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Wang F, Qi Y, Gao Y, Wang Z, Shen X, Wu H. Syringic acid suppresses ferroptosis of skeletal muscle cells to alleviate lower limb ischemia/reperfusion injury in mice via the HMGB1 pathway. Chem Biol Drug Des 2023; 102:1387-1398. [PMID: 37604776 DOI: 10.1111/cbdd.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/06/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
Ischemia/reperfusion (I/R) of skeletal muscle in the lower limbs is an important factor affecting the outcome of lower limbs ischemia patients, with no effective preventive or therapeutic approaches available. The study was to investigate the effect of syringic acid (SA) on I/R skeletal muscle in the lower limbs injury. Mice femoral artery I/R models and C2C12 cell hypoxia/reoxygenation (H/R) models was establish, tissue damage, inflammatory status, and high mobility group box 1 (HMGB1) pathway were evaluated using histological analysis, enzyme-linked immunosorbent assay, and western blotting. Further, the study detected the effect of SA on cell apoptosis, lipid peroxidation, Fe2+ level, and ferroptosis-related proteins expression. Finally, the effect of HMGB1 expression on SA in H/R stimulation was studied. SA alleviated pathological damage and reduced levels of IL-1β, IL-6, and TNF-α in muscle tissues from femoral artery I/R mouse models. SA upregulated Bcl-2 and SOD as well as downregulated Bax, MDA, TBARS content, and Fe2+ level in H/R-induced cells. SA inhibited HMGB1 expression and promoted Nrf2, HO-1, GPX4, and SLC7A11 expressions in the injured tissues and cells. Such effects of SA on H/R-induced cells were rescued by HMGB1 overexpression. SA suppressed ferroptosis of skeletal muscle cells to alleviate lower limb I/R injury in mice by blocking the HMGB1 pathway, providing new insights for the treatment of lower limb ischemia-reperfusion injury.
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Affiliation(s)
- Fengdan Wang
- Cardiovascular Surgery Department, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yanqing Qi
- Cardiovascular Surgery Department, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Yakun Gao
- Cardiovascular Surgery Department, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Zhifang Wang
- Cardiovascular Surgery Department, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Xiaowei Shen
- Cardiovascular Surgery Department, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Hongyu Wu
- Cardiovascular Surgery Department, The First Affiliated Hospital of Ningbo University, Ningbo, China
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Panigrahi G, Goodwin SM, Staffier KL, Karlsen M. Remission of Type 2 Diabetes After Treatment With a High-Fiber, Low-Fat, Plant-Predominant Diet Intervention: A Case Series. Am J Lifestyle Med 2023; 17:839-846. [PMID: 38511112 PMCID: PMC10948923 DOI: 10.1177/15598276231181574] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background: Prevalence of type 2 diabetes (T2D) is rising, and its burden on the healthcare system remains a challenge. Consumption of a plant-predominant diet is a promising approach for achieving remission, which has emerged as a therapeutic target. Objective: To establish feasibility of achieving T2D remission with a plant-predominant diet in a cohort of free-living individuals. Methods: Patients referred to a wellness clinic were treated with a low-fat, whole food, plant-predominant diet while receiving standard medical treatment. Included patients were adults, mostly elderly, with HbA1c > 6.5%, with or without use of antidiabetic medications. Results: N = 59 patients were included in this analysis, with mean age 71.5 years (range 41-89). Twenty-two (37%) patients achieved T2D remission. Mean differences showed a significant decrease post-lifestyle change (T2) compared to prior to lifestyle change (T1) for the following outcomes [least squares mean difference (95% CI)]: BMI [-2.6 (-4.8, -.3)] kg/m2; HbA1c [ -1.3 (-1.6, -1.0)] %; and fasting glucose [-29.6 (-41.8, -17.5)] mg/dL. No significant differences were observed for systolic or diastolic blood pressure, HDL, LDL, or triglycerides. Conclusion: A lifestyle-based treatment intervention promoting adherence to a plant-predominant diet and integrated as part of routine care can successfully achieve T2D remission in wellness clinic patients.
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Affiliation(s)
- Gunadhar Panigrahi
- Sentara Cardiology Specialists Wellness Clinic, Sentara Princess Anne Hospital, Virginia Beach, VA, USA
| | - Sally M Goodwin
- Sentara Cardiology Specialists Wellness Clinic, Sentara Princess Anne Hospital, Virginia Beach, VA, USA
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Dzhemilova ZN, Galstyan GR. [Evaluation of tissue perfusion by indocyanine green fluorescein angiography in patients with neuroischemic diabetic foot syndrome after endovascular treatment]. Khirurgiia (Mosk) 2023:43-53. [PMID: 37682546 DOI: 10.17116/hirurgia202309243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
OBJECTIVE To evaluate the fluorescence angiography (FA) parameters with Indocyanine green (ICG) and their dynamics in diabetic foot patients after endovascular treatment. MATERIAL AND METHODS A single-center prospective non-blinded study was conducted with the inclusion of 47 diabetic foot patients with Chronic limb-threatening ischemia (CLTI). TcPO2 and FA-ICG were done before and after angioplasty. Zones of interest were selected for FA-ICG: the area of minimum and maximum fluorescence, the area of of the largest part of the foot. Also presented are the parameters of FA ICG: Tstart (sec) - the time of occurrence of min fluorescence (Istart, unit) in the zone of interest after the introduction of ICG; Tmax (sec) - the time to achieve max fluorescence (Imax, unit) after the introduction of ICG; Tmax -Tstart (sec) - the difference in the time of reaching Imax and Istart. RESULTS The median TcPO2 values indicated the presence of CLTI before revascularization. Technical success of revascularization was achieved in 45 patients. In the postoperative period, statistically significant changes in TcPO2 and Tstart, Tmax, Tmax-Tstar were obtained. A reduction in the time to reach the ICZ to the zones of interest was noted. CONCLUSION FA-ICG evaluate the visual and quantitative characteristics of perfusion of soft tissues of the foot. Reducing the time to reach the fluorescent substance in the areas of interest makes it possible to assume the restoration of the main blood flow to the foot. Further investigations are warranted to determine threshold values to predict wound healing and indications for revascularization.
