Thermal injury are the fourth most common type of trauma globally. This study aimed to examine the impact of ophiopogonin D (OPD) on thermal injury and elucidate its underlying molecular mechanisms of Skin epithelial cells C57BL/6 mice were anaesthetized with inhaled isoflurane, pre-heated in boiling water for 10 min, was lowered onto the skin and maintained under its own weight for 5 s. USP25 mRNA and protein expression in mice model of thermal injury were down-regulation. USP25 mRNA and protein expression was suppressed in vitro model of thermal injury.Sh-USP25 exacerbated toxicity in mice model of thermal injury. In contrast, USP25 was found to reduce inflammation and ROS-induced oxidative stress in an in vitro model. Furthermore, USP25 attenuated mitochondrial damage in vitro, and increased GPX4 protein expression, thereby reducing ferroptosis in Skin epithelial cells. Mechanistically, USP25 suppressed TAB2 expression in the thermal injury model. OPD was shown to reduce ferroptosis in skin epithelial cells following thermal injury via the USP25/ TAB2. Additionally, OPD alleviated thermal injury-induced toxicity in mitigating inflammation and ROS-induced oxidative stress. In conclusion, USP25 suppressed TAB2 expression to reduce ferroptosis in Skin epithelial cells, at least in part through the inhibition of Mitochondrial damage. OPD reduces ferroptosis and overall toxicity to thermal injury by targeting inflammation and ROS-induced oxidative stress via the USP25/ TAB2 axis. These findings suggest that OPD could be a potential therapeutic compound for treating thermal injury by modulating USP25.
BackgroundThe maintenance of physiological homeostasis in the human body depends on healthy skin, making optimal wound treatment crucial. In this study, a natural bioactive wound dressing combining astaxanthin and a hyaluronic acid hydrogel was developed.MethodsMice with full-thickness skin wounds were divided into different groups: the untreated control group, the blank hyaluronic acid hydrogel group, the polyethylene glycol hyaluronic acid hydrogel group, and the 2%, 4%, and 8% astaxanthin-hyaluronic acid hydrogel groups. The wound healing process was evaluated by observing the general view of the wound and collecting skin samples for HE and Masson staining. The mRNA expression levels of interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-10 (IL-10) in the wound tissue were analysed via qRT-PCR. The protein expression levels of collagen I, CD31, α-SMA, Nrf2, HO-1, and NF-κB were examined through Western blot analysis. Additionally, the levels of oxidative stress-related indicators (MDA and SOD) were quantified.ResultsCompared with other hydrogels, ATX@HA gels accelerated full-thickness wound healing, promoting faster wound contraction. These gels enhanced vascularization, as shown by increased CD31 and α-SMA protein expression and increased granulation tissue formation. The ATX@HA gels improved collagen deposition, with a more regular arrangement of collagen fibres in the treated wounds. They reduced oxidative stress (lower MDA and higher SOD) and inflammation (less IL-1β and IL-6 and more IL-10). ATX@HA gels inhibited NF-κB activation and activated the Nrf2/HO-1 signalling pathway during wound healing.ConclusionsATX@HA has a therapeutic effect on wounds by enhancing vascularization and facilitating orderly collagen formation at the wound site while exerting anti-inflammatory and antioxidant effects. Further investigation revealed that these effects may be attributed to the inhibition of NF-κB activation and promotion of Nrf2/HO-1 pathway activation.
