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Zhao C, Feng M, Gluchman M, Ma X, Li J, Wang H. Acellular fish skin grafts in the treatment of diabetic wounds: Advantages and clinical translation. J Diabetes 2024; 16:e13554. [PMID: 38664883 PMCID: PMC11045921 DOI: 10.1111/1753-0407.13554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 01/23/2024] [Accepted: 02/26/2024] [Indexed: 04/29/2024] Open
Abstract
Diabetic wounds cannot undergo normal wound healing due to changes in the concentration of hyperglycemia in the body and soon evolve into chronic wounds causing amputation or even death of patients. Diabetic wounds directly affect the quality of patients and social medical management; thus researchers started to focus on skin transplantation technology. The acellular fish skin grafts (AFSGs) are derived from wild fish, which avoids the influence of human immune function and the spread of the virus through low-cost decellularization. AFSGs contain a large amount of collagen and omega-3 polyunsaturated fatty acids and they have an amazing effect on wound regeneration. However, after our search in major databases, we found that there were few research trials in this field, and only one was clinically approved. Therefore, we summarized the advantages of AFSGs and listed the problems faced in clinical use. The purpose of this paper is to enable researchers to better carry out original experiments at various stages.
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Affiliation(s)
- Chenyu Zhao
- Department of Ion Channel Pharmacology, School of PharmacyChina Medical UniversityShenyangChina
- Department of China Medical University‐The Queen's University of Belfast Joint College, School of PharmacyChina Medical UniversityShenyangChina
- School of PharmacyQueen's University BelfastBelfastUK
| | - Mengyi Feng
- School of Pharmaceutical ScienceWenzhou Medical UniversityWenzhouChina
| | - Martin Gluchman
- Department of China Medical University‐The Queen's University of Belfast Joint College, School of PharmacyChina Medical UniversityShenyangChina
- School of PharmacyQueen's University BelfastBelfastUK
| | - Xianghe Ma
- Department of China Medical University‐The Queen's University of Belfast Joint College, School of PharmacyChina Medical UniversityShenyangChina
- School of PharmacyQueen's University BelfastBelfastUK
| | - Jinhao Li
- Department of Ion Channel Pharmacology, School of PharmacyChina Medical UniversityShenyangChina
| | - Hui Wang
- Department of Ion Channel Pharmacology, School of PharmacyChina Medical UniversityShenyangChina
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Zhang L, Yang J, Liu W, Ding Q, Sun S, Zhang S, Wang N, Wang Y, Xi S, Liu C, Ding C, Li C. A phellinus igniarius polysaccharide/chitosan-arginine hydrogel for promoting diabetic wound healing. Int J Biol Macromol 2023; 249:126014. [PMID: 37517765 DOI: 10.1016/j.ijbiomac.2023.126014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/01/2023]
Abstract
Inadequate angiogenesis and inflammation at the wound site have always been a major threat to skin wounds, especially for diabetic wounds that are difficult to heal. Therefore, hydrogel dressings with angiogenesis and antibacterial properties are very necessary in practical applications. This study reported a hydrogel (PCA) based on L-arginine conjugated chitosan (CA) and aldehyde functionalized polysaccharides of Phellinus igniarius (OPPI) as an antibacterial and pro-angiogenesis dressing for wound repair in diabetes for the first time. and discussed its possible mechanism for promoting wound healing. The results showed that PCA had good antioxidant, antibacterial, biological safety and other characteristics, and effectively promoted the healing course of diabetic wound model. In detail, the H&E and Masson staining results showed that PCA promoted normal epithelial formation and collagen deposition. The Western blot results confirmed that PCA decreased the inflammation by inhibiting the IKBα/NF-κB signaling pathway and enhanced angiogenesis by adjusting the level of HIF-1α. In conclusion, PCA is a promising candidate for promoting wound healing in diabetes. Graphic abstract.
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Affiliation(s)
- Lifeng Zhang
- Engineering Research Center of the Ministry of Education, Jilin Agricultural University, Changchun 130118, China; College of traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Jiali Yang
- Engineering Research Center of the Ministry of Education, Jilin Agricultural University, Changchun 130118, China; College of traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Wencong Liu
- School of Food and Pharmaceutical Engineering, Wuzhou University, Wuzhou 543002, China
| | - Qiteng Ding
- College of traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Shuwen Sun
- College of traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Shuai Zhang
- College of traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Ning Wang
- College of traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Yue Wang
- College of traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Siyu Xi
- College of traditional Chinese Medicine, Jilin Agricultural University, Changchun 130118, China
| | - Chunyu Liu
- Engineering Research Center of the Ministry of Education, Jilin Agricultural University, Changchun 130118, China
| | - Chuanbo Ding
- College of traditional Chinese Medicine, Jilin Agriculture Science and Technology College, Jilin 132101, China.
| | - Changtian Li
- Engineering Research Center of the Ministry of Education, Jilin Agricultural University, Changchun 130118, China.
