Due to peripheral neuropathy and varying degrees of vascular disease, patients with diabetes often suffer from foot ulcers that are challenging to heal and may even progress to gangrene. In recent years, autologous platelet rich plasma (au-PRP) gel has been widely used in the treatment of chronic ulcers, including diabetes foot. However, its limitations have become increasingly evident, such as difficulties in collecting sufficient blood from patients, deficiencies in platelet count and/or function among individuals with diabetes, and high costs associated with individually required equipment. Allogeneic platelet rich plasma (al-PRP) offers similar anti-inflammatory, anti-infective, and growth promoting effects while addressing these drawbacks. Notably, al-PRP can be mass-produced into ready-to-use products, simplifying clinical applications and significantly reducing costs. This article conducted a comprehensive analysis of the application mechanism, necessity, effectiveness and safety, preparation and application methods of al-PRP in the treatment of diabetic foot ulcers, it showed that al-PRP has a promising application prospect in the treatment of diabetic foot.

Heel ulcer is one of the severe complications of patients with diabetes mellitus, which poses a high risk for foot infection and amputation, especially in patients with peripheral arterial disease and neuropathy. Researchers have searched for new treatments for treating diabetic foot ulcers in recent years. In this case report, we demonstrated the treatment of large ischemic ulcers for the first time in a diabetic patient. The overall treatment goal of this patient was designed to improve blood supply to her diseased lower extremities and close the ulcer. This two-stage reconstruction approach resulted in an ulcer-free, stable, plantigrade foot at postoperative follow-up.

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.

AIM:To explore the growth-promoting effect of vacuum sealing drainage (VSD) during the healing processes of diabetic foot ulcers (DFUs).METHODS:From November 2018 to December 2019, 38 patients with unilateral DFUs were enrolled in this retrospective study. All patients were divided into two groups according to the use of VSD or not: the VSD group (n=20) and the control group (n=18). The following parameters were used to evaluate the healing process: changes in the mean areas of the ulcers; healing rate (HR); epithelial hyperplasia and angiogenesis as determined by hematoxylin-eosin staining (HE staining); and expression of CD34, CD68 and VEGF as assessed through immunohistochemistry. Perioperative side effects and complications were also recorded.RESULTS:All patients received follow-up and eventually healed. The mean area of wounds was reduced in the VSD group compared to the control group (1.75±0.64 cm2 vs 0.88±0.54 cm2, P=0.031). The mean HR of the ulcers in the VSD group was significantly higher than that in the control group (35.23±2.87% vs 28.78±1.09%, P=0.017). HE staining showed that the amount of epithelial hyperplasia and angiogenesis increased significantly after VSD, and the immunohistochemistry results showed that the expression of CD34, CD68 and VEGF increased significantly in the VSD group.CONCLUSION:VSD could significantly accelerate the wound healing process, probably by enhancing the inflammatory response and promoting granulation and angiogenesis in DFUs.

This exploratory study attempted to establish the rules in diagnosis and treatment of diabetic foot, through interpretation and comparison of the guidelines for diabetic foot from domestic with international ones. The document provided comparison between Guidelines of International Working Group on Diabetic Foot (IWGDF) and Chinese Diabetes Society (CDS) in 2019, related to diabetic foot disease on: methodology, content, prevention, offloading, peripheral artery disease (PAD), infection, wound healing interventions, and classification of diabetic foot ulcers. Prevention of ulcers in persons with diabetes foot is very important, and a non-removable offloading device is the first-choice of offloading treatment; Surgical indications and reasonable treatment should be mastered in PAD; Different anti-infection treatments, including surgical debridement, should be used base on the severity of foot infection; There are lots of treatments to improve healing, however the Grand Standard of medical evidence is not very high; There are a larger number of proposed classifications and scoring systems for diabetic foot, but none of them could cover all the needs of diagnosis and treatment. Thus, the principles outlined have to be adapted or modified by our health care professionals, based on local circumstances, to develop a standardizated procedure in diagnosis and treatment of diabetic foot.

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.