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Wu FL, Lung CW, Wang WTJ, Elliott J, Jain S, Jan YK. Effects of Walking Speeds and Durations on Peak Plantar Pressures. J Am Podiatr Med Assoc 2022; 112:20-043. [PMID: 36525323 DOI: 10.7547/20-043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Walking at various speeds and durations may result in different peak plantar pressure (PPP). However, there is no study comparing the effect of walking speeds and durations on PPP. The purpose of this study was to explore whether different walking speeds and durations significantly change PPP and establish a normal response in healthy people. METHODS An in-shoe plantar pressure system was used to measure PPP under the first toe, first metatarsal, second metatarsal, and heel regions in 12 healthy, young people. All participants performed six walking trials at three speeds (3, 6, and 9 km/h) and for two durations (10 and 20 min). The 3 × 2 two-way analysis of variance was used to examine the main effects of speeds and durations and their interaction. RESULTS The results showed that walking speeds significantly affected PPP and that walking duration did not. No interaction between the walking speed and duration was observed. Peak plantar pressure values under the first toe and the first metatarsal head were significantly higher (P < .05) at 9 km/h (509.1 ± 314.2 kPa and 591.4 ± 302.4 kPa, respectively) than at 3 km/h (275.4 ± 168.7 kPa and 369.4 ± 205.4 kPa, respectively) after 10-min walking. CONCLUSIONS People at risk for foot ulcers may use slow and brisk walking for exercise to reduce PPP, thus reducing risk for foot ulcers. Our study demonstrated that slow running at 9 km/h significantly increases PPP.
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Affiliation(s)
- Fu-Lien Wu
- *Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Chi-Wen Lung
- *Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL.,†Department of Creative Product Design, Asia University, Taichung, Taiwan
| | - Wendy Tzyy-Jiuan Wang
- ‡Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan
| | - Jeannette Elliott
- §Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL
| | - Sanjiv Jain
- ‖Department Physical Medicine and Rehabilitation, Carle Foundation Hospital, Urbana, IL
| | - Yih-Kuen Jan
- *Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL.,¶Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, People's Republic of China
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Clinical Efficacy of Interventional Therapy on Lower Extremity Arteriosclerosis Obliterans and Prognostic Factors. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9190292. [PMID: 35966252 PMCID: PMC9371862 DOI: 10.1155/2022/9190292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 07/01/2022] [Indexed: 12/24/2022]
Abstract
Objective This study was designed to analyse the clinical efficacy of interventional therapy on lower extremity arteriosclerosis obliterans (LEASO) and prognostic factors. Methods A total of 122 patients with LEASO diagnosed in our hospital from March 2017 to March 2019 were retrospectively analysed. Among them, 72 patients who received conservative therapy were assigned to a conservative group, and 50 patients who received interventional therapy additionally based on conservative therapy were assigned to an intervention group. The short-term (12 weeks after therapy) and long-term (3 years after therapy) clinical efficacies on the two groups were compared. Death, amputation, and vascular restenosis (vascular stenosis > 50% in computed tomography reexamination) were defined as unfavourable outcomes, and Cox regression was conducted to analyze the factors influencing the prognosis of patients. The incidence of adverse events in the two groups within 3 years was compared and statistically analyzed. Additionally, the hospital stay, therapy cost, claudication distance, and ankle brachial index were compared between the two groups. Results After therapy, the conservative group showed a notably lower total effective rate than the intervention group (P < 0.05), but the clinical efficacy after 3 years was similar between the two groups (P > 0.05). Additionally, the conservative group experienced notably longer hospital stay than the intervention group (P < 0.05), and cost less in treatment than the intervention group (P < 0.05). However, the conservative group experienced a notably shorter claudication distance and showed a notably lower ankle brachial index than the intervention group (P < 0.05). The two groups were not significantly different in mortality, amputation rate, and vascular restenosis rate (P > 0.05). Moreover, Cox regression analysis revealed that age and conservative therapy were independent risk factors for the prognosis of patients (P < 0.05). Conclusion Interventional therapy can substantially improve the short-term efficacy and prognosis of patients with LEASO, but the cost is high, so the therapeutic regimen should be selected according to the patient's economic condition.
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Bauer KL. Differentiation of Lower Extremity Skin Changes in the Intensive Care Setting. AACN Adv Crit Care 2022; 33:196-207. [PMID: 35657763 DOI: 10.4037/aacnacc2022737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Digital and lower extremity skin changes often signify critical underlying disorders. Patients in the intensive care unit also frequently have hemodynamic instability requiring the use of vasoactive medications, which may lead to various presentations of limb ischemia; preexisting conditions increase these patients' risk for arterial embolization. Most arterial emboli are clots that originate in the heart and travel to distant vascular beds, where they cause arterial occlusion, ischemia, and, potentially, infarction; the 2 most common sequelae are stroke and lower limb ischemia. Emboli also arise from atherosclerotic plaques. Other conditions can also cause skin color changes in this vulnerable population. Prompt recognition and differentiation of lower extremity skin changes can result in improved patient outcomes. A thorough literature search was conducted to differentiate the primary causes of lower extremity and digital skin changes in the critically ill patient and outline diagnostic and management techniques.
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Affiliation(s)
- Karen L Bauer
- Karen L. Bauer is Director of Wound and Vascular Services, Division of Vascular, Endovascular, and Wound Surgery, University of Toledo, 3000 Arlington Avenue, Mail Stop 1095, Toledo, OH 43614
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Fletcher J, Porter R, Boulton Z, Brown L, Knight B, Romanczuk L, Aiken S, Delury C, Michell S. In vitro efficacy of antibiotic loaded calcium sulfate beads (Stimulan Rapid Cure) against polymicrobial communities and individual bacterial strains derived from diabetic foot infections. J Med Microbiol 2022; 71. [PMID: 35604937 DOI: 10.1099/jmm.0.001517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Diabetic foot infection (DFI) is the main reason for diabetes-related hospitalisation and is a major cause of diabetes-related amputation. DFIs are often complicated by ischaemia in the affected limb, the presence of polymicrobial biofilms and increasingly the occurrence of antibiotic resistant bacteria.Hypothesis/Gap statement. Antibiotic loaded beads could inhibit the growth of polymicrobial DFI communities with differing compositions in vitro.Aim. This study investigates the in vitro efficacy of antibiotic loaded calcium sulfate beads (Stimulan Rapid Cure, Biocomposites Ltd., UK) against polymicrobial DFI communities and individual bacterial strains derived from DFIs.Methodology. Debrided tissue obtained from the base of infected diabetic foot ulcers was homogenised and spread over the surface of Columbia blood agar (CBA) and fastidious anaerobe agar (FAA) plates. Calcium sulfate beads containing a combination of vancomycin and gentamicin were then placed on the surface of the agar and following incubation, zones of inhibition (ZOI) were measured. For individual bacterial strains isolated from the infected tissue, calcium sulfate beads containing vancomycin, gentamicin, flucloxacillin or rifampicin and beads containing a combination of vancomycin and gentamicin or flucloxacillin and rifampicin were tested for their ability to inhibit growth.Results. Calcium sulfate beads loaded with a combination of vancomycin and gentamicin were able to inhibit bacterial growth from all polymicrobial tissue homogenates tested, with ZOI diameters ranging from 15 to 40 mm. In the case of individual bacterial strains, beads containing combinations of vancomycin and gentamicin or flucloxacillin and rifampicin were able to produce ZOI with Gram-positive facultatitive anaerobic strains such as Staphylococcus aureus and Enterococcus faecalis, Gram-negative facultative anaerobic strains such as Pseudomonas aeruginosa and obligate anaerobic strains such as Finegoldia magna even where acquired resistance to one of the antibiotics in the combination was evidenced.Conclusion. The local use of calcium sulfate beads containing a combination of two antibiotics demonstrated high efficacy against polymicrobial DFI communities and individual DFI bacterial strains in in vitro zone of inhibition tests. These results show promise for clinical application, but further research and clinical studies are required.
