More studies are necessary to establish the effectiveness of Jinhuang powder in the treatment of diabetic foot

Diabetes mellitus is a common global public health problem that can cause serious illness and premature death. Diabetic foot ulcer, one of the complications of diabetes, is a major cause of morbidity and mortality and is associated with many other devastating complications. Previous study found that a group of traditional Chinese medicine (TCM) can be used for treating diabetic foot ulcers. More and more attention is being paid to the use of Chinese medicine to heal diabetic feet. Under the guidance of relevant theories of traditional Chinese medicine, more studies are needed to reveal the key active components and related signal pathways of TCM in the treatment of diabetic foot ulcer. One clinical study explored the treatment of diabetic foot with infection combined moist exposed burn ointment with Jinhuang powder. However, large-scale multi-center, double blind, randomized, placebo-controlled clinical trials and animal studies are necessary to establish the effectiveness of Jinhuang powder in the treatment of diabetic foot.     

Potential of Oncostatin M to accelerate diabetic wound healing

Oncostatin M (OSM) is a multifunctional cytokine found in a variety of pathologic conditions, which leads to excessive collagen deposition. Current studies demonstrate that OSM is also a mitogen for fibroblasts and has an anti‐inflammatory action. It was therefore hypothesised that OSM may play an important role in healing of chronic wounds that usually involve decreased fibroblast function and persist in the inflammatory stage for a long time. In a previous in vitro study, the authors showed that OSM increased wound healing activities of diabetic dermal fibroblasts. However, wound healing in vivo is a complex process involving multiple factors. Thus, the purpose of this study was to evaluate the effect of OSM on diabetic wound healing in vivo. Five diabetic mice were used in this study. Four full‐thickness round wounds were created on the back of each mouse (total 20 wounds). OSM was applied on the two left‐side wounds (n = 10) and phosphate‐buffered saline was applied on the two right‐side wounds (n = 10). After 10 days, unhealed wound areas of the OSM and control groups were compared using the stereoimage optical topometer system. Also, epithelialisation, wound contraction and reduction in wound volume in each group were compared. The OSM‐treated group showed superior results in all of the tested parameters. In particular, the unhealed wound area and the reduction in wound volume demonstrated statistically significant differences (P < 0·05). The results of this study indicate that topical application of OSM may have the potential to accelerate healing of diabetic wounds.     

振动觉阈值测定在糖尿病足预见性护理中的应用

目的探讨糖尿病患者足部VPT测定在糖尿病足预见性护理中的应用效果。方法对50例0级糖尿病足患者采用VPT测定，评估其糖尿病足发生风险，根据评估结果采取预见性护理干预。结果50例0级糖尿病患者中38例VPT升高，其中轻微者8例占16．0％，中危患者26例占52％，高危者4例占8％；实施预见性护理干预3个月后行VPT复查，原来VPT正常的12例患者复查时VPT测定值未有上升；VPT异常的38例患者复查VPT测定值较干预前有所好转，好转率44．73％（17／38）；38例VPT异常患者无1例发生糖尿病足。结论VPT测定有助于早发现高风险患者，及早采取相应的预见性护理措施，可以有效减少患者糖尿病足的发生率。     

健康信念模式在老年糖尿病患者足部自我管理中的应用

目的 探讨健康信念模式在老年糖尿病患者足部自我管理中的应用效果。方法 随机抽取2012年6月~2013年12月老年糖尿病患者80例,通过健康信念模式开展观察实施前后患者对足部自我管理能力的变化。结果 实施健康信念模式护理教育后,80例老年糖尿病患者对疾病的认识均有所提高,在认知态度、主动足部护理、掌握足部护理方法和足部症状改善方面与干预前比较,差异有统计学意义（P〈0.05）。结论 健康信念模式可提高老年糖尿病患者自我足部管理的能力,减轻足部神经病变症状,提高了患者的生活质量。     

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.     

p38MAPK信号通路在鞘内注射利多卡因诱发糖尿病神经病变大鼠脊髓神经元凋亡中的作用

目的探讨p38丝裂原活化蛋白激酶(p38MAPK)信号通路在鞘内注射利多卡因诱发糖尿病(DM)神经病变(DNP)大鼠脊髓神经元凋亡中的作用。方法健康成年雄性SD大鼠50只,随机取10只为对照组(C组),余40只大鼠高糖高脂饮食+小剂量链脲佐菌素(STZ)腹腔注射建立2型DM,之后继续喂养28d,得35只DNP大鼠。将C组大鼠和DNP大鼠均进行鞘内置管。将置管成功的25只DNP大鼠采用随机数字法分为三组:NS组8只,鞘内注射重比重利多卡因10μl 3d+0.9%NaCl 10μl 5d;DM组8只,鞘内注射重比重利多卡因10μl 3d+2%二甲亚砜(DMSO)10μl 5d;SB组9只,鞘内注射重比重利多卡因10μl 3d+SB203580(SB203580需溶解在DMSO溶剂中)10μg/10μl 5d。于腹腔注射STZ前(C组鞘内置管前28d,T1)、STZ后28d(C组鞘内置管前,T2)、STZ后34d(T3)、STZ后39d(T4)时测定大鼠后爪机械缩足反射阈值(MWT);测完MWT立即处死大鼠,取L4~5的脊髓组织,光镜下观察其病理学结果,采用TUNEL法检测脊髓神经元凋亡的情况,采用ELISA法检测p-p38MAPK水平。结果 T2、T3时NS、DM和SB组MWT均明显低于C组(P0.05)。T4时NS和DM组MWT明显低于C和SB组(P0.05)。NS和DM组脊髓神经元凋亡指数,脊髓p-p38MAPK水平明显高于C和SB组(P0.05)。HE染色光镜下见NS组及DM组大鼠脊髓组织结构模糊,出现轻度的水肿,同时神经元的细胞核间隙轻微增宽;C组脊髓组织无明显病理改变;SB组大鼠脊髓组织病理损伤较轻,几乎正常。结论鞘内注射重比重利多卡因诱发DNP大鼠脊髓神经元的凋亡可能与进一步激活p38MAPK信号通路有关,且应用p38MAPK抑制剂SB203580对其有保护作用。     

益肾固精方干预66例糖尿病肾病的临床观察

目的:通过对早、中期糖尿病肾病(DN)患者观察,探讨益肾固精方干预DN肾小管间质损害作用及机制。方法:临床纳入66例早、中期DN患者进行益肾固精方联合缬沙坦(中西医结合治疗组)与单纯缬沙坦(西药组)治疗比较,3个月后观察治疗前后空腹血糖(FPG)、血脂、纤维蛋白原(Fbg)、血粘度、血白蛋白(Alb)及肾脏损伤血、尿液标志物变化。结果:共纳入观察病例66例,脱落及剔除共6例,最终纳入统计60例。治疗前后比较:(1)两组患者中医证候积分均显著降低,中西医结合治疗组优于单用西药组(P0.05),前者证候疗效有效率86.7%,明显高于后者的76.7%(P0.05)。(2)中西医结合治疗组显著降低尿微量白蛋白(MA)(P0.01)、血尿胱抑素C、尿β2-微球蛋白(P0.05)、血脂、Fbg、血黏度(P0.05,P0.01),提升血Alb(P0.05),尤其在降低尿MA、Fbg方面疗效优于单用缬沙坦组。结论:益肾固精方可有效改善DN患者的临床症候,提高生活质量,通过调节血液流变学、凝血因子,减轻肾小管间质损伤,降低尿蛋白的异常排泄,其远期疗效值得进一步关注。