OBJECTIVE:To clarify and quantify risk factors among local characteristics of the foot for major amputation in diabetic foot patients.METHODS:Articles published before January 2018 on PubMed and Embase were conducted observational studies about risk factors for major amputation in patients with diabetic foot were retrieved and systematically reviewed by using Stata 12.0 statistical software.RESULTS:A total of 4668 major amputees and 65 831 controls were reported in 18 observational studies. Across the studies, the overall odds ratios (ORs) and 95% confidence intervals (CIs) of significant risk factors are ulcer reaching bone (OR, 11.796; 95% CI, 6.905-20.152), gangrene (OR, 6.487; 95% CI, 4.088-10.293), hindfoot position (OR, 3.913; 95% CI, 2.254-6.795), decreased ankle-brachial index (ABI) (OR, 2.522; 95% CI, 1.805-3.523), infection (OR, 2.516; 95% CI, 1.708-3.706), peripheral arterial disease (PAD) (OR, 2.114; 95% CI, 1.326-3.372). While there is no significant difference in the size of the ulcer, neuropathy, Charcot foot, osteomyelitis and intermittent claudication (OR, 1.15; 95% CI, 0.85-1.54).CONCLUSION:Factors among local characteristics of the foot associated with major amputation in patients with diabetic foot are the ulcer reaching bone, gangrene, hindfoot position, decreased ABI, infection, and PAD, a negative risk factor for the risk of amputation. Further studies are required to provide more details of foot local characteristics.

Objective To analyze the causes of failure of negative pressure wound therapy ( NPWT) in the treatment of diabetic foot wounds, and to explore preventive measures in order to improve therapeutic effects. Meth-ods The clinical data of 580 patients with diabetic foot who were treated with NPWT in Dongzhimen Hospital of Bei-jing University of Chinese Medicine from January 2012 to December 2016 were analyzed retrospectively. After one course of NPWT treatment, the patients who did not respond to therapies were included in the failure group and those with effective and markedly effective treatment as well as those with clinically healed wounds were included in the success group according to curative effect evaluation based on the Guiding Principles of Clinical Research on New Drugs of Traditional Chinese Medicine. The general conditions, wound-related indicators and indicators related to the whole body before treatment were compared between the two groups. Logistic multivariate regression analysis was used to analyze the factors that had statistical differences. Thus, the factors influencing the failure of NPWT in diabetic foot wounds were investigated. Results Of 580 patients, 36 cases failed in NPWT treatment, mainly due to the ag-gravation of wound infection. Multivariate Logistic analysis showed independent risk factors in treatment failure of dia-betic foot wound by NPWT, including ankle brachial index less than 0. 3, wound infection grade greater than or equal to grade 3, wound with active bleeding, wound granulation coverage less than 25% , and wound skin malignant trans-formation. Conclusion To improve the success rate of NPWT for patients with diabetic foot, it is the key to evaluate the degree of ischemia, infection and debridement as well as the general condition of the patients, and to prepare the wound bed accordingly before applying NPWT.

Objective: The aim of this study was to investigate the inhibitory effects and related mechanisms of lycium barbarum polysaccharides (LBP) on type 2 diabetes mellitus (T2DM) vascular lesions. Methods: A T2DM rat model was established by intraperitoneal injections of streptozotocin combined with a high-fat diet. Diabetic Sprague-Dawley rats were divided into a control group, T2DM group, experiment A group (group A), and experiment B group (group B). Group A and group B received 20 mg and 40 mg of LBP, respectively. The control group and T2DM group received the same amount of normal saline by gavage. The duration of the experiment was 4 weeks. At the end of the experiment, serum levels of insulin, glycosylated hemoglobin (HbA1c), triglycerides (TG), superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), low-density lipoprotein cholesterol (LDL-C), interleukin 4 (IL-4), and interleukin 6 (IL-6) were measured. H&E staining was used to detect pathological changes in vascular structures. MicroRNA and protein levels of p38 mitogen-activated protein kinase (p38MAPK) and intercellular adhesion molecule 1 (ICAM-1) in rat thoracic aortas were analyzed by qRT-PCR and Western blotting, respectively. Results: In group B, serum insulin was significantly increased after large doses of LBP but serum levels of HbA1c, LDL-C, TG, and IL-6 were significantly decreased (all P<0.05). Compared with group A, serum levels of IL-4, SOD, and GSH-PX increased significantly in group B but levels of serum HbA1c, LDL-C, TG, and IL-6 decreased significantly (all P<0.05). H& E staining showed that, compared with T2DM group, the degree of vascular lesions in group A and group B was lower. Compared with group A, mRNA and protein levels of p38MAPK were significantly increased and those of ICAM-1 were decreased in group B (all P<0.05). Conclusion: LBP reduces inflammatory response and vascular lesions induced by T2DM through regulating p38MAPK signaling pathways and increasing antioxidative capacity.

