Conservative surgery for chronic diabetic foot osteomyelitis: Procedures and recommendations

Osteomyelitis (OM) is the most frequent infection associated with diabetic foot ulcers (DFU) that typically involve the forefoot, the most common location of DFU.Conservative surgical procedures could be attractive alternative that reduces minor and major amputations and avoid future recurrence thus preserving the functionally of the foot. This review aimed to analyze and describe the current evidence on conservative diabetic foot osteomyelitis (DFO) surgical procedures depending on DFU location and indications.A narrative revision of the evidence was carried out by searching Medline through PubMed databases from inception to late July 2020 to identify retrospective, prospective, and randomized controlled trials pertaining to conservative DFO procedures on the forefoot.Seven types of conservative surgical procedures for DFO treatment in the forefoot are described in this review: (1) partial or total distal phalangectomy, (2) arthroplasty of the proximal or distal interphalangeal joint, (3) distal Syme amputation, (4) percutaneous flexor tenotomy, (5) sesamoidectomy, (6) arthroplasty of the metatarsophalangeal joint, and (7) metatarsal head resection.When indicated, conservative surgery for DFUs in patients with chronic forefoot OM is a safe and effective option that increases the chances of healing and reduces the possibility of limb loss and death compared with radical amputation procedures.Since a lack of sufficient evidence supporting this procedure exists, future investigations should be focused on the random clinical trial (RCT) design. The results of prospective trials could help surgeons select the appropriate procedure in each case in order to minimize complications.     

Our experience of reinnervation of sole in diabetic sensorimotor polyneuropathy: A chance to change the natural history of disease

Diabetic sensorimotor polyneuropathy (DSPN) is the commonest form of neuropathy which leads to insensate sole, diabetic foot ulcers (DFU) and its complications. We share our experience in recovery of sensation in the sole after prophylactic surgery such as nerve decompression (ND) or sensory neurotization by nerve transfer (NT) in patients having Diabetic sensorimotor polyneuropathy DSPN. 32 patients (46 feet) were selected for either nerve decompression or sensory neurotization depending upon presence or absence of Tinel’s sign at tarsal tunnel. At 6 month post-operatively perception of touch and pain recovered in all feet; temperature and pressure perception recovered in ∼95% feet; average vibration perception threshold returned to normal range and 2-Point Discrimination came down significantly. There were no ulcers or amputation in operated limbs during follow up period of 6 months. Prophylactic surgery in the form of ND and NT can be offered with minimal complications which significantly improve sensations in the sole in selected cases of DSPN. These have the potential to improve the quality of life of patient and change the natural course of disease.     

中医药在糖尿病胃轻瘫治疗中的应用及思考

糖尿病胃轻瘫（DGP）发病率较高,药物治疗存在一定的局限性,部分患者可能出现一定的不良反应,这影响糖尿病的治疗。中药治疗DGP可以有效缓解患者症状,降低现有药物不良反应,辅助控制血糖。现代医家多利用辨证分型组方、经方验方及中成药进行辨病辨证治疗相结合,运用单味药、药对、中药提取物进行个体化治疗。现通过概述中药的多种组方思路,总结其优势,并对中药治疗DGP的现状进行思考与总结,以期中医药治疗DGP得到更好的发挥。     

中医药治疗糖尿病肾病实验研究进展

糖尿病肾病（DN）是糖尿病常见慢性并发症之一,白蛋白尿和肾小球滤过率下降是目前糖尿病肾病诊断的重要临床指征。DN严重影响着患者的生命质量,尽早地干预糖尿病肾病的危险因素,纠正胰岛素代谢障碍导致的长期高血糖因素影响下的肾脏损伤,是有效阻止其进展为终末期肾脏疾病的关键。中医药秉持其特色理论取得了独特的治疗优势,随着中医药对于DN的认识与研究的加深,实验研究方面也取得了一定的进展。本文总结了中医研究DN动物模型的常用构建方法,同时从中医药调节免疫炎症反应、降低氧化应激水平、改善肾脏血流动力学改变、纠正糖脂代谢紊乱等机制方面列举分析中医药辨治糖尿病实验研究进展,探讨中医药防治DN的机制,以期对临床有所裨益。     

