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Feleke SF, Faris AM, Habtie TE, Atalay AA, Dejazmach Z, Tesfa NA, Derbew G. Diabetic foot self-care practices and its predictors among diabetes mellitus patients in Ethiopia: systematic review and meta-analysis. BMJ Open 2025; 15:e092626. [PMID: 40081984 PMCID: PMC11907051 DOI: 10.1136/bmjopen-2024-092626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 02/24/2025] [Indexed: 03/16/2025] Open
Abstract
OBJECTIVE The study aims to identify self-care practices related to diabetic foot care and determine their predictors among diabetes mellitus (DM) patients in Ethiopia. DESIGN Systematic review and meta-analysis. DATA SOURCES Data were collected from PubMed/MEDLINE, ScienceDirect, Google Scholar and grey literature sources. Databases were searched from inception to August 2024. ELIGIBILITY CRITERIA Observational studies (including cross-sectional, case-control, cohort and survey designs) reporting diabetic foot self-care practices and their predictors among DM patients in Ethiopia. Our inclusion criteria encompassed articles published in English, and we considered studies conducted in both healthcare institutions and community settings. DATA EXTRACTION AND SYNTHESIS Microsoft Excel was used for data extraction and summary, while the analysis was performed with R software V.4.3.2. The overall pooled prevalence of diabetic foot self-care practices and their predictors were estimated using a random-effects model. Publication bias was assessed both graphically, using funnel plots, and statistically, with tests such as Egger's regression test. The reviewers systematically assessed potential bias in individual studies using the Newcastle-Ottawa Quality Assessment Scale, and the certainty of evidence was assessed by Grade of Recommendations Assessment, Development and Evaluation (GRADE). Subgroup analysis was carried out to minimise random variations in the estimates from the primary studies. RESULTS The pooled prevalence of good diabetic foot self-care practice in Ethiopia was 51% (95% CI: 41% to 61%; I²=98%, p≤0.001). Factors associated with diabetic foot self-care practices among diabetic patients included knowledge of foot care (adjusted OR (AOR)=2.42; 95% CI: 1.20, 3.62), being female (AOR=1.23; 95% CI: 1.02, 1.98) and rural residency (AOR=1.23; 95% CI: 1.02, 1.98). Both Egger's test (p=0.4430) and Begg's test (p=0.501) indicated no significant evidence of publication bias. Regarding the certainty of evidence, the overall GRADE rating is categorised as low. CONCLUSIONS The overall prevalence of good diabetic foot self-care practices among DM patients in Ethiopia is relatively high. Residence, sex and knowledge of foot care were identified as key predictors of effective foot self-care practices in this population. To enhance diabetic foot self-care in Ethiopia, it is crucial to strengthen education on foot care. Tailored interventions should be developed specifically for men and rural residents to improve their diabetic foot self-care practices.
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Affiliation(s)
- Sefineh Fenta Feleke
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
| | - Abebe Merchaw Faris
- Department of Nursing, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | | | | | - Zelalem Dejazmach
- Departement of Medical Laboratory Sciences, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Natnael Amare Tesfa
- School of Medicine, College of Health Sciences, Woldia University, Woldia, Ethiopia
| | - Getachew Derbew
- Department of Public Health, College of Health Science, Woldia University, Woldia, Ethiopia
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Mitchell A, Hill B. Assessment of diabetic foot ulcers: back to basics. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S24-S32. [PMID: 38386520 DOI: 10.12968/bjon.2024.33.4.s24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
Diabetic foot ulceration affects up to 34% of the global diabetic population as a result of poor glycaemic control. Complications resulting from diabetic foot ulceration can be complex, expensive and challenging. It is important for risk factors to be recognised early and for regular assessment to take place. Streamlining a coordinated approach that enhances communication and guides treatment approaches can help to improve wound outcomes.
