Emergence and Distribution of Foot‐and‐Mouth Disease Virus Serotype A and O in Bangladesh

Foot‐and‐mouth disease (FMD) is endemic in Bangladesh and is predominantly due to FMDV serotype O. In 2012, FMD outbreaks were identified in five different districts of Bangladesh. Of 56 symptomatic cattle epithelial tissue samples, diagnostic PCR assay based on 5′‐URT detected 38 FMDV infections. Viral genotyping targeting VP1‐encoding region confirmed emergence of two distinct serotypes, A and O with an abundance of serotype A in Chittagong and Gazipur districts and serotype O in Pabna and Faridpur. Only single lineage of both A and O was retrieved from samples of five different regions. Sequencing and phylogenetic analysis of VP1 sequences revealed that serotype O sequences were closely related to the Ind 2001 sublineage of Middle East–South Asia (ME‐SA) topotype that was previously circulating in Bangladesh, and serotype A sequences belonging to the genotype VII that was dominant in India during the last decade. The results suggest that extensive cross‐border animal movement from neighbouring countries is the most likely source of FMDV serotypes in Bangladesh.     

Heterogeneity in the Antibody Response to Foot‐and‐Mouth Disease Primo‐vaccinated Calves

Foot‐and‐mouth disease (FMD) vaccines are routinely used as effective control tools in large regions worldwide and to limit outbreaks during epidemics. Vaccine‐induced protection in cattle has been largely correlated with the FMD virus (FMDV)‐specific antibodies. Genetic control of cattle immune adaptive responses has been demonstrated only for peptide antigens derived from FMDV structural proteins. Here, we quantify the heterogeneity in the antibody response of cattle primo‐vaccinated against FMD and study its association with the genetic background in Holstein and Jersey sires. A total of 377 FMDV‐seronegative calves (122 and 255 calves from 16 and 15 Holstein and Jersey sires, respectively) were included in the study. Samples were taken the day prior to primo‐vaccination and 45 days post‐vaccination (dpv). Animals received commercial tetravalent FMD single emulsion oil vaccines formulated with inactivated FMDV. Total FMDV‐specific antibody responses were studied against three viral strains included in the vaccine, and antibody titres were determined by liquid‐phase blocking ELISA. Three linear hierarchical mixed regression models, one for each strain, were formulated to assess the heterogeneity in the immune responses to vaccination. The dependent variables were the antibody titres induced against each FMDV strain at 45 dpv, whereas sire's ‘breed’ was included as a fixed effect, ‘sire’ was included as a random effect, and ‘farm’ was considered as a hierarchical factor to account for lack of independence of within herd measurements. A significant association was found between anti‐FMDV antibody responses and sire's breed, with lower immune responses found in the Jersey sires’ offspring compared with those from Holstein sires. No significant intrabreed variation was detected. In addition, farm management practices were similar in this study, and results of the serological assays were shown to be repeatable. It therefore seems plausible that differences in the immune response may be expected in the event of a mass vaccination campaigns.     

Analysis of Recent Serotype O Foot‐and‐Mouth Disease Viruses from Livestock in Kenya: Evidence of Four Independently Evolving Lineages

Foot‐and‐mouth disease (FMD) is endemic in Kenya where four serotypes (O, A, SAT 1 and SAT 2) of the virus are currently in circulation. Within 2010 and 2011, the National Laboratory recorded an increase in the number of FMD outbreaks caused by serotype O virus. The characteristics of these viruses were determined to ascertain whether these were independent outbreaks or one single strain spreading throughout the country. The sequences of the complete VP1‐coding region were analysed from viruses sampled within different areas of Kenya during 2010 and 2011. The results indicated that the 2010 to 2011 outbreaks in Kenya were caused by four independent strains. By comparison with earlier type O isolates from Eastern Africa, it was apparent that the outbreaks were caused by viruses from three different lineages of topotype EA‐2 and a fourth virus strain belonging to topotype EA‐4. The topotypes EA‐1 and EA‐3 were not detected from these outbreaks. Implications of these results for FMD control in Eastern Africa are discussed.     

