Objective To investigate clinical efficacy of lateral tibia bone removal micro vessel regeneration combined with hyperbaric oxygen (HBO) in the treatment of diabetic foot ulcer.Methods A retrospective analysis was made on the clinical practice of lateral tibia bone removal micro vessel regeneration combined with HBO in 21 patients (the treatment group)with diabetic foot ulcer who received treatment in the hospital from November 2015 to March 2017.The patients in the treatment group were compared with the 21 patients (the control group) with diabetic foot ulcer who were treated with HBO at the same period.For the patients in the treatment group,a bone window with an area of about 2 cm × 10 cm was performed at medial surface of the affected lateral tibia,and a special external fixation lateral traction frame was placed and debridement was performed on the affected foot at the same time.On the first day after surgery,the patients received HBO therapy with a pressure of 0.20 MPa,once a day,10 days a treatment course,with a total of 3 courses.On the fifty day after surgery,the bone window was slowly removed laterally (1 mm/day).For the patients in the control group,debridement of the affected foot was performed,and on the first day after surgery,HBO therapy was also implemented in the control group with the same treatment scheme as the treatment group.Before surgery and 3 months after surgery,corresponding dada of healing time,ankle brachial index (ABI) and Michigan neuropathy sensation instruments (MNSI) were closely observed in the patients of the 2 groups.Results The patients of the two groups all had medical followed-ups for an average of 9.3 months.In the control group,the wound of one patient with Wagner Ⅴ failed to heal and in the end had amputation,but the wound of the remaining patients all healed,with an average healing time of (39.52 ± 8.43) days.The wound of the treatment group all healed,with an average healing time of (31.74 ± 6.12) days.Three months after surgery,the ABI level of the treatment group increased from pre-surgical level 0.56 ± 0.18 to post-surgical level 0.94 ± O.16,and the MNSI level decreased from pre-surgical level 5.92 ± 1.13 to post-surgical level 4.11 ± 1.25.Three months after surgery,the ABI level of the control group increased from pre-surgical level 0.54 ±0.21 to post-surgical level 0.81 ±0.20,and the MNSI level decreased from pre-surgical level 5.74 ± 1.26 to post-surgical level 4.98 ± 1.34.Statistical significance could be noted in wound healing time when comparisons were made between the two groups.Three months after surgery,statistical significance could also be found in ABI and MNSI levels as compared with those detected before surgery.The treatment group was superior to the control group,also with statistical significance.Conclusions Lateral tibia bone removal micro vessel regeneration could be used to reconstruct vasoganglion below lower leg and promote surrounding vessel and nerve function recovery.Combined with HBO therapy,it could promote wound surface healing,with the advantages of simple surgery,accurate curative effect,high success rate of limb-salvage.For this reason,it was one of the ideal methods for the treatment of diabetic foot ulcer.

Objective To investigate clinical efficacy of lateral tibia bone removal micro vessel regeneration combined with hyperbaric oxygen (HBO) in the treatment of diabetic foot ulcer.Methods A retrospective analysis was made on the clinical practice of lateral tibia bone removal micro vessel regeneration combined with HBO in 21 patients (the treatment group)with diabetic foot ulcer who received treatment in the hospital from November 2015 to March 2017.The patients in the treatment group were compared with the 21 patients (the control group) with diabetic foot ulcer who were treated with HBO at the same period.For the patients in the treatment group,a bone window with an area of about 2 cm × 10 cm was performed at medial surface of the affected lateral tibia,and a special external fixation lateral traction frame was placed and debridement was performed on the affected foot at the same time.On the first day after surgery,the patients received HBO therapy with a pressure of 0.20 MPa,once a day,10 days a treatment course,with a total of 3 courses.On the fifty day after surgery,the bone window was slowly removed laterally (1 mm/day).For the patients in the control group,debridement of the affected foot was performed,and on the first day after surgery,HBO therapy was also implemented in the control group with the same treatment scheme as the treatment group.Before surgery and 3 months after surgery,corresponding dada of healing time,ankle brachial index (ABI) and Michigan neuropathy sensation instruments (MNSI) were closely observed in the patients of the 2 groups.Results The patients of the two groups all had medical followed-ups for an average of 9.3 months.In the control group,the wound of one patient with Wagner Ⅴ failed to heal and in the end had amputation,but the wound of the remaining patients all healed,with an average healing time of (39.52 ± 8.43) days.The wound of the treatment group all healed,with an average healing time of (31.74 ± 6.12) days.Three months after surgery,the ABI level of the treatment group increased from pre-surgical level 0.56 ± 0.18 to post-surgical level 0.94 ± O.16,and the MNSI level decreased from pre-surgical level 5.92 ± 1.13 to post-surgical level 4.11 ± 1.25.Three months after surgery,the ABI level of the control group increased from pre-surgical level 0.54 ±0.21 to post-surgical level 0.81 ±0.20,and the MNSI level decreased from pre-surgical level 5.74 ± 1.26 to post-surgical level 4.98 ± 1.34.Statistical significance could be noted in wound healing time when comparisons were made between the two groups.Three months after surgery,statistical significance could also be found in ABI and MNSI levels as compared with those detected before surgery.The treatment group was superior to the control group,also with statistical significance.Conclusions Lateral tibia bone removal micro vessel regeneration could be used to reconstruct vasoganglion below lower leg and promote surrounding vessel and nerve function recovery.Combined with HBO therapy,it could promote wound surface healing,with the advantages of simple surgery,accurate curative effect,high success rate of limb-salvage.For this reason,it was one of the ideal methods for the treatment of diabetic foot ulcer.

Smoothened (SMO) is a member of sonic hedgehog homology (SHH) signaling pathway. It plays a key role as a bridge between patched-1 (PTCH-1) and Gli. Aberrant SHH expression can be detected in various malignant tissues, and the expression in pancreatic cancer stem cells is higher apparently. SHH signals are closely associated with self-duplication of cancer stem cells, formation of tumor vessels as well as matrixes. SMO antagonists such as cyclopamine, GDC-0449 and so on show potential to inhibit activity of SHH signaling, and arrest the growth as well as metastases of tumors. Recently, a few of SMO antagonists have been studied in phase I clinical trials and some are in phase II, meanwhile, phase I or II trials of SMO antagonists to treat pancreatic cancer are performed currently. As the classical SMO antagonist, cyclopamine is extracted from a medicinal plant. Perhaps researchers may be able to determine more effective SMO-targeting drugs from herbal medicines in the future.