Consensus on the application of negative pressure wound therapy of diabetic foot wounds.

Because China is becoming an aging society, the incidence of diabetes and diabetic foot have been increasing. Diabetic foot has become one of the main health-related killers due to its high disability and mortality rates. Negative pressure wound therapy (NPWT) is one of the most effective techniques for the treatment of diabetic foot wounds and great progress, both in terms of research and its clinical application, has been made in the last 20 years of its development. However, due to the complex pathogenesis and management of diabetic foot, irregular application of NPWT often leads to complications, such as infection, bleeding and necrosis, that seriously affect its treatment outcomes. In 2020, under the leadership of Burns, Trauma and Tissue Repair Committee of the Cross-Straits Medicine Exchange Association, the writing group for 'Consensus on the application of negative pressure wound therapy of diabetic foot wounds' was established with the participation of scholars from the specialized areas of burns, endocrinology, vascular surgery, orthopedics and wound repair. Drawing on evidence-based practice suggested by the latest clinical research, this consensus proposes the best clinical practice guidelines for the application and prognostic evaluation of NPWT for diabetic foot. The consensus aims to support the formation of standardized treatment schemes that clinicians can refer to when treating cases of diabetic foot.

Downregulation of L1CAM inhibits proliferation, invasion and arrests cell cycle progression in pancreatic cancer cells in vitro.

The aim of the present study was to establish the effect of silencing L1 cell adhesion molecule (L1CAM) on the proliferation, invasion, cell cycle progression and apoptosis of pancreatic cancer cells, and to determine the potential molecular mechanisms that are involved. The human Capan-2 pancreatic cancer cell line was infected with lentivirus-mediated short hairpin RNA (shRNA) to target L1CAM. Cell proliferation and invasion were analyzed using cell counting kit-8 and Transwell assays, respectively, and cell cycle progression and apoptosis were analyzed using flow cytometry. L1CAM protein expression in Capan-2 cells decreased following shRNA-L1CAM infection. Furthermore, knockdown of L1CAM significantly inhibited cell proliferation and reduced the number of invasive cells, while increasing the percentage of cells in the G0/G1 phase (P<0.05). However, the effect on apoptosis was not identified to be statistically significant. In addition, L1CAM silencing may induce activation of p38/extracellular signal regulated kinase 1/2. Downregulation of L1CAM may inhibit proliferation, invasion and arrests cell cycle progression in pancreatic cancer via p38/ERK1/2 signal pathway, and therefore, L1CAM may serve as a potential target for gene therapy in pancreatic cancer.

Therapeutic effects of hydrogen saturated saline on rat diabetic model and insulin resistant model via reduction of oxidative stress.

BACKGROUND: Molecular hydrogen, as a novel antioxidant, has been proven effective in treating many diseases. This study aimed to evaluate the therapeutic effects of hydrogen saturated saline in treatment of a rat model of diabetes mellitus and a rat model of insulin resistant. METHODS: A rat diabetes mellitus model was established by feeding a high fat/high carbohydrate diet followed by injection of a small dose of streptozotocin, and an insulin resistant model was induced with a high glucose and high fat diet. Hydrogen saturated saline was administered to rats with both models conditions on a daily basis for eight weeks. A pioglitazone-treated group and normal saline-treated group served as positive and negative controls. The general condition, body weight, blood glucose, blood lipids, and serum insulin levels of rats were examined at the 8th week after treatment. The oxidative stress indices, including serum superoxide dismutase (SOD), glutathione (GSH) and malondialdehyde (MDA) were also evaluated after eight weeks of treatment using the commercial kits. RESULTS: Hydrogen saturated saline showed great efficiency in improving the insulin sensitivity and lowering blood glucose and lipids. Meanwhile, the therapeutic effects of hydrogen saturated saline were superior to those of pioglitazone. Hydrogen saturated saline markedly attenuated the MDA level and elevated the levels of antioxidants SOD and GSH. CONCLUSION: Hydrogen saturated saline may improve the insulin resistance and alleviate the symptoms of diabetes mellitus by reducing the oxidative stress and enhancing the anti-oxidant system.

Clinical profiles and long-term outcomes of patients with pancreatic ductal adenocarcinoma and diabetes mellitus.