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Carle R, Tehan P, Stewart S, Semple D, Pilmore A, Carroll MR. Variability of toe pressures during haemodialysis: comparison of people with and without diabetes; a pilot study. J Foot Ankle Res 2023; 16:42. [PMID: 37430286 DOI: 10.1186/s13047-023-00642-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 06/29/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Diabetes, end stage renal disease (ESRD), and peripheral arterial disease (PAD) are associated with a higher risk of diabetes-related lower limb amputation. Timely identification of PAD with toe systolic blood pressure (TSBP) and toe-brachial pressure index (TBPI) is critical in order to implement foot protection strategies to prevent foot complications in people with ESRD. There is limited evidence describing the effect of haemodialysis on TSBP and TBPI. This study aimed to determine the variability of TSBP and TBPI during haemodialysis in people with ESRD, and to determine whether any observed variability differed between people with and without diabetes. METHODS TSBP and TBPI were taken before dialysis (T1), one hour into dialysis (T2) and in the last 15 min of dialysis (T3) during a single dialysis session. Linear mixed effects models were undertaken to determine the variability in TSBP and TBPI across the three time points and to determine whether this variability differed between people with and without diabetes. RESULTS Thirty participants were recruited, including 17 (57%) with diabetes and 13 (43%) with no diabetes. A significant overall reduction in TSBP was observed across all participants (P < 0.001). There was a significant reduction in TSBP between T1 and T2 (P < 0.001) and between T1 and T3 (P < 0.001). There was no significant overall change in TBPI over time (P = 0.62). There was no significant overall difference in TSBP between people with diabetes and people with no diabetes (mean difference [95% CI]: -9.28 [-40.20, 21.64], P = 0.54). There was no significant overall difference in TBPI between people with diabetes and people with no diabetes (mean difference [95% CI]: -0.01 [-0.17, 03.16], P = 0.91). CONCLUSION TSBP and TBPI are an essential part of vascular assessment of the lower limb. TBPI remained stable and TSBP significantly reduced during dialysis. Given the frequency and duration of dialysis, clinicians taking toe pressures to screen for PAD should be aware of this reduction and consider how this may have an impact on wound healing capacity and the development of foot related complications.
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Affiliation(s)
- Rachel Carle
- Community and Long-Term Conditions Directorate, Te Toka Tumai, Auckland, New Zealand
| | - Peta Tehan
- Department of Surgery, School of Clinical Sciences, Faculty of Medicine, Nursing and Allied Health, Monash University, Clayton, VIC, Australia
| | - Sarah Stewart
- Department of Podiatry, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92 006, Auckland, 1142, New Zealand
- Active Living and Rehabilitation, Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - David Semple
- Department of Renal Medicine, Te Toka Tumai, Auckland, New Zealand
- School of Medicine, University of Auckland, Auckland, New Zealand
| | - Andrew Pilmore
- Department of Renal Medicine, Te Toka Tumai, Auckland, New Zealand
| | - Matthew R Carroll
- Department of Podiatry, School of Clinical Sciences, Faculty of Health and Environmental Sciences, Auckland University of Technology, Private Bag 92 006, Auckland, 1142, New Zealand.
- Active Living and Rehabilitation, Aotearoa New Zealand, Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand.
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Guo J, Yang X, Chen J, Wang C, Sun Y, Yan C, Ren S, Xiong H, Xiang K, Zhang M, Li C, Jiang G, Xiang X, Wan G, Jiang T, Kang Y, Xu X, Chen Z, Li W. Exosomal miR-125b-5p derived from adipose-derived mesenchymal stem cells enhance diabetic hindlimb ischemia repair via targeting alkaline ceramidase 2. J Nanobiotechnology 2023; 21:189. [PMID: 37308908 DOI: 10.1186/s12951-023-01954-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/03/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Ischemic diseases caused by diabetes continue to pose a major health challenge and effective treatments are in high demand. Mesenchymal stem cells (MSCs) derived exosomes have aroused broad attention as a cell-free treatment for ischemic diseases. However, the efficacy of exosomes from adipose-derived mesenchymal stem cells (ADSC-Exos) in treating diabetic lower limb ischemic injury remains unclear. METHODS Exosomes were isolated from ADSCs culture supernatants by differential ultracentrifugation and their effect on C2C12 cells and HUVECs was assessed by EdU, Transwell, and in vitro tube formation assays separately. The recovery of limb function after ADSC-Exos treatment was evaluated by Laser-Doppler perfusion imaging, limb function score, and histological analysis. Subsequently, miRNA sequencing and rescue experiments were performed to figure out the responsible miRNA for the protective role of ADSC-Exos on diabetic hindlimb ischemic injury. Finally, the direct target of miRNA in C2C12 cells was confirmed by bioinformatic analysis and dual-luciferase report gene assay. RESULTS ADSC-Exos have the potential to promote proliferation and migration of C2C12 cells and to promote HUVECs angiogenesis. In vivo experiments have shown that ADSC-Exos can protect ischemic skeletal muscle, promote the repair of muscle injury, and accelerate vascular regeneration. Combined with bioinformatics analysis, miR-125b-5p may be a key molecule in this process. Transfer of miR-125b-5p into C2C12 cells was able to promote cell proliferation and migration by suppressing ACER2 overexpression. CONCLUSION The findings revealed that miR-125b-5p derived from ADSC-Exos may play a critical role in ischemic muscle reparation by targeting ACER2. In conclusion, our study may provide new insights into the potential of ADSC-Exos as a treatment option for diabetic lower limb ischemia.
