With the increasing number of diabetic patients, the incidence of diabetic foot is also significantly increased. Diabetic foot leads a high rate of disability and huge medical expences, which attracts more and more attention. The treatment of diabetic foot is based on the adjustment of the whole body condition, especially the treatment of the wound. At present, there are many external therapies for diabetic foot, which provide individualized treatment.

BACKGROUND: Studies have shown that mesenchymal stem cells can participate in the repair of wound injury caused by diabetes, but the high glucose environment obviously inhibits the function of mesenchymal stem cells and the effect of transplantation. OBJECTIVE: To observe the effect of conditioned medium of bone marrow mesenchymal stem cells intervened by rosiglitazone on the proliferation and migration of endothelial progenitor cells in high glucose environment. METHODS: (1) The bone marrow mesenchymal stem cells from the logarithmic growth period were cultured in three groups. The normal group was cultured with alpha-MEM medium containing 10% fetal bovine serum. The high glucose group was cultured with alpha-MEM medium containing 10% fetal bovine serum and 25 mmol/L glucose. The rosiglitazone group was cultured with alpha-MEM medium containing 10% fetal bovine serum, 25 mmol/L glucose and 10 μmol/L rosiglitazone. After 48 hours of culture, the culture supernatant was extracted as conditioned medium. The levels of vascular endothelial growth factor and matrix cell derived factor 1 in conditioned medium were detected by ELISA. (2) The endothelial progenitor cells from the logarithmic growth period were divided into three groups. The control group was cultured with the EGM-2 MV medium containing 10% fetal bovine serum. The model group was cultured with the EGM-2 MV medium containing 10% fetal bovine serum, 30 mmol/L glucose and conditioned medium of the high glucose group. The experimental group was cultured with EGM-2 MV medium containing 10% fetal bovine serum, 30 mmol/L glucose and conditioned medium of the rosiglitazone group. After 24 hours of culture, the ability of cell proliferation and migration was detected. RESULTS AND CONCLUSION: (1) The levels of vascular endothelial growth factor and matrix cell derived factor 1 in the conditioned medium of high glucose group were significantly lower than that of the normal group (P < 0.05). The levels of vascular endothelial growth factor and matrix cell derived factor 1 in the conditioned medium of the rosiglitazone group were significantly higher than in the high glucose group (P < 0.05). (2) The proliferation and migration ability of endothelial progenitor cells in the model group was lower than that in the control group (P < 0.05). The proliferation and migration ability of endothelial progenitor cells in the experimental group was higher than that in the model group (P < 0.05). (3) It is suggested that the conditioned medium of rosiglitazone intervened bone marrow mesenchymal stem cells can promote the proliferation and migration of endothelial progenitor cells.

Objective:To observe the therapeutic effect of medical maggot on diabetic foot, and analyze its possible mechanism.Methods:Sixty diabetic foot ulcer patients with Wagner grade 1 or 2 from July 2018 to September 2019 in Second Affiliated Hospital of Dalian Medical University were selected. The patients were divided into control group and experimental group by random digits table methods with 30 cases in each group. The control group was treated with traditional method, and the experimental group was treated with medical maggots. In experimental group, the wound surface Notch 1 mRNA expression before treatment and at the 4th day of treatment was detected by polymerase chain reaction method. The recovery rate 21 d after treatment was compared between 2 groups.Results:The recovery rate in experimental group was significantly higher than that in control group: 100.00% (30/30) vs. 76.67% (23/30), and there was statistical difference ( χ2 = 7.925, P<0.01). In experimental group, there was no statistical difference in the wound surface Notch 1 mRNA expression between before treatment and the 4th day of treatment (0.96 ± 0.08 vs. 0.93 ± 0.08; t = 1.545, P>0.05). Conclusions:Medical maggot has an obvious effect on Wagner grade 1 or 2 diabetic foot ulcers, but its mechanism maybe unrelated to Notch1 signaling pathway.