基于TLR4/MyD88/NF-κB通路探究桃红四物汤对糖尿病周围神经病变大鼠炎症反应的影响

目的:探究桃红四物汤对糖尿病周围神经病变(DPN)大鼠炎症反应及对Toll样受体4(TLR4)/髓样分化因子88(MyD88)/核转录因子kappan B(NF-κB)通路的影响。方法:从45只SD大鼠中随机选取10只为对照组,其余35只大鼠建立DPN模型,3只大鼠建模失败,其余随机分为模型组,桃红四物汤低、高剂量组及α-硫辛酸组,每组各8只。桃红四物汤低、高剂量组分别给予4.5、18 g/(kg·d)的桃红四物汤,α-硫辛酸组给予α-硫辛酸20 mg/(kg·d),对照组及模型组给予等量的0.9%氯化钠溶液,均灌胃给药。连续给药8周后,检测大鼠血清炎症因子、血糖及血脂指标及神经传导情况,观察坐骨神经病理学变化,检测TLR4相关通路蛋白表达情况。结果:与对照组比较,模型组血清肿瘤坏死因子-α(TNF-α)、白细胞介素-1β(IL-1β)及白细胞介素-6(IL-6)水平升高,血糖、糖化血红蛋白(HbA1c)、甘油三酯(TG)及血清总胆固醇(TC)水平升高,感觉神经传导速度(SNCV)及运动神经传导速度(MNCV)水平降低,TLR4、MyD88、NF-κB蛋白表达上调(P<0.05)...     

Wound outcomes and factors associated with wound healing after first-time femoropopliteal artery intervention in patients with ischemic tissue loss

Background/objectiveThis study’s goal is to describe wound outcomes at 2 years following intervention for atherosclerotic femoropopliteal lesions in patients with ischemic tissue loss.MethodsA retrospective review of 135 first-time endovascular procedures for chronic femoropopliteal atherosclerotic lesions related to ischemic tissue loss was performed. The final wound outcomes were categorized according to the initial wound healing, recurrence and the need of major/minor amputation.ResultsAt 2-years of follow up, 76 limbs (56.3%) showed complete wound healing without recurrence, however, wound development occurred at other sites on the same foot following complete primary healing in 11 limbs (8.1%). Tolerable wounds persisted or wounds recurred at the same site in 30 limbs (22.2%), and 18 limbs (13.3%) needed major amputations. Independent factors that prevented wound healing without recurrence at 2 years were renal insufficiency (HR = 0.225, 95% C.I. = 0.091–0.556, p = 0.001), ankle pressure < 50 mmHg or flat forefoot PVR (HR = 0.328, 95% C.I. = 0.124–0.867, p = 0.025) and functional performance < 4 metabolic equivalents (MET) (HR = 0.150, 95% C.I. = 0.063–0.360, p < 0.001).ConclusionWound outcome classifications showed detailed information regarding clinical outcomes in patients with ischemic tissue loss. Renal insufficiency, ischemia grade 3 and poor functional performance were independent risk factors that prevented wound healing.     

负压封闭引流促进糖尿病足溃疡的愈合

目的分析负压封闭引流(vacuum sealing drainage,VSD)能否促进糖尿病足溃疡的愈合。方法回顾分析自2015年1月至2019年12月,北部战区总医院烧伤整形科收治的糖尿病足溃疡患者60例,并根据患者的治疗方式分为常规治疗组(30例)和VSD治疗组(30例)。统计对比分析两组患者的平均换药次数、平均愈合时间、疼痛程度及满意度。搜集治疗前和治疗14 d后的肉芽组织进行HE染色和VEGF免疫组化染色,分析创面愈合情况以及VEGF的表达情况。结果VSD治疗组换药次数[(5.40±0.28)次]显著少于常规治疗组[(31.41±1.11)次],组间比较P<0.05;VSD治疗组平均愈合时间(29.38±0.63)d显著短于常规治疗组(50.81±2.15)d,组间比较P<0.05;VSD治疗组患者的痛苦程度明显轻于常规治疗组,满意度显著优于常规治疗组,组间比较P<0.05。结论VSD治疗能够促进创面成纤维细胞的增殖、减少炎性细胞的浸润、促进VEGF的表达及创面的愈合。     