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Affiliation(s)
- Jiahe Guo
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiaofan Yang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Chen
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Cheng Wang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yue Sun
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, 430022, China
| | - Chengqi Yan
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Sen Ren
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hewei Xiong
- Department of Emergency Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Kaituo Xiang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Maojie Zhang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chengcheng Li
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Guoyong Jiang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xuejiao Xiang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Gui Wan
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Tao Jiang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yu Kang
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Xiang Xu
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Zhenbing Chen
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| | - Wenqing Li
- Department of Hand and Foot Surgery, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, China.
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Seidel D, Lefering R. NPWT resource use compared with standard moist wound care in diabetic foot wounds: DiaFu randomized clinical trial results. J Foot Ankle Res 2022; 15:72. [PMID: 36180953 PMCID: PMC9524075 DOI: 10.1186/s13047-022-00569-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/24/2022] [Indexed: 11/21/2022] Open
Abstract
Background Diabetic foot ulcers not only have a negative impact on patient mortality, morbidity and quality of life, but also require high resource utilization to achieve complete wound healing. The aim of this evaluation was to compare resource utilization of negative pressure wound therapy (NPWT) and standard moist wound care (SMWC) for diabetic foot wounds after amputation, surgical debridement or wound cleansing. Methods The multicenter clinical DiaFu study enrolled 368 adults with diabetic foot ulcers between December 23, 2011 and October 21, 2014. Patients were randomly assigned to NPWT and SMWC. Evaluation of direct resource use comprised inpatient and outpatient treatment time, and personnel and material for wound treatment within 16 weeks. This resource use analysis was primarily based on the per protocol population (NPWT 44; SMWC 110). Results Treatment duration was 16 days shorter with NPWT (mean (SD) 82.8 (31.6), SMWC 98.8 (24.6); U test, p = 0.001) with 14.9 days shorter outpatient treatment (mean (SD) NPWT 68.3 (31.1), SMWC 83.2 (29.7)). The number of dressing changes per study participant was lower with NPWT (mean (SD) 35.1 (18.6), SMWC (42.9 (21.4); U test, p = 0.067). Time per dressing change was significantly lower with SMWC (mean (SD) 19.7 (12.8), NPWT (16.5 (8.2) minutes; U test, p < < 0.0001). Time for surgical debridements per study participant was 23.3 minutes shorter with NPWT (mean (SD) 20.5 (20.5), SMWC (43.8 (46.7); U test, p = 0.395). Conclusions Resource use was lower for NPWT, which may be an efficient treatment alternative to SMWC for diabetic foot wounds, to be demonstrated in subsequent cost analyses. Trial registration clinicaltrials.govNCT01480362 on November 28, 2011 Supplementary Information The online version contains supplementary material available at 10.1186/s13047-022-00569-w.
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Affiliation(s)
- Dörthe Seidel
- Institut für Forschung in der Operativen Medizin (IFOM), University of Witten/Herdecke, Ostmerheimerstraße 200 Haus 38, 51109, Köln, Germany.