Objective We conducted a systematic review and meta-analysis to clarify risk factors for major amputation in patients with diabetic foot. Methods Observational studies of risk factors for major amputation in patients with diabetic foot published before September 2017 were searched on PubMed and EMBASE. Analysis was performed using Stata 12.0 statistical software and study quality was rated by Newcastle-Ottawa scale (NOS). Results Ten observational studies was identified with 659 major amputation patients and 4 905 controls. Across studies, the overall odds ratios (OR) and 95% confidence intervals (95%CI) of significant risk factors were the depth of ulcer involved bone (OR=11.80, 95%CI 6.90-20.15), dialysis (OR=5.19, 95%CI 2.69-10.04), peripheral arterial disease (PAD) (OR=4.80, 95%CI 2.22-10.36), gangrene (OR=4.67, 95%CI 1.62-13.48), hind foot position (OR=3.64, 95%CI 1.19-11.13), decreased ankle brachial index (ABI) (OR=3.36, 95%CI 1.51-7.52), lower albumin levels (OR=3.13, 95%CI 1.82-5.37), anemia (OR=2.66, 95%CI 1.22-5.79), infection (OR=2.52, 95%CI 1.71-3.71), elevated serum creatinine (OR=1.19, 95%CI 1.08-1.31), ischemic heart disease (IHD) (OR=1.39, 95%CI 1.05-1.84). While there were no significant difference in white blood cell (WBC), C reactive protein (CRP), diabetic peripheral neuropathy (DPN), glycated hemoglobin A1c (HbA1c), hypertension and Charcot foot (all P>0.05). Conclusion Factors associated with major amputation in patients with diabetic foot are the depth of ulcer involved bone, dialysis, PAD, gangrene, hind foot position, decreased ABI, lower albumin levels, IHD, there is no relation with WBC, CRP, HbA1c, DPN, hypertension and charcot foot. Key words: Diabetic foot; Risk factors; Meta-analysis; Major amputation

目的:观察中药对下肢静脉曲张微创治疗术后并发症的预防作用.方法:选择单纯大隐静脉曲张患者134例,按治疗方法分为中药干预组和对照组.两组均行大隐静脉根部结扎、主干剥脱术,小腿部泡沫硬化剂(1%聚多卡醇)注射/腔内光灼闭术治疗,术后弹力绷带加压包扎3天,后改用弹力袜3个月.中药组围手术期口服中药(自拟方),对照组不服中药.术后3天、1个月、3个月随访,比较两组术后疼痛、皮下瘀血、血栓性静脉炎、隐神经损伤、色素沉着、皮肤灼伤等并发症.结果:术后3天两组深静脉血栓形成发生率均较低,仅对照组有1例术肢治疗前后周径差值大于1 cm.中药组疼痛1~3分6例,4~5分9例,6~10分2例均少于对照组10例、11例、6例,差异有统计学意义;中药组血栓性浅静脉炎5例,对照组15例、P=0.10,色素沉着中药组4例,对照组12例,P=0.024,中药组具有明显优势,皮下淤血中药组20例,对照组30例,差异有统计学意义,隐神经损伤和皮肤灼伤中药组例数少于对照组,但无统计学意义;术后1个月疼痛、皮下淤血、皮肤灼伤并发症两组均消失.术后3个月静脉彩超提示中药组深静脉返流通畅,对照组有1例术肢出现小腿部陈旧性血栓.结论:凉血通络法对下肢静脉曲张术后并发症起到有效的预防作用,值得临床推广.