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Affiliation(s)
- Julie Fletcher
- Biosciences, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
| | - Rob Porter
- Microbiology Department, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
| | - Zoe Boulton
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
| | - Laura Brown
- Macleod Diabetes and Endocrine Centre, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
| | - Bridget Knight
- National Institute for Health Research Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
| | - Lidia Romanczuk
- National Institute for Health Research Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK
| | - Sean Aiken
- Biocomposites Ltd., Keele Science Park, Keele, Staffordshire, ST5 5NL, UK
| | - Craig Delury
- Biocomposites Ltd., Keele Science Park, Keele, Staffordshire, ST5 5NL, UK
| | - Stephen Michell
- Biosciences, University of Exeter, Stocker Road, Exeter, EX4 4QD, UK
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Qin Y, Shi Y, Zhuo H, Yu T, Wang W, Li X, Da L, Ran F. Short-term efficacy and safety of TurboHawk atherectomy for in-stent restenosis in peripheral artery disease: a single-centre experience. ANZ J Surg 2022; 92:448-452. [PMID: 35040546 DOI: 10.1111/ans.16551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 11/05/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Information regarding the efficacy of the TurboHawk atherectomy for the treatment of in-stent restenosis (ISR) in patients with peripheral artery disease (PAD) of the lower extremity is scarce. This study was performed to investigate the curative efficacy and safety of the TurboHawk system for ISR in PAD patients over 60 years old. METHODS The TurboHawk atherectomy device was used to treat ISR in 28 patients with PAD. The intraoperative, 2-day postoperative, 3-month, and 2-year follow-up data were obtained. Differences in the ankle-brachial index (ABI), Rutherford class and minimum diameter of the femoral-popliteal artery were analysed along with the correlations of the factors associated with patency. RESULTS Twenty-six patients (92.86%) had successful surgeries. All patients reported alleviation of pain and intermittent claudication after surgery. One patient who had a malignant hepatoma and coronary heart disease received an amputation on the 76th postoperative day and another patient who had atrial fibrillation received a thrombectomy on the 40th postoperative day. TurboHawk atherectomy increased the ABI (from 0.30 to 0.70, P < 0.0001) and minimum diameter (from 0 to 4.93 mm, P < 0.0001) and reduced the Rutherford class (from 4.00 to 2.00, P < 0.0001). During the 3-month follow-up, the median minimum diameter, ABI, and Rutherford class were 4.12, 0.69, and 2.00, respectively. No death happened during the 3-month follow-up. CONCLUSIONS The TurboHawk atherectomy is a safe and effective technique for ISR in PAD patients over 60 years old.
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Affiliation(s)
- Yi Qin
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Yan Shi
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Huawei Zhuo
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Tong Yu
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Wei Wang
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Xiaoqiang Li
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
| | - Lun Da
- Nanjing Prevention and Treatment Center for Occupational Disease, Nanjing, Jiangsu, China
| | - Feng Ran
- Department of Vascular Surgery, Nanjing Drum-Tower Hospital, Affiliated to Nanjing University Medical School, Nanjing, Jiangsu, China
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Kim DY, Kim Y, Moon SH. Overcoming severe calcified lower extremity artery in lower limb salvage operation by using the Fogarty catheter and vein graft. Microsurgery 2021; 41:734-742. [PMID: 34636068 DOI: 10.1002/micr.30816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/15/2021] [Accepted: 09/17/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND With severe vascular calcifications, vascular clamp application and utilizing the vessel for free flap recipient vessel becomes impossible. These obstacles can be overcome with the Fogarty catheter and vein graft. PATIENTS AND METHODS When unclampable artery was encountered intraoperatively, a vein graft was used to make a clampable recipient site for six diabetic foot patients (ages from 42 to 80). The end of the Fogarty catheter was inserted into the proximal end of the vein graft and the transected calcified vessel in sequence, and the balloon of the catheter was used as an intraluminal tourniquet. The remaining end of the vein graft was connected to the distal vessel with a vascular clamp. RESULTS Five short vein graft revascularization for segmental arterial occlusion, one long vein graft for recipient artery elongation was done (lengths from 2 to 13.8 cm). Three delayed, and two immediate anterolateral thigh flaps (sizes from 15 to 150 cm2 ) were performed, and one patient received vein graft revascularization surgery only. Postoperative vascular sonography of all six patients showed well-maintained patency. Minor flap marginal disruption occurred at two patients but healed with conservative care. Postoperative follow-up was done for 1-18 months (average 7.17). Limb salvage was achieved for five patients and all five free flaps survived. However, for one patient, arterial restenosis at popliteal artery a month later lead to major amputation. CONCLUSION Using a Fogarty catheter and a vein graft may obtain perfect hemostasis during micro-anastomosis and achieve successful microvascular reconstruction in patients with severely calcified vessels.
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Affiliation(s)
- Dong Yeon Kim
- Department of Plastic and Reconstructive Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Yesol Kim
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Suk-Ho Moon
- Department of Plastic and Reconstructive Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Wound Healing and Antioxidant Evaluations of Alginate from Sargassum ilicifolium and Mangosteen Rind Combination Extracts on Diabetic Mice Model. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11104651] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
A diabetic foot ulcer is an open wound that can become sore and frequently occurs in diabetic patients. Alginate has the ability to form a hydrophilic gel when in contact with a wound surface in diabetic patients. Xanthones are the main compounds of mangosteen rind and have antibacterial and anti-inflammatory properties. The purpose of this research was to evaluate the wound healing and antioxidants assay with a combination of alginate from S. ilicifolium and mangosteen rind combination extracts on a diabetic mice model. The characterization of alginate was carried out by size exclusion chromatography with multiple angle laser light scattering (SEC-MALLS) and thermogravimetric analysis (TGA). The M/G ratio of alginate was calculated by using proton nuclear magnetic resonance (1H NMR). The antioxidant activity of mangosteen rind and the combination extracts was determined using the DPPH method. The observed parameters were wound width, number of neutrophils, macrophages, fibrocytes, fibroblasts, and collagen densities. The 36 male mice were divided into 12 groups including non-diabetic control (NC), diabetes alginate (DA), alginate–mangosteen (DAM), and diabetes control (DC) groups in three different groups by a histopathology test on skin tissue. The treatment was carried out for 14 days and mice were evaluated on Days 3, 7, and 14. The SEC-MALLS results showed that the molecular weight and dispersity index (Ð) of alginate were 2.77 × 104 Dalton and 1.73, respectively. The M/G ratio of alginate was 0.77 and described as single-stage decomposition based on TGA. Alginate, mangosteen rind extract, and their combination were divided into weak, medium, and strong antioxidant, respectively. The treatment of the DA and DAM groups showed a decrease in wound width and an increase in the number of fibrocytes, fibroblasts, and macrophages. The number of neutrophils decreased while the percentage of collagen densities increased for all the considered groups.
