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    Critical Appraisal of the Quality of Evidence Addressing the Diagnosis, Prognosis, and Management of Peripheral Artery Disease in Patients With Diabetic Foot Ulceration.
    Eur J Vasc Endovasc Surg 2018 Jun 13. Epub 2018 Jun 13.
    Bristol Centre for Surgical Research, University of Bristol, Bristol, UK.
    Aims: There is a paucity of robust evidence on prevention and management of diabetic foot ulcers (DFUs) to inform treatment. This study appraises the current quality of the evidence addressing diagnosis, prognosis, and management of peripheral artery disease (PAD) in patients with DFUs using a newly devised 21 point scoring (TOPS) disease specific research appraisal tool published by the International Working Group on the Diabetic Foot (IWGDF) and European Wound Management Association.

    Methods: The 2015 IWGDF guidance on diagnosis, prognosis, and management of PAD in patients with DFUs was used to identify studies pertaining to prevention and management. Read More

    Methicillin-resistant Staphylococcus aureus nasal carriage and infection among patients with diabetic foot ulcer.
    J Microbiol Immunol Infect 2018 Jun 4. Epub 2018 Jun 4.
    School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan. Electronic address:
    Purpose: To evaluate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in patients with diabetic foot ulcer (DFU) in Taiwan, and to assess the concordance between colonizing and clinical MRSA isolates from the patients.

    Method: A total of 354 nasal specimens were collected from 112 to 242 diabetic patients with and without foot ulcer, respectively. MRSA clinical isolates from DFU wound cultures were collected for comparison. Read More

    [Nursing care of a patient admitted to a hyperbaric chamber for a chronic wound].
    Rev Infirm 2018 Jun - Jul;67(242):21-22
    Service de médecine hyperbare et d'expertise plongée, Hôpital d'instruction des armées (HIA) Sainte-Anne, 2, boulevard Sainte-Anne, 83000 Toulon, France.
    The hyperbaric chamber is a particularly relevant therapy for the healing of chronic wounds such as radiation-induced wounds, ulcers, diabetic foot or osteomyelitis. This article describes the pathway of a patient with a chronic wound from the perspective of a hyperbaric medicine nurse. Read More

    Can ultrasound measures of intrinsic foot muscles and plantar soft tissues predict future diabetes-related foot disease? A systematic review.
    PLoS One 2018 15;13(6):e0199055. Epub 2018 Jun 15.
    School of Health Sciences, University of South Australia, Adelaide, South Australia.
    Introduction: Diabetes mellitus (DM) is associated with hyperglycaemia and advanced glycosylation end-products. In the foot, the consequences of chronic or uncontrolled diabetes are micro and macrovascular disease, neuropathy, reduced joint mobility and structural and soft tissue changes that increase the risk of ulcer development and amputation. Diabetes foot assessment currently includes a comprehensive history, neurological and vascular assessments and examination focussed on dermatological and musculoskeletal abnormalities. Read More

    Experimental study of epidermal growth factor and acidic fibroblast growth factor in the treatment of diabetic foot wounds.
    Exp Ther Med 2018 Jun 3;15(6):5365-5370. Epub 2018 May 3.
    Burn Center, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330001, P.R. China.
    The aim of the present study was to investigate the effect of epidermal growth factor (EGF) and acidic fibroblast growth factor (aFGF) on the healing of diabetic foot wounds. A total of 199 patients with diabetic foot ulcers were recruited and randomly divided into four groups: A recombinant human EGF group (n=50), an aFGF group (n=50), a combined EGF and aFGF group (n=50) and a normal saline control group (n=49). Patients in all groups received a daily dressing change and growth factor reagents were applied topically when dressing. Read More

    A novel dressing seeded with embryonic artery CD133 cells and loaded with the Sirt1 agonist SRT1720 accelerates the healing of diabetic ischemic ulcers.
    Exp Ther Med 2018 Jun 25;15(6):5243-5250. Epub 2018 Apr 25.
    Department of Anatomy, Third Military Medical University, Chongqing 400038, P.R. China.
    Refractory ischemic ulcers that occur in patients with diabetes present a major clinical challenge. Embryonic artery cluster of differentiation 133 cells (EACCs) may promote the healing of diabetic ulcers; however, the high glucose environment in the diabetic ulcers decreases the survival rate of transplanted EACCs and inhibit their biological function. Furthermore, microcirculation in diabetic ischemic ulcers is impaired, which inhibits the beneficial effect of EACCs. Read More

