Objective: This study aimed to evaluate the effectiveness of podiatrists in preventing diabetic foot ulcers (DFUs) in China. Method: The study was a prospective investigation. A total of 300 patients were enrolled from May 2016 to May 2018 in Handan Central Hospital, China. All patients who participated in this study had been diagnosed with type 2 diabetes, according to the International Classification of Diseases (ICD-10). All participants underwent our survey, which included basic patient data and information about DFUs. The patients were followed for one year, during which time they received appropriate intervention from podiatrists, including lifestyle guidance, callus resection, tinea grinding and ingrown nail correction. At the end of the year all the patients were surveyed again. The data before and after the year were statistically compared. Results: The results showed that the incidence of DFUs in patients with diabetes was significantly decreased after one year of intervention from podiatrists (20.7% versus 6.7%, p<0.001). Additionally, there was a negative correlation between the number of intervention visits and the number of DFU occurrences (Spearman correlation coefficient: –0.496, p<0.001). Furthermore, we found that 68 patients with a history of DFUs or amputation had an obviously reduced incidence of DFUs after intervention by a podiatrist (89.7% versus 27.9%, p<0.001). We also investigated other foot risk factors in all participants, such as limb neuropathy (76.3%), lower extremity vascular disease (65.7%) and foot paralysis (43.7%). Conclusion: The results of this study help in understanding the situation of patients with diabetes in China and to prove that standardised podiatrist intervention has an important role in inhibiting the occurrence and development of DFUs.

Abstract Diabetic foot ulcers (DFUs) are associated with complex pathogenic factors and are considered a serious complication of diabetes. The potential mechanisms underlying DFUs have been increasingly investigated. Previous studies have focused on the three aspects of diabetic peripheral vascular disease, neuropathy, and wound infections. With advances in technology, researchers have been gradually conducting studies using immune cells, endothelial cells, keratinocytes, and fibroblasts, as they are involved in wound healing. It has been reported that the upregulation or downregulation of molecular signaling pathways is essential for the healing of DFUs. With a recent increase in the awareness of epigenetics, its regulatory role in wound healing has become a much sought‐after trend in the treatment of DFUs. This review focuses on four aspects involved in the pathogenesis of DFUs: physiological and pathological mechanisms, cellular mechanisms, molecular signaling pathway mechanisms, and epigenetics. Given the challenge in the treatment of DFUs, we are hopeful that our review will provide new ideas for peers.

Self-repair of lower limb wounds has always been one of the research hotspots. Flaps and skin graft are the preferred treatment for lower extremity wound reconstruction. However, these treatments have many disadvantages, such as secondary damage, poor healing quality. In recent years, the use of acellular dermal matrix has emerged as an alternative treatment option for extremity ulcers. This study aimed to explore whether acellular dermal matrix can be used as a single treatment to promote wound healing. 7 patients with lower extremities cutaneous deficiency exposing bone or tendon, were covered by Pelnac, which was an acellular dermal matrix product approved by China Food and Drug Administration. All the wound was treated by Pelnac without flaps and skin graft. The external dressing was changed every 10 days. After a maximum of 20 weeks, all the wounds were completely healed. During the 12 months follow-up period none of the patients developed skin wear on the treatment area. All patients maintained their postoperative ambulatory ability. All patients were satisfied with the appearance and feeling after wound healing. These findings may mean acellular dermal matrix is a novel method offering opportunity for treatment of lower extremities cutaneous deficiency exposing bone or tendon. It also has the potential to close wounds of all uninfected, non-ischemic, full-thickness cutaneous deficiency.

Diabetic foot ulcers (DFUs) are associated with complex pathogenic factors and are considered a serious complication of diabetes. The potential mechanisms underlying DFUs have been increasingly investigated. Previous studies have focused on the three aspects of diabetic peripheral vascular disease, neuropathy, and wound infections. With advances in technology, researchers have been gradually conducting studies using immune cells, endothelial cells, keratinocytes, and fibroblasts, as they are involved in wound healing. It has been reported that the upregulation or downregulation of molecular signaling pathways is essential for the healing of DFUs. With a recent increase in the awareness of epigenetics, its regulatory role in wound healing has become a much sought-after trend in the treatment of DFUs. This review focuses on four aspects involved in the pathogenesis of DFUs: physiological and pathological mechanisms, cellular mechanisms, molecular signaling pathway mechanisms, and epigenetics. Given the challenge in the treatment of DFUs, we are hopeful that our review will provide new ideas for peers.