| | - Rolf Lefering
- Institut für Forschung in der Operativen Medizin (IFOM), University of Witten/Herdecke, Ostmerheimerstraße 200 Haus 38, 51109, Köln, Germany
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Chen J, He J, Yang Y, Qiao L, Hu J, Zhang J, Guo B. Antibacterial adhesive self-healing hydrogels to promote diabetic wound healing. Acta Biomater 2022; 146:119-130. [PMID: 35483628 DOI: 10.1016/j.actbio.2022.04.041] [Citation(s) in RCA: 129] [Impact Index Per Article: 64.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 04/20/2022] [Accepted: 04/21/2022] [Indexed: 12/20/2022]
Abstract
The development of compressible, stretchable and self-healing hydrogel dressings with good adhesive, antibacterial and angiogenesis properties is needed to promote the regeneration of diabetic wounds in clinical applications. In this work, a series of self-healing, adhesive and antibacterial hydrogels based on gelatin methacrylate (GelMA), adenine acrylate (AA), and CuCl2 were designed through covalent bonding, coordination complexation of Cu2+ and carboxyl groups and hydrogen bonding to promote diabetic wound healing. These hydrogels exhibit efficient self-healing properties, remarkable fatigue resistance, and good adhesive properties due to the hydrogen bond and the metal-ligand coordination provided by the Cu2+ and the carboxyl group. The GelMA/AA/Cu1.0 hydrogel (containing 1.0 mg/mL Cu2+) with well-balanced biocompatibility and antibacterial properties exhibited efficient hemostatic performance in a mouse liver trauma model and significantly promoted the healing process in a full-thickness skin diabetic wound model. The immunohistochemistry results showed that the GelMA/AA/Cu1.0 hydrogel can promote regular epithelialization and collagen deposition when compared to the TegadermTM Film, GelMA hydrogel, and GelMA/AA/Cu0 hydrogel. The immunofluorescence results confirmed that the GelMA/AA/Cu1.0 hydrogel can reduce the expression of proinflammatory factors and promote angiogenesis. In conclusion, the GelMA/AA/Cu hydrogel is an effective wound dressing to promote the healing process of diabetic skin wounds. STATEMENT OF SIGNIFICANCE: Diabetic wounds exhibit an extremely high risk of bacterial infection and poor angiogenesis in a high-sugar environment, hindering their healing process. Hydrogel wound dressings are a promising wound care material that need to have stable and long-lasting adhesive properties, avoid shedding, provide lasting protection to wounds, antibacterial properties and promote angiogenesis. In this study, a series of self-healing, adhesive, and antibacterial hydrogels based on gelatin methacrylate (GelMA), acrylated adenine (AA), and CuCl2 were designed and synthesized via free radical polymerization, hydrogen bond, and ionic bond to promote diabetic wound healing. Overall, GelMA/AA/Cu hydrogels are promising materials to promote diabetic wound healing.
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Hyaluronic acid-methacrylic anhydride/polyhexamethylene biguanide hybrid hydrogel with antibacterial and proangiogenic functions for diabetic wound repair. CHINESE CHEM LETT 2022. [DOI: 10.1016/j.cclet.2022.03.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Latz CA, Deluca E, Lella S, Waller HD, DeCarlo C, Dua A. Rates of Conversion from Dry to Wet Gangrene Conversion Following Lower Extremity Revascularization. Ann Vasc Surg 2022; 83:20-25. [DOI: 10.1016/j.avsg.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 12/15/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
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Moore Z, Avsar P, Wilson P, Mairghani M, O'Connor T, Nugent L, Patton D. Diabetic foot ulcers: treatment overview and cost considerations. J Wound Care 2021; 30:786-791. [PMID: 34644133 DOI: 10.12968/jowc.2021.30.10.786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Zena Moore
- Professor of Nursing, Head of School of Nursing and Midwifery and Director of the Skin Wounds and Trauma Research Centre. RCSI University of Medicine and Health Sciences, Dublin; Adjunct Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Adjunct Professor, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Professor, Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Honorary Professor, Lida Institute, Shanghai, China; Visiting Professor, University of Wales, Cardiff, UK; Adjunct Professor, Griffith University, Australia
| | - Pinar Avsar
- Senior Postdoctoral Fellow. Skin Wounds and Trauma Research Centre. The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin
| | - Pauline Wilson
- Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin
| | - Maisoon Mairghani
- Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery. RCSI University of Medicine and Health Sciences, Dublin
| | - Tom O'Connor
- Director of Academic Affairs and Deputy Head of School, School of Nursing and Midwifery and Lead Researcher, Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin; Honorary Professor, Lida Institute, Shanghai, China; Adjunct Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Adjunct Professor, Griffith University, Australia
| | - Linda Nugent
- Lecturer and Programme Director, School of Nursing and Midwifery. The Royal College of Surgeons in Ireland (RCSI), University of Medicine and Health Sciences, Dublin; Adjunct Assistant Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia
| | - Declan Patton
- Director of Nursing and Midwifery Research and Deputy Director of the Skin, Wounds and Trauma Research Centre, School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin; Adjunct Associate Professor, Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; Honorary Senior Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia; Adjunct Professor, Griffith University, Australia