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Suma H, Yoshida Y, Sugimoto T, Matsuo Y, Law SM, Nakashima R, Kobayashi H, Hosokawa Y, Ishitoku M, Kohno H, Watanabe H, Tokunaga T, Mokuda S, Nojima T, Hirata S, Sugiyama E. The clinical characteristics and predictors of severe digital ischemia in patients with anti-aminoacyl transfer RNA synthetase antibodies. J Dermatol 2021; 48:1044-1051. [PMID: 33847003 DOI: 10.1111/1346-8138.15884] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/12/2021] [Accepted: 03/19/2021] [Indexed: 01/30/2023]
Abstract
Severe digital ischemia (SDI), which presents with digital ulcers, necrosis, or gangrene, has been reported to be a rare manifestation of anti-aminoacyl transfer RNA synthetase (ARS) antibody-positive polymyositis/dermatomyositis or anti-synthetase syndrome. A retrospective study was conducted between 2009 and 2020 at our department to investigate the clinical features of anti-ARS antibody-positive patients with SDI and identify their predictors. A total of 46 patients who were positive for anti-ARS antibody were included, four of whom (8.7%) presented with SDI. The characteristics of the patients with SDI were as follows: the median age was 74 years, with 75% being female; anti-Jo-1 antibody, Raynaud's phenomenon, interstitial lung disease, and myositis were observed in two (50%), four (100%), four (100%), and three patients (75%), respectively. Next, we reviewed the literature of anti-ARS antibody-positive patients with SDI and investigated the predictors of SDI by analyzing a total of 51 patients, including the previously reported five patients with SDI. Multivariable analyses revealed that Raynaud's phenomenon and myositis independently predicted the development of SDI in patients with anti-ARS antibody. In conclusion, digital ulcers, necrosis, or gangrene seem to be more common presentations in our study, and Raynaud's phenomenon and myositis can predict the complications of SDI in anti-ARS antibody-positive patients.
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Affiliation(s)
- Harumichi Suma
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yusuke Yoshida
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Tomohiro Sugimoto
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yoshimi Matsuo
- Department of Dermatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Sze-Ming Law
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ran Nakashima
- Department of Rheumatology and Clinical Immunology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Kobayashi
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Yohei Hosokawa
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Michinori Ishitoku
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroki Kohno
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hirofumi Watanabe
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Tadahiro Tokunaga
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Sho Mokuda
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Takaki Nojima
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shintaro Hirata
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
| | - Eiji Sugiyama
- Department of Clinical Immunology and Rheumatology, Hiroshima University Hospital, Hiroshima, Japan
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Yunir E, Kurniawan F, Rezaprasga E, Wijaya IP, Suroyo I, Matondang S, Irawan C, Soewondo P. Autologous Bone-Marrow vs. Peripheral Blood Mononuclear Cells Therapy for Peripheral Artery Disease in Diabetic Patients. Int J Stem Cells 2021; 14:21-32. [PMID: 33377454 PMCID: PMC7904521 DOI: 10.15283/ijsc20088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 01/09/2023] Open
Abstract
Diabetes mellitus (DM) remains one of the most important risk factors for peripheral artery disease (PAD), with approximately 20% of DM patients older than 40 years old are affected with PAD. The current standard management for severe PAD is endovascular intervention with or without surgical bypass. Unfortunately, up to 40% of patients are unable to undergo these revascularization therapies due to excessive surgical risk or adverse vascular side effects. Stem cell therapy has emerged as a novel therapeutic strategy for these ‘no-option’ patients. Several types of stem cells are utilized for PAD therapy, including bone marrow mononuclear cells (BMMNC) and peripheral blood mononuclear cells (PBMNC). Many studies have reported the safety of BMMNC and PBMNC, as well as its efficacy in reducing ischemic pain, ulcer size, pain-free walking distance, ankle-brachial index (ABI), and transcutaneous oxygen pressure (TcPO2). However, the capacity to establish the efficacy of reducing major amputation rates, amputation free survival, and all-cause mortality is limited, as shown by several randomized placebo-controlled trials. The present literature review will focus on comparing safety and efficacy between BMMNC and PBMNC as cell-based management in diabetic patients with PAD who are not suitable for revascularization therapy.
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Affiliation(s)
- Em Yunir
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Farid Kurniawan
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Edo Rezaprasga
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Ika Prasetya Wijaya
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Indrati Suroyo
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Sahat Matondang
- Department of Radiology, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Cosphiadi Irawan
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Pradana Soewondo
- Department of Internal Medicine, Dr. Cipto Mangunkusumo National General Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.,Metabolic Disorder, Cardiovascular, and Aging Cluster, Indonesian Medical Education and Research Institute, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
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13
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Liu Y, Shi Y, Zhu J, Chen X, Yang R, Shu B, Zhou Z, Liu J, Wu RQ, Xie J. Study on the Effect of the Five-in-One Comprehensive Limb Salvage Technologies of Treating Severe Diabetic Foot. Adv Wound Care (New Rochelle) 2020; 9:676-685. [PMID: 33124965 DOI: 10.1089/wound.2018.0903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Objective: To explore the clinical efficacy and advantages of five-in-one comprehensive limb salvage technologies for the treatment of severe diabetic foot ulcer (DFU). Approach: Clinical data for 120 patients with severe DFU treated between January 2012 and December 2017 were analyzed retrospectively. The control group (48 cases) was treated with traditional therapies, including controlling blood sugar, improving microcirculation, preserving nerve function, and dressing changes, whereas the experimental group (72 cases) was treated with traditional therapy combined with additional techniques, such as early and thorough debridement, negative pressure wound therapy, revascularization, and skin graft or flap. Ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), wound healing rate, healing time, ulcer recurrence rate, and amputation rate were recorded. Results: Compared with the control group, the experimental group significantly improved wound healing rate (93.1% vs. 72.9%; p < 0.01), decreased wound healing time (16.2 ± 5.4 days vs. 32.2 ± 7.8 days; p < 0.05), reduced major limb amputation rate (1.4% vs. 10.4%, p < 0.05), and ulcer recurrence rate (5.6% vs. 14.6%; p < 0.05). There were no significant differences in amputation rate between experimental and control group (29.2% vs. 33.3%, p = 0.628). After revascularization, the revascularization group showed significantly improved ABI (0.75 ± 0.21 vs. 0.35 ± 0.16, p < 0.05) and TcPO2 (36 ± 6 mmHg vs. 15 ± 4 mmHg, p < 0.05). Innovation: We propose a five-in-one comprehensive treatment method, which provides a multidisciplinary cooperative model for comprehensive medical and surgical treatments for DFU. Conclusion: The five-in-one comprehensive limb salvage treatment technologies played a vital role in enhancing the healing rate of severe DFU, shortening the healing time, and reducing the rate of recurrence and major amputation, thus improving the overall quality of life.