ObjectiveThe objective of this study was to ascertain the relationships between Vitamin D levels and ulcers, balance, and mobility in patients with diabetic foot disease.Material and MethodsThis study is a cross-sectional study based on the prospective examination of diabetic foot patients referred from the diabetic foot outpatient clinic of Gülhane Training and Research Hospital to the Physical Medicine and Rehabilitation Clinic. The present study was conducted with a total of 120 diabetic patients, including 60 with diabetic foot ulcers (DFU group) and 60 with non-DFU group comprises of diabetic peripheral neuropathy. The Functional Ambulation Scale (FAS) and the 10-Meter Walk Test were utilized to assess mobility. The evaluation of balance was conducted using the Tinetti balance test.ResultsThe study found no significant differences in vitamin D levels between the groups; however, calcium levels were found to be significant in DFU group. Patients with DFU group exhibited lower scores on the Tinetti balance test and the Functional Ambulation Scale (P < .05).ConclusionThe findings of this study suggest that diabetic foot ulcers are associated with the risk of falling and mobility limitations. Conversely, no substantial discrepancy in vitamin D levels was observed between the two groups, with and without ulcers. This finding indicates that the balance and mobility impairments observed in the DFU group may have developed independently of vitamin D levels.
ImportanceTissue healing is a complex physiological process that includes the phases of inflammation, proliferation, and remodeling. Interruption in these processes may cause delays in the healing process and lead to abnormal scar formation, which may affect the functional and aesthetic outcomes. Microcurrent electrical stimulation, which uses electrical currents in the range of microamperes, similar to the endogenous bioelectric currents, has been developed as a therapeutic technique to modulate tissue healing and abnormal scar formation.ObjectiveTo assess the clinical effectiveness of microcurrent electrical stimulation in the promotion of tissue healing and the modification of scar formation.Evidence ReviewA systematic review of clinical studies was performed using the PRISMA 2020 approach and registered in PROSPERO (CRD420261285174). An electronic search of PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library was performed, covering all available literature up to 2024. Clinical studies involving human subjects with wounds, tissue injuries, or scar formations treated with microcurrent electrical stimulation (MES) were included. The study types included randomized controlled trials, controlled clinical trials, and prospective or retrospective clinical studies. The main parameters evaluated were the wound healing rate, time for wound healing, and scar thickness, pliability, and appearance. The risk of bias in the included studies was evaluated using the Cochrane Risk of Bias 2 tool.ResultsEleven studies (2012-2024) suggest MES may enhance wound healing and improve scar outcomes; however, results are inconsistent due to variability in protocols, populations, and assessment methods.Conclusionsand Relevance: Microcurrent electrical stimulation (MES) may improve wound healing and scar outcomes, but current evidence is limited by study variability and small sample sizes. It should be considered a complementary therapy, with further robust trials needed to confirm efficacy and optimize treatment protocols.
IntroductionThe treatment of chronic non-healing wounds represents a great challenge in healthcare, especially in rehabilitation medicine, as it contributes significantly to increased patient mortality and morbidity. Various types of laser therapies have shown to enhance wound- healing potential while remaining safe and easy to administer.ObjectiveThis prospective comparative study aimed to evaluate the efficacy of the Safe Laser 1800 Infra therapy compared with conventional wound treatment protocols in cases of patient with impaired wound healing.MethodsPatients in the control group received conventional wound care, consisting of wound toilette and the application of hydro- responsive wound dressings (Hydro- Clean Advance, Hartmann) for both groups. Patients in the Safe Laser group received laser treatment at least three times per week, with 1-3 minof exposure per treatment point.ResultsIn the Safe Laser group 7 out of 10 patients became free of inflammation, while inflammation was markedly reduced in the remaining 3 cases. In 90% of patients in the Safe Laser group wound dimensions were substantially reduced or complete wound healing was achieved. Wound depth decreased in all cases. In contrast, in the control group inflammation did not improve, while wound dimensions showed only minimal reduction in only one case.ConclusionDespite the small sample size and heterogeneous wound characteristics, Safe Laser 1800 Infra therapy demonstrated significant benefits in reducing both wound dimensions and inflammation when compared to conventional treatment protocols used in our facility.