    Kinetic studies of complex biomedical process by magnetic resonance: Cuban experiences.
    Appl Magn Reson 2018 26;49(6):589-598. Epub 2018 Mar 26.
    2Center for Genetic Engineering and Biotechnology, Havana, Cuba.
    The potentials of the magnetic resonance (MR) methods in the research of biomedical systems have been demonstrated during the 70 years of its existence. It is presented that the Cuban experience in quantitative magnetic resonance associated with molecular, preclinical and clinical studies of significant diseases and drugs development. MR "in vitro" and "in vivo" studies of sickle cell disease, the diabetic foot ulcer, the brain tumor response and the magnetic nano-particle pharmacokinetics, are presented as example. Read More

    Topical Epidermal Growth Factor Spray for the Treatment of Chronic Diabetic Foot Ulcers: A Phase III Multicenter, Double-Blind, Randomized, Placebo-Controlled Trial.
    Diabetes Res Clin Pract 2018 Jun 11. Epub 2018 Jun 11.
    Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, South Korea. Electronic address:
    Aims: This study was conducted to evaluate the efficacy and safety of a novel spray-applied growth factor therapy containing recombinant human epidermal growth factor (rhEGF) for the treatment of chronic diabetic foot ulcers (DFU).

    Methods: This study was a phase III double-blind, randomized, placebo-controlled trial. 167 adult patients at six medical centers were randomized to receive routine wound care plus either topical spray treatment with 0. Read More

    The association between MCP-1, VEGF polymorphisms and their serum levels in patients with diabetic foot ulcer.
    Medicine (Baltimore) 2018 Jun;97(24):e10959
    The purpose of the present study was to investigate distribution of monocyte chemoattractant protein-1 (MCP-1) -2518A/G and vascular endothelial growth factor (VEGF) -634G/C polymorphisms in type 2 diabetes melitus patients (T2DM) presenting diabetic foot ulcer (DFU). Additionally, we evaluated the effects of these 2 polymorphisms on serum levels of MCP-1 and VEGF in the study population.Patients diagnosed with T2DM without or with DFU were recruited in the study. Read More

    Recurrence of Critical Limb Ischemia After Endovascular Intervention in Patients with Diabetic Foot Ulcers.
    Adv Wound Care (New Rochelle) 2018 Jun;7(6):171-176
    Department of Systems Medicine, University of Tor Vergata, Rome, Italy.
    To establish the rate of clinical recurrence of critical limb ischemia (CLI) in diabetic patients with ischemic foot ulcers (DFUs) treated by percutaneous transluminal angioplasty (PTA). The study group was composed of 304 patients with ischemic DFUs treated by PTA. We evaluated the rate of clinical recurrence of CLI requiring a second PTA (repeated PTA [rePTA]), the factors related to CLI relapse, and the outcomes of rePTA patients. Read More

    Potent laminin-inspired antioxidant regenerative dressing accelerates wound healing in diabetes.
    Proc Natl Acad Sci U S A 2018 Jun 11. Epub 2018 Jun 11.
    Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208;
    The successful treatment of chronic dermal wounds, such as diabetic foot ulcers (DFU), depends on the development of safe, effective, and affordable regenerative tools that the surgeon can rely on to promote wound closure. Although promising, strategies that involve cell-based therapies and the local release of exogenous growth factors are costly, require very long development times, and result in modest improvements in patient outcome. We describe the development of an antioxidant shape-conforming regenerative wound dressing that uses the laminin-derived dodecapeptide A5G81 as a potent tethered cell adhesion-, proliferation-, and haptokinesis-inducing ligand to locally promote wound closure. Read More

    Effect of different casting design characteristics on offloading the diabetic foot.
    Gait Posture 2018 May 22;64:90-94. Epub 2018 May 22.
    Diabetic Foot Unit, Department of Surgery, Hospital Group Twente, Almelo, The Netherlands; Department of Rehabilitation, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
    Background: Non-removable knee-high devices, such as a total contact cast (TCC), are recommended for offloading diabetic plantar forefoot ulcers. However, it is insufficiently known how each of the different design characteristics of these devices contribute to offloading the diabetic foot.