Objective To research the clinical efficacy of negative-pressure wound therapy with instillation of FufangHuangbaiye on diabetic foot infection wound and to observe its influence on related inflammatory factors. Methods 120 patients with diabetic foot were enrolled in this study, who had ever hospitalized in the department of vascular diseases, Dongzhimen hospital, Beijing University of Chinese Medicine from December 2015 to January 2018. The patients were divided into experimental group (60 cases) and control group (60 cases) according to the random number table method. The patients in experimental group were treated with negative-pressure wound therapy with instillation of Fufang-Huangbaiye, meanwhile those in control group were treated with negative pressure wound therapy with instillation of normal saline. After 2 weeks and 4 weeks, the wound surface area, serum procalcitonin(PCT), interleukin-6 (IL-6), C-reactive protein (CRP) and local symptom score of two groups, as well as secretion culture of wounds were analyzed. Variance analysis was used to compare data difference in each group, t test or rank sum test were used to compare data difference between two groups. Results (1) Basel diabetic course, glycated hemoglobin A1c, wounds area, etc: There was no significance between two groups (all P>0.05). (2) Wound area and symptom score: After 2 weeks of treatment, the wound area and the symptom score in two groups were both reduced. After 4 weeks of treatment, the wound area reduction and symptom score in experimental group were better than those in control group [(2.3±2.0) vs (4.4±2.9) cm2, (5±3) vs (7±3) score, t=4.544, 3.321 respectively, both P 0.05). (4) Bacteriological changes: after 2 weeks of treatment, the positive rate of bacterial culture in experimental group and control group decreased from 100% to 31.67%(19/60) and 66.67%(40/60), respectively (χ2=100.022, 37.162, both P 0.05), but much lower in experimental group than that in control group (χ2=21.624, P<0.001). Conclusion Negative-pressure wound therapy with instillation of FufangHuangbaiye can control diabetic foot wound infection, promote wound healing, and improve clinical symptoms. Its effect is better than negative pressure wound therapy with instillation of normal saline. Key words: Diabetic foot; Negative-pressure wound therapy; Drugs, Chinese herbal; Fufang Huangbaiye

Objective: To conduct a meta-analysis to evaluate the clinical efficacy and safety of Compound Cortex Phellodendri Liquid for treatment of diabetic foot ulcer (DFU). Methods: Databases including Pub Med, EMBASE, The Cochrane Library, CBM, CNKI, Wanfang and VIP data were searched to collect randomized controlled trials (RCTs) about Compound Cortex Phellodendri Liquid in the treatment of DFU from inception to March 2018. Two reviewers independently evaluated the quality of the included studies and extracted the data.Meta-analysis was systematically reviewed by using Rev Man 5. 3 statistical software. Results: A total of 11 RCTs involving 2 147 patients were included. The result of meta-analysis showed that, compared with control group, Compound Cortex Phellodendri Liquid produced a statistically significant improvement for a higher effective rate in DFU (RR = 1. 28, 95％ CI: 1. 17 ～ 1. 41). Six trials revealed that no serious adverse event was related to the use of the drug. Conclusion: Compound Cortex Phellodendri Fluid is an effective and safe external preparation for treating DFU. More high-quality RCTs need to be carried out to confirm the present findings.

OBJECTIVE:This study explored the association between the CYP2C9*3/CYP2D6*10/CYP3A5*3 genetic polymorphisms with lower extremity deep venous thrombosis (LEDVT) and the warfarin maintenance dose.METHODS:Five hundred thirty-six patients who were pathologically diagnosed with LEDVT after surgery were included in the LEDVT group. At the same time, 540 patients without LEDVT who underwent surgery were recruited as the control group. Patients were given warfarin at an initial dose of 2.5-3.0 mg. Blood samples were collected to detect the initial and stable international normalized ratio (INR) values. The warfarin maintenance dose was obtained if the INR remained within a range of 2.0-3.0 for 3 consecutive days. The genotype distribution and haplotype analysis of the CYP2C9*3/CYP2D6*10/CYP3A5*3 alleles were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) testing and SHEsis software, respectively. Logistic regression analysis was used to analyze the risk and protective factors for LEDVT.RESULTS:The A/G genotypes, G/G genotypes, and G allele of CYP3A5*3 in the LEDVT group were observed with increased frequency compared with the control group. The LEDVT group displayed a higher ACG haplotype frequency, and lower ACA and ATA haplotype frequencies than the control group. Age, diabetes, low-density lipoprotein, CYP3A5*3 and the ACG haplotype were independent risk factors for LEDVT. High-density lipoprotein and the ACA haplotype were independent protective factors for LEDVT. The genotype distributions of the CYP2C9*3, CYP2D6*10, and CYP3A5*3 genetic polymorphisms were associated with the warfarin maintenance dose.CONCLUSION:The CYP3A5*3 genetic polymorphism may be an important risk factor for LEDVT. Moreover, CYP2C9*3, CYP2D6*10, and CYP3A5*3 are associated with the warfarin maintenance dose.