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Affiliation(s)
- Yiling Liu
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Yan Shi
- Medical Cosmetology Department, Jiangxi Maternal and Child Health Hospital, Nanchang, P.R. China
| | - Junyou Zhu
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - XiaoDong Chen
- Department of Burn Surgery, The First People's Hospital of Foshan, Foshan, P.R. China
| | - RongHua Yang
- Department of Burn Surgery, The First People's Hospital of Foshan, Foshan, P.R. China
| | - Bin Shu
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Ziheng Zhou
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Jian Liu
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
| | - Ri-qiang Wu
- Department of Burn Surgery, Yunfu City People's Hospital, YunFu, P.R. China
| | - Julin Xie
- Department of Burn Surgery, First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, P.R. China
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14
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Jaly I, Iyengar K, Bahl S, Hughes T, Vaishya R. Redefining diabetic foot disease management service during COVID-19 pandemic. Diabetes Metab Syndr 2020; 14:833-838. [PMID: 32540738 PMCID: PMC7289094 DOI: 10.1016/j.dsx.2020.06.023] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Diabetic Foot Disease (DFD) management had to be redefined during COVID-19. We aim to evaluate the impact of this on diabetic foot care services and the strategies adopted to mitigate them. METHODS We have performed a comprehensive review of the literature using suitable keywords on the Search engines of PubMed, SCOPUS, Google Scholar and Research Gate in the first two weeks of May 2020. We have reviewed how the diabetic foot service in the hospital and community setting has been affected by the current Coronavirus outbreak. RESULTS We found considerable disruption in diabetic foot service provisions both in the primary care and in the hospital settings. Social distancing and shielding public health guidelines have impacted the delivery of diabetic foot services. CONCLUSION As the COVID-19 pandemic spreads worldwide, health care systems are facing the tough challenges in delivering diabetic foot service to patients. Public health guidelines and the risk of virus transmission have resulted in reconfiguration of methods to support and manage diabetic foot patients including remote consultations.
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Affiliation(s)
- Ibrahim Jaly
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, United Kingdom.
| | - Karthikeyan Iyengar
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, United Kingdom.
| | - Shashi Bahl
- Department of Mechanical Engineering, I.K. Gujral Punjab Technical University Hoshiarpur Campus, Hoshiarpur, 146001, India.
| | - Thomas Hughes
- Department of Trauma and Orthopaedics, Southport and Ormskirk NHS Trust, Southport, PR8 6PN, United Kingdom.
| | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, 110076, India.
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15
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Zhu X, Wu FL, Zhu T, Liao F, Ren Y, Jan YK. Effects of Preconditioning Local Vibrations on Subsequent Plantar Skin Blood Flow Response to Walking. INT J LOW EXTR WOUND 2020; 20:143-149. [DOI: 10.1177/1534734620905744] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Weight-bearing exercise such as walking may increase risk of foot ulcers in people with diabetes mellitus (DM) because of plantar ischemia due to repetitive, high plantar pressure. Applications of local vibrations on plantar tissues as a preconditioning intervention before walking may reduce plantar tissue ischemia during walking. The objective of this study was to explore whether preconditioning local vibrations reduce reactive hyperemia after walking. A double-blind, repeated-measures, and crossover design was tested in 10 healthy participants without DM. The protocol included 10-minute baseline, 10-minute local vibrations (100 Hz or sham), 10-minute walking, and 10-minute recovery periods. The order of local vibrations was randomly assigned. Skin blood flow (SBF) was measured over the first metatarsal head during baseline and recovery periods. SBF responses were characterized as peak SBF, total SBF, and recovery time of reactive hyperemia. SBF was expressed as a ratio of recovery to baseline SBF to quantify the changes. Peak SBF in the vibration protocol (6.98 ± 0.87) was significantly lower than the sham control (9.26 ± 1.34, P < .01). Total SBF in the vibration protocol ([33.32 ± 7.98] × 103) was significantly lower than the sham control ([48.09 ± 8.9] × 103, P < .05). The recovery time in the vibration protocol (166.08 ± 32.71 seconds) was not significantly different from the sham control (223.53 ± 38.85 seconds, P = .1). Local vibrations at 100 Hz could reduce walking-induced hyperemic response on the first metatarsal head. Our finding indicates that preconditioning local vibrations could be a potential preventive intervention for people at risk for foot ulcers.
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Affiliation(s)
- Xiaotong Zhu
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Fu-Lien Wu
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Ting Zhu
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Fuyuan Liao
- Xi’an Technological University, Xi’an, Shaanxi, China
| | | | - Yih-Kuen Jan
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Beihang University, Beijing, China
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16
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Dalla Paola L, Cimaglia P, Carone A, Boscarino G, Scavone G. Use of Integra Dermal Regeneration Template for Limb Salvage in Diabetic Patients With No-Option Critical Limb Ischemia. INT J LOW EXTR WOUND 2020; 20:128-134. [PMID: 32056470 DOI: 10.1177/1534734620905741] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
We have analyzed in a retrospective study of consecutive diabetic patients affected by no-option critical limb ischemia (CLI) the efficacy of the dermal substitute Integra Dermal Regeneration Template for treatment of complicated foot lesions. The primary end point was limb salvage and 1-year amputation-free survival. The secondary end point was healing time of surgical site. Between October 2014 and October 2017, 1024 patients with diabetic foot ulcer (DFU) and CLI were admitted. In 84 patients (8.2%), there was a failure in distal revascularization with a persistent CLI after the procedure. Despite the persistent CLI, a group of 26 patients of this cohort obtained complete wound healing. Among them, 13 patients were treated with surgical debridement or open amputations and application of dermal substitute Integra Dermal Regeneration Template and the other 13 patients were treated without any dermal substitute. The Integra group healed within a mean time of 83.5 days, and the control group healed within a mean of 139 days (P = .028). No major amputation was carried out at 1-year follow-up in the Integra group versus 15% in the control group. A conservative foot surgery or an approach with minor amputation in diabetic patients with no-option CLI may achieve limb salvage. The use of Integra Dermal Regeneration Template in patients with DFU and no-option CLI may be a useful option in a limb salvage program.