    Research Question: What is the offloading effect of the different design characteristics that make up a non-removable knee-high cast for people with diabetes and active or previous plantar forefoot ulcers?

    Methods: Sixteen persons with diabetes, peripheral neuropathy and a healed or active plantar forefoot ulcer had their plantar pressures measured during walking in a non-removable knee-high device (TCC), in that device made removable (BTCC), in that device made below-ankle (cast shoe), in that cast shoe worn with a different walking sole and in a newly made cast shoe without a custom-moulded foot-device interface. Read More

    The Changes of Trends in the Diagnosis and Treatment of Diabetic Foot Ulcer over a 10-Year Period: Single Center Study.
    Diabetes Metab J 2018 04 27. Epub 2018 Apr 27.
    Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
    Background: This study aims to describe the trends in the severity and treatment modality of patients with diabetic foot ulcer (DFU) at a single tertiary referral center in Korea over the last 10 years and compare the outcomes before and after the introduction of a multidisciplinary diabetic foot team.

    Methods: In this retrospective observational study, electronic medical records of patients from years 2002 to 2015 at single tertiary referral center were reviewed. Based on the year of first admission, patients were assigned to a group either before or after the year 2012, the year the diabetes team launched. Read More

    Effects of Low-Power Light Therapy on the Tissue Repair Process of Chronic Wounds in Diabetic Feet.
    Photomed Laser Surg 2018 Jun;36(6):298-304
    6 Department of Health Sciences, Universidade do Vale do Paraíba , UNIVAP, São Paulo, Brazil .
    Objective: To analyze the efficacy of the therapeutic use of Low-Level Laser Therapy (LLLT) on the tissue repair process of chronic wounds in patients with diabetic feet through the analysis of Pressure Ulcer Scale for Healing (PUSH) scales, pain and the measurement done using the ImageJ software.

    Methods: This clinical trial was carried out with 18 patients 30-59 years of age, who had chronic wounds on their foot due to complications of diabetes mellitus. The patients were randomly allocated in two different groups of equal numbers: Control and Laser Groups. Read More

    Quality assessment of diabetic foot ulcer clinical practice guidelines.
    J Evid Based Med 2018 Jun 7. Epub 2018 Jun 7.
    School of Public Health, Kerman University of Medical Sciences, Kerman, Iran.
    Objective: Nurses play an effective role in diabetic foot care and they should know the best evidence. In this way, implementations according evidence-based clinical practice guidelines have positive effects on nurses' practice and patient outcomes. The objective of this study was quality assessment of diabetic foot ulcer clinical practice guidelines. Read More

    Electromagnetic simulation of non-invasive approach for the diagnosis of diabetic foot ulcers.
    J Orthop 2018 Jun 31;15(2):514-521. Epub 2018 Mar 31.
    Department of Electrical and Computer Engineering, IUPUI, Indianapolis, IN, United States.
    Diabetic foot ulcers are systemic diseases that affect all blood vessels within the human body. From major blood vessels to microvasculature, hardening, thickening, and narrowing of blood vessels ultimately results to diminished blood flow to end organs. The detrimental effects of peripheral vascular disease are well recognized across medicine, particularly with regards to diabetic foot ulcers. Read More

    A systematic review and meta-analysis of patient education in preventing and reducing the incidence or recurrence of adult diabetes foot ulcers (DFU).
    Heliyon 2018 May 2;4(5):e00614. Epub 2018 May 2.
    The University of Nottingham, School of Health Sciences, B Floor, South Block Link, Queen's Medical Centre, Nottingham, NG7 2HA, UK.
    Background: The World Health Organization (WHO) states that diabetic foot ulcers (DFU) are associated with disability, death among patients with diabetes and substantial costs, if not prevented or managed effectively. The aim here is to examine the effectiveness of patient education in preventing and reducing the incidence or recurrence of adult DFU and amputation.