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Hart O, Jansen S, Fitridge R, Khashram M. Protocol for a prospective observational study: the Australia and New Zealand Diabetic and Ischaemic Foot Outcomes Study (ANZ-DIFOS). BMJ Open 2021; 11:e050833. [PMID: 34475182 PMCID: PMC8413961 DOI: 10.1136/bmjopen-2021-050833] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/19/2021] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Diabetic foot disease is a common condition globally and is over-represented in indigenous populations. The propensity for patients with diabetic foot disease to undergo minor or major limb amputation is a concern. Diabetic foot disease and lower limb amputation are debilitating for patients and have a substantial financial impact on health services. The purpose of this multicentre study is to prospectively report the presentation, management and outcomes of diabetic foot disease, to validate existing scoring systems and assess long term outcomes for these patients particularly in relation to major limb amputation. METHODS AND ANALYSIS This is a multisite, international, prospective observational study, being undertaken at Waikato Hospital, New Zealand (NZ); Sir Charles Gairdner Hospital, the Royal Adelaide Hospital and the Queen Elizabeth Hospital, Australia. Consecutive participants with diabetic foot disease that meet inclusion criteria and agree to participate will be recruited from multidisciplinary team diabetic foot clinic, vascular clinic, dialysis and admission to hospital. Follow-up of participants will occur at 1, 3, 6 and 12 months. At recruitment and follow-up reviews, information about service details, demographic and clinical history, wound data and discharge information will be recorded. The primary outcomes are the time to wound healing, major amputation, overall mortality and amputation-free survival at 12 months. This study started in NZ in August 2020 and will commence in Australian sites in early 2021. ETHICS AND DISSEMINATION New Zealand Central Health and Disability Ethics Committee (20/CEN/122), Waikato DHB Research Department (RDO020044), Quality Improvement HoD Sir Charles Gairdner Hospital (39715) and the Central Adelaide Local Health Network (CALHN) Human Research Ethics Committee (13928). Results will be presented at international conferences and published in peer-reviewed journals. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12621000337875).
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Affiliation(s)
- Odette Hart
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
| | - Shirley Jansen
- Curtain Medical School, Curtin University, Perth, Western Australia, Australia
- Surgery Division, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Department of Vascular and Endovascular Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Robert Fitridge
- Discipline of Surgery, The University of Adelaide, Adelaide, South Australia, Australia
- Department of Vascular Surgery, Royal Adelaide and Queen Elizabeth Hospitals, Adelaide, South Australia, Australia
| | - Manar Khashram
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Department of Vascular Surgery, Waikato Hospital, Hamilton, New Zealand
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Zhang X, Jiang Y, Huang Q, Wu Z, Pu H, Xu Z, Li B, Lu X, Yang X, Qin J, Peng Z. Exosomes derived from adipose-derived stem cells overexpressing glyoxalase-1 protect endothelial cells and enhance angiogenesis in type 2 diabetic mice with limb ischemia. Stem Cell Res Ther 2021; 12:403. [PMID: 34266474 PMCID: PMC8281719 DOI: 10.1186/s13287-021-02475-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/26/2021] [Indexed: 01/09/2023] Open
Abstract
Background Diabetic limb ischemia is a clinical syndrome and refractory to therapy. Our previous study demonstrated that adipose-derived stem cells (ADSCs) overexpressing glyoxalase-1 (GLO-1) promoted the regeneration of ischemic lower limbs in diabetic mice, but low survival rate, difficulty in differentiation, and tumorigenicity of the transplanted cells restricted its application. Recent studies have found that exosomes secreted by the ADSCs have the advantages of containing parental beneficial factors and exhibiting non-immunogenic, non-tumorigenic, and strong stable characteristics. Methods ADSCs overexpressing GLO-1 (G-ADSCs) were established using lentivirus transfection, and exosomes secreted from ADSCs (G-ADSC-Exos) were isolated and characterized to coculture with human umbilical vein endothelial cells (HUVECs). Proliferation, apoptosis, migration, and tube formation of the HUVECs were detected under high-glucose conditions. The G-ADSC-Exos were injected into ischemic hindlimb muscles of type 2 diabetes mellitus (T2DM) mice, and the laser Doppler perfusion index, Masson’s staining, immunofluorescence, and immunohistochemistry assays were adopted to assess the treatment efficiency. Moreover, the underlying regulatory mechanisms of the G-ADSC-Exos on the proliferation, migration, angiogenesis, and apoptosis of the HUVECs were explored. Results The G-ADSC-Exos enhanced the proliferation, migration, tube formation, and anti-apoptosis of the HUVECs in vitro under high-glucose conditions. After in vivo transplantation, the G-ADSC-Exo group showed significantly higher laser Doppler perfusion index, better muscle structural integrity, and higher microvessel’s density than the ADSC-Exo and control groups by Masson’s staining and immunofluorescence assays. The underlying mechanisms by which the G-ADSC-Exos protected endothelial cells both in vitro and in vivo might be via the activation of eNOS/AKT/ERK/P-38 signaling pathways, inhibition of AP-1/ROS/NLRP3/ASC/Caspase-1/IL-1β, as well as the increased secretion of VEGF, IGF-1, and FGF. Conclusion Exosomes derived from adipose-derived stem cells overexpressing GLO-1 protected the endothelial cells and promoted the angiogenesis in type 2 diabetic mice with limb ischemia, which will be a promising clinical treatment in diabetic lower limb ischemia. Supplementary Information The online version contains supplementary material available at 10.1186/s13287-021-02475-7.
