目的：对糖尿病足溃疡中面积和体积计算的方法学的临床应用进行评价。方法：广泛查阅文献,并结合我们的实际，对计算糖尿病足溃疡中面积和体积的各种方法效果进行综合分析。结果：目前常用于计算糖尿病足溃疡面积的方法有公式法、数码照像计算法、无菌薄膜勾边法等，但以数码照像计算法更准确，更易被患者接受；目前常用于计算糖尿病足溃疡体积的方法有公式法、媒介填充法、CT足部扫描法等，但以媒介填充法更经济易行。结论：数码照像计算法是目前较好的用于测量糖尿病足溃疡面积的方法，而媒介填充法是较简便易行的测量糖尿病足溃疡体积的方法。
Objective To review and evaluate the clinical application of autologous plateletrich gel (APG) in refractory chronic diabetic cutaneous ulcers. Methods The latest literature was extensively reviewed, and the potential mechanism of APG for healing diabetic cutaneous ulcers was discussed. Results APG accelerated the ulcer healing, especially in healing the refractory diabetic cutaneous ulcers, and the high-level growth factors from the platelet releasate were thought to be the major potential mechanism of the APG action. Conclusion APG can promote the healing of refractory chronic diabetic cutaneous ulcers. Topical haemotherapy withAPG may be considered an adjuvant treatment of a multidisciplinary process and may be useful to the effective therapy of cutaneous ulcers.
The Diabetic Foot and Peripheral Vascular Disease Study Group, Chinese Diabetes Society, released an expert advice Recommendations of Chinese Experts on the Standardized Diagnosis and Treatment of Diabetic Foot During Coronavirus Disease (COVID-19) Pandemic, and the International Diabetic Foot Care Group and D-Foot International released a document Fast-track Pathway for Diabetic Foot Ulceration During COVID-19 Crisis: A Document from International Diabetic Foot Care Group and D-Foot International during the 2020 outbreak, respectively. Both have the same goals, but the implementation focuses are different. The aim of this article is to give an interpretation of both expert advices in terms of the general principles, the epidemic prevention and control, the family, community and hospitalization management model of diabetic foot, the holistic principle of diabetic foot standardized management, and the telemedicine application in the late epidemic period.
Collagenase can promote wound healing, and its effect depends on the degradation of necrotic tissue and the collagen degradation products produced by collagenase. The possible mechanisms include accelerating re-epithelialization, promoting the formation of granulation tissue and blood vessels, and regulating inflammatory response. At present, clinical studies have shown that collagenase combined with sharp debridement or negative pressure wound therapy can significantly promote the healing of diabetic foot ulcers, and its efficacy is similar to that of hydrocolloid occlusive dressing and silver-containing wound dressings. Collagenase can promote the repair of diabetic foot ulcers, but its effect is affected by many factors, and large-sample, good design, high quality and multi-center randomized controlled trials are still needed to explore its efficacy and appropriate use conditions. This paper expounds that collagenase is one of the options in the treatment of diabetic foot ulcers from mechanism and clinical effect.
The annual incidence of diabetic foot ulcers in China is as high as 8.1%, which ranks first among the causes of chronic wounds in China. Although through the efforts of several generations of podiatrists and the building of multidisciplinary collaboration team, the major amputation rate in patients with diabetic foot ulcers in China has been decreased significantly, it is still far higher than the level of developed countries in Europe and the United States. Therefore, in order to cope with the increasing occurrence and recurrence of refractory diabetic foot ulcers, in addition to further optimizing the construction of multidisciplinary collaboration team, it is an urgent topic for us to explore the construction of a multidisciplinary integrated team to seamlessly connect the diagnosis and treatment of different aspects of foot disease. This article describes the importance and necessity of building a wound repair center with Chinese characteristics, which is a model of multidisciplinary integrated team, aiming at provide a theoretical basis for establishing a multidisciplinary integrated management model and realizing seamless connection between diagnosis and treatment, so as to further improve the cure rate of diabetic foot ulcers.
Objective To systematically review the effectiveness and safety of autologous implantation of stem cells for diabetic peripheral neuropathy (DPN). Methods Randomized controlled trials on relevant studies were retrieved in databases including CBM (1978-2011.6), CNKI (1979-2011.6), MEDLINE (1950-2011.6), PubMed (1950-2011.6), EMbase (1970-2011.6) and The Cochrane Library (Issue 3, 2011). References of the included studies were also retrieved. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assess the methodological quality of the included studies. Then, meta-analysis was performed using RevMan 5.0 software.Results Four RCTs involving 68 patients (136 limbs) were included, most of which were low in methodological quality. The results of meta-analysis indicated that, autologous stem cell therapy improved or even eliminated DPN symptoms including pain, numbness, and cold sensation in the limbs, intermittent limping, and rest pain. Compared with the routine therapy, autologous stem cell therapy improved tibial sensory nerve conduction velocity (MD=5.75, 95%CI 3.86 to 7.64, Plt;0.000 01), tibial motor nerve conduction velocity (MD=4.04, 95%CI 0.90 to 7.18, P=0.001), sural sensory nerve conduction velocity (MD=7.47, 95%CI 4.00 to 10.94, Plt;0.000 1), and sural motor nerve conduction velocity (MD=3.38, 95%CI 0.07 to 7.58, P=0.05), with no adverse reaction reported. Conclusion Current evidence shows that, autologous stem cell therapy is effective in treating DPN. Due to the lack of high quality studies, more high quality RCTs are needed to verify the above conclusion.
Objective To evaluate the effectiveness and safety of autologous hemopoietic stem cell implantation for peripheral arterial disease (PAD). Methods Randomized controlled trials (RCTs) were identified from CBM (1978 to September 2010), CNKI (1979 to September 2010), MEDLINE (1950 to September 2010), Pubmed (1950 to September 2010), Embase (1970 to September 2010), and Cochrane l ibrary (issue 4, 2010). The papers of the RCTs of cl inical therapeutic studieson PAD treated by autologous hemopoietic stem cell implantation were included and analyzed according to the criteria of the Cochrane handbook. Results Eight RCTs involving 280 patients and 322 extremities were included, with majority of trials of low methodological qual ity. Meta-analysis indicated that autologous hemopoietic stem cell transplantation had an increased ulcer cure rate [RD=0.38, 95% CI= (0.25, 0.50)], a significant improvement in the ankle brachial index [MD=0.11, 95%CI= (0.04, 0.18)], transcutaneous oxygen tension [MD=7.33, 95%CI= (3.14, 11.51)], and pain-free walking distance [SMD=1.35, 95%CI= (0.90, 1.79)], a significant reduction in rest pain scores [MD= —1.70, 95%CI= (—2.15, —1.25)], and a significant benefit in terms of l imb salvage [RD= —0.19, 95%CI= (—0.31, —0.07)]. Only 2 trials reported the side effects of autologous hemopoietic stem cell transplantation, such as l imbs swell ing and concentrations of serum creatine phosphokinase increasing, and the long-term safety was not reported. Conclusion Based on the review, autologous hemopoietic stem cell transplantation may have positive effect on “no-option” patients with PAD. However, the evidence is not b enough due to the general low methodological qual ity, so we can not draw a rel iable conclusion about the effects of autologous stem cell transplantation for PAD at the moment. Further larger, randomized, double bl ind, placebo-controlled, and multicenter trials are needed.