BackgroundDiabetic foot ulcer (DFU) is one of the most severe complications of diabetes, with hemoglobin (HGB) and inflammatory markers playing pivotal roles in its pathogenesis. However,the modifying effects of interactions between blood cadmium (Cd) and lead (Pb) exposure and these biological indicators on the risk of DFU remain unclear. This study evaluates how Cd and Pb exposure contributes to DFU risk, with a specific focus on the potential mediating role of HGB.MethodsData were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2004. A total of 1633 participants (including 132 with DFU and 1501 Non-DFU) were included in the final analysis. Weighted logistic regression and restricted cubic splines (RCS) assessed associations between blood cadmium (Cd), lead (Pb), HGB, and DFU. Mediation analysis explored HGB's regulatory role in the Cd-DFU pathway, supplemented by subgroup analyses.ResultsAfter adjusting for all covariates, Blood Cd level was significantly associated with DFU risk (OR = 1.84; 95% CI:1.17-2.90, P = 0.01).RCS revealed a potential non-linear dose-response relationship with a risk threshold at 1.268 nmol/L, beyond which risk escalated sharply. In contrast,HGB served as an independent protective factor for DFU(OR = 0.73; 95% CI:0.60-0.87, P < 0.001).Notably, a positive correlation was observed between Blood Cd and HGB levels(β = 0.33, P < 0.001). Mediation analysis demonstrated that HGB exerted a significant suppression effect on the Cd-DFU association, accounting for -35.79% of the total effect (P = 0.04). Subgroup analyses identified higher DFU susceptibility among smokers (OR = 2.63;95%CI: 1.78-3.78), males, and individuals with elevated HbA1c levels.ConclusionBlood Cd is a significant risk factor for the development of DFU, while HGB provides a compensatory suppression effect that partially buffers Cd-induced toxicity. These findings suggest that elevated HGB levels in people with diabetes may mask the true risks associated with blood Cd, potentially leading to a significant underestimation of DFU risk in clinical practice.
The objective of this paper is to compare outcomes for patients treated with healthcare administered Outpatient Parenteral Antimicrobial Therapy (H-OPAT) versus S-OPAT (self-administered antibiotics) for the treatment of foot osteomyelitis. This was a retrospective cohort study of 202 subjects with osteomyelitis that were admitted to the hospital for moderate or severe foot infections and followed for 1 year. There were 134 subjects in the H-OPAT group and 68 in the S-OPAT group. Diabetes was prevalent in 157/202 (77.7%) subjects in the study cohort. The primary outcomes were reinfection, wound healing, time until wounds healed, amputation (minor and major), mortality, rehospitalization of the same foot, and length of stay. Reinfection was defined as infection of the same site from index procedure. S-OPAT patients were more likely to require rehospitalization (O.R = 2.10 [1.11, 3.70]) and less likely to have complete wound healing within 90 days (O.R = 0.49 [0.25, 0.96]). When Kaplan Meier survival analysis was evaluated, S-OPAT patients had longer times to heal (H-OPAT; 136.0 ± 105.2 days vs S-OPAT; 183.7 ± 118.9 days, p = 0.01. There were no differences between S-OPAT and H-OPAT for 1-year wound healing, amputation, rate of reinfection, mortality, or length of stay. Overall, S-OPAT subjects demonstrated an increased association with binary wound healing at 90 days, hospitalization, and require longer antibiotic duration.