Objective: To investigate the mechanism of maggot debridement therapy (MDT) in promoting wound angiogenesis in patients with diabetic foot ulcer (DFU). Methods: (1) From June 2018 to June 2019, the patients admitted to Nanjing Junxie Hospital who met the inclusion criteria were recruited, including 12 DFU patients given MDT for three days [6 males and 6 females, aged (56±12) years] and 12 acute trauma patients without diabetes mellitus [6 males and 6 females, aged (53±10) years], who were enrolled into DFU group and non-diabetic trauma group respectively. Before and after application of MDT, the wound characteristics of patients in DFU group were observed and the wound tissue samples were taken. The wound tissue in non-diabetic trauma group was taken at patient's first visit before debridement. The expression of angiogenesis marker CD31 in the wound tissue of patients in DFU group was detected by immunohistochemistry before and after application of MDT. Western blotting and real-time fluorescent quantitative reverse transcription polymerase chain reaction (RT-PCR) were used respectively to detect the protein and mRNA expressions of fatty acid synthase (FAS) in wound tissue of patients in DFU group before and after application of MDT and in non-diabetic trauma group before debridement. (2) Human umbilical vein endothelial cells (HUVECs) were cultured in endothelial cell culture medium containing 10% fetal bovine serum. The 3rd to 6th passages of cells in logarithmic growth phase were used in the following experiments. Excretions/secretions (ES) were extracted from 3-day-old sterile Lucilia sericata larvae for subsequent experiments. Three batches of cells were divided into phosphate buffer solution (PBS) control group, high glucose alone group, high glucose+ 5 μg/mL maggot ES group, and high glucose+ 10 μg/mL maggot ES group, which were treated with PBS, glucose in final molarity concentration of 20 mmol/L, glucose in final molarity concentration of 20 mmol/L+ maggot ES in final mass concentration of 5 μg/mL, and glucose in final molarity concentration of 20 mmol/L+ maggot ES in final mass concentration of 10 μg/mL respectively. The total volume of reagents in each group was the same. After 48 hours of culture, Western blotting, real-time fluorescent quantitative RT-PCR and immunofluorescence method were used to detect the protein and mRNA expressions of FAS in each batch of cells and the expression and localization of FAS protein in cells respectively. The number of samples for mRNA expression was 3. (3) Two batches of cells were divided into small interference RNA (siRNA) alone group, siRNA control+ maggot ES group and siRNA-FAS+ maggot ES group, which were transfected with 100 μmol/L (final molarity concentration) insignificant control siRNA, insignificant control siRNA, and siRNA-FAS for 4-6 h respectively, and then they were routinely cultured for 24 h with PBS added, maggot ES in final mass concentration of 10 μg/mL, and maggot ES in final mass concentration of 10 μg/mL respectively. The total volume of reagents in each group was the same. One batch of cells was used for scratch test, the scratch width was observed at 24 hour after scratching to detect the cell migration ability; one batch of cells was subjected to tube forming experiment, and the formation of cell tubules was observed after 24 hours of culture. The number of samples was 3 in scratch test and tube forming experiments. Data were statistically analyzed with t test, one-way analysis of variance, least significant difference test, analysis of variance for repeated measurement, and Bonferroni method. Results: (1) Compared with those before application of MDT, fresh granulation tissue significantly increased and necrotic tissue decreased obviously in wound, and the expression of CD31 significantly increased in wound tissue of patients in DFU group after application of MDT. The expression of FAS protein in wound tissue of patients in DFU group before application of MDT was significantly lower than that in non-diabetic trauma group before debridement, and the expression of FAS protein in wound tissue of patients in DFU group after application of MDT was significantly higher than that before application of MDT. The expression of FAS mRNA in wound tissue of patients in DFU group before application of MDT was 1.00±0.17, which was significantly less than 3.87±1.02 in non-diabetic trauma group before debridement (t=9.808, P<0.01). The expression of FAS mRNA in wound tissue of patients in DFU group after application of MDT was 1.85±0.31, which was significantly higher than that before application of MDT (t=-10.853, P<0.01). (2) After 48 hours of culture, Western blotting detection showed that the expression of FAS protein in cells in high glucose alone group was significantly less than that in PBS control group, and the expressions of FAS protein in cells in high glucose+ 5 μg/mL maggot ES group and high glucose+ 10 μg/mL maggot ES group were significantly higher than the expression in high glucose alone group. Real-time fluorescent quantitative RT-PCR determination showed that the expression of FAS mRNA in cells in high glucose alone group was 0.392±0.073, which was significantly lower than 1.000±0.085 in PBS control group (P<0.01); there was statistically significant difference between the expression of FAS mRNA in cells in high glucose+ 5 μg/mL maggot ES group (0.561±0.047) and that in high glucose+ 10 μg/mL maggot ES group (0.687±0.013) (P<0.05), both of which were significantly higher than the expression in high glucose alone group (P<0.01). The results of immunofluorescence detection showed that FAS protein was mainly located in the cytoplasm of cells in each group, and its expression was similar to that detected by Western blotting. (3) At 24 hour after scratch, the uncured widths of cell scratch in siRNA control+ maggot ES group and siRNA-FAS+ maggot ES group were significantly narrower than the uncured width in siRNA alone control group (P<0.01), and the uncured width of cell scratch in siRNA-FAS+ maggot ES group was significantly wider than that in siRNA control+ maggot ES group (P<0.01). After 24 hours of culture, the numbers of tubules in siRNA+ maggot ES group and siRNA-FAS+ maggot ES group were significantly more than the number in siRNA alone control group (P<0.05 or P<0.01), and the number of tubules in siRNA-FAS+ maggot ES group was obviously less than that in siRNA control+ maggot ES group (P<0.05). Conclusions: MDT up-regulates the expression of FAS through maggot ES, which promotes the activity of vascular endothelial cells, thus promoting the wound angiogenesis in patients with DFU.