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Affiliation(s)
| | | | - Anna Carone
- Maria Cecilia Hospital, Cotignola, Ravenna, Italy
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17
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Chen L, Zheng Q, Chen X, Wang J, Wang L. Low-frequency ultrasound enhances vascular endothelial growth factor expression, thereby promoting the wound healing in diabetic rats. Exp Ther Med 2019; 18:4040-4048. [PMID: 31656542 PMCID: PMC6812475 DOI: 10.3892/etm.2019.8051] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 08/16/2019] [Indexed: 12/22/2022] Open
Abstract
Diabetes is a chronic metabolic disease with a high prevalence worldwide, which typically delays or impairs wound healing, potentially causing death. Low-frequency ultrasound treatment promotes the repair of various injuries and may promote wound healing. The aim of the present study was to determine whether low-frequency ultrasound can accelerate wound healing, as well as investigate its effects on the expression of vascular endothelial growth factor (VEGF), transforming growth factor (TGF)-β1, interleukin (IL)-6 and tumor necrosis factor (TNF)-α in diabetic rats. A total of 45 Wistar rats were intraperitoneally injected with 1% streptozocin following intraperitoneal injection of pentobarbital sodium anesthesia. Subsequently an incision wound was created in the skin of back. The area of the wound was recorded to calculate the rate of wound healing. The expression of VEGF and TGF-β1 was determined via immunohistochemical analysis and their mRNA and protein levels were measured via reverse transcription-quantitative PCR analysis. The results revealed that when compared with the control group, low-frequency ultrasound treatment significantly increased wound healing rate in diabetic rats and markedly increased the mRNA and protein levels of VEGF and TGF-β1. US treatment also reduced the mRNA and protein levels of TNF-α and IL-6. In conclusion, the results of the present study indicated that low-frequency ultrasound promotes the expression of VEGF and TGF-β1, and inhibits the expression of IL-6 and TNF-α, thereby promoting wound healing in diabetic rats.
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Affiliation(s)
- Lang Chen
- Department of Burns and Plastic, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Qian Zheng
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Xianzhuo Chen
- Department of Burns and Plastic, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Jun Wang
- Department of Burns and Plastic, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
| | - Lan Wang
- Department of Burns and Plastic, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan 637000, P.R. China
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18
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Bolton L. Peripheral arterial disease: Scoping review of patient-centred outcomes. Int Wound J 2019; 16:1521-1532. [PMID: 31597226 DOI: 10.1111/iwj.13232] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 09/04/2019] [Accepted: 09/13/2019] [Indexed: 01/13/2023] Open
Abstract
Peripheral arterial disease (PAD) impairs patients' quality of life (QOL), walking and ulcer healing, increasing patient pain, costs, and risks of amputation or mortality. A literature appraisal described PAD treatment capacity to improve validated patient-centred outcomes in controlled clinical studies. The PUBMED database was searched from 1 January 1970 to 21 June 2018, for original and derivative controlled clinical trial references addressing MeSH terms for 'ischemia' AND 'leg ulcer'. Non-ischemic ulcer treatment references were excluded. Frequencies of improved (P < .05) outcomes were reported. Eighty-eight studies on 4153 patients were summarized. Walking, pain or QOL improved mainly for interventions administered before PAD became severe. Amputation incidence, pain and ulcer healing were more frequently reported in those with severe PAD. Independent of PAD severity, patients experienced more likely improved walking, QOL, or pain reduction in response to structured walking interventions or those increasing calf muscle activity. Those with more severe PAD were more likely to report amputation reduction, mainly in response to invasive interventions. Those with PAD experienced more consistently improved patient-centred outcomes if they received multidisciplinary PAD management with supervised walking or calf muscle activity, with more likely amputation risk reduced for those with more severe PAD.
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Affiliation(s)
- Laura Bolton
- Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, New Jersey
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19
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Abstract
The accurate assessment of peripheral perfusion is a critical step in caring for a diabetic patient with active ulceration. This article guides the provider through diagnostic and therapeutic options. The perfusion assessment begins with a physical examination and augmented using noninvasive tests. Although some of these tests can be performed at the bedside, often a dedicated vascular laboratory is required. Additional cross-sectional imaging studies or formal angiography should be performed as well. These tools aid in the creation of the best therapeutic plan, which aims to restore perfusion and allow for rapid wound healing via open or endovascular means.
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Affiliation(s)
- Michael Cyrus Siah
- Department of Vascular Surgery, MedStar Washington Hospital Center, 106 Iriving Street Northwest POB North 3150, Washington, DC 20010, USA
| | - Steven Abramowitz
- Department of Vascular Surgery, MedStar Washington Hospital Center, 106 Iriving Street Northwest POB North 3150, Washington, DC 20010, USA.
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20
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Ragno VM, Zello GA, Klein CD, Montgomery JB. From Table to Stable: A Comparative Review of Selected Aspects of Human and Equine Metabolic Syndrome. J Equine Vet Sci 2019; 79:131-138. [PMID: 31405493 DOI: 10.1016/j.jevs.2019.06.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 06/06/2019] [Accepted: 06/08/2019] [Indexed: 12/18/2022]
Abstract
Obesity data in people and companion animals are depicting a future of increasing morbidity, cost for society, and significant health and welfare concerns. Between 25 and 50% of cats, dogs, and horses in developed countries are overweight or obese, which mirrors the situation in humans. Equine metabolic syndrome (EMS) was named after human metabolic syndrome (MetS), which has about 30 years of lead in research efforts. Even though the complications of the two syndromes seem to grossly differ (cardiac vs. laminitis risk), a number of similar disease mechanisms are worthy of investigation. Since the first EMS consensus statement by the American College of Veterinary Internal Medicine in 2010, numerous studies have confirmed the link between insulin dysregulation and laminitis, even though the mechanisms are not fully understood. After the discovery of the role of adipokines in MetS, evidence about inflammatory mechanisms related to adiposity in rodent models, companion animals, horses, and humans is constantly increasing. Oxidative and dicarbonyl stress have been correlated with insulin dysregulation, obesity, and recently with laminitis. Vascular actions of insulin through nitric oxide, endothelin-1, and other mechanisms are being studied in horses and can provide a better understanding of laminitis pathophysiology. More research is needed on neuropathic mechanisms in insulin-dysregulated horses, which could be important in the pathogenesis of laminitis and laminitic pain. Human literature can provide viable material for novel studies in areas that have received limited attention, in addition to being valuable information for clients about the consequences of unhealthy management of their horses.
