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.

Diabetic foot ulcer is one of the most common chronic complications of diabetes.Infection,nerve and/or vascular lesions,and healing impairment are common pathophysiologic characteristics of diabetic foot ulcer.Chemokines play roles in immune regulation,chemotaxis and catalytic,but their roles in diabetic foot ulcer are still unclear.They may play roles in inflammatory response,atherosclerosis,angiogenesis as well as wound healing by acting on inflammatory cells,vascular smooth muscle cells,endothelial progenitor cells and epithelial cells.Further researches on the role of chemokines in diabetic foot ulcer may provide new direction for the treatment of diabetic foot ulcers.

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.

Objective: Few studies have identified factors as predictors of clinical prognosis of patients with diabetic foot ulcers (DFUs), especially of Chinese patients. In this study, we assessed the prognostic factors of Chinese patients with DFUs.Methods and materials: This was a retrospective study (January 2009 - January 2011) of 194 DFUs conducted in an inpatient population at PLA 454 Hospital in Nanjing, China, to determine the prognostic influential factors of DFUs in Chinese patients. All of the studied patients were grouped into an amputation group, a non-healing group, and a cured group, according to the clinical prognosis. Patient parameters, including gender, age, smoking habits, education level, family history of diabetes mellitus, medical history, duration of foot lesions and complications, ankle-brachial index (ABI), transcutaneous oxygen pressure (TcPO2), urinary albumin/ creatinine ratio (Alb/Cr), fundus oculi, electrocardiogram, DFU characteristics, bacterial nature, and neuropathy, were cross-studied among the three groups.Results: Compared with the other two groups, the amputation group showed a higher number of males, older in age, lower ABI and TcPO2 levels, higher Wagner wound grading and size, and significantly higher urinary Alb/Cr ratio, blood urea nitrogen, serum creatinine, white blood cell count, and erythrocyte sedimentation rate. Compared to the cured group (162 patients), more patients with an older age, smoking, family history of diabetes mellitus, medical history of foot ulcerations, lower ABI and TcPO2 levels, higher urine Alb/Cr ratio, and serum creatinine were found in the non-healing group. Regression analysis was used to study the correlation between various factors and clinical prognosis, and the results were as follows: age, Wagner wound classification, and heel ulcerations were negatively correlated to the DFU prognosis, whereas the female population, ABI, and TcPO2 were positively correlated with DFU prognosis.Conclusion: In this retrospective study, we conclude that the DFU prognosis may be related

Objective: This study aimed to systematically evaluate maggot debridement therapy (MDT) in the treatment of chronically infected wounds and ulcers.Methods: We performed a meta-analysis referring to the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We searched for published articles in the following databases: PubMed, Web of Science, Embase, Wanfang (Chinese), and the China National Knowledge Infrastructure (CNKI). The latest search was updated on March 14, 2014. For dichotomous outcomes, the effects of MDT were expressed as the relative risk (RR) and 95% confidence interval (CI). For continuous outcomes with different measurement scales, we calculated the standardized mean difference (SMD). The pooled effects were estimated using a fixed effect model or random effect model based on the heterogeneity test. Subgroup analyses were performed according to the types of wounds or ulcers.Results: MDT had a significantly increased positive effect on wound healing compared with conventional therapies, with a pooled RR of 1.80 (95% CI 1.24-2.60). The subgroup analysis revealed that the combined RRs were 1.79 (95% CI 0.95-3.38) for patients with diabetic foot ulcers (DFU) and 1.70 (95% CI 1.28-2.27) for patients with other types of ulcers. The time to healing of the ulcers was significantly shorter among patients treated with MDT, with a pooled SMD of -0.95 (95% CI -1.24, -0.65). For patients with DFU, the SMD was -0.79 (95% CI -1.18, -0.41), and for patients with other types of ulcers, the SMD was -1.16 (95% CI -1.63, -0.69).Conclusion: MDT not only shortened the healing time but also improved the healing rate of chronic ulcers. Therefore, MDT may be a feasible alternative in the treatment of chronic ulcers. (C) 2014 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.

