Association of vitamin D status with all‐cause mortality and outcomes among Chinese individuals with diabetic foot ulcers

Aims/IntroductionThe aim of this study was to examine the correlation between serum vitamin D concentrations and prognosis among Chinese individuals with diabetic foot ulcers (DFUs).Materials and MethodsWe retrospectively recruited 488 adults with DFUs in West China Hospital from 1 January 2012 to 31 December 2019. After telephone follow up, 275 patients were finally included. We compared serum vitamin D concentrations among DFUs patients with different prognostic status, and examined the association of vitamin D status with prognostic variables by Kaplan–Meier analysis. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for all‐cause mortality.ResultsThe median concentration of serum vitamin D of patients with DFUs was 37.78 nmol/L (interquartile range 27.91–50.66 nmol/L), with 31.6% having vitamin D deficiency (<30 nmol/L) and 42.2% having insufficient vitamin D (<50 nmol/L). During a median follow‐up period of 52 months, 65 patients died, with an all‐cause mortality of 23.64%. Vitamin D deficiency was independently linked to increased all‐cause mortality after multivariable adjustments (hazard ratio 0.565, 95% confidence interval 0.338–0.946, P = 0.030). There were no significant differences between vitamin D concentrations and other outcomes of DFUs. Patients who suffered amputations had a tendency of lower vitamin D concentrations (34.00 [interquartile range 26.90–41.81] vs 40.21 [interquartile range 29.60–53.96] nmol/L, P = 0.053).ConclusionsVitamin D deficiency was significantly associated with increased all‐cause mortality in Chinese individuals with DFUs. Vitamin D supplementation might be a potential therapy for DFUs to prevent premature death and improve outcomes.     

Changes in physical function and ambulatory state after Achilles tendon lengthening for diabetic foot ulcers

[Purpose] The recurrence rate of diabetic foot ulcers is high and is related to kinematic factors. Achilles tendon lengthening has been shown to reduce the recurrence rate of foot ulcers by increasing the range of motion in the ankle joint and decreasing the plantar load. However, there are few reports on the effects of Achilles tendon lengthening in Japanese patients, but the results are yet to be clarified. This study aims to investigate the effects of Achilles tendon lengthening on physical function and ambulatory state in patients with diabetic foot ulcers. [Participants and Methods] This study initially included 10 patients with diabetic ulcers who had undergone Achilles tendon lengthening between April 2013 and March 2020. We retrospectively evaluated the factors available from the medical records. [Results] The dorsiflexion range of motion in the ankle joint increased by 10.5 degrees on average after surgery, while the plantar load decreased by 19.1 percent, while gait speed and stride length remained unchanged. [Conclusion] Achilles tendon lengthening for diabetic foot ulcers increased the range of motion in the ankle joint and decreased the plantar load without changing the ambulatory state.     

Home-Based Electrical Stimulation to Accelerate Wound Healing—A Double-Blinded Randomized Control Trial

Background:Electrical stimulation (E-Stim) may offer a unique adjunctive treatment to heal complicated diabetic foot ulcers (DFU). Our primary goal is to examine the effectiveness of daily home-based E-Stim therapy to speed-up wound healing.Methods:Patients with chronic DFUs and mild to severe peripheral arterial disease (PAD) were recruited and randomized to either control (CG) or intervention (IG) groups. The IG received 1-hour home-based E-Stim therapy on daily basis for 4 weeks (4W). E-Stim was delivered through electrical pads placed above the ankle joint using a bio-electric stimulation technology (BEST^®) platform (Tennant Biomodulator^® PRO). The CG was provided with an identical but non-functional device for the same period. The primary outcome included wound area reduction at 4W from baseline (BL).Results:Thirty-eight patients were recruited and 5 were removed due to non-compliance or infection, leaving 33 participants (IG, n = 16; CG, n =17). At 4W, the IG showed a significant wound area reduction of 22% (BL: 7.4 ± 8.5 cm² vs 4W: 5.8 ± 8.0 cm², P = 0.002). Average of wound area was unchanged in the CG (P = 0.982). The self-report adherence to daily home-therapy was 93.9%.Conclusions:Daily home-based E-Stim provides early results on the feasibility, acceptability, and effectiveness of E-Stim as an adjunctive therapy to speed up wound healings in patients with chronic DFU and mild to severe PAD.     