Growing evidence has supported the potential method of umbilical cord mesenchymal stem cell (UCMSC) therapy for diabetic foot and lower extremity peripheral artery disease (PAD), but their results are not consistent. Thus, the authors conducted the first meta-analysis concerning the safety and efficacy of UCMSC treatment in diabetic foot patients. 8 English and Chinese databases were searched to identify randomized controlled trials regarding UCMSC therapy in diabetic foot patients. Two independent investigators carried out literature inclusion, data extraction, and quality assessment. Meta-analysis was performed using ReviewManager 5.4.1., 6 RCT studies involving 380 patients were included. Primary endpoints included ulcer healing, transcutaneous oxygen pressure (TcPO2), ankle-brachial index (ABI), and intermittent claudication. Compared with conventional treatment, patients who accepted UCMSC therapy had a better ulcer healing rate (Odds Ratio (OR) = 2.88 [1.20-6.91]), TcPO2 (standardized mean difference (SMD) = 1.39, [0.01-2.77]), and ABI improvement (SMD=1.22 [0.30-2.13]). Moreover, they also experienced significantly better improvements in pain amelioration, skin temperature, and ulcer area reduction. Whereas, intermittent claudication cannot be ameliorated by UCMSC therapy (SMD=0.83 [-0.45-2.10]). Additionally, neovascularization, examined by angiography, was significantly promoted after UCMSC administration. Moreover, two studies recorded adverse events during follow-up, which were considered to be transient, minor, and regional. The present meta-analysis validated that UCMSC treatment enhances diabetic foot ulcer healing and circulation recovery, and has a promising safety profile, though limited by incomplete reporting. Larger-sample multicenter randomized controlled trials and longer-term follow-up are urgently needed to further explore the safety and efficacy of UCMSC treatment in diabetic foot patients. The meta-analysis was prospectively registered on PROSPERO.
ObjectiveTo investigate the predictive value of the γ-glutamyltransferase (GGT) to platelet (PLT) ratio (GPR) for the risk of diabetic foot ulcer (DFU) in persons living with type 2 diabetes mellitus (T2DM).MethodsWe included 435 persons with T2DM at Zigong Fourth People's Hospital from January 2023 to December 2024. Participants were divided into a DFU group (n = 87) and a non-DFU group (n = 348) based on DFU status. Baseline, clinical, and biochemical data were collected. Using R 4.3.1, 70% of data were randomly assigned as training set and 30% as test set. Univariate and binary logistic regression analyses identified factors influencing DFU. Models included regression, gradient boosting, and random forests. Their predictive ability was evaluated by AUC. A separate validation set of 287 T2DM patients from January to December 2025 was also included.ResultsIn the training set, the DFU group exhibited significantly higher proportions of males, higher body mass index, higher prevalence of smoking history, and higher GPR and low-density lipoprotein (LDL) levels than the non-DFU group (P < .05). Logistic regression analysis identified sex, smoking history, GPR, HbA1c, and LDL as independent risk factors for DFU in T2DM patients. The AUCs for training were 0.797, 0.889, and 0.926 for the nomogram, gradient boosting, and random forest models, respectively, with test set AUCs of 0.825, 0.811, and 0.817. External validation showed the random forest model had the best performance.ConclusionMale sex, smoking, elevated GPR, elevated HbA1c, and elevated LDL are risk factors for DFU in persons living with T2DM. Among the three models built using these factors, the random forest model demonstrated the best performance across the evaluation metrics, followed by the gradient boosting machine model, and then the nomogram model.
Sepia officinalis ink contains bioactive secondary metabolites abundant in melanin granules, has extensive medicinal properties and is commonly utilized in the prevention of different diseases. This research examined the topical wound healing efficacy of sepia ink extract (SIE) and SIE- Nanoparticle-loaded phytosome (SIE-NP) in a murine model of excisional wound healing. Mice were divided into five groups, all groups were anesthetized, and excisional skin wounds were established using a biopsy punch, except the control group. Both SIE and SIE-NP significantly improved the wound healing rate; nevertheless, the effect of SIE-NP was more pronounced. Treatment with SIE and SIE-NP accelerated the wound healing process by mitigating oxidative stress, evidenced by a reduction in malondialdehyde levels and an enhancement in antioxidants levels, including catalase and glutathione. SIE and SIE-NP attenuated oxidative stress-induced DNA fragmentation in wound tissue. Additionally, they reduced the levels of inflammatory markers, such as TNF-α and IL-6, myeloperoxidase activity, and the infiltration of inflammatory cells in the skin tissue. Furthermore, SIE and SIE-NP reduced histopathological abnormalities and concentration of fragmented DNA and elevated nitric oxide levels and collagen content. Moreover, SIE and SIE-NP decreased apoptosis by lowering caspase 3 expression. The data indicate that SIE and SIE-NP expedited wound healing via their antioxidant, anti-inflammatory, and anti-apoptotic characteristics.
