Introduction and importance: Necrotizing fasciitis (NF) represents a rapidly progressive, life-threatening infection involving the fascia and subcutaneous tissue. Early diagnosis and intervention are crucial to treat, especially in diabetic patients. Case presentation: This case report presents on a patient with diabetes mellitus rapidly developed a NF of the upper extremities following a minor trauma in the palmar of greater thenar. In the initial stages of her hospital admission, severe hand soft tissue infection, and systemic toxicity is the most prominent clinical manifestation. During her hospitalization, efficacious multidisciplinary treatment was carried out to avoid severe consequences. Clinical discussion and conclusion: The objective of this case report is to present a successful individual strategy in a complex case to standardize the treatment process. Accurate and standardized management can improve the prognosis of patients affected from upper extremities NF of diabetic avoiding and severe complications and saving lives.

Aims: The impaired angiogenesis is one of the main factors affecting the healing of diabetic foot ulcer (DFU) wounds. Maggot debridement therapy (MDT) promotes granulation tissue growth and angiogenesis during DFU wound healing. Non-coding microRNAs can also promote local angiogenesis in DFU wounds by regulating wound repairing related gene expression. The purpose of this study was to investigate the mechanism of microRNAs in MDT promoting DFU wound angiogenesis. Methods: In this study, we applied MDT to treat DFU wound tissue and detect the expression of the miR-17-92 cluster. In vitro experiments, human umbilical vein endothelial cells (HUVECs) were treated with maggot excretions/secretions (ES), the miR-17-92 cluster and the predicted target gene expression were measured. Tube formation assay and cell scratch assay were performed when inhibition of miR-18a/19a or overexpression of thrombospondin-1 (TSP-1) were used in this study. Results: miR-18a/19a transcription significantly up-regulated and TSP-1 expression down-regulated in patients wound tissue and in HUVECs. Inhibition of miR-18a/19a or overexpression of TSP-1 partially blocked the migration and tube formation ability stimulated by ES. Conclusion: Targeted activation of miR-18a/19a transcription levels and subsequent regulation of TSP-1 expression may be a novel therapeutic strategy for DFU. (C) 2020 Elsevier B.V. All rights reserved.

To determine the role of maggot debridement therapy (MDT) on diabetic foot wound healing, we compared growth related factors in wounds before and after treatment. Furthermore, we utilized human umbilical vein endothelial cells (HUVECs) to explore responses to maggot excretions/secretions on markers of angiogenesis and proliferation. The results showed that there was neo-granulation and angiogenesis in diabetic foot wounds after MDT. Moreover, significant elevation in CD34 and CD68 levels was also observed in treated wounds. In vitro, ES increased HUVEC proliferation, improved tube formation, and increased expression of vascular endothelial growth factor receptor 2 in a dose dependent manner. These results demonstrate that MDT and maggot ES can promote diabetic foot wound healing by up-regulating endothelial cell activity.

Five new nor-dammarane triterpenes, 12β-O-acetyl-17β-hydoxy-3,15-dioxo-20,21,22,23,24,25,26,27-octanordammanran (1), 12β-hydoxy-17β-methoxy-3,15-dioxo-20,21,22,23,24,25,26,27-octanordammanran (2), 12β-O-acetyl-3,15-dioxo-17-en-20,21,22,23,24,25,26,27-octanordammanran (3), 12β-hydoxy-15α-O-acetyl-3-oxo-17-en-20,21,22,23,24,25,26,27-octanordammanran (4) and 3β-hydoxy-17-oxo-12-en-20,21,22,23,24,25,26,27-octanordammanran (5), were obtained from the ethanol extract of the whole plants of Viburnum hainanense Merr. et Chun. Structural elucidation of all the compounds was performed by spectral methods such as 1D and 2D NMR, IR, UV, and HRESIMS. The isolated compounds were tested in vitro for cytotoxic potential against seven tumor cell lines (Hep-2, SCL-1, CAL-27, UMSCC-1, Detroit-562, SCC-PKU, and TCA-83). As result, compounds 1 and 2 exhibited cytotoxic activities with IC50 values less than 10 μM.

[Summary] Neuroischemic diabetic foot ulcer ( NDFU) is characterized by infection, ulceration of deep tissues, neurological abnormalities, and various degrees of peripheral vascular disease in the lower limbs. The patients often have multiple risk factors such as older, longer duration, cardiovascular disease. The treatment is very difficult. The prognosis depends on the severity of complications, tissue range of infections, and the peripheral vascular disease. In this article, the treatment process of an old inpatient with NDFU and severe complications was reviewed and to propose a standard pathway for its management.

Phytochemical investigation of the 70% EtOH extract of the leaves of Alstonia scholaris afforded seven new monoterpenoid indole alkaloids: scholarisins I-VII (1-7), and three known compounds: (3R,5S,7R,15R,16R,19E)-scholarisine F (8), 3-epi-dihydro- corymine (9), and (E)-16-formyl-5α-methoxystrictamine (10). Structural elucidation of all the compounds was accomplished by spectral methods such as 1D- and 2D-NMR, IR, UV, and HRESIMS. The isolated compounds were tested in vitro for cytotoxicity against seven tumor cell lines, anti-inflammatory activities against Cox-1 and Cox-2, and antifungal potential against five species of fungi. Compounds 1, 6, and 10 exhibited significant cytotoxicities against all the tested tumor cell lines with IC50 values of less than 30 μM and selective inhibition of Cox-2 comparable with the standard drug NS-398 (>90%). Additionally, 1, 2, 3 and 8 showed antifungal activity against two fungal strains (G. pulicaris and C. nicotianae).

Maggot debridement therapy(MDT)and conventional therapy were applied to diabetic foot ulcers(DFUs)with Wagner 2-4 respectively. The results showed that the prognosis was better in MDT group than in conventional therapy group. The reduction of circumference, square and volume of DFUs, healing rate of DFUs, decrease in number of bacterial species, and cost of antibiotics were all improved in the former group. The results suggest that MDT offers a fresh and effective method in the treatment of DFUs.