Objective:To investigate the effects of long non-coding RNA lymphoenhancer binding factor 1 antisense RNA1 (LEF1-AS1) gene silencing on the proliferation, migration and angiogenesis of human umbilical vein endothelial cells (HUVECs).Methods:HUVECs were obtained from american type culture collection (ATCC). The expression of LEF1-AS1 gene was silenced in huvecs by RNA interference. The cells were divided into control group and experimental group, namely NC-small interfering RNA (siRNA) group and LEF1-AS1-sirna group. The cell counting kit-8 (CCK-8) and Transwell assays were used to detect the changes of cell proliferation and migration, and the effect of LEF1-AS1 on angiogenesis was detected in vitro. The experimental data were expressed as ± s. The independent-sample t-test was used to compare the two groups. Results:RT-qPCR results showed that the relative expression of LEF1-AS1 mRNA in si-LEF1-AS1 group (0.059±0.010) was lower than that in NC group (1.000±0.018), and the difference was statistically significant ( t=40.824, P<0.01). HUVECs had lower absorbance ( A) values (0.103±0.004) in si-LEF1-AS1 group than in NC group (0.129±0.006) at 24 h after treatment. The A values (0.235±0.016) in si-LEF1-AS1 group were also lower than in NC group (0.431±0.018) at 48 h after treatment. The A values in si-LEF1-AS1 group (0.454±0.029) were lower than those in NC group (0.846±0.034) after 72 h of treatment. Transwell migration experiment showed that the relative number of cells migrating to the inferior chamber in SI-LEF1-AS1 group (0.446±0.025) was significantly less than that in NC group (1.000±0.046, t=17.120, P<0.01). The results of angiogenic experiment showed that the length of the adult tube in SI-LEF1-AS1 group (3 152.333±200.959) was significantly shorter than that in NC group (13 263.667±247.823, t=54.891, P<0.01). Conclusion:Silencing LEF1-AS1 inhibits the proliferation, migration and angiogenesis of HUVECs.