The study aimed to assess the outcomes of patients with diabetic foot osteomyelitis (DFO) and concomitant soft tissue infection (STI). It is a retrospective observational study including consecutive patients affected by DFO located in the forefoot (toes and/or rays) who referred to a specialized diabetic foot service from 2019 to 2022. Patients were categorized in two groups: those with DFO and STI and those with DFO without STI. All patients were managed by a conservative surgical approach aiming to remove only the infected bone in association with antibiotic therapy. After 1-year of follow-up, the following outcomes were evaluated and compared between groups: healing, healing time, minor amputation, major amputation, and hospitalization. Overall, 166 patients were included. The mean age was 68.5 ± 13.2 years, 94.9% of them were affected by type 2 diabetes with a mean duration of 19.3 ± 7.1 years. One hundred fourteen patients (68.7%) had DFO complicated by STI, while 52 (31.3%) had DFO without STI. The outcomes for DFO with and without STI were: healing (52.3 vs 94.2%, p = 0.005), healing time (7.8 ± 5.8 vs 4.6 ± 2.7 weeks, p = 0.0002), minor amputation (13.1 vs 3.8%, p = 0.04), major amputation (0 vs 0%, ns), and hospitalization (66.7 vs 48.1%, p < 0.002) respectively. In addition, STI resulted an independent predictor of non-healing [OR 3.1, CI 95% (1.7-9.3), p = 0.002]. Patients with DFO complicated by STI showed higher rate of non-healing, delayed healing time, and more case of minor amputation and hospitalization in comparison to those without STI. STI was independently associated to the risk of non-healing, while any association was found for amputation and hospitalization.
The aim of this review was to examine the association between diabetic peripheral neuropathy (DPN) and deficiency of fat-soluble vitamins A, D, and E. Vitamins A, D, and E are involved in crucial neuroprotective mechanisms through the regulation of gene expression and antioxidant activity. Vitamin A appears to actively regulate the expression of nerve growth factor (NGF), essential for the development, survival, and regeneration of peripheral neurons. Vitamin D exhibits immunomodulatory effects, reduces the production of pro-inflammatory cytokines, and enhances neuroplasticity. Similarly, vitamin E, through its potent antioxidant action, minimises damage by reactive oxygen species (ROS), which are responsible for demyelinating lesions. Vitamin supplementation studies have shown a potential symptom improvement or reversal. These findings underline the necessity for early detection and correction of vitamin deficiencies as an integral component of a comprehensive strategy for the prevention and management of DPN.
Background and AimsThe aim of the study was to evaluate the prevalence of recurrent diabetic foot ulcers (DFUs) requiring hospital admission and to assess their impact on mid-term clinical outcomes.Methods and ResultsIt is a single-center retrospective observational study including a population of patients with DFUs requiring hospitalization managed between January and September 2024 in a tertiary level diabetic foot service. All patients were treated by a local multidisciplinary team in accordance with international guidelines. The study cohort consisted of two groups: patients with a recurrent DFU and those with a first-time DFU. After discharge, all patients were regularly followed as outpatients. After six months of follow-up, the following outcomes were evaluated and compared between groups: healing, major amputation, and mortality. Overall, 205 patients were included (31.7% recurrent DFU vs 68.3% first-time DFU). The mean age was 68.9 ± 12.3 years, the majority had type 2 diabetes (93.4%) with a mean diabetes duration of 20.9 ± 12.6 years; 155 (75.6%) patients presented with ischemic DFUs, and 158 (77.1%) patients had diabetic foot infections. There were no significant differences between the two groups at the assessment, except for the higher rate of ischemic heart disease in recurrent patients when compared to not recurrent (50.8 vs 30.7%, P = .006).ConclusionSix-months outcomes (recurrent DFU vs first-time DFU) were as follows: wound healing (47.7 vs 62.8%, P = .04), major amputation (4.6 vs 5%, P = .2), and mortality (12.3 vs 4.3% P = .03), respectively. Multivariate logistic regression analysis showed that ulcer recurrence was an independent predictor of non-healing, while it did not significantly influence the risk of major amputation or mortality.