    Methods: A systematic review and meta-analysis of randomised clinical trials (RCTs) in adults aged 18+ who have diabetes mellitus (type 1 or type 2) or DFU. Read More

    Osteopontin levels in plasma, muscles, and bone in patient with non-healing diabetic foot ulcers: A new player in wound healing process?
    J Diabetes Complications 2018 May 17. Epub 2018 May 17.
    Department of Endocrinology, Wolfson Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. Electronic address:
    Background: The present study was designed to investigate the impact of osteopontin (OPN) in different tissue (e.g., plasma, muscles and bone) on amputation rate (in-hospital and during one year follow-up) for non-healing diabetic foot ulcers (DFUs). Read More

    Diabetic foot ulcer outcomes from a podiatry led tertiary service in Kuwait.
    Diabet Foot Ankle 2018 28;9(1):1471927. Epub 2018 May 28.
    Clinical Research Unit, Medical Division, Dasman Diabetes Institute, Dasman, Kuwait.
    : This single-centred study aims to evaluate the incidence, risk factors and treatment outcomes of a podiatry led, evidence-based diabetic foot ulcer (DFU) clinic. : Data from the DFU database and patient electronic health records were retrospectively collected from patients with new DFUs who were referred for treatment to the Department of Podiatry, Dasman Diabetes Institute, Kuwait, from 1 October 2014, to 31 December 2016. Patients were followed-up until healing occurred or until 6 months after the study end date, whichever came first. Read More

    Role of anaerobes in polymicrobial communities and biofilms complicating diabetic foot ulcers.
    Int Wound J 2018 Jun 4. Epub 2018 Jun 4.
    Institute for Wound Research, Department Obstetrics & Gynaecology, University of Florida, Gainesville, Florida.
    Infected tissues in the feet of people with diabetes in the form of a diabetic foot ulcer (DFU) present a complex pathology for clinicians to manage. This is partly attributed to the multi-factorial nature of the disease, which may include; altered foot architecture leading to excessive plantar pressures and frictional forces peripheral arterial disease and loss of protective sensation. In addition, to the above co-morbid variables, it is understood that a delayed wound healing state may be perpetuated by the presence of microorganisms residing in the wound tissue. Read More

    Peak pressure data and pressure-time integral in the contralateral limb in patients with diabetes and a trans-tibial prosthesis.
    Gait Posture 2018 May 19;64:55-58. Epub 2018 May 19.
    Faculty of Health Sciences, University of Malta, Malta. Electronic address:
    Background: Clinicians currently rely on observational clinical data pertaining to the biomechanics of the diabetic foot. However, advances in technology can objectively describe this. A thorough understanding of the functional and mechanical consequences following trans-tibial amputations is lacking. Read More

    Reliability of a novel thermal imaging system for temperature assessment of healthy feet.
    J Foot Ankle Res 2018 30;11:22. Epub 2018 May 30.
    1Diabetic Foot Clinic, King's College Hospital NHS Foundation Trust, Denmark Hill, London, SE5 9RS UK.
    Background: Thermal imaging is a useful modality for identifying preulcerative lesions ("hot spots") in diabetic foot patients. Despite its recognised potential, at present, there is no readily available instrument for routine podiatric assessment of patients at risk. To address this need, a novel thermal imaging system was recently developed. Read More

    Potential of silk sericin based nanofibrous mats for wound dressing applications.
    Mater Sci Eng C Mater Biol Appl 2018 Sep 27;90:420-432. Epub 2018 Apr 27.
    Biomaterial and Tissue Engineering Laboratory, Department of Biosciences and Bioengineering, Indian Institute of Technology Guwahati, Guwahati 781039, Assam, India. Electronic address:
    Wound dressing developed using bioactive materials has been a current area of research for treating chronic non-healing wounds owing to its high demand. Here, we report the fabrication and evaluation of nanofibrous matrix based wound dressings using biopolymer poly(vinyl alcohol) (PVA) incorporated with silk sericin (SS). SS extracted from the cocoons of mulberry variety Bombyx mori and non-mulberry variety Antheraea assama has been used to develop two types of blended mats. Read More

    The Predictive Factors Associated With Comorbidities for Treatment Response in Outpatients With King Classification III Diabetes Foot Ulcers.
    Ann Plast Surg 2018 May 30. Epub 2018 May 30.
    Graduate Institute of Nursing, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan.
    Objective: The aim of this study is to investigate the preexisting predictive factors associated with comorbidities for diabetic foot ulcer (DFU) in King classification III at an outpatient clinic.