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Affiliation(s)
- Valentina M Ragno
- Department of Large Animal Clinical Sciences, WCVM, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada.
| | - Gordon A Zello
- Section of Nutrition, College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon SK S7N 5E5, Canada
| | - Colby D Klein
- Department of Large Animal Clinical Sciences, WCVM, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
| | - Julia B Montgomery
- Department of Large Animal Clinical Sciences, WCVM, University of Saskatchewan, Saskatoon, SK S7N 5B4, Canada
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21
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Mizeva IA, Potapova EV, Dremin VV, Zherebtsov EA, Mezentsev MA, Shuleptsov VV, Dunaev AV. Optical probe pressure effects on cutaneous blood flow. Clin Hemorheol Microcirc 2019; 72:259-267. [PMID: 30958335 DOI: 10.3233/ch-180459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The variation of blood flow characteristics caused by the probe pressure during noninvasive studies is of particular interest within the context of fundamental and applied research. It has been shown previously that the weak local pressure induces vasodilation, whereas the increased pressure is able to stop the blood flow in the compressed area, as well as to significantly change optical signals.The blood flow oscillations measured by laser Doppler flowmetry (LDF) characterize the functional state of the microvascular system and can be used for noninvasive diagnostics of its abnormality. This study was intended to identify the patterns of the relationship between the oscillating components of blood flow registered by the LDF method under different levels of pressure applied to an optical fiber probe.For this purpose, we have developed an original optical probe capable of regulating the applied pressure. The developed protocol included six sequential records of the blood perfusion at a pressure within the 0 to 200 mmHg range with unloading at the last stage.Using wavelet analyses, we traced the variation of energy of oscillations for these records in five frequency bands associated with different vascular tone regulation mechanisms. Six young volunteers of the same age (three males and three females) were included in this preliminary study and the protocol was repeated five times in each volunteer. Accordingly, 30 LDF records were available for the analyses. As expected, the LDF signal increases at weak pressure (30 mmHg) and decreases at increased pressure. The statistically stable amplification of endothelial associated blood flow oscillations under the 90 mmHg pressure allowed us to put forward a hypothesis that the endothelial activity increases. The possible causes of this phenomenon are discussed.
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Affiliation(s)
- Irina A Mizeva
- Institute of Continuous Media Mechanics of the Ural Branch, RAS, Perm, Russia.,Orel State University Named After I.S. Turgenev, Orel, Russia
| | | | - Viktor V Dremin
- Orel State University Named After I.S. Turgenev, Orel, Russia
| | | | | | | | - Andrey V Dunaev
- Orel State University Named After I.S. Turgenev, Orel, Russia
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22
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Vein conduit for end-to-side anastomosis of a calcified vessel in lower extremity free flap reconstruction. J Plast Reconstr Aesthet Surg 2019; 72:1100-1109. [PMID: 31036502 DOI: 10.1016/j.bjps.2019.02.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/26/2018] [Accepted: 02/12/2019] [Indexed: 01/18/2023]
Abstract
BACKGROUND As the microsurgical and interventional revascularization techniques are evolving, traditionally amputated limbs are now challenged to salvage. However, a calcified recipient vessel is a common but challenging problem encountered in lower extremity reconstruction. METHODS An end-to-side anastomosis of a vein graft (1.5-3.5 cm in length) was performed to the recipient vessel when it was difficult to clamp the recipient vessel near the defect because of the inelastic and hard vessel wall. The vascular clamp was applied to the vein graft, and the flap's pedicle was anastomosed to the vein graft. RESULTS A total of 18 free flaps (10 ALT cases, 4 TDAP cases, 2 PAP cases, and 2 SCIP cases) were anastomosed with a bridge vein graft to the heavily calcified recipient vessels (7 ATA cases, 3 PTA cases, 7 DPA cases, and 1 MPA case). Overall flap survival rate was 83.3%. Limb salvage rate was 93.7%, and anastomosis patency rate was 94.4% CONCLUSION: Vein conduit in an end-to-side anastomosis of severely calcified recipient vessels shows a reasonable limb salvage rate. It acts as a buffer, which makes microscopic vessel manipulation easier. If vessel calcification is the only drawback for a free flap reconstruction, then a vein graft needs to be prepared instead of an amputation. This method may extend the surgical option to more high-risk patients in lower extremity microsurgical reconstruction and increase the limb salvage rate.
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23
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Matos M, Mendes R, Silva AB, Sousa N. Physical activity and exercise on diabetic foot related outcomes: A systematic review. Diabetes Res Clin Pract 2018; 139:81-90. [PMID: 29477503 DOI: 10.1016/j.diabres.2018.02.020] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Revised: 02/01/2018] [Accepted: 02/13/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetic foot is one of the most common complications of diabetes. It has the potential risk of pathologic consequences including infection, ulceration and amputation, but a growing body of evidence suggests that physical activity and exercise may improve diabetic foot outcomes. OBJECTIVE To analyze de effects of exercise and physical activity interventions on diabetic foot outcomes. METHODS A comprehensive and systematic search was conducted according to PRISMA recommendations. Only controlled clinical trials with patients with diabetes were included. RESULTS Six studies, involving 418 patients with diabetes, were included. Two studies used only aerobic exercise; two studies combined aerobic, resistance and balance exercise; and two studies combined aerobic and balance exercise by Thai Chin Chuan methods. Physical activity and exercise significantly improved nerve velocity conduction, peripheral sensory function and foot peak pressure distribution. Moreover, the ulcers incidence rate per year was lower in the intervention groups, compared with the controls [0.02 vs. 0.12]. CONCLUSION This review suggests evidence that physical activity and exercise is an effective non-pharmacological intervention to improve diabetic foot related outcomes. Combined multi-disciplinary treatments are more effective in the prevention of foot complications in patients with diabetes.
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Affiliation(s)
- Monica Matos
- Research Center in Sports Sciences, Health Sciences and Human Development, Vila Real, Portugal.
| | - Romeu Mendes
- University of Trás-os-Montes e Alto Douro, Vila Real, Portugal; Public Health Unit, ACES Douro I - Marão e Douro Norte, Vila Real, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
| | - André B Silva
- Centro Hospitalar Tondela Viseu, Ophthalmology Department, Viseu, Portugal.
| | - Nelson Sousa
- Research Center in Sports Sciences, Health Sciences and Human Development, Vila Real, Portugal; University of Trás-os-Montes e Alto Douro, Vila Real, Portugal.
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24
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Liao F, Cheing GLY, Ren W, Jain S, Jan YK. Application of Multiscale Entropy in Assessing Plantar Skin Blood Flow Dynamics in Diabetics with Peripheral Neuropathy. ENTROPY 2018; 20:e20020127. [PMID: 33265218 PMCID: PMC7512620 DOI: 10.3390/e20020127] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 02/10/2018] [Accepted: 02/12/2018] [Indexed: 11/16/2022]
Abstract
Diabetic foot ulcer (DFU) is a common complication of diabetes mellitus, while tissue ischemia caused by impaired vasodilatory response to plantar pressure is thought to be a major factor of the development of DFUs, which has been assessed using various measures of skin blood flow (SBF) in the time or frequency domain. These measures, however, are incapable of characterizing nonlinear dynamics of SBF, which is an indicator of pathologic alterations of microcirculation in the diabetic foot. This study recruited 18 type 2 diabetics with peripheral neuropathy and eight healthy controls. SBF at the first metatarsal head in response to locally applied pressure and heating was measured using laser Doppler flowmetry. A multiscale entropy algorithm was utilized to quantify the regularity degree of the SBF responses. The results showed that during reactive hyperemia and thermally induced biphasic response, the regularity degree of SBF in diabetics underwent only small changes compared to baseline and significantly differed from that in controls at multiple scales (p < 0.05). On the other hand, the transition of regularity degree of SBF in diabetics distinctively differed from that in controls (p < 0.05). These findings indicated that multiscale entropy could provide a more comprehensive assessment of impaired microvascular reactivity in the diabetic foot compared to other entropy measures based on only a single scale, which strengthens the use of plantar SBF dynamics to assess the risk for DFU.