BackgroundKangfuxin Liquid, with properties of promoting tissue repair, anti-inflammation, and bacteriostasis, requires systematic evaluation regarding its efficacy and safety in adjuvant treatment of pressure ulcers.MethodsDatabases including PubMed, Embase, Cochrane Library, CNKI, and Wanfang were searched for randomized controlled trials (RCTs) published from January 2015 to June 2025, comparing Kangfuxin Liquid adjuvant therapy with standard dressing in treating stage II-III pressure ulcers. Two researchers independently screened literature, extracted data, and evaluated quality. Meta-analysis was performed using RevMan 5.4 software. Outcome indicators included wound healing rate, healing time, wound area reduction rate after 2 weeks of treatment, and adverse reaction rate.ResultsA total of 12 RCTs involving 886 patients were included, with 450 patients in the experimental group (Kangfuxin Liquid + standard dressing) and 436 in the control group (standard dressing alone). Meta-analysis showed that the experimental group had significantly higher wound healing rate [RR = 1.44, 95% CI (1.32, 1.56), P < 0.0001, I2 = 79.4%], significantly shorter healing time [MD = -6.77 days, 95% CI (-7.22, -6.32), P < 0.0001, I2 = 82.8%], significantly increased wound area reduction rate after 2 weeks of treatment [MD = 19.02%, 95% CI (17.94, 20.09), P < 0.0001, I2 = 81.7%], and a lower adverse reaction rate with no statistically significant difference [RR = 0.73, 95% CI (0.47, 1.12), P = 0.15, I2 = 83.2%]. Kangfuxin Liquid adjuvant therapy is well-tolerated with a favorable safety profile, as adverse events in the control group were mostly infection-related, while those in the KFX group were mild local irritation.ConclusionKangfuxin Liquid adjuvant therapy can significantly improve wound healing rate, shorten healing time, promote wound reduction, and ensure high safety in treating stage II-III pressure ulcers, which is worthy of clinical promotion.
ObjectiveThis study investigated the clinical value of antibiotic-loaded bone cement (ALBC) in managing infected diabetic foot ulcers (DFUs), aiming to address the limitations of conventional therapies such as slow healing and high recurrence rates.MethodsA retrospective analysis was conducted on 43 eligible DFU patients (21 males, 22 females) with infected ulcers who underwent debridement combined with ALBC implantation. Clinical data on infection control, wound healing, adverse events, and functional assessments were collected.ResultsThe results demonstrated effective local infection control: 90.7% of patients achieved normalized white blood cell counts and C-reactive protein levels within 1-2 weeks, with no observable pus secretion after 3 weeks. Wound healing outcomes were favorable, with an overall healing rate of 95.3% (41/43). The median healing time was 42 days (range: 30-63 days), and the average wound area reduction rate reached 85% at 4 weeks post-treatment. Only two cases experienced delayed healing due to poor glycemic control, with no reports of severe adverse reactions. Furthermore, all patients maintained basic ambulation without significant gait impairment during follow-up, as the ALBC was customized to minimize interference with foot function.ConclusionsALBC combined with debridement effectively controls infection, promotes wound healing, and exhibits a good safety profile in treating infected DFUs, without adversely affecting daily ambulation. This regimen represents a novel and cost-effective therapeutic option. Future prospective randomized controlled trials are warranted to validate these findings and optimize protocols for patients with poor baseline conditions.Trial registry statementNot applicable.