    Method: This prospective study included 100 patients with DFU in King classification III treated at outpatient clinics in Chiayi Chang Gung Memorial Hospital from January 2011 to December 2011. The least follow-up time was 1 year. Read More

    Human myiasis in patients with diabetic foot: 18 cases.
    Ann Saudi Med 2018 May-Jun;38(3):208-213
    Serhat Uysal, Infectious Diseases and Clinical Microbiology,, Ministry of Health, Republic of Turkey,, Seyfi Demirsoy State Hospital,, Infectious Diseases and Clinical Microbiology Service,, Diabetic Foot Clinic, Buca, Izmir, 35390, Turkey, T: 902-32425252, ORCID: http://orcid.org/0000-0002-4294.5999.
    Background: Myiasis complication of diabetic foot ulcer has only been presented in a few case reports. Therefore, there is a need for additional data on this infestation.

    Objective: Evaluate clinical characteristics of human myiasis in patients with diabetic foot. Read More

    A randomized controlled trial comparing helium-neon laser therapy and infrared laser therapy in patients with diabetic foot ulcer.
    Lasers Med Sci 2018 May 30. Epub 2018 May 30.
    Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia.
    This study aimed to compare the effects of (HNLT) and (ILT) on diabetic foot ulcer. Sixty-five patients with diabetic foot ulcer (51 males and 14 females) aged 50-60 years. The participants were classified randomly to two groups, groups I and II. Read More

    Staphylococcus aureus requires less virulence to establish an infection in diabetic hosts.
    Int J Med Microbiol 2018 May 22. Epub 2018 May 22.
    Institute of Medical Microbiology, Jena University Hospital, Jena, Germany.
    Staphylococcus aureus is the most frequent pathogen causing diabetic foot infections. Here, we investigated the degree of bacterial virulence required to establish invasive tissue infections in diabetic organisms. Staphylococcal isolates from diabetic and non-diabetic foot ulcers were tested for their virulence in in vitro functional assays of host cell invasion and cytotoxicity. Read More

    Clinical Applications and Validation of an Innovative Wound Score.
    Wounds 2018 Mar 21. Epub 2018 Mar 21.
    VA Long Beach Healthcare System, Long Beach, CA.
    Objective: This study demonstrates the applicability of an innovative wound score that summates 5 assessments using 2-point (best) to 0-point (worst) grades based on specific findings to generate a 0- to 10-point wound score for categorizing diabetic foot ulcers as well as validates its effectiveness.

    Materials And Methods: Long Beach Wound Scores (LBWS) were determined prospectively over an 18-month period in 105 hospitalized patients, with or without diabetes, with lower extremity wounds. Wounds were categorized as healthy, problem, or end-stage from their initial LBWS. Read More

    Diabetic foot infection: A critical complication.
    Int Wound J 2018 May 28. Epub 2018 May 28.
    Division of Pharmacy and Optometry, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
    The number of people in the world with diabetes has nearly quadrupled in the past 40 years. Current data show that 25% of these diabetics will develop a foot ulcer in their lifetime and that the cost of care for a diabetic foot ulcer (DFU) is over twice that of any other chronic ulcer aetiology. Microbial biofilm has been linked to both wound chronicity and infection. Read More

    Characteristics, prevalence, and outcomes of diabetic foot ulcers in Africa. A systemic review and meta-analysis.
    Diabetes Res Clin Pract 2018 May 26;142:63-73. Epub 2018 May 26.
    Department of Medicine, University of Padova, Padova, Italy. Electronic address:
    Background: Among non-communicable diseases, diabetes represents a growing public health problem in Africa, where diabetes-related needs remain mostly unmet and the disabling features of foot are worsened by hygienic, cultural, and healthcare issues. We aimed to review clinical characteristics, prevalence, and outcomes of patients with diabetic foot ulcer in Africa.