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Affiliation(s)
- Xing Zhang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Yihong Jiang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Qun Huang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Zhaoyu Wu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Hongji Pu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Zhijue Xu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Bo Li
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Xinwu Lu
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China
| | - Xinrui Yang
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
| | - Jinbao Qin
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
| | - Zhiyou Peng
- Department of Vascular Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200011, China.
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12
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Zhao X, Guo J, Zhang F, Zhang J, Liu D, Hu W, Yin H, Jin L. Therapeutic application of adipose-derived stromal vascular fraction in diabetic foot. Stem Cell Res Ther 2020; 11:394. [PMID: 32928305 PMCID: PMC7488783 DOI: 10.1186/s13287-020-01825-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/15/2020] [Accepted: 07/10/2020] [Indexed: 02/06/2023] Open
Abstract
Diabetic foot is one of the severest complications of diabetes. In severe cases, this disease may be lead to amputation or even death due to secondary infection and ischemic necrosis. Since the ineffectiveness of traditional therapy, autologous stem cell transplantation has been used to treat diabetic foot. This simple, safe, and effective therapy is expected to be applied and promoted in the future.In this review, we described the detailed pathogenesis of diabetic foot and the common clinical treatments currently used. We also revealed vascular remodeling as the potential mechanism of therapeutic functions of adipose-derived stromal vascular fraction (SVF) in treating diabetic foot.
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Affiliation(s)
- Xiansheng Zhao
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, Jiangsu Province, China
| | - Jiamin Guo
- Irell & Manella Graduate School of Biological Sciences, City of Hope National Medical Center, California, 91010, USA
| | - Fangfang Zhang
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, Jiangsu Province, China
| | - Jue Zhang
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Delin Liu
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, 210009, Jiangsu Province, China
| | - Wenjun Hu
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, Jiangsu Province, China.
| | - Han Yin
- Department of Endocrinology, The Affiliated ZhongDa Hospital of Southeast University, Nanjing, 210009, Jiangsu Province, China.
| | - Liang Jin
- School of Life Science and Technology, China Pharmaceutical University, Nanjing, 211198, Jiangsu Province, China.
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13
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Platelet-Released Growth Factors and Platelet-Rich Fibrin Induce Expression of Factors Involved in Extracellular Matrix Organization in Human Keratinocytes. Int J Mol Sci 2020; 21:ijms21124404. [PMID: 32575800 PMCID: PMC7378768 DOI: 10.3390/ijms21124404] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/18/2020] [Accepted: 06/19/2020] [Indexed: 02/07/2023] Open
Abstract
Platelet-released growth factor (PRGF) is a thrombocyte concentrate lysate which, like its clinically equivalent variations (e.g., Vivostat PRF® (platelet-rich fibrin)), is known to support the healing of chronic and hard-to-heal wounds. However, studies on the effect of PRGF on keratinocytes remain scarce. This study aims to identify genes in keratinocytes that are significantly influenced by PRGF. Therefore, we performed a whole transcriptome and gene ontology (GO) enrichment analysis of PRGF-stimulated human primary keratinocytes. This revealed an increased expression of genes involved in extracellular matrix (ECM) organization. Real-time polymerase chain reaction (PCR) and enzyme-linked immunosorbent assay (ELISA) analysis confirmed the PRGF-mediated induction of selected ECM-related factors such as transforming growth factor beta-induced protein, fibronectin 1, matrix metalloproteinase-9, transglutaminase 2, fermitin family member 1, collagen type I alpha 1 and collagen type XXII alpha 1. PRGF-induced expression of the above factors was influenced by blockade of the epidermal growth factor receptor (EGFR), a receptor playing a crucial role in wound healing. A differential induction of the investigated factors was also detected in skin explants exposed to PRGF and in experimentally generated in vivo wounds treated with Vivostat PRF®. Together, our study indicates that the induction of ECM-related factors may contribute to the beneficial wound-healing effects of PRGF-based formulations.