多中心完全随机、标准治疗平行对照评价京万红软膏治疗糖尿病足慢性创面的临床研究

目的：：通过多中心完全随机、标准治疗平行对照方法评价京万红软膏治疗糖尿病足慢性创面的疗效。方法：本研究共有11家医院参加,采用多中心完全随机、标准治疗平行对照、前瞻性临床研究设计。131例糖尿病足溃疡患者随机分为京万红软膏组67例和对照组64例,两组创面面积分别为(16.7±6.1)cm2和(15.9±8.3) cm2,创面形成时间(45.7±68.3)d和(52.5±79.6)d 。两组分别用京万红软膏或复方磺胺嘧啶锌凝胶涂于创面,观察疗程均为20周。结果：两组患者年龄、糖尿病病程、血常规、肝功能、肾功能等数据差异无统计学意义。京万红组于2、5、10、15周创面愈合速率明显优于复方磺胺嘧啶锌凝胶组,以第5周、10周最为明显(P<0.01)。京万红组创面达到完全上皮化平均时间为(46.5±15.6)d,复方磺胺嘧啶锌凝胶组为(67.9±17.9)d,差异显著(P<0.05)。结论：京万红软膏与复方磺胺嘧啶锌凝胶均有促进糖尿病足创面愈合的作用,京万红软膏作用更优。     

Safety,efficacy and pitfalls of fibrocyte application in the treatment of diabetic foot ulcer

Fibrocytes are unique bone marrow‐derived cells with great potential in wound healing. Hence, the aim of this study was to determine the safety and efficacy of the applied circulating fibrocytes in the treatment of non healing diabetic foot ulcers. Peripheral blood mononuclear cells were isolated by centrifugation through Ficoll–Paque method. After 3 days, the non adherent cells were removed by a single, gentle aspiration. Adherent cells were cultured in the same medium for 10 days. The cells were characterised using mouse anti‐human‐CD45‐fluorescein isothiocyanate (FITC) and mouse anti‐human–collagen I, and also characterised by immunofluorescence microscopy using the above mentioned antibodies. Sterility measures were applied for clinical evaluation. Based on the literature review, cell transplantation generally requires at least 3 × 10⁶ cells regarding efficacy measures. As fibrocytes are non proliferating cells, 350 ml patient's blood is required to prepare patient‐specific serum before cell isolation and culture, and 85 ml patient's blood is needed for cell isolation and differentiation on cell transplantation applications. In our survey, no diabetic patient was inclined to be donor of such blood volume, mainly because of their pre‐assumption that they are anaemic. It is concluded that fibrocytes do not seem to be candidate cells for cell therapy in the treatment of diabetic foot ulcers because of the rarity of this cell population in circulation.     

Cyclic negative pressure wound therapy: an alternative mode to intermittent system

The purpose of this study was to develop and test a novel mode of negative pressure wound therapy (NPWT) that minimises pain while preserving the efficacy in wound healing. A porcine model was used in this study. Wounds were generated in animals and treated with either simple dressing or various treatment modes of NPWT. The wound volume, perfusion level and vasculature status were analysed and compared among different groups. Clinical application was performed to evaluate the level of pain occurring when negative pressure is applied. Among the NPWT groups, the Cyclic‐50 group showed most decrement in wound volume, even though statistical relevance was not found (P = 0·302). The perfusion level was significantly increased in the Cyclic‐50 group compared with the Intermittent group (P < 0·001) and the Cyclic‐100 group (P = 0·004). Evaluation of blood vessel formation revealed that the Cyclic‐50 group showed the highest number of vasculature with statistical significance (P < 0·001). In clinical application, the cyclic group showed significant decrease in pain compared with the intermittent group (P = 0·001). The cyclic NPWT mode decreased patient discomfort while maintaining superior wound healing effects as the intermittent mode.     

