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Response to Comment on Hoffstad et al. Diabetes, lower-extremity amputation, and death. Diabetes care 2015;38:1852-1857
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Clinical results related to the use of the tissuetech autograft system in the treatment of diabetic foot ulceration
No full textThe application of tissue-engineering technology to wound healing has resulted in the development of a number of living skin equivalents, which have become a viable option in the treatment of chronic wounds. Unique among technologies of tissue engineering of skin is the TissueTech((R)) Autograft System (FIDIA Advanced Biopolymers, Abano Terme, Italy), as it incorporates an autologous dermal substitute (Hyalograft((R)) 3D, FIDIA Advanced Biopolymers) and an autologous epidermal replacement (Loserskin((R)), FIDIA Advanced Biopolymers). Each includes a matrix consisting of a hyaluronic acid ester (FIDIA Advanced Biopolymers) to promote cellular migration and graft take. Randomized clinical trials and extensive clinical experience have shown positive results in the treatment of diabetic foot ulcers using TTAS with high healing rates and excellent safety profile. A large retrospective analysis was conducted to assess the characteristics and outcomes of all chronic ulcers treated with TTAS from January 1997 to December 2000. Data deriving from the subgroup of the 401 diabetic foot ulcers are presented in this study. This group consisted of 104 neuropathic, 115 neuroischemic, 114 ischemic, and 58 post-surgical ulcers. Most of the ulcers treated were very large (85% with area greater than 5cm(2)) and full thickness or deep (85%), particularly in the neuroischemic and ischemic ulcer groups. The percentage of healed ulcers was high in all the subgroups (70.3% in the total diabetic foot population with 63.5% healed within 4 months), and the rate of recurrences was low, with 8.2 percent at a mean observation time from healing of 240 days in the total ulcer population. According to the available clinical evidence, TTAS can be effectively and safely used for the treatment of diabetic foot ulcers
Advances in the Treatment of Peripheral Vascular Disease in Diabetes and Reduction of Major Amputations
Full text linkGenetic susceptibility factors of Type 1 diabetes in Asians
No full textType 1 diabetes is a multifactorial disease in which the insulin producing β-cells of the pancreas are destroyed by the immune system, a process determined by the activity of major histocompatibility complex (MHC)-restricted T lymphocytes. Progress has been made in elucidating genetic factors involved in Type 1 diabetes in Caucasians, with less data available from Asia. For Asians, the human MHC locus (HLA region), especially the class II region, is the major susceptibility interval. The role of IDDM2, the insulin locus, has been questioned in Asia. In contrast to Caucasians, Asian populations have a very low incidence of Type 1 diabetes (0.4-1.1 cases/ year/100 000 individuals). This low incidence rate in the Asian population may be related to the population frequency distribution of susceptible Type 1 diabetes genes, especially of HLA. The overall risk for Type 1 diabetes from HLA DR and DQ is determined by polymorphic residues (alleles) and particular combinations of alleles (haplotypes and genotypes) in a given individual. In Asians, it is very common that a protective DR4 allele is associated with susceptible DQ alleles while neutral/protective DQ alleles are associated with the susceptible DR4 alleles. Our analyses indicate that the counterbalancing between susceptible DRB1 and protective DQB1, and vice versa, is a factor that may contribute to the low incidence of diabetes in Asians. We find that identical HLA DRB1-DQB1 haplotypes of Asians and Caucasians have similar transmission to diabetic children and similar associations with diabetes. Moreover, the association with diabetes and transmission to a diabetic offspring of DR4 haplotypes varies depending on the haplotype borne on the homologous chromosome. This might contribute not only to the synergistic effect of DR3/4, but also to the susceptibility influence of DQB1*0401 haplotypes confined to DR4/X. High-risk DR4 subtypes were predominant in DR4/X, whereas protective DR4 subtypes were observed mainly in the DR3/4 genotype. Since in Asians DQB1*0401 is in linkage disequilibrium (LD) with DRB1*0405, we find more DRB1*0405-DQB1*0401 haplotypes in patients with DR4/X than in patients with DR3/4, suggesting that the contribution of the DRB1 locus may be greater in DR4/X than in DR3/4 genotypes. Several genome scans suggested additional susceptibility intervals and provided supporting evidence for several previously reported linkages. Other studies focused on the confirmation of linkage using multipoint sib-pair analyses with densely spaced markers and multiethnic collection of families. Although significant and consistent linkage evidence was reported for the susceptibility intervals IDDM12 (on 2q33) even in Asia, evidence for most other intervals varies in different data sets. LD mapping has become an increasingly important tool for both confirmation and fine-mapping of susceptibility intervals, as well as identification of etiological mutations. The examination of large and ethnically varied data sets including those of Asia has allowed identification of haplotypes that differ only at a single codon in a single locus. As more data become available, the study of pairs of haplotypes which differ at a single polymorphic site, but have different effects on disease susceptibility, should allow more precise definition of the polymorphisms involved in the disease process. Copyright © 2001 John Wiley & Sons, Ltd