Objective:Analyzed the epidemiological characteristics of inpatients with chronic refractory wounds in a wound repair center in Hubei province by reviewing the data of them, in order to provide reference for the formulation of prevention and treatment strategies for the disease.Methods:The case data of inpatients with chronic refractory wounds admitted to the Wound Repair Center of Liyuan Hospital of Tongji Medical College of Huazhong University of Science and Technology from January 2018 to December 2019 were retrospectively analyzed. The collected information includes the patient's gender, living area, occupation, underlying disease, smoking history, wound type, age, hospital stay, hospitalization cost, treatment method (surgical treatment, conservative treatment), clinical outcome, various medical expenses and wound surface detection of pathogenic bacteria. Data were compared by chi-square test and Kruskal-Wallis H test.Results:(1) A total of 2 402 inpatients with chronic refractory wounds were included in this study, including 1 593 males (66.3%) and 809 females (33.7%); there were 1 459 (60.7%) of the urban population and 943 cases (39.3%) of the rural population; the proportion of patients engaged in retirement and manual labor was relatively large, 52.1% and 28.8%, respectively; 74.4% of the patients had diabetes, followed by hypertension (57.5%) and heart disease (31.8%); 52.7% of patients had a history of smoking. (2) Among different wound types, diabetic wounds were the most common, accounting for 62.3% (1 497/2 402); followed by pressure wounds, accounting for 13.9% (334/2 402); arterial wounds accounted for 6.2% (148/2 402); venous wounds accounted for 5.0% (121/2 402), and wounds caused by other reasons accounted for 12.6% (302/2 402). (3) The gender and age distribution of chronic refractory wound patients with different types of wounds were compared, and the differences were statistically significant (χ2=30.564, 28.536; P<0.05); the age group with the highest prevalence rate was 61-80 years old (54.7%), followed by 41-60 years old (29.4%) and over 80 years old (11.8%); 41-60 years old and 61-80 years old with high incidence of diabetic wounds and venous wounds, and 61-80 years old and over 80 years old were the high incidence of pressure wounds and arterial wounds. (4) Among the 2 402 inpatients with chronic refractory wounds, the patients with pressure wounds had the longestaverage hospital stay, which was 31 (19, 35) d, and the patients with arterial wounds and venous wounds had the shortest average hospitalization time, which were 19 (9, 25) d and 19 (11, 26) d, respectively. The average hospitalization cost of patients with arterial wounds was the highest, which was 91 361.5 (17 033.5, 143 090.4) yuan, followed by patients with diabetic wounds, which was 45 008.4 (10 574.0, 57 020.7) yuan. There were statistically significant differences in hospitalization time and hospitalization expenses among patients with different types of chronic refractory wounds (χ2=25.346, 32.460; P<0.05). (5) Among the patients treated by surgery, patients with pressure wounds had the longest hospitalization time 39 (26, 42) d, and patients with arterial wounds had the highest hospitalization costs, which was 118 341.1 (77 151.3, 162 281.1) yuan; among the patients with conservative treatment, other wound patients had the longest hospitalization time, and patients with arterial wounds had the highest hospitalization costs; the hospitalization costs and hospitalization time of patients with different treatment methods were statistically significantly differents (χ2=110.260, 120.765; P<0.05). (6) Among the 2 402 patients, 22.0% (529/2 402) were cured, 76.3% (1 833/2 402) were markedly effective, 1.7% (40/2 402) were not cured, and 12 of them died, accounting for 0.5% of the total number of patients. The hospitalization time of the cured, markedly effective and unhealed patients were 31 (15, 39), 25 (12, 30), and 19 (5, 24) d, respectively, and the hospitalization expenses were 45 360.6 (11 664.3, 56 208.8), 42 824.2 (10 107.1, 52 415.1), 37 017.4 (8 031.3, 31 942.9) yuan, respectively. The hospitalization time of cured patients was longer than that of markedly effective and unhealed patients, and the hospitalization cost was higher than that of markedly effective and unrecovered patients. There were no statistically significant differences in hospitalization time and hospitalization cost among patients with different clinical outcomes (χ2=3.031, 6.780; P>0.05). (7) The total medical expenses of the 2 402 inpatients with chronic refractory wounds were 103 973 107 yuan. Consumables and medicines accounted for a relatively high proportion of various medical expenses, accounting for 42.1% and 23.4%, respectively. Nursing expenses and blood transfusion expenses accounted for a relatively low proportion, at 1.2% and 0.2%, respectively. (8) Among the 2 402 patients, 926 (38.6%) were examined for pathogenic bacteria on the wound surface, of which 681 were positive for pathogenic wounds, with a positive rate of 73.5% (681/926). Among them, Gram-negative bacteria accounted for 50.8% (346/681), mainly Pseudomonas aeruginosa (13.5%), Escherichia coli (11.6%), and Acinetobacter baumannii (6.2%); Gram-positive bacteria accounted for 42.4% (289/681), mainly Staphylococcus aureus (17.8%), Staphylococcus epidermidis (7.2%), and Enterococcus (9.2%); fungi accounted for 6.8% (46/681), mainly Candida albicans (2.5%).Conclusions:The inpatients with chronic refractory wounds are mainly middle-aged and elderly people, and there are more males than females. Diabetic wounds, pressure wounds and vascular wounds are the main causes of the disease. Patients with pressure wounds had the longest average hospital stay, and patients with arterial wounds had the highest average hospitalization costs. The main treatment method is surgery. The unit adopts a multidisciplinary diagnosis and treatment mode for wound treatment, and the healing rate is high. Gram-negative bacteria are the most common pathogens on the wound surface, mainly Pseudomonas aeruginosa, Escherichia coli, and Acinetobacter baumannii. It is necessary to advocate and improve the two-way referral mechanism between wound treatment centers in large general hospitals and community health service centers, and establish wound repair and nursing centers, strengthen publicity and education about the disease, and improve awareness of prevention and treatment.