Background Sterile larvae—maggots of the green bottle blowfly Lucilia sericata are employed as a treatment tool for various types of chronic wounds. Previous studies reported that excretions/secretions (ES) of the sterile larvae could prevent and remove the biofilms of various species of bacteria. In the present study we assessed the effect of ES from the larvae pretreated with Pseudomonas aeruginosa on the bacteria biofilms. Methods and Findings We investigated the effects of ES from the maggot pretreated with P. aeruginosa on the biofilms using microtitre plate assays and on bactericidal effect using the colony-forming unit (CFU) assay. The results showed that only 30 µg of the ES from the pretreated maggots could prevent and degrade the biofilm of P. aeruginosa. However, the CFU count of P. aeruginosa was not decrease when compared to the ES from non pretreated maggots in this study condition. It is suggested that the ES from the pretreated maggot was more effective against biofilm of P. aeruginosa than sterile maggot ES. Conclusions Our results showed that the maggot ES, especially the bacteria-pretreated larva ES may provide a new insight into the treatment tool of the bacterial biofilms.

Evidence of diabetic foot infections includes classic signs of Inflammation.The gradation for the severity of infection is ranging from 1 to 4.Most diabetic foot infections are polymicrobial,anerobic bacteria alone or in combination,the discrepancies could be due to geographical variations,or the types and severity of infection.Diabetic foot infections need multidisciplinary treatment,including surgical intervention (debridement,revascularization,etc),antibiotic therapy and adjunctive therapy( such as granulocyte colonystimulation factors).The proper diagnositic and therapeutic approaches could control the infection,and decrease amputation rate.Thus,clinicians should diagnose and manage diabetic foot infections properly,and thereby improve the outcome.

5％-10％ of diabetic patients arise lower extremity infection,ulcer and deep tissue damage which occur as a consequeuce of neuropathy and various degrees of vasculopathy.Diabetic foot ulcers (DFUs) increase the risk of amputations,morbidity and mortality.Debridement is performed gradually,and may transform a chronic wound into an acute one,which including mechanical methods (eg.surgical debridement and maggot debridement) and non mechanical methods ( eg.enzymes and gel) to encounter different wounds.On the other hand,debridement is performed step by step until the bleeding or hard places.Sufficient debridement could decrease amputation in DFUs.

蛆虫,一种无脊椎的节肢动物,相信大家对其都不陌生.而它带给大家的第一印象似乎都是"恶心",不愿靠近,更不愿接触.可是,您是否知道,这小小的蛆虫,在如今的临床医疗中,正发着它独有的"光"和"热"呢?

<正>长期以来,慢性骨髓炎一直是医学上的一个难题,它可导致长期的患肢疼痛、病理性骨折、肢体功能丧失、贫血、感染扩散等,甚至可导致恶性肿瘤或癌前病变。慢性骨髓炎治疗较为棘手的原因为骨组织血液循环差,免疫介质和全身抗体进入感染灶受到抑制,因此目前慢性骨髓炎的治疗均为手术清

<正>例1,女,61岁,糖尿病2年余于2009年7月1日入院,使用胰岛素治疗,血糖控制不佳。入院前2月余出现双下肢软组织破溃、恶臭、进行性加重。先后在多家医院治疗,给予局部清创换药,抗感染及降血糖等综合治疗,创面仍逐渐增

Diabetic foot is one of the diabetic complications. Lucilia sericata has unique biological properties,eating rotten tissue and none of living tissue, secreting proteolytic enzyme which can degrade and liquify necrotic tissue. Maggot debridement therapy (MDT) has a 500-year history,and to regain attention in Europe till 1983 ,and not be admitted by FDA until 2004. The effect of MDT on diabetic foot ulcers(DFUs) includes three aspects by various mechanism,which are cleaning up the wounds, promoting growth and resisting bacteria. MDT can be used to treat many types of wound,but should not be applied to wounds that have a tendency to bleed easily,or that communicate with a body cavity or internal organ, and that near to any large blood vessels.

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.

慢性难愈合创面是由一系列创伤和疾病所致的、发生于体表的长期未愈合的创面.失活坏死的组织阻止伤口愈合,并有利于细菌定植.而目前的手术清创及其他多种清创方法均存在一定的局限性.生物清创[蛆虫治疗(larval therapy,LT)]目前被认为对坏死组织清除效率仅次于手术清除,而且还有其他方法无可比拟的多种优点,因此LT目前在世界上使用越来越广泛.本文对LT的历史、方法、机制以及适应证、禁忌证等作一综述.