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Jafary MR, Amini MR, Sanjari M, Aalaa M, Goudarzi Z, Najafpour Z, Mohajeri Tehrani MR. Comparison home care service versus hospital-based care in patients with diabetic foot ulcer : an economic evaluation study. J Diabetes Metab Disord 2020; 19:445-452. [PMID: 32550196 DOI: 10.1007/s40200-020-00527-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 04/03/2020] [Indexed: 10/24/2022]
Abstract
Introduction Providing health care to patients at home could be causing the mortality and readmission rates reduction in addition to satisfaction of both patients and health care providers increase. The aim of this study was to assess the cost-effectiveness of home care service compared to hospital based care in patients with diabetic foot ulcer. Methods An economic evaluation study and a trial study were simultaneously conducted in Iran. In trial phase, patients with diabetic foot ulcer were randomly assigned to the home care or hospital care. The Cost and Quality of life data were determined as measures of the study. Incremental cost-effectiveness ratio was calculated for comparative purposes. The model consisted of five stages of the disease. The Tree Age Pro 2009 and R software's were used for data analysis. Results 120 patients were enrolled in our trial; among which 30 patients were in home care service group and 90 patients in hospital based care group. The rate of ulcer size reduction in hospital based care was significant (P value = 0.003) in comparison with home care service. The total cost of the home care and hospital strategies were 1720.4 US$, 3940.3 US$ and the total effectiveness were 0.31 and 0.29, respectively. The incremental cost-effectiveness ratio (ICER) was 117,300 US$ per quality-adjusted life year for home care intervention compared to hospital based care. Based on ICER plane home care treatment will be placed on the southeastern quadrant of the Cost-Effectiveness Plane, and is suggested as a more dominant treatment alternative. Conclusions Regarding current evidence, home care strategy for patients suffering diabetic foot ulcer enjoys more cost effectiveness compared to hospital care. It is suggested that healthcare policy makers determine the tariff for health care services for disease groups according to the activity based costing approach.
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Affiliation(s)
- M R Jafary
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - M R Amini
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - M Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - M Aalaa
- Department of Medical Education, Center for Educational Research in Medical Sciences (CERMS), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Z Goudarzi
- Department of Pharmacoeconomics and pharmaceutical administration, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Zh Najafpour
- Department of Health care Management, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - M R Mohajeri Tehrani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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15
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Hicks CW, Canner JK, Karagozlu H, Mathioudakis N, Sherman RL, Black JH, Abularrage CJ. Contribution of 30-day readmissions to the increasing costs of care for the diabetic foot. J Vasc Surg 2019; 70:1263-1270. [DOI: 10.1016/j.jvs.2018.12.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 12/04/2018] [Indexed: 12/22/2022]
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16
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Joret MO, Osman K, Dean A, Cao C, van der Werf B, Bhamidipaty V. Multidisciplinary clinics reduce treatment costs and improve patient outcomes in diabetic foot disease. J Vasc Surg 2019; 70:806-814. [PMID: 30850290 DOI: 10.1016/j.jvs.2018.11.032] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/04/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Diabetic foot disease poses a significant and rising financial burden on health care systems worldwide. This study investigated the effect of a new multidisciplinary diabetic foot clinic (MDDFC) in a large tertiary hospital on patient outcomes and treatment cost. METHODS Patients' records were retrospectively reviewed to identify all patients who had been managed in a new MDDFC between July 2014 and July 2017. The wound episode-the period from initial presentation to the achievement of a final wound outcome-was identified, and all relevant inpatient and outpatient costs were extracted using a fully absorbed activity-based costing methodology. Risk factor, treatment, outcome, and costing data for this cohort were compared with a group of patients with diabetic foot wounds who had been managed in the same hospital before the advent of the MDDFC using a generalized linear mixed model. RESULTS The MDDFC and pre-MDDFC cohorts included 73 patients with 80 wound episodes and 225 patients with 265 wound episodes, respectively. Compared with the pre-MDDFC cohort, the MDDFC group had fewer inpatient admissions (1.56 vs 2.64; P ≤ .001). MDDFC patients had a lower major amputation rate (3.8% vs 27.5%; P ≤ .001), a lower mortality rate (7.5% vs 19.2%; P ≤ .05), and a higher rate of minor amputation (53.8% vs 31.7%; P ≤ .01). No statistically significant difference was noted in the rate of excisional débridement, skin graft, and open or endovascular revascularization. In the MDDFC cohort, the median total cost, inpatient cost, and outpatient cost per wound episode was New Zealand dollars (NZD) 22,407.465 (U.S. dollars [USD] 17,253.74), NZD 21,638.93 (USD 16,661.97), and NZD 691.915 (USD 532.77), respectively. The MDDFC to pre-MDDFC wound episode total cost ratio was 0.7586 (P < .001). CONCLUSIONS This study is the first to compare the cost and treatment outcomes of diabetic foot patients treated in a large tertiary hospital before and after the introduction of an MDDFC. The results show that an MDDFC improves patient outcomes and reduces the cost of treatment. MDDFCs should be adopted as the standard of care for diabetic foot patients.