JAK/STAT信号途径参与高糖诱导的肾小管上皮细胞转分化

目的：观察Janus激酶/信号转导和转录活化因子(JAK/STAT) 信号的激活对高糖诱导肾小管上皮细胞转分化的影响。方法:体外培养人肾近曲小管上皮细胞株（HKCs）,分别给予高糖和JAK拮抗剂AG490干预,采用免疫沉淀和Western印迹检测JAK2的磷酸化;Western印迹检测平滑肌肌动蛋白(α-SMA)、E-钙黏素(E-cadherin)及信号蛋白STAT1、STAT3、磷酸化STAT1 (phospho-STAT1, p-STAT1) 和p-STAT3的水平; 酶联免疫吸附法(ELISA)测定细胞上清液中转化生长因子β₁(TGF-β₁)和I型胶原的分泌,逆转录聚合酶链反应(RT-PCR)检测TGF-β₁mRNA表达。结果:与低糖对照组比较,高糖培养的HKCs中α-SMA 的水平及p-JAK2 、p-STAT1 和p-STAT3 比例明显上调；E-cadherin表达明显下调；TGF-β₁ mRNA 表达增加；细胞培养上清液中TGF-β₁、Ⅰ型胶原分泌增加。AG490明显抑制JAK2磷酸化、下调p－STAT1 和p-STAT3的同时,明显抑制高糖刺激HKCs中α-SMA表达的升高，减轻E-cadherin表达下降程度；降低TGF-β₁ mRNA 表达及TGF-β₁、Ⅰ型胶原的分泌。结论:JAK/STAT信号途径参与高糖诱导的HKCs转分化，并刺激TGF-β₁和细胞外基质的分泌。     

全域扫频OCTA与荧光素眼底血管造影在糖尿病视网膜病变应用中的对比分析

目的 比较全域扫频光学相干断层扫描血管造影（OCTA）与荧光素眼底血管造影（FFA）对糖尿病视网膜病变（DR）的诊断价值。方法 选取2022年2月至2022年4月就诊于安徽医科大学第二附属医院眼科门诊的糖尿病视网膜病变患者35例（70眼）,每位患者均使用超广角彩色眼底照相（UWF CFP）检查。采用全域扫频OCTA和FFA分别检查受试者视网膜,并分析两者对视网膜微血管瘤（MA）、视网膜新生血管（RNV）、视网膜无灌注区（NPAs）、视网膜内微血管异常（IRMA）、糖尿病性黄斑水肿（DME）的检出率差异。结果 全域扫频OCTA中MA、RNV、NPAs、IRMA、DME的检出率与FFA相比,差异无统计学意义（P>0.05）,全域扫频OCTA与FFA对DR的筛查、诊断、分类一致性良好（Kappa值>0.75）。结论 全域扫频OCTA在DR应用中具有广阔的前景,可作为DR无创性筛查、诊断、随访的重要依据。     

皮肤电导率在早期糖尿病肾病筛查中的应用价值

目的 探讨皮肤电导率（ESC）在早期糖尿病肾病筛查中的应用价值。方法 选取2022年10月至2023年2月于安徽医科大学第二附属医院分泌科住院的176例2型糖尿病患者,根据尿白蛋白/肌酐比值（UACR）和肾小球滤过率（eGFR）将其分为两组,糖尿病肾病组（DKD组,n=68）和糖尿病非肾病组（non-DKD组,n=108）,所有患者均完善SUDOSCAN仪检测,获得双手、双足ESC(HESC、FESC),肾病风险分数（SUDOSCAN-DN）,采用Spearman相关性分析UACR与SUDOSCAN各指标的关系。采用受试者工作特征（ROC）曲线判断SUDOSCAN各指标对糖尿病肾病的诊断效能。结果 与non-DKD组相比,DKD组年龄较大,病程较长,收缩压较高,三酰甘油（TG）、血尿酸及肌酐、促甲状腺激素（TSH）水平较高,HbA1c水平偏低,HESC、FESC、SUDOSCAN-DN值均较低,差异有统计学意义（P<0.05）;Spearman相关分析显示,UACR与TC、LDL-C、血肌酐、TSH呈正相关（r值分别为0.202、0.207、0.378、0.174,P<0....