From a spark to a flame: the evolution of diabetic foot disease in the last two decades
No full textDespite many improvements have been achieved, diabetic foot disease (DFD) remains a clinical, social, and economic burden. In the last years, DFD showed an evolution of its characteristics with an increase of the ischaemic/neuro-ischaemic foot in comparison to the pure neuropathic foot. Simultaneously, there was and increased incidence of concomitant cardiovascular co-morbidities, which influences the higher fragility of patients with DFS. Peripheral arterial disease (PAD) in subjects with diabetic foot seems to show a more aggressive pattern, being more distal and difficult to treat. Untreatable PAD remains the unmet need for clinicians and the main risk factor of major amputation in patients with diabetic foot ulcers. Authors aimed to describe the evolution of diabetic foot patients in the last two decades, describing also the current and future treatment which may improve outcomes in the next generations
A clinical investigation on the characteristics and outcomes of treating chronic lower extremity wounds using the tissuetech autograft system
No full textThe Effectiveness of Negative Pressure Therapy in Diabetic Foot Ulcers with Elevated Protease Activity: A Case Series
No full textObjective: Despite several works have described the usefulness of negative pressure therapy (NPT) in the treatment of diabetic foot ulcers (DFUs), no studies have reported its ability in the proteases modulation in DFUs. The aim of this work was to evaluate the role of NPT as a protease-modulating treatment in DFUs. Approach: We conducted a prospective study of a series of diabetic patients affected by chronic DFUs. Each ulcer was assessed for matrix metalloproteinases (MMPs) activity with a protease status diagnostic test at the baseline and after 2 weeks of NPT. Results: Four patients were included. All patients had type 2 diabetes with a disease duration of ≈20 years. A1c was 79.5 ± 15.3 mmol/mol. Ulcer area was >5 cm2 in all cases. All wounds showed elevated protease activity (EPA) at the baseline. After 2 weeks, all patients showed a normalization of MMPs activity. Innovation: NPT showed its effectiveness in the reduction of EPA in chronic DFUs. Conclusion: This study confirms the role of NPT in the positive modulation of protease activity also in chronic DFUs
Letter Regarding “The Prostacyclin Analogue Iloprost as an Early Predictor of Successful Revascularization in Diabetic Patients Affected by Critical Limb Ischemia and Foot Ulcers”
No full textPurpose: The aim of this study is to evaluate the role of Iloprost as an early predictor of successful revascularization in patients affected by ischemic diabetic foot ulcers (DFUs).Methods: Consecutive patients with ischemic DFUs with persistent low TcPO2 (<30mmHg) one day after a technical successful Percutaneous Transluminal Angioplasty (PTA) have been included.All patients underwent Iloprost infusion and TcPO2 has been recorded at days 3, 14 and 30.According to the TcPO2 reported at day 3, patients were divided into two groups: group A (patients with TcPO2 >= 30mmHg) and group B (patients with TcPO2 <30mmHg). Baseline TcPO2 values at days 3, 14 and 30 after Iloprost infusion and needing of re-intervention (re-PTA) have been evaluated.Results: Twenty-five patients have been included, 12/25 (48%) in Group A and 13/25 (52%) in Group B.There were no significant differences at the baseline and one day after PTA between the two groups while TcPO2 values recorded in Group A at days 3, 14 and 30 after Iloprost infusion were significant higher in comparison to the Group B (chi = 0.005).The rate of re-PTA were respectively 33,3% (Group A) and 53,8% (Group B) (p = 0.03).Conclusions: Iloprost may be an early predictor of successful revascularization in patients affected by critical limb ischemia (CLI) and DFUs. (C) 2018 The Authors. Published by Elsevier Inc
An in-depth assessment of diabetes-related lower extremity amputation rates 2000–2013 delivered by twenty-one countries for the data collection 2015 of the Organization for Economic Cooperation and Development (OECD)
No full textInternational comparisons of diabetes-related lower extremity amputation rates are still hampered by different criteria used for data collection and analysis. We aimed to evaluate trends and variation of major/minor amputations, using agreed definitions adopted by the Organization for Economic Cooperation and Development in 2015
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