    Methods: We searched the literature for cross-sectional and longitudinal studies reporting the characteristics of patients with diabetic foot in African countries, with a particular focus on ulcer prevalence, amputation rate, and mortality. Read More

    [Research progress of dipeptidyl peptidase 4 inhibitors on healing of chronic diabetic foot ulcers].
    Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi 2018 May;32(5):630-633
    Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
    Objective: To review the effect of dipeptidyl peptidase 4 (DPP-4) inhibitors on the wound healing and its mechanisms in chronic diabetic foot ulcers.

    Methods: The latest literature concerning DPP-4 inhibitors for chronic diabetic foot ulcers was extensively reviewed, as well as the potential benefit and mechanism of DPP-4 inhibitors on wound healing of diabetic foot ulcers was analyzed thoroughly.

    Results: DPP-4 inhibitors can accelerated the ulcer healing. Read More

    Hesperidin, a plant flavonoid accelerated the cutaneous wound healing in streptozotocin-induced diabetic rats: Role of TGF-ß/Smads and Ang-1/Tie-2 signaling pathways.
    EXCLI J 2018 4;17:399-419. Epub 2018 May 4.
    Department of Pharmacology, Poona College of Pharmacy, Bharati Vidyapeeth Deemed University, Erandwane, Paud Road, Pune-411 038, India.
    Delayed wound healing is a diverse, multifactorial, complex and inter-related complication of diabetes resulting in significant clinical morbidity. Hesperidin possesses potent antidiabetic and wound healing activity. To evaluate the potential of hesperidin against experimentally induced diabetes foot ulcers. Read More

    Impact of General and Oral Complications of Diabetes Mellitus Type I on Lebanese Children's Quality of Life.
    Int J Clin Pediatr Dent 2018 Jan-Feb;11(1):40-45. Epub 2017 Feb 1.
    Assistant Professor, Department of Life Science, Lebanese University, Beirut Lebanon.
    Introduction: Diabetes mellitus type I (DM1) has been increasing at an alarming rate worldwide. Children suffering from this chronic disease are subject to a high risk of systemic and oral complications, due to their young age and the lack of awareness of the relation between diabetes and oral health.

    Objective: The aim of this study is to evaluate the impact of oral and general complications of DM1 on the Lebanese children's quality of life. Read More

    An Innovative Application of the Free Vascularized Medial Femoral Condyle Flap in the Prevention of Recurring Neuropathic Ulcer in the Diabetic Foot: A Case Report.
    J Foot Ankle Surg 2018 May 24. Epub 2018 May 24.
    Professor, Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
    Despite various therapy options, the prophylactic and symptomatic treatment of recurrent ulcerations in the diabetic foot are still challenging. We report the application of a free vascularized medial femoral condyle flap to prevent the recurrence of pressure ulcer in a patient with diabetic foot syndrome. Our patient had type 2 diabetes and presented with pressure ulcers and osteomyelitis of metatarsal heads 2 and 3 after a great toe amputation. Read More

    [A MODEL TO SOLVE BARRIERS IN TREATING COMPLEX MEDICAL PATIENTS - 'DIABETIC FOOT' AS A CASE STUDY].
    Harefuah 2018 May;157(5):296-300
    Assaf Harofeh Medical Center.
    Aims: To identify barriers for diabetic foot detection within the medical team, to plan and conduct interventions to solve these barriers and to follow-up their outcomes, resulting in creating a model to cope with barriers in the treatment of complicated patients.

    Background: Diabetes mellitus is a rising epidemic worldwide, with a significant medical and economic impact (about 20% of the annual health expenditure). A major complication of diabetes is 'diabetic foot', including neuropathy and peripheral vascular disease, resulting in leg ulcers and amputation. Read More

    The Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification system predicts wound healing better than direct angiosome perfusion in diabetic foot wounds.
    J Vasc Surg 2018 May 23. Epub 2018 May 23.
    Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, The Johns Hopkins Hospital, Baltimore, Md; Diabetic Foot and Wound Service, The Johns Hopkins Hospital, Baltimore, Md. Electronic address:
    Objective: Previous studies show conflicting results in wound healing outcomes based on angiosome direct perfusion (DP), but few have adjusted for wound characteristics in their analyses. We have previously shown that the Society for Vascular Surgery Wound, Ischemia, and foot Infection (WIfI) classification correlates with wound healing in diabetic foot ulcers (DFUs) treated by a multidisciplinary team. The aim of this study was to compare WIfI classification vs DP and pedal arch patency as predictors of wound healing in patients presenting with DFU and peripheral arterial disease. Read More

    Short-term predictors of amputation in patients with diabetic foot ulcers.
    Diabetes Metab Syndr 2018 May 17. Epub 2018 May 17.
    Division of Endocrinology, Diabetes and Metabolism, Centro Hospitalar do Porto, Portugal.
    Background: Diabetic foot ulcers are the leading cause of non-traumatic lower extremity amputation. The aim of this study was to establish short-term predictors of lower extremity amputation (LEA) in patients with diabetic foot ulcers (DFU).