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Affiliation(s)
- Aby Mitchell
- Senior Lecturer Nursing Education, Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London
| | - Barry Hill
- Associate Professor of Nursing and Critical Care, Northumbria University
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Zaki SM, El Karsh DS, Faden TM, Almghamsi LT, Fathaldin JO, Alhazmi OA. Diabetic Foot Complications in Saudi Arabia: A Retrospective Study. Cureus 2024; 16:e53531. [PMID: 38445149 PMCID: PMC10912821 DOI: 10.7759/cureus.53531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2024] [Indexed: 03/07/2024] Open
Abstract
REVIEW A common chronic health problem among Saudi Arabians is diabetes mellitus (DM). One of the most serious complications of diabetes is diabetic foot (DMF). AIM The objective of this study was to identify the most common complications that develop among patients with DMF. In addition, we conducted a demographic analysis of chronic diabetic complications related to DMF. MATERIAL AND METHODS The study involved 100 DMF attending the Jeddah clinic of Dr Soliman Fakeeh Hospital. Several chronic complications associated with DMF were reported, including peripheral arterial disease (PAD), coronary artery disease (CAD), retinopathy, nephropathy, and neuropathy. We examined the feet for ulcers, gangrene, amputations, bone deformities, Charcot joints, osteoarthritis, septic arthritis, and osteomyelitis. By using B-mode ultrasound and spectral Doppler imaging, we imaged the posterior tibial and anterior tibial arteries. RESULTS People with poorly controlled diabetes mellitus type 2 (T2DM) are more likely to develop diabetic feet. The most common foot complications were foot ulcers (81%), foot amputations (31%), foot gangrene (29%) (29/100), bone deformities (22%) (22/100), ingrown toenails (17%) (17/100), Charcot's foot (10%) (10/100), and calluses (9%) (9/100). The majority of the patients suffered from hypertension and half had anaemia. Diabetic peripheral neuropathy affected about half of the patients, diabetic nephropathy affected one-third, and diabetic retinopathy affected 14%. Approximately a quarter (25/100) of the patients had CAD and less than half had PAD. There was atherosclerosis in 43% (43/100) of popliteal/infra-popliteal arteries. Twenty-two percent (22/100) of the anterior tibial arteries and 25% (25/100) of the posterior tibial arteries were stenotic or occluded. A biphasic mode was observed in 21% (21/100) of anterior tibial arteries, a monophasic mode in 9% (9/100), and a non-flowing mode in 3% (3/100). Twenty-three percent (23/100) of the posterior tibial arteries displayed biphasic Doppler modes, 5% (5/100) displayed monophasic modes, and 6% (6/100) displayed non-flowing modes. Conclusion: Diabetes foot is common among older males with poorly controlled T2DM. The most common foot complications were amputations, gangrene, foot ulcers, bone deformities, ingrown toenails, Charcot's foot, and calluses. Most DMF patients were anemic and hypertensive. Diabetes-related microvascular complications, such as diabetic peripheral neuropathy, nephropathy, and retinopathy, as well as macrovascular complications, such as coronary artery disease and peripheral arterial disease, were associated with DMF.
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Affiliation(s)
- Sherif M Zaki
- Anatomy, Fakeeh College for Medical Sciences, Jeddah, SAU
| | | | - Tuleen M Faden
- Anatomy, Fakeeh College for Medical Sciences, Jeddah, SAU
| | | | | | - Omar A Alhazmi
- Anatomy, Fakeeh College for Medical Sciences, Jeddah, SAU
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Monteiro RL, Drechsel TJ, Ferreira JSSP, Zippenfennig C, Sacco ICN. Potential predictive effect of mechanical properties of the plantar skin and superficial soft tissue, and vibration perception on plantar loading during gait in individuals with diabetes. BMC Musculoskelet Disord 2023; 24:712. [PMID: 37674163 PMCID: PMC10483699 DOI: 10.1186/s12891-023-06851-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/02/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This exploratory study aimed to investigate the extent to which mechanical properties of the plantar skin and superficial soft tissue (hardness, stiffness, and thickness) and vibration perception thresholds (VPTs) predict plantar pressure loading during gait in people with diabetes compared to healthy controls. METHODS Mechanical properties, VPTs, and plantar loadings during gait at the heel and first metatarsal head (MTH) of 20 subjects with diabetes, 13 with DPN, and 33 healthy controls were acquired. Multiple regression analyses were used to predict plantar pressure peaks and pressure-time integrals at both locations based on the mechanical properties of the skin and superficial soft tissues and VPTs. RESULTS In the diabetes group at the MTH, skin hardness associated with 30-Hz (R2 = 0.343) and 200-Hz (R2 = 0.314) VPTs predicted peak pressure at the forefoot. In the controls at the heel, peak pressure was predicted by the skin thickness, hardness, and stiffness associated with 30-Hz (R2 = 0.269, 0.268, and 0.267, respectively) and 200-Hz (R2 = 0.214, 0.247, and 0.265, respectively) VPTs. CONCLUSION The forefoot loading of people with diabetes can be predicted by the hardness of the skin when combined with loss of vibration perception at low (30-Hz) and high (200-Hz) frequencies. Further data from larger sample sizes are needed to confirm the current findings.
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Affiliation(s)
- Renan L Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Department of Health and Biological Science, Federal University of Amapá, Macapá, Brazil
| | - Tina J Drechsel
- Department of Human Locomotion, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Jane Suelen S P Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Claudio Zippenfennig
- Department of Human Locomotion, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Isabel C N Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, 05360-160, Brazil.