Objective:To study the relationship between blood pressure,blood glucose and the different causes of death in elderly,and then provide a guidance for clinical prevention.Methods:883 dead patients with relatively complete information were investigated,to choose cases aged over 60 years as subjects.The 501 patients were divided into two groups:180 diabetics and 321 non-diabetics,and then were subgrouped according to blood pressure:diabetes /hypertension group(DM /HT,108 cases,60.14%),diabetes group(DM,72 cases,39.86%),hypertension group(HT,130 cases,40.50%),non diabetes/hypertension group(non-DM/HT,191 cases,59.50%) respectively.Sex,age,blood pressure,blood glucose and cause of death were observed in each group.Results:① The incidence of hypertension in the elderly were 40% in non-diabetes and 60% in diabetes,and higher in men;②Cerebral hemorrhage was the first cause of death(more than 30%) in DM/HT and HT groups;meanwhile vascular accident,mostly infarction was only 20% in DM and non-DM /HT groups;③Malignant tumors was the first cause of death in DM and non-DM/HT groups,and meanwhile it was not related with hypertension(except for renal spindle cell carcinoma);④There was a high prevalence of infection in the two sub-groups of diabetes;⑤The uremia prevalence was higher in DM /HT group and HT group than in the other two subgroups;⑥Multiple regression analysis showed systolic blood pressure and diastolic blood pressure were associated with cardio-cerebral vascular accident,unrelated to tumors and infection,the systolic blood pressure was also associated with uremia;fasting blood glucose were associated with the four causes of death.Conclusions:There was a relationship between blood pressure and blood glucose with the different causes of death in the elderly,and we should carry into disease prevention accordingly to different groups.

1 临床资料 患者,男,50岁,因"多饮、多食、多尿伴消瘦10年,左下肢水肿10 d",于2009年5月12日入院.入院前10 d出现左足前部凹陷性水肿,不红,不痛,未予重视.此后水肿逐渐加重.入院前9 d用热水泡脚后左足跟出现水泡,水泡破溃后自行涂"紫药水",然后以纸张外敷.此后因左下肢水肿明显,门诊治疗无效而住院治疗.入院时查体:血压20.0/13.3kPa,心肺无异常,左下肢前下1/3以下凹陷性水肿.

目的采用生物清创(蛆虫治疗)结合传统治疗方法,治疗静脉曲张性溃疡,以观察生物清创的疗效及可能的不良反应。方法对于溃疡下肢采用抬高患肢,抗感染治疗,并结合生物清创至坏死组织清除干净。结果每个创面经1～2次生物清创治疗,创面坏死组织均清除干净,结合传统治疗,创面均明显好转,部分完全愈合。清创时除有轻度疼痛外,无其它不良反应。结论蛆虫疗法是清洁静脉曲张性溃疡创面的安全有效方法,是临床治疗的一种选择。

Objective To explore the change of serum interleukin-8(IL-8) and tumor necrosis factor-α (TNF-α) of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) accompanied with anxiety-depressive disorder. Methods Thirty-five patients 421 male and 14 female) in the hospital diagnosed AECOPD during March 1999 and March 2004 were randomly divided into two groups, anxiety-depressive disorder group and no anxiety-depressive disorder group. Observation time was two weeks. Observed symptoms included cough, expectoration, asthma, dyspnea, chest distress, anxiety and depressive disorder and others. Lung function was observed, too. Level of serum IL-8 and TNF-α were detected by radio-immunity method. Results Difference of symptoms between two groups had no statistic significance before therapy(lst day after admission). After therapy(14th day after admission) , difference of some symptoms (cough,expectoration,dyspnea,chest distress,anxiety and depressive disorder) between two groups had statistic significance. Difference of lung function of two groups between before and after therapy had no statistic significance. TNF-α showed significant difference in its concentration decrease between before and after therapy in anxiety-depressive disorder group, but IL-8 was of no significant decrease. Conclusions Level of serum IL-8 and TNF-α increased in patients with AECOPD accompanied with anxiety-depressive disorder. Anxiety-depressive disorder may be one of dangerous factors of AECOPD. It is related with overflowing of inflammatory factor during the disease. Mechanism will be researched more in future.

对临床上5例糖尿病足部溃疡患者行蛆虫清创治疗,观察创面情况.平均7天,创面坏死组织均清除干净.新鲜的肉芽组织生长,创面愈合加快.结论:蛆虫对糖尿病足部溃疡创面,有较强的清创作用,加快创面愈合.