Smart Offloading Boot System for Remote Patient Monitoring: Toward Adherence Reinforcement and Proper Physical Activity Prescription for Diabetic Foot Ulcer Patients

Background:A critical factor in healing diabetic foot ulcers is patient adherence to offloading devices. We tested a smart offloading boot (SmartBoot) combined with a smartwatch app and cloud dashboard to remotely monitor patient adherence and activity. In addition, the impact of SmartBoot on balance, gait, and user experience was investigated.Methods:Fourteen volunteers (31.6±8.7 years; 64% female) performed natural activities (eg, sitting, standing, walking) with and without the SmartBoot for approximately 30 minutes. All participants completed balance tests, 10-meter walking tests at slow, normal, and fast pace while wearing the SmartBoot, and a user experience questionnaire. The accuracy of real-time adherence reporting was assessed by comparing the SmartBoot and staff observation. Center of mass (COM) sway and step counts were measured using a validated wearable system.Results:Average sensitivity, specificity, and accuracy for adherence and non-adherence were 90.6%, 88.0%, and 89.3%, respectively. The COM sway area was significantly smaller with the SmartBoot than without the SmartBoot regardless of test condition. Step count error was 4.4% for slow waking, 36.2% for normal walking, 16.0% for fast walking. Most participants agreed that the SmartBoot is easy to use, relatively comfortable, nonintrusive, and innovative.Conclusions:To our knowledge, this is the first smart offloading system that enables remote patient monitoring and real-time adherence and activity reporting. The SmartBoot enhanced balance performance, likely due to somatosensory feedback. Questionnaire results highlight SmartBoot’s technical and clinical potential. Future studies warrant clinical validation of real-time non-adherence alerting to improve wound healing outcomes in people with diabetic foot ulcers.     

The Effect of Customized and Silicon Insoles on Mid- and Hindfoot in Adult Flexible Pes Planovalgus

BackgroundFlexible flat foot or pes planovalgus is a common foot deformity, and silicone and customized insole are commonly used as a non-operative treatment modality of flexible planovalgus. However, there are inadequate data and limited evidence available regarding the immediate effects of their use in midfoot and hindfoot of adults. The aim of this study is to quantify and compare the radiological parameters immediately on weightbearing with silicon and customized insoles and without them to assess the effect on midfoot and hindfoot of the flexible planovalgus in adults.MethodsA total number of 11 (8 females and 3 males) subjects with flexible pes planovalgus deformity without any other foot deformity were included in the study. Each patient was assessed three times in a random sequence without and with use of either silicon insoles or customized insole. The radiographic parameters without insole, with silicon insole, and with customized insole conditions were calculated using online available computer software Kinovea.ResultsOne-way ANOVA analysis was performed between groups (without insole, with silicone insole and with customized insole). The hindfoot parameters depicted that calcaneal inclination angle (CIA) was significant increased (P = 0.000) and talar declination angle (TDA) was significantly decreased (P = 0.003) only with the use of customized insole compared to without insole. The midfoot parameters depicted that the first metatarsal angle (FMA) and talonavicular coverage angle (TCA) were significantly lower with customized insole (P = 0.00) as compared to other two groups and significantly lower with silicone insole (P = 0.00) as compared to without insole group.ConclusionThe results imply that the compressibility of the insole material affects the forefoot and hindfoot biomechanics differently. This study concludes that silicone insole affects only the midfoot which bears 45% of bodyweight and customized insole affects both midfoot and more importantly the hindfoot which bears 55% of bodyweight.     