BACKGROUND: Diabetes mellitus (DM) is considered to be a possible risk factor and/or a manifestation of pancreatic ductal adenocarcinoma (PDAC). This study is aimed at analysing the potential association of diabetes mellitus with the development and pathogenic degrees of PDAC and post-surgical survival of Chinese Han PDAC patients. METHODS: A total of 1123 patients with PDAC were recruited and included 256 patients with diabetes mellitus within 2 years (new-onset) and 62 patients with diabetes mellitus ≥ 2 years (long-standing). Additional 466 patients with type 2 diabetes mellitus were included in this study. Their clinical characteristics and long-term outcomes were analysed. RESULTS: In comparison with patients with type 2 diabetes mellitus alone, PDAC patients with new-onset diabetes mellitus had an older onset age of diabetes mellitus and lower body mass index (BMI). Among PDAC cases, patients with new-onset diabetes mellitus were associated with neural invasion, poor tumour differentiation and shorter post-surgical survival. However, more than half of these patients became euglycemic after surgical resection of tumours. CONCLUSIONS: PDAC patients developed new-onset diabetes mellitus at an older age, and they had shorter post-surgical survival. The underlying mechanisms by which comorbid diabetes mellitus affect the clinical profiles and outcomes of PDAC patients deserve further researches.

Diabetes mellitus and risk of pancreatic cancer: A meta-analysis of cohort studies.

BACKGROUND: Diabetes mellitus (DM) is widely considered to be associated with risk of pancreatic cancer (PaC), however, whether DM is a cause or a consequence of PaC is still controversial. We examined this association by conducting a detailed meta-analysis of cohort studies. METHODS: Studies were identified by searching Medline and Embase through November 30, 2010. Summary relative risks (RRs) with their corresponding 95% confidence intervals (CIs) were calculated using a random-effects model. RESULTS: A total of thirty-five cohort studies were included in this meta-analysis. DM was associated with an increased risk of PaC (the summary RRs=1.94; 95% CI, 1.66-2.27), with significant evidence of heterogeneity among these studies (p<0.001, I²=93.6%). Subgroup analyses revealed that the increased risk of PaC was independent of geographic locations, sex, study design, alcohol consumption, body mass index (BMI) and smoking status. In addition, the relative risk of PaC was correlated negatively with the duration of DM, with the highest risk of PaC found among patients diagnosed within less than 1 year. There was no significant publication bias (p=0.136 for Egger's regression asymmetry test). CONCLUSIONS: Findings from this meta-analysis strongly support that diabetes is associated with an increased risk of PaC in both males and females and that DM is both an early manifestation and an etiologic factor of pancreatic cancer.

Intensive glycemic control and macrovascular events in type 2 diabetes mellitus: a meta-analysis of randomized controlled trials.

BACKGROUND: There is no agreement as to whether intensive glucose control in type 2 diabetes can reduce the incidence of macrovascular events in these patients. We performed a meta-analysis comparing intensive glucose control or conventional glucose control in randomized controlled trials. METHODS: Databases including MEDLINE, EMBASE, and Cochrane controlled trials register, the Cochrane Library, and Science Citation Index were searched to find relevant trials. Outcome measures were the incidence of major macrovascular events. RESULTS: Six trials involving 28 065 patients were included. Analysis suggested that there was an obviously decreased incidence of major macrovascular events in patients having intensive glucose treatment vs. controls (RR 0.92; 95%CI 0.87, 0.98; P = 0.005). However, intensive glycemia control strategies in type 2 diabetes showed no significant impact on the incidence of death from any cause compared with conventional glycemia control strategies, intensive 14.7%, controls 12.0% (RR 0.95; 95%CI 0.80, 1.12; P = 0.55), as well as on the incidence of cardiovascular death, intensive 3.7%, controls 3.6% (RR 1.10, 95%CI 0.79, 1.53; P = 0.57). CONCLUSIONS: Control of glycemia to normal (or near normal levels) in type 2 diabetes appears to be effective in reducing the incidence of major macrovascular events, but there were no significant differences of either the mortality from any cause or from cardiovascular death between the two glycemia-control strategies.

A systematic review on intrapyloric botulinum toxin injection for gastroparesis.

BACKGROUND: Though trials evaluating the effect of intrapyloric botulinum toxin injection on gastroparesis have been reported, there is no agreement whether botulinum toxin can effectively relieve the symptoms and improve the results of gastric emptying study in patients with gastroparesis. We performed a systematic literature review to address this issue. METHODS: Databases including PubMed, EMBASE, and the Cochrane Library and Science Citation Index were searched. Two reviewers independently identified relevant trials. Outcome measures were the improvement of subjective symptoms and objective measurement. RESULTS: 15 reports were included; only 2 randomized controlled trials were available. Almost all the non-randomized trials reported significant improvement in subjective symptoms and objective gastric emptying study after botulinum toxin injection. While the 2 randomized controlled trials did not confirm the efficacy of botulinum toxin injection, none of the individual trials showed that there was statistically significant subjective and objective improvement in the active patients when compared with patients receiving placebo. CONCLUSIONS: Available high-quality trials showed that intrapyloric botulinum toxin injection could not significantly relieve subjective symptoms and improve objective measurement in patients with gastroparesis, and there is no evidence to recommend botulinum toxin injection for the treatment of gastroparesis.