Objective:To explore the application value of flexible endoscopy and rigid endoscopy in the clinical examination of chronic sinus tract wounds with different shapes.Methods:A retrospective observational study was conducted. From January 1 to December 23, 2019, a total of 46 patients with chronic sinus tract wounds, who met the inclusion criteria were admitted to the Wound Healing Center of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, including 23 males and 23 females, aged 18-81 (48±21) years. On admission, computer tomography (CT) imaging and three-dimensional reconstruction were performed to examine the shapes of wound sinus tract and classify the wounds, with the lengths of wound sinus tract by CT imaging examination (hereinafter referred to as reference lengths) recorded. The lengths of wound sinus tract were examined and measured by rigid endoscopy and flexible endoscopy. The wounds with and without obviously curved sinus tract were classified into curve group and linear group respectively, and the deviation rates between the lengths of wound sinus tract measured by flexible endoscopy or rigid endoscopy and the reference lengths (hereinafter referred to as deviation rates of lengths) in each group were calculated. The difference between the deviation rates of lengths examined by flexible endoscopy and rigid endoscopy and the differences between the above two and the deviation rate of reference lengths (0) in each group were compared. Data were statistically analyzed with paired sample t test and Wilcoxon signed rank sum test. Results:CT imaging and three-dimensional reconstruction showed that there were 4 types of wound sinus tract, including tubular (36/46), lamellar (4/46), club-mallet (4/46), and irregular (2/46) shape. Tubular wounds were further divided into type I (23/36), type L (4/36), and type Y (9/36). Wounds with type I tubular, lamellar, and club-mallet sinus tract were classified into linear group (31/46), while those with type Y tubular, type L tubular, and irregular sinus tract were classified into curve group (15/46). In linear group, the deviation rates of lengths examined and measured by rigid endoscopy and flexible endoscopy were 0. In curve group, the deviation rate of lengths examined and measured by flexible endoscopy was 0 (0, 0.58%), which was significantly lower than 41.18% (31.68%, 48.41%) examined and measured by rigid endoscopy, Z=-3.408, P<0.01; the deviation rate of lengths examined and measured by rigid endoscopy (40±19)% was significantly higher than the deviation rate of reference lengths ( t=8.343, P<0.01), while the deviation rate of the lengths examined and measured by flexible endoscopy was similar to the deviation rate of reference lengths ( Z=-1.342, P>0.05). Conclusions:Compared with rigid endoscopy, flexible endoscopy can observe the internal characteristics of chronic sinus tract wounds in a wider range in the clinical examination of this kind of wound, especially for the exploration of curved chronic sinus tract wounds. The promotion of this method will be conducive to the diagnosis and treatment of chronic sinus tract wounds.

Objective: To explore the advantages of endoscopy combined with contrast fistulography in the clinical diagnosis and treatment of chronic wound with sinus tract adjacent to body cavity. Methods: Thirty-two patients (14 males and 18 females, aged 17 to 87 years) of chronic wounds with sinus tracts adjacent to body cavity, who underwent endoscopy combined with contrast fistulography (CT or magnetic resonance imaging) for the diagnosis and treatment in the Outpatient Department of Wound Healing Center of our hospital from October 2017 to March 2019, were enrolled in the study. Their diagnosis and treatment results were retrospectively analyzed. The following data were calculated. (1) The incidence rates of sinus wound involving body cavity or fistula. (2) The detection rates of sinus wound involving body cavity detected by routine examination and by endoscopy combined with contrast fistulography. (3) The detection rate of pathological features at deep part of wound by routine examination and by endoscopy combined with contrast fistulography. (4) The proportion of patients who benefited from routine examination and from endoscopy combined with contrast fistulography. Data were processed with paired chi-square test and Fisher′s exact probability test. Results: (1) The incidence rate of sinus wound involving body cavity was 43.75% (14/32); the incidence rate of fistula was 0. (2) The detection rate of sinus wound involving body cavity detected by endoscopy combined with contrast fistulography was 43.75% (14/32), which was obviously higher than that by routine examination [12.50% (4/32), χ²=32.0, P<0.01]. (3) The detection rate of pathological features at deep part of wound by endoscopy combined with contrast fistulography was 37.50% (12/32), which was obviously higher than that by routine examination (0, P<0.01). (4) The proportion of patients who benefited from endoscopy combined with contrast fistulography was 71.43% (20/28), which was obviously higher than that from routine examination [12.50% (4/32), χ²=21.6, P<0.01]. Conclusions Compared with routine examination, endoscopy combined with contrast fistulography is more accurate in detecting chronic wound with sinus tract adjacent to body cavity. The diagnosis and treatment of chronic wound with sinus tract adjacent to the body cavity can benefit from this joint examination.