Teach-Back健康教育模式对学龄期手足口病患儿家属疾病认知水平及防护行为的影响

目的:探讨Teach-Back健康教育模式对学龄期手足口病(HFMD)患儿家属疾病认知水平及防护行为的影响。方法:2018年7月—2020年11月选取我院学龄期113名HFMD患儿家属为研究对象,按照随机数字表法分为对照组56例与观察组57例,对照组给予常规健康教育干预,观察组给予Teach-Back健康教育模式干预,观察两组患儿家属疾病认知水平、行为干预遵从率、患儿症状改善状况。结果:干预后,观察组患儿家属发病原因、传播途径、隔离治疗、并发症预防认知评分高于对照组(P<0.05);观察组患儿家属消毒隔离措施、饭前便后洗手、勤晒衣被、居家开窗通风遵从率高于对照组(P<0.05);观察组患儿发热、口腔溃疡、皮疹、食欲减退改善时间短于对照组(P<0.05)。结论:对学龄期HFMD患儿家属开展Teach-Back健康教育模式,可明显提高家属对疾病认知水平,提高行为干预遵从率,促进患儿恢复。     

强化管理在糖尿病足高危患者保肢治疗中的意义

目的探讨综合强化管理与医疗方法的运用对糖尿病足高危患者保肢及生活质量提高的意义。方法入选的糖尿病患者在糖尿病教育中心接受专科糖尿病教员的教育,包括常规糖尿病教育及足部特别教育,教育前后各完成糖尿病知识问卷,到达研究终点时评价强化管理组(n=65)及普通管理组(n=58),两组患者糖尿病知识、足部防护知识、血糖控制情况、足部溃疡发生率、截肢率的差异。结果两组的糖尿病一般知识和足部防护知识在干预前和干预后1月无显著性差异(P>0.05),而干预后1年和2年的差异则具有显著统计学意义(P<0.001)。强化管理组在HBA1c犤(7.1±2.3)%犦、平均收缩压犤(142±10)mmHg〗、平均舒张压犤(80±10)mmHg犦、总胆固醇犤(4.4±1.1)mmol/L犦、三酰甘油犤(1.8±0.9)mmol/L犦的改善较普通管理组犤分别为(8.5±4.2)%,(158±9)mmHg,(92±10)mmHg,(5.6±2.6)mmol/L,(2.5±1.8)mmol/L犦显著(t=2.310,9.019,6.647,2.804,2.745,P<0.05),强化管理组的糖尿病足发生率(7.7%)及截肢率(3.1%)较普通管理组(20.7%,13.8%)显著降低(t=4.347,4.712,P<0.05)。结论强化管理有助于减少糖尿病足发生率及截肢率,提高生活质量及节省医疗费用。     

冰黄凝胶治疗糖尿病足的作用及机理研究

目的观察冰黄凝胶干预治疗糖尿病足的作用,探讨糖尿病足大鼠血浆肿瘤坏死因子-α(TNF-α)和血管性假血友病因子(vWF)表达水平变化及其相关性。方法雄性Wistar大鼠65只,以链脲佐菌素和降温法制备糖尿病足模型。造模成功后大鼠随机分为4组:正常组、造模后未治疗组(A组)、西药治疗组(B组)、冰黄凝胶治疗组(C组)。15天后,取大鼠血浆,采用ELISA法检测大鼠血浆TNF-α和vWF的变化。结果造模后未治疗组大鼠血浆TNF-α(4.6±0 9)和vWF(1442.4±38 2)的表达水平明显高于正常对照组(2.5±0.5,461 0±28 4),差异具有显著性(P<0.01)。冰黄凝胶组TNF-a(2.5±0 7)和vWF(957.6±37.1)的表达水平明显低于西药治疗组(3.8±0 3,1031.8±35.3),差异具有显著性(P<0.01)。未治疗组大鼠血浆TNF-a与vWF的表达呈正相关(r=0.01)。结论冰黄凝胶干预治疗糖尿病足大鼠,可显著降低血浆TNF-a与vWF的表达,疗效明显优于西药。     

Prospects for improved foot and mouth disease vaccines

Improved foot and mouth disease (FMD) vaccines which have increased efficiency and stability are highly desirable. Work which aims to increase the stability of FMD virus particles for vaccine use is described and the use of these particles and of antigenic fragments of the virus for controlled release vaccine products is considered.