032]; severe [P = .008]). No difference was found in the 2 groups (either mild or moderate/severe) for those without PAD. The clinical outcomes of mild infection in patients were similar in the 2 groups. For moderate/severe infection, the healing rate was higher (73.3% vs 48.3%), and the rate of minor/major amputation and death was lower (23.8% vs 49.4%; 6.9% vs 20.7%; 2.0% vs 13.8%) in the CAG. When the clinical signs and symptoms of infection have resolved, it might be appropriate to stop antibiotics for DFI patients without PAD, and also for patients with mild infection with mild/moderate PAD. For patients with mild infection with severe PAD and moderate/severe infection with PAD, we should perhaps continue antibiotic treatment. Continuing antibiotic therapy could improve clinical outcomes for patients with moderate/severe infection.

Clinical characteristics and risk factors of diabetic foot ulcer with multidrug-resistant organism infection.

The objective was to determine multidrug-resistant organisms' (MDROs) profile in diabetic foot ulcers (DFU), antibiotic resistance of MDROs, and to find the potential risk factors for infection with MDROs. In 157 patients with DFU admitted to Tianjin Metabolic Disease Hospital, China, from January 2011 to January 2012, microbiological specimens were taken on admission. The patients were divided into 2 groups according to the infection of MDROs. Potential risk factors for MDRO-positive specimens were examined using univariate and multivariate analyses. Seventy-eight MDRO strains were isolated from patients in the MDRO+ group, among which the top 3 were Staphylococcus aureus (16.7%), Enterobacter spp (16.7%), and Pseudomonas aeruginosa (15.4%). Most of the MDROs were resistant to at least 8 kinds of commonly used antibiotics. Gram-negative MDROs showed 23% to 50% resistance to third-generation cephalosporins. The resistant rates of Gram-positive MDROs to fluoroquinolone were more than 70%; penicillin and semisynthetic penicillin were 57% to 100% resistant. Previous hospitalization (odds ratio [OR] = 3.000; 95% confidence interval [CI] = 1.100-8.182; P = .032), previous duration of antibiotic therapy (OR = 1.078; 95% CI = 1.001-1.160; P = .046), ulcer type (OR = 7.185; 95% CI = 2.115-24.408; P = .002), ulcer size (OR = 1.403; 95% CI = 1.042-1.888; P = .026), and osteomyelitis (OR = 3.390; 95% CI = 1.178-9.756; P = .024) were associated with MDRO infection in patients with DFU.

Risk factors and gene type for infections of MRSA in diabetic foot patients in Tianjin, China.

The objective was to study risk factors and gene type of DF patients infected with MRSA. A total of 429 DF patients were recruited. The patients with S aureus infections were divided into MRSA and MSSA groups. MRSA were genotyped by SCCmec. pvl and lukE-lukD were detected. A total of 559 pathogens were isolated from them, with G+ bacteria firstly(59.0%), followed G- bacilli (37.7%) and true fungi (3.3%). The 3 most frequently isolated pathogens were S aureus (35.2%), S epidermidis (12.3%), and Pseudomonas aeruginosa (11.2%). SCCmec III MRSA and SCCmec IVa MRSA had the same antibacterial spectrum. mecA positive rate was 100%. lukE-lukD and pvl positive rates were 100% and 0%, respectively. 28 strains belonged to SCCmec III and the others belonged to SCCmec IVa. The G+ cocci were the main pathogens, S aureus and S epidermidis were predominant among them. Antibiotic usage in 6 months prior to hospitalization, long course of ulcer, osteomyelitis and hypoproteinemia are risk factors for MRSA. SCCmec IVa is high in proportion to MRSA isolates, suggesting that CA-MRSA has become major pathogen of DF infection. All the MRSA were harboring lukE-lukD, which has been reported to present poor leucotoxin compared to pvl, and may be a response to atypical local inflammatory reaction in DF infection.