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Affiliation(s)
- Fuyuan Liao
- Department of Biomedical Engineering, Xi’an Technological University, Xi’an 710021, China
| | - Gladys L. Y. Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong 999077, China
| | - Weiyan Ren
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 1206 South Fourth Street, MC-588, Champaign, IL 61820, USA
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
| | - Sanjiv Jain
- Department of Physical Medicine and Rehabilitation, Carle Hospital, Urbana, IL 61801, USA
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, 1206 South Fourth Street, MC-588, Champaign, IL 61820, USA
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing 100083, China
- Correspondence: ; Tel.: +1-217-300-7253
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Liu JT, Su CH, Chen SY, Liew SJ, Chang CS. Spinal Cord Stimulation Improves the Microvascular Perfusion Insufficiency Caused by Critical Limb Ischemia. Neuromodulation 2018; 21:489-494. [PMID: 29377343 DOI: 10.1111/ner.12753] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Revised: 11/22/2017] [Accepted: 12/06/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE This retrospective case-controlled study intended to identify the benefits and efficacy of spinal cord stimulation (SCS) as a therapeutic strategy for patients with perfusion problems caused by critical limb ischemia (CLI). The outcomes of patients who received SCS were compared with those of patients who did not receive SCS. METHODS This study recruited 78 patients who were diagnosed with perfusion problems over the period of 2003-2011. Lower-limb Thallium-201 (201 Tl) scintigraphy revealed that the patients exhibited a perfusion difference of <0.95. Thirty-seven of the recruited patients received SCS treatment and 41 did not receive SCS treatment. All patients received the same medication: 100 mg aspirin once a day and 500 mg paracetamol thrice a day. The outcomes of walking distance, walking time, and sleeping quality were measured and recorded. Pain intensities were evaluated using the visual analog scale (VAS) scoring system. RESULTS Prior to SCS implantation, patients in the SCS treatment group had worse walking distance (64.86 ± 40.80 vs. 613.70 ± 535.00, p < 0.001), walking time (2.65 ± 1.64 vs. 13.90 ± 11.91, p < 0.001), and sleep quality (1.70 ± 0.78 vs. 3.32 ± 1.17, p < 0.001) than patients in the non-SCS treatment group. At the one-year follow-up, however, patients in the SCS treatment group had significantly better walking distance (1595.00 ± 483.60, p < 0.001), walking time (48.92 ± 14.10, p < 0.001), and sleep quality (4.65 ± 0.92, p < 0.001) than patients in the non-SCS treatment group. Moreover, the VAS score of patients in the SCS treatment group improved one week (8.63 ± 0.54 vs. 4.48 ± 0.59, p < 0.001) and one year after SCS implantation (2.35 ± 0.62, p < 0.001). By contrast, at the one-year follow-up, the walking distance (277.60 ± 374.80, p = 0.002), walking time (9.44 ± 10.73, p = 0.078), sleep quality (2.20 ± 1.10, p < 0.001), and VAS score (7.98 ± 0.43, p = 0.020) of patients in the non-SCS treatment group worsened. Furthermore, lower-limb 201 Tl scintigraphy revealed that microcirculation intensity increased in the lower extremities of patients in the SCS treatment group after SCS implantation relative to that before SCS implantation. Most importantly, 10 of the 41 patients in the non-SCS treatment group required the use of wheelchairs, whereas none of the patients in the SCS treatment group required the use of wheelchairs. CONCLUSION Treatment of CLI patient with SCS improved patient's walking ability, pain severity, and sleep quality. SCS should be considered as an effective treatment toward limb salvage in CLI.
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Affiliation(s)
- Jung-Tung Liu
- Department of Neurosurgery, School of Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
| | - Chen-Hsing Su
- Department of Neurosurgery, School of Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
| | - Se-Yi Chen
- Department of Neurosurgery, School of Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
| | - Sang-Jek Liew
- Department of Neurosurgery, School of Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
| | - Cheng-Siu Chang
- Department of Neurosurgery, School of Medicine, Chung-Shan Medical University Hospital, Chung-Shan Medical University, Taichung, Taiwan
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Liu X, Zheng G, Wen S. Drug-eluting stents versus control therapy in the infrapopliteal disease: A meta-analysis of eight randomized controlled trials and two cohort studies. Int J Surg 2017. [PMID: 28648791 DOI: 10.1016/j.ijsu.2017.06.075] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUD Drug-eluting stents (DES) have been proposed for the treatment of infrapopliteal arteries disease. However, the long-term clinical impact of DES treatment in the vascular territory still remains uncertain. METHODS AND RESULTS Pubmed, Embase, Cochrane data, CNKI and Wanfang Data were searched until December 20, 2016 for eligible studies according to identical strategies. Additional data were manually retrieved. STATA ver. 12.0 software were used to Meta-analyze the efficacies of DES and control treatment (BMS or PTA) for infrapopliteal arteries disease. A total of 927 patients from 10 studies (8 randomized controlled trials and 2 cohort studies) were assigned to DESs (n = 484) versus control treatment (n = 443). The results showed that infrapopliteal DES therapy yielded higher primary patency and EFS, while decreased the risk of restenosis at 12-months compared to controls significantly. At 3 years there were no significant differences between two groups, pooled RRs and 95% CI were 1.639 [0.526-5.105], P = 0.394; 1.197 [0.432-3.317], P = 0.729 and 0.992 [0.960-1.024], P = 0.661, respectively. Subgroup analysis showed that infrapopliteal DES therapy using Sirolimus-eluting stents rather than Everolimus-eluting stents provided higher clinic benefits. Infrapopliteal DES therapy yielded no significant difference for TLR, overall survival, Rutherford-Becker class improvement, limb amputation at 12-months and 3-years compared with control treatment. CONCLUSIONS The results of the present meta-analysis indicate the non-superiority of infrapopliteal DES therapy over control therapies (BMS/PTA) at 3 years, although short-term benefits at 12 months after DES therapy were evident. Further randomized trials with longer follow-up are required to provide the best scientific evidence regarding the preferred endovascular treatment for patients with occlusive disease of infrapopliteal arteries.
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Affiliation(s)
- Xiaochun Liu
- The Second Department of General Surgery, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou 341000, China.
| | - Guofu Zheng
- The Second Department of General Surgery, The Affiliated Ganzhou Hospital of Nanchang University, Ganzhou 341000, China.
| | - Song Wen
- Department of Interventional Treatment, Zhejiang Cancer Hospital, Hangzhou 310006, China.
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