Wireless micro current stimulation – an innovative electrical stimulation method for the treatment of patients with leg and diabetic foot ulcers

Clinical experience with a new electrical stimulation (ES) technique, the wireless micro current stimulation (WMCS), for the treatment of chronic wounds is described. WMCS transfers the current to any surface wound from a distance, by using oxygen's and nitrogen's ability to exchange electrons. We studied 47 patients with hard‐to‐heal wounds. Patients with venous, arterial and mixed leg ulcers were predominant; other aetiologies such as diabetic foot lesions, pressure ulcers, vasculitis and pyoderma were also included. WMCS treatment protocol specified treatment twice or thrice per week, for 45–60 minutes per session, with 1·5 μA current intensity. Standard wound care was applied to all patients, including compression bandages, if necessary. Clear progress of wound healing, even after 2 weeks, was observed in all cases. The mean reduction of the wound surface after WMCS treatment was 95% in 8 weeks. Complete healing was achieved within 3 months for the majority of the cases. No clinical side effects were observed. WMCS technology significantly accelerated wound healing for patients with hard‐to‐heal wounds of different aetiologies. This new therapy offers multiple advantages compared with the previous methods of ES, as it is contactless, free of pain and very easy to use.     

Effective management of patients with diabetes foot ulcers: outcomes of an Interprofessional Diabetes Foot Ulcer Team

A longitudinal observational study on a convenience sample was conducted between 4 January and 31 December of 2010 to evaluate clinical outcomes that occur when a new Interprofessional Diabetes Foot Ulcer Team (IPDFUT) helps in the management of diabetes‐related foot ulcers (DFUs) in patients living in a small urban community in Ontario, Canada. Eighty‐three patients presented to the IPDFUT with 114 DFUs of average duration of 19·5 ± 2·7 weeks. Patients were 58·4 ± 1·4 years of age and 90% had type 2 diabetes, HbA1c of 8·3 ± 2·0%, with an average diabetes duration of 22·3 ± 3·4 years; in 69% of patients, 78 DFUs healed in an average duration of 7·4 ± 0·7 weeks, requiring an average of 3·8 clinic visits. Amputation of a toe led to healing in three patients (4%) and one patient required a below‐knee amputation. Six patients died and three withdrew. Adding a skilled IPDFUT that is trained to work together resulted in improved healing outcomes. The rate of healing, proportion of wounds closed and complication rate were similar if not better than the results published previously in Canada and around the world. The IPDFUT appears to be a successful model of care and could be used as a template to provide effective community care to the patients with DFU in Ontario, Canada.     

Variation of plantar pressure in Chinese diabetes mellitus

To investigate dynamic changes in plantar pressure in Chinese diabetes mellitus patients and to provide a basis for further preventing diabetic foot. This is a cross‐sectional investigation including 649 Chinese diabetes mellitus patients (diabetes group) and 808 “normal” Chinese persons (nondiabetes group) with normal blood glucose levels. All the subjects provided a complete medical history and underwent a physical examination and a 75‐g oral glucose tolerance test. All subjects walked barefoot with their usual gait, and their dynamic plantar forces were measured using the one‐step method with a plantar pressure measurement instrument; 5 measurements were performed for each foot. No significant differences were found in age, height, body weight, or body mass index between the two groups. The fasting blood glucose levels, plantar contact time, maximum force, pressure‐time integrals and force‐time integrals in the diabetes group were significantly higher than those in the nondiabetes group (p < 0.05). However, the maximum pressure was significantly higher in the nondiabetes group than in the diabetes group (p < 0.05). No difference was found in the contact areas between the two groups (p > 0.05). The maximum plantar force distributions were essentially the same, with the highest force found for the medial heel, followed by the medial forefoot and the first toe. The peak plantar pressure was located at the medial forefoot for the nondiabetes group and at the hallucis for the diabetes group. In the diabetes group, the momentum in each plantar region was higher than that in the nondiabetes group; this difference was especially apparent in the heel, the lateral forefoot and the hallucis. The dynamic plantar pressures in diabetic patients differ from those in nondiabetic people with increased maximum force and pressure, a different distribution pattern and significantly increased momentum, which may lead to the formation of foot ulcers.