目的 利用3D生物打印技术将脱细胞真皮基质(ADM)及甲基丙烯酸酯化明胶(GelMA)混合制备成不同规格的皮肤复合支架,评价其生物相容性及对人脐静脉血管内皮细胞(HUVECs)生物学行为的影响.方法 将0％、0.75％、1.50％的ADM与GelMA混合配置成光敏性生物墨水,利用3D生物打印技术分别制备A组:单纯GelMA支架、B组:0.75％ADM/GelMA支架及C组:1.5％ADM/GelMA支架,扫描电镜观察其形态结构.通过CCK-8实验方法于第1、2、3天检测细胞增殖;将HUVECs与其共培养,通过Live/Dead染色观察皮肤支架表面细胞生长状态;使用Transwell小室实验检测皮肤支架对HUVECs迁移的影响;两组间比较采用非配对t检验,多组间比较采用单因素方差分析.结果 扫描电镜结果显示,各组皮肤复合支架均为十字交叉网格结构立体结构,且孔隙均匀,C组比A和B两组微观孔隙更加密集,孔隙之间的连通性更好.细胞计数试剂盒(CCK-8)实验结果显示,与阴性对照组(0 d:0.18±0.03;1 d:0.39±0.02;2 d:0.8±0.03;3 d:1.21±0.06)比较,在不同时间 A 组(0 d:0.19±0.04;1 d:0.39±0.03;2 d:0.75±0.03;3 d:1.19±0.06)细胞活力均无明显变化(F=1.37,P＞0.05),而 B 组(0d:0.21±0.05;1 d:0.6±0.04;2 d:1.15±0.04;3d:1.72±0.05)和C组(0d:0.22±0.06;1 d:0.59±0.03;2 d:1.18±0.05;3 d:1.87±0.02)细胞活力显著提高(F=22.85、26.76,P＜0.05).与A组比较,B组和C组在各时间点细胞活力显著提高(F=24.22、28.13,P＜0.05).Live/Dead实验染色结果显示,细胞在各组皮肤支架表面均能较好地黏附与生长,与A组(2.47±0.15)荧光强度比较,B组(4.63±0.35)和C组(11.98±0.31)荧光强度显著增高(t=10.00、48.26,P＜0.05),并且C组荧光强度明显高于B组(t=27.45,P＜0.05).Transwell小室实验结果显示,与A组(38.67±6.56)比较,B组(134±17.59)和C组(251.33±20.13)的血管内皮细胞迁移数显著增多(t=8.375、17.37,P＜0.05).结论 1.5％ADM/GelMA的皮肤支架具有较好的生物相容性和促进血管内皮细胞迁移的效应,有望为创面修复提供一种可降解的3D生物打印皮肤支架.

Numerous studies have proposed the transplantation of mesenchymal stem cells (MSCs) in the treatment of typical type 2 diabetes mellitus (T2DM). We aimed to find a new strategy with MSC therapy at an early stage of T2DM to efficiently prevent the progressive deterioration of organic dysfunction. Using the high-fat-fed hyperinsulinemia rat model, we found that before the onset of typical T2DM, bone marrow-derived MSCs (BM-MSCs) significantly attenuated rising insulin with decline in glucose as well as restored lipometabolic disorder and liver dysfunction. BM-MSCs also favored the histological structure recovery and proliferative capacity of pancreatic islet cells. More importantly, BM-MSC administration successfully reversed the abnormal expression of insulin resistance-related proteins including GLUT4, phosphorylated insulin receptor substrate 1, and protein kinase Akt and proinflammatory cytokines IL-6 and TNFα in liver. These findings suggested that MSCs transplantation during hyperinsulinemia could prevent most potential risks of T2DM for patients.