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Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes 2022; 13:1049-1065. [PMID: 36578871 PMCID: PMC9791567 DOI: 10.4239/wjd.v13.i12.1049] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection, amputation, and death, and is affecting increasing numbers of patients with diabetes mellitus. The pathogenesis of foot ulcers is complex, and different factors play major roles in different stages. The refractory nature of foot ulcer is reflected in that even after healing there is still a high recurrence rate and amputation rate, which means that management and nursing plans need to be considered carefully. The importance of establishment of measures for prevention and management of DFU has been emphasized. Therefore, a validated and appropriate DFU classification matching the progression is necessary for clinical diagnosis and management. In the first part of this review, we list several commonly used classification systems and describe their application conditions, scope, strengths, and limitations; in the second part, we briefly introduce the common risk factors for DFU, such as neuropathy, peripheral artery disease, foot deformities, diabetes complications, and obesity. Focusing on the relationship between the risk factors and DFU progression may facilitate prevention and timely management; in the last part, we emphasize the importance of preventive education, characterize several of the most frequently used management approaches, including glycemic control, exercise, offloading, and infection control, and call for taking into account and weighing the quality of life during the formulation of treatment plans. Multidisciplinary intervention and management of diabetic foot ulcers (DFUs) based on the effective and systematic combination of these three components will contribute to the prevention and treatment of DFUs, and improve their prognosis.
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Affiliation(s)
- Xuan Wang
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Chong-Xi Yuan
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Bin Xu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Zhi Yu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
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Negash W, Assefa T, Sahiledengle B, Tahir A, Regassa Z, Feleke Z, Regasa T, Tekalegn Y, Mamo A, Teferu Z, Solomon D, Gezahegn H, Bekele K, Zenbaba D, Tasew A, Desta F, Atlaw D, Wilfong T. Prevalences of diabetic foot ulcer and foot self-care practice, and associated factors in adult patients with diabetes in south-east Ethiopia. J Int Med Res 2022; 50:3000605221129028. [PMID: 36224759 PMCID: PMC9561672 DOI: 10.1177/03000605221129028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/08/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We aimed to assess the prevalences of foot ulcer and foot self-care practices, and identify associated factors in adult patients with diabetes attending a referral hospital in south-east Ethiopia. METHODS We performed a cross-sectional study of 267 diabetic patients. Multivariable binary logistic regression was used to identify factors associated with diabetic foot ulcer and foot self-care practice. RESULTS The prevalence of diabetic foot ulcer was 11.2% (95% confidence interval [CI] 7.42-15.05). One hundred and forty-four (53.9%; 47.9, 59.9) patients demonstrated good foot self-care. Living rurally (adjusted odds ratio 2.27; 95% CI: 1.86-6.97), lack of regular exercise (3.91; 1.51-10.10), peripheral neuropathy (2.77; 1.05-7.33) and foot calluses (5.69; 1.74-18.59) were associated with diabetic foot ulcer. Urban inhabitants (2.01; 1.09-3.69), patients with diabetes for >10 years (2.92; 1.48-5.77), women (2.95; 1.66-5.22), and patients with a glucometer at home (2.05; 1.09-3.85) were more likely to have good foot self-care practice. CONCLUSION The prevalence of diabetic foot ulcer was 11.2%. This prevalence is lower than those identified in other Ethiopian studies. However, patient awareness regarding foot self-care practice and risk reduction should be improved.
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Affiliation(s)
- Wogene Negash
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Tesfaye Assefa
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Biniyam Sahiledengle
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Anwar Tahir
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Zegeye Regassa
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Zegeye Feleke
- Nursing Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Tadele Regasa
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Yohannes Tekalegn
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Ayele Mamo
- Pharmacy Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Zinash Teferu
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Damtew Solomon
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Habtamu Gezahegn
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Kebebe Bekele
- Surgery Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Demisu Zenbaba
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Alelign Tasew
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Fikreab Desta
- Public Health Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Daniel Atlaw
- Biomedical Department, Madda Walabu University, Goba Referral
Hospital, Bale Goba, Ethiopia
| | - Tara Wilfong
- School of Public Health, Haramaya University College of Health
and Medical Sciences, Harar, Ethiopia
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7
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Yoshikawa Y, Maeshige N, Uemura M, Tanaka M, Kawabe N, Yamaguchi A, Fujino H, Terashi H. Prediction of callus and ulcer development in patients with diabetic peripheral neuropathy by isosceles triangle-forming tuning fork. SAGE Open Med 2022; 10:20503121221085097. [PMID: 35310932 PMCID: PMC8928360 DOI: 10.1177/20503121221085097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/15/2022] [Indexed: 01/09/2023] Open
Abstract
Objectives: Tuning fork vibration sensation testing is widely used as a diagnostic test to detect diabetic neuropathy. However, evidence-based literature indicates that reliability between examiners is low. Attaching isosceles triangle diagrams on tuning forks lowers the discrepancy between examiners. This study aimed to analyze the relationship between vibration sensation measurement using an improved tuning fork and the presence of callus and wound development in patients with diabetic peripheral neuropathy. Methods: Participants included 56 general older adults and 52 patients with diabetic peripheral neuropathy. The methods included confirmation of the presence or absence of callus, range of motion of the ankle and the first metatarsophalangeal joint, vibratory sensitivity of the medial malleolus and the dorsal aspect of the first distal phalanx using an improved tuning fork, and touch-pressure sensitivity of the plantar aspect of the hallux. Patients with diabetic