Objective To explore the action of Chinese herbal medicine of damp clearing and circulation promotion formula in the treatment of limb ischemia reperfusion injury.Methods 60 patients with ischemic reperfusion injury were selected and randomly divided into a treatment group and a control group,and each group had 30 cases.The control group was given Lipoic Acid Injection and Sodium Aescinate Injection for ⅣV;apart from the treatment for the control group,the treatment group also took damp clearing and circulation promotion granules orally;on treatment day 1,3,7 and 14,the activity of SOD and the concentration of tumor necrosis factor(TNF-α) in intravenous serum were analyzed.Results The symptom scores of the treatment group was significantly lowered than those of the control group on day 3,7 and 14 after treatment,the difference was statistically significant (P ＜ 0.05);TNF-a concentration of the treatment group was significantly lowered than that of the control group on day 3 and day 7,the difference was statistically significant (P ＜ 0.05);SOD activity of the treatment group was significantly higher than that of the control group on day 1 and 3,the difference was statistically significant (P ＜ 0.05).Conclusion Chinese herbal medicine of damp clearing and circulation promotion formula had obvious effects on limb ischemia reperfusion injury.

Objective To investigate clinical features, misdiagnosed causes and diagnosis and treatment strategy of cholesterol crystal embolization (CCE).Methods Clinical data of 3 misdiagnosed patients with CCE admitted in recent years was retrospectively analyzed.Results The 3 patients with lower limb arteriosclerosis occlusion underwent lower limb intracavity angioplasty treatment, all patients had postoperative lyons blue lesions in toe extremitates skin, and then all patients were misdiagnosed as having blue toe syndrome.Abnormally increased values of renal function level, c-reaction protein (CRP), erythrocyte sedimentation rate and eosinophils were found in 3patients, of whom 2 patients were timely confirmed the diagnosis of CCE, and were forbidden with anticoagulation and thrombolytic therapy, and the prognoses were good by follow-up;1 patient was continuously treated with anticoagulation and thrombolysis, and finally died of multiple organ failure.Conclusion If patients with atherosclerosis have increased eosinophils and inflammatory index levels, skin lesions, unexplained renal injury, gastrointestinal or neurological manifestations after vascular intervention, and CCE should be considered, and therefore histopathologic examination for many times can confirm the diagnosis.

Objective To Compare postoperative complications between patients with varicose veins of the lower limbs treated with foam sclerotherapy or endovenous laser.Method From 2011 to 2015,simple varicosis of great saphenous vein patients (grade C3-6) in 2 542 cases,3 468 limbs were divided into 2 groups.Combined with high ligation of great saphenous vein plus stripping,foam sclerotherapy group (1 355 cases) underwent calf foam sclerotherapy (1％ polidocanol),endovenous laser group (1 187 cases) underwent endovenous laser therapy.All postoperative patients were treated with stretch socks for 3 months.Postoperative pain (calf),deep vein thrombosis,pulmonary embolism,superficial thrombophlebitis,saphenous nerve injury,ecchymoma,migraine,allergic dermatitis,pigmentation in 2 groups were compared.Result During the follow-up,28 cases in foam sclerotherapy group had saphenous nerve injury (2％),1 071 (79.1％) cases had subcutaneous ecchymosis,613 cases (51.6％) in endovenous laser group had saphenous nerve injury,979 cases (82.5％) had subcutaneous ecchymosis,8 cases (1.0％) had skin burns (x2 =824.660,4.786,9.161,P ＜ 0.05).Endovenous laser group (23.8％) was significantly better than that of foam sclerotherapy group (30.8％) in pigmentation (x2 =15.243,P ＜0.05).Conclusion Treatment of varicose veins of the lower leg with foam sclerotherapy has less postoperative complications compared with endovenous laser.

糖尿病足是指由于糖尿病周围神经病变和/或周围血管病变所致的足部感染、破溃和深层组织破坏.糖尿病足伤口情况复杂、治疗难度大,糖尿病患者由于自身葡萄糖代谢改变和氧化应激反应导致细胞吞噬功能和抗菌功能障碍[1],伤口高度细菌负荷,使血液中促凝物质、局部氧耗增加,局部缺血加重[2],进一步影响伤口愈合.因此,控制感染和促进伤口愈合,是糖尿病足治疗进程中的关键环节.负压 滴 灌 治 疗(negative pressure wound therapy with instillation,NPWTi)作为一种新型的伤口治疗方法,在控制感染及促进肉芽组织生长方面具有显著效果.本文将回顾NPWTi的作用机制,并就NPWTi在治疗糖尿病足中的临床应用作一综述.