BackgroundClinical guidelines conventionally define nutritional adequacy using a 35 g/L serum albumin threshold. However, its biological sufficiency for driving diabetic foot ulcer (DFU) regeneration remains unvalidated. This investigation utilized a structural modeling framework to interrogate the non-linear relationship between albumin and DFU repair and to identify the precise physiological threshold required for active healing.MethodsThis prospective, dual-center cohort study of 733 DFU patients utilized a 20-week observation window anchored to baseline enrollment (Time Zero, T0). To isolate the independent metabolic effect of albumin from systemic inflammatory confounding, we implemented a doubly robust framework integrating generalized propensity score (GPS) weighting with restricted cubic spline (RCS) modeling. The primary endpoint was Percentage Area Reduction (PAR) at 20 weeks.ResultsBaseline albumin was identified as a significant independent driver of wound reduction (β = 3.25; 95% CI: 0.76-5.73; P = 0.01) and a protective factor against major amputation (OR = 0.89; 95% CI: 0.79-0.99; P = 0.037). RCS analysis revealed a highly significant non-linear trajectory (P for non-linearity < 0.001) with a biological inflection point at 37.9 g/L. No significant regenerative progress occurred within the 31.4-37.9 g/L stagnation plateau. Sensitivity analysis confirmed the conventional 35 g/L cutoff failed to differentiate healing outcomes (P = 0.869), resulting in 45.8% of normoalbuminemic patients being misclassified within a state of regenerative arrest. The calculated E-value of 3.40 confirms profound robustness against unmeasured confounding.ConclusionsThe conventional 35 g/L albumin threshold is clinically inadequate to sustain the metabolic demands of DFU repair. To breach the identified stagnation plateau and transition the wound bed toward active regeneration, clinicians should prioritize a new physiological target of 37.9 g/L (clinically operationalized as ≥ 38 g/L). This necessitates a strategic shift toward metabolic intensification in limb salvage protocols.
Peripheral arterial disease (PAD) is one of the most common underlying causes of major lower extremity amputations (LEAs). Often revascularization is not adequate to save the leg. Tibial Transverse Transport (TTT) represents a revolutionary approach to increase angiogenesis in people with critical limb threatening ischemia (CLTI). A systematic review and meta-analysis was conducted across six databases. Inclusion criteria required studies to evaluate TTT combined with revascularization versus revascularization or TTT alone as a monotherapy. Outcomes analyzed included tarsal-metatarsal amputation (TMA), wound healing, and change in visual analogue scale (VAS) for pain. A total of five studies were identified across four databases that met inclusion criteria. TTT + Revascularization was shown to have a protective effect in reducing follow up TMA, O.R = 0.44 [0.23, 0.81], p = 0.009. TTT + Revascularization was also found to have an association with wound healing, OR = 3.25 [1.84,5.73], p = 0.0001. Four studies observed the change in Visual Analogue Scale (VAS), and the cumulative effect showed no association between either TTT + Revascularization or monotherapy with change in VAS pain pre and post procedure, standard mean difference = -0.05 [-0.16, 0.05], p = 0.33. TTT in combination with peripheral endovascular revascularization offers a promising addition for patients with CLTI with lower incidence of TMA increase rates of wound healing. However, considering the limited studies available and overall small sample size, further trials are necessary to understand the relationship between this novel therapy and CLTI management.