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Affiliation(s)
- Maximilian O Joret
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand
| | - Kareem Osman
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand
| | - Anastasia Dean
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand
| | - Colin Cao
- Department of Business Intelligence, ADHB, Auckland, New Zealand
| | - Bert van der Werf
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Venu Bhamidipaty
- Department of Vascular Surgery, Auckland Hospital, ADHB, Auckland, New Zealand.
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17
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Delgado-Enciso I, Madrigal-Perez VM, Lara-Esqueda A, Diaz-Sanchez MG, Guzman-Esquivel J, Rosas-Vizcaino LE, Virgen-Jimenez OO, Kleiman-Trujillo J, Lagarda-Canales MR, Ceja-Espiritu G, Rangel-Salgado V, Lopez-Lemus UA, Delgado-Enciso J, Lara-Basulto AD, Soriano Hernández AD. Topical 5% potassium permanganate solution accelerates the healing process in chronic diabetic foot ulcers. Biomed Rep 2018; 8:156-159. [PMID: 29435274 PMCID: PMC5778841 DOI: 10.3892/br.2018.1038] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 12/01/2017] [Indexed: 12/26/2022] Open
Abstract
Potassium permanganate has been reported to be an effective treatment for certain types of wounds. The aim of the present study was to evaluate the use of potassium permanganate in the treatment of diabetic foot ulcers. A single-blind, randomized, controlled clinical trial was conducted on patients with type 2 diabetes mellitus that presented with a foot ulcer persisting for >3 months. The control group (n=10) was treated with the current standard treatment, which comprises of measures for reducing pressure in the ulcerated area, daily cleansing of the ulcer with potable water and antiseptic wash solution, and the application of a disinfectant solution on the entire surface area of the ulcer; while the intervention group (n=15) received the standard treatment plus 5% topical potassium permanganate solution applied once a day for 21 days. In the intervention group, 1 patient did not tolerate the treatment and was eliminated from the study on the first day. The remaining patients tolerated the interventions well. At the end of the treatment period, ulcers in the control group had decreased by 38% whereas those in the intervention group decreased by 73% (P<0.009). The degree of decrease was also investigated; the ulcer size was ≥50% decreased in 40% of patients in the control group and in 86% of patients in the intervention group (P=0.02). In conclusion, the results of the present study indicate that topical potassium permanganate is well tolerated and significantly accelerates the healing process of diabetic foot ulcers.
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Affiliation(s)
- Iván Delgado-Enciso
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico.,Department of Public Health, School of Medicine, University of Colima, Las Víboras, Colima 28040, Mexico
| | - Violeta M Madrigal-Perez
- Department of Public Health, School of Medicine, University of Colima, Las Víboras, Colima 28040, Mexico
| | - Agustin Lara-Esqueda
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Martha G Diaz-Sanchez
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Jose Guzman-Esquivel
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Luis E Rosas-Vizcaino
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Oscar O Virgen-Jimenez
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Juleny Kleiman-Trujillo
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Maria R Lagarda-Canales
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Gabriel Ceja-Espiritu
- Department of Public Health, School of Medicine, University of Colima, Las Víboras, Colima 28040, Mexico
| | - Viridiana Rangel-Salgado
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Uriel A Lopez-Lemus
- Department of Public Health, School of Medicine, University of Colima, Las Víboras, Colima 28040, Mexico
| | - Josuel Delgado-Enciso
- Department of Research, Foundation for Cancer Ethics, Education and Research of the Cancerology State Institute, Colima 28085, Mexico
| | - Agustin D Lara-Basulto
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico
| | - Alejandro D Soriano Hernández
- Department of Research, Cancerology State Institute, Colima State Health Services, Colima 28085, Mexico.,Department of Public Health, School of Medicine, University of Colima, Las Víboras, Colima 28040, Mexico
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Bayer A, Tohidnezhad M, Berndt R, Lippross S, Behrendt P, Klüter T, Pufe T, Jahr H, Cremer J, Rademacher F, Simanski M, Gläser R, Harder J. Platelet-released growth factors inhibit proliferation of primary keratinocytes in vitro. Ann Anat 2018; 215:1-7. [DOI: 10.1016/j.aanat.2017.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/02/2017] [Accepted: 09/02/2017] [Indexed: 12/22/2022]
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Affiliation(s)
- S Schreml
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
| | - M Berneburg
- Department of Dermatology, University Medical Centre Regensburg, Regensburg, Germany
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