    Methods: A retrospective observational study was performed. Read More

    Polymicrobial interactions influence the agr copy number in Staphylococcus aureus isolates from diabetic foot ulcers.
    Antonie Van Leeuwenhoek 2018 May 23. Epub 2018 May 23.
    Interdisciplinary Centre of Research in Animal Health (CIISA)/Faculty of Veterinary Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477, Lisbon, Portugal.
    Diabetic foot ulcers are a major complication of diabetes and are often colonised by complex bacterial communities, where Staphylococcus aureus is frequently co-present with Pseudomonas aeruginosa. These bacteria interact through quorum sensing, encoded in S. aureus by the accessory gene regulator (agr). Read More

    Mistaken Diabetic Ulcers: A Case of Bilateral Foot Verrucous Carcinoma.
    Case Rep Dermatol Med 2018 23;2018:4192657. Epub 2018 Jan 23.
    Department of Obstetrics and Gynecology, University of Calgary, Calgary, AB, Canada.
    Verrucous carcinoma (VC) is a rare, low-grade, and well-differentiated variant of squamous cell carcinoma. These tumors are slow-growing and exophytic and have a negligible incidence of metastasis. Treatment is complete surgical resection, ideally by Mohs micrographic surgery, to ensure adequate clear margins. Read More

    Increasing SBP variability is associated with an increased risk of developing incident diabetic foot ulcers.
    J Hypertens 2018 May 22. Epub 2018 May 22.
    Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia.
    Objective: SBP variability may be a target for mitigating end-organ damage associated with vascular disease. We evaluated the relationship between increased SBP variability and risk of incident diabetic foot ulceration.

    Methods: Using a nested case-control design, we followed patients diagnosed with diabetes and treated within the US Department of Veterans Affairs Healthcare system for development of a diabetic foot ulcer (event) between 2006 and 2010. Read More

    Efficacy of cord blood platelet gel application for enhancing diabetic foot ulcer healing after lower limb revascularization.
    Semin Vasc Surg 2017 Dec 7;30(4):106-112. Epub 2017 Dec 7.
    Unit of Vascular and Endovascular Surgery, SS Annunziata Hospital, Via Leonida 49, Taranto, Italy. Electronic address:
    The efficacy of umbilical cord blood platelet gel (CBPG) application on healing foot ulcers was analyzed in 10 diabetic patients treated for critical lower limb ischemia by surgical or endovascular arterial revascularization. During a 9-month period, 20 diabetic patients affected by critical lower limb ischemia with tissue loss were enrolled in this nonblinded, consecutive series, randomized clinical trial. After clinical evaluation, patients underwent endovascular or surgical revascularization of the affected limb, followed by minor amputations or surgical debridement of ischemic lesions. Read More

    Presence of chronic diabetic foot ulcers is associated with more frequent and more advanced retinopathy.
    Diabet Med 2018 May 23. Epub 2018 May 23.
    Clinical Sciences in Lund, Lund University.
    Aims: To clarify the frequency and severity of diabetic retinopathy in a group of people with Type 2 diabetes and chronic diabetic foot ulcers, and to compare visual acuity, levels of retinopathy and clinical significant macular oedema with a matched control group of people with Type 2 diabetes without a history of chronic diabetic foot ulcers.