BackgroundLiterature on Financial Toxicity (FT) using the Comprehensive Score for Financial Toxicity - Functional Assessment of Chronic Illness Therapy (COST-FACIT) among people with diabetic foot ulcers (DFUs) is unavailable in India. This study assessed FT among people with DFUs using the COST measure.Materials and MethodsA total of 234 participants with DFUs were included from April-June 2025 in a tertiary care diabetes center and administered with COST-FACIT and sleep health (RU-SATED) questionnaires. Demographic, clinical, socio-economic status (SES), biochemical, co-morbidities and complications, cost of illness were recorded. Multivariable logistic regression was performed to identify predictors of FT.ResultsAround 85% of the participants had FT in which 15.8% experienced high FT. Lower socio-economic group recorded the lowest COST score (15 ± 6.5). Nearly one-third underwent minor (28.2%) and major (3.8%) amputations. DFU treatment expenses included inpatient costs: ₹98,167 ($1180), medications: ₹6869 ($83), offloading devices: ₹5374 ($65), and indirect cost: ₹4604 ($55). Cost coping behaviours identified were money borrowed (49.6%) and selling belongings (39.7%). Individuals with higher FT reported poor sleep health. Lower SES (AOR=24.9, p < 0.001), DFU duration>3years (AOR=2.3, p = 0.024), delayed doctor's visit (AOR=4.4, p = 0.048) and revascularization procedure (AOR=3.2, p = 0.014) were significant predictors of higher FT.ConclusionAround 85% of individuals with DFUs experienced FT. Early foot screening, social and health protection schemes, and appropriate policy measures would possibly alleviate high FT.
PurposeThis study aims to evaluate the antioxidant, antibacterial, and wound-healing properties of powders from Cytisus triflorus and Teucrium polium, plants endemic to Algeria harvested during two phenological stages and for enhancing wound care using a rat wound model.MethodsPhytochemical characterization of powders has involved: total phenol, flavonoids and condensed tannins content, as well as the carbohydrates composition. Such investigation was supported by their efficiency as antibacterial and antioxidant determined by different test systems, namely DPPH radicals scavenging activity, reducing power and β-carotene bleaching assay. In this regard, a rat excision wound model was used to assess wound healing. Wound contraction, hydroxyproline contents and histological evaluation were performed.ResultsPowders from studied plants differed predominantly in their total phenol, flavonoids and condensed tannins content as well as the carbohydrates composition between phenological stages. Indeed, the powders from both plants harvested at the flowering stage showed a potential antioxidant activity and exhibited significant antibacterial activity against Gram positive bacteria. After twelve days of treatment in excision wound model, wound contractions for Cfl'Ont and Tfl'Ont ointments mention a value of 100% which it showed highly significant temporal reduction in those wounds area (P < .01) followed by Cfr'Ont and Tfr'Ont ointments with 98.11%, 96.88%, decreased epithelialization time, arranged derma and increased hydroxyproline content over the reference groups during the trial.ConclusionOur findings have proved, for the first time, scientific evidence of the efficiency of Algerian plants namely Cytisus triflorus L'Her and Teucrium polium to possess a remarkable wound healing activities supporting the folkloric assertion.
Diabetic foot ulcers (DFUs) are a serious complication of diabetes, associated with high risks of infection, amputation, and reduced quality of life. Silver nanoparticle dressings, known for their broad-spectrum antimicrobial and anti-inflammatory properties, offer a promising advanced treatment option. This prospective, randomized, single-blind controlled trial evaluated the efficacy of tetra silver tetroxide dressings compared to conventional dressings in managing DFUs, with limb salvage as the primary endpoint and wound healing parameters as secondary endpoints. Fifty-nine patients were randomly assigned to Group A (tetra silver tetroxide spray and gel, n = 30) or Group B (conventional dressings, n = 29). While no statistically significant difference in limb salvage rates was observed (Group A: 100% vs 86.21%; P = .052), the silver nanoparticle dressing demonstrated superior outcomes in all secondary endpoints: a higher rate of complete healing (100% vs 82.76%, P = .024), reduced mean healing time (9.77 vs 18.79 weeks, P < .001), lower incidence of post-treatment infection (0% vs 20.69%, P = .011), and fewer median dressing days (62.5 vs 122.5 days, P < .001). These findings indicate that tetra silver tetroxide nanoparticle dressings significantly accelerate wound healing, reduce infection, and lessen treatment burden, supporting their use as an effective DFU treatment option.