目的:建立符合中国糖尿病足住院特点的治疗方法,以指导糖尿病足的临床治疗工作.方法:将糖尿病足溃疡患者的治疗流程分成手术前准备、手术及术后促生长、防止溃疡复发3个阶段,每个阶段对患者的主要矛盾进行动态评估并制定相应的诊疗计划的糖尿病足治疗流程——SIANM疗法.结果:按照此治疗流程治疗的糖尿病足患者创面均得到较好的愈合.结论:SIANM治疗法是安全、有效的糖尿病足诊治方法.

随机抽取2型糖尿病123例;根据踝肱指数(ABI)五十百分位将其分为高ABI组和低ABI组;比较两组血25羟维生素D水平等.结果 VD(OR=1.169,95％ CI0.995 ～ 1.373,P=0.01)、MA(OR=1.005,95％Cl0.995～ 1.016,P=0.04)是LEAD ABI低的独立危险因素.回归分析发现VD缺乏显著增加DF的危险.结论 LEAD与VD、MA有关,其中VD缺乏与DF的危险性增加有关.

Objective To build a new diabetic foot assessment method to evaluate patients ' condition and guide their follow-up treatments.Methods According to the current diabetic foot assessment methods ,we built the SIANM assessment method (system of infection,arterial disease,neuropathy and mixed causes,SIANM)which could assess changes of wound dynamically and was also suitable for infection-based Asian diabetic foot patients.Results Based on this method,the wounds of different types of diabetic foot patients were well healed.Conclusion SIANM assessment method can assess changes of wound dynamically and may be more applicable to diabetic foot patients in Asia .

[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.

周围血管疾病(Peripheral vascular disease,PVD)是一种慢性肢体缺血性疾病,按来源分为动脉、静脉、动静脉联合的病变;按病变性质分为阻塞性疾病、急慢性炎症、退行性变以及发育畸形等.5％糖尿病病人在确诊1年内有PVD症状,随访12年23％的糖尿病病人合并PVD.PVD会增加糖尿病足(Diabetic foot,DF)风险,糖尿病足亦是糖尿病病人致残致死的并发症;WHO将糖尿病足定义为糖尿病患者由于合并神经病变及各种不同程度末梢血管病变而导致下肢感染、溃疡形成和(或)深部组织的破坏[1].全世界约30秒钟有1例糖尿病病人因糖尿病足而截肢,西方国家每年甚至超过30000名糖尿病病人因合并PVD而截肢(2005年,Boulton等).PVD是糖尿病足预后最重要的影响因素,是截肢主要的危险因素[2].

More than 50％ of diabetics with diabetic history of 10-15 years combine with diabetic peripheral neuropathy.Diabetic peripheral neuropathy,which includes motor neuropathy,autonomic neuropathy,sentory neuropathy,is one of the most important etiology of diabetic foot.With the amyotrophy,the loss of sweat and sensation and the pedal deformity,the plantar pressure will change,the soft tissue of the plantar surface will injure easily and diabetic foot ulcers will take place.Prescribed foot orthosis system could decrease the prevalence and recurrence rate of plantar ulceration in diabetics.In addition,it could reduce plantar pressure,avoid chronic wounds delaying and reduce the risk of amputations.There are many kinds of prescribed foot orthosis system that are applied to different wounds.When prescribed foot orthosis system is used in patients with diabetes,gait velocity,planter peak pressure,time integration and strain rate of forefoot pressure should be observed regularly.

一、糖尿病足病临床路径标准住院流程 1.适用对象:第一诊断为糖尿病足病(ICD-10:E14.601). 2.诊断依据:根据《糖尿病足国际临床指南》(国际糖尿病足工作组,2003年、2011年)、《临床治疗指南-内分泌及代谢性疾病分册》(中华医学会编著,人民卫生出版社,2009年)、《临床技术操作规范-内分泌及代谢性疾病分册》(中华医学会编著,人民军医出版社,2009年)、《2012年美国感染疾病学会关于糖尿病足感染诊断和治疗的临床实用指南》(美国感染疾病协会,2012年)、《糖尿病诊疗标准(2012)版》(美国糖尿病协会,2012年).