    Methods: Visual acuity and fundus imaging were evaluated in 90 white people with at least 3 months' duration of full-thickness diabetic foot ulcers below the ankle and the results compared with those in 180 white people with Type 2 diabetes without a history of chronic diabetic foot ulcers (control group). Controls were matched for age, sex and duration of diabetes. Read More

    Understanding the microbiome of diabetic foot osteomyelitis: insights from molecular and microscopic approaches.
    Clin Microbiol Infect 2018 May 19. Epub 2018 May 19.
    Infectious Diseases and Microbiology, School of Medicine, Western Sydney University, Australia; Liverpool Hospital, South Western Sydney LHD, Sydney, Australia; Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Medical Research, Sydney, Australia. Electronic address:
    Objectives: Rigorous visual evidence on whether or not biofilms are involved in diabetic foot osteomyelitis (DFO) is lacking. We employed a suite of molecular and microscopic approaches to investigate the microbiome, and phenotypic state of microorganisms involved in DFO.

    Methods: In 20 consecutive subjects with suspected DFO, we collected intraoperative bone specimens. Read More

    A randomized controlled trial of the safety and efficacy of a topical gentamicin-collagen sponge in diabetic patients with a mild foot ulcer infection.
    SAGE Open Med 2018 13;6:2050312118773950. Epub 2018 May 13.
    Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
    Objectives: The initial phase of infection of a foot ulcer in a person with diabetes is often categorized as mild. Clinicians usually treat these infections with antimicrobial therapy, often applied topically. Some experts, however, believe that mild diabetic foot ulcer infections will usually heal with local wound care alone, without antimicrobial therapy or dressings. Read More

    Comparison of Pedal Soft Tissue Thickness Between Those With and Without Diabetes.
    J Foot Ankle Surg 2018 May 18. Epub 2018 May 18.
    Full Professor, Department of Rehabilitation Medicine, Keimyung University School of Medicine & Institute for Medical Science, Daegu, Republic of Korea.
    Ulceration is a serious consequence of diabetes that can lead to disability in patients with diabetes. One of the risk factors for ulceration is high foot pressure. The thickness of the pedal soft tissue is important because it has a cushioning effect. Read More

    Acellular Flowable Matrix in the Treatment of Tunneled or Cavity Ulcers in Diabetic Feet: A Preliminary Report.
    Adv Skin Wound Care 2018 Jun;31(6):270-275
    In the Operative Unit of General and Geriatric Surgery, Department of Medical, Surgical, Neurologic, Metabolic and Ageing Sciences, University of Campania, Naples, Italy, Ferdinando Campitiello, MD, is a physician; Manfredi Mancone, PhD, MD, is a physician; Angela Della Corte, PhD, MD, is a physician; Raffaella Guerniero, MD, is a physician; and Silvestro Canonico, MD, is Unit Chief and Professor of Surgery.
    Objective: The authors aimed to explore the feasibility and safety of an advanced, acellular, flowable wound matrix (FWM) in patients with diabetes-related cavity or tunnel lesions involving deep structures.

    Methods: Patients with diabetic foot ulcers were hospitalized at the General and Geriatric Surgery Unit of the University of Campania in Naples, Italy, between March 2015 and December 2015. Twenty-three patients with tunneled or cavity ulcers were treated. Read More

    Intervention planning for the REDUCE maintenance intervention: a digital intervention to reduce reulceration risk among patients with a history of diabetic foot ulcers.
    BMJ Open 2018 May 18;8(5):e019865. Epub 2018 May 18.
    Centre for Clinical and Community Applications of Health Psychology, University of Southampton, Southampton, UK.
    Objectives: To develop a comprehensive intervention plan for the REDUCE maintenance intervention to support people who have had diabetic foot ulcers (DFUs) to sustain behaviours that reduce reulceration risk.

    Methods: Theory-based, evidence-based and person-based approaches to intervention development were used. In phase I of intervention planning, evidence was collated from a scoping review of the literature and qualitative interviews with patients who have had DFUs (n=20). Read More

    Perioperative and long-term all-cause mortality in patients with diabetes who underwent a lower extremity amputation.
    Diabetes Res Clin Pract 2018 May 17;141:175-180. Epub 2018 May 17.
    Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
    Introduction: Long-term mortality of patients with diabetes who undergo lower extremity amputation (LEA) has not been reported in Spain.

    Methods: The retrospective cohort included all subjects who underwent LEAs from January 1, 2005 to December 31, 2015 in San Jorge Hospital, Huesca, Spain. Live status of every patient up to September 2017 and the date of death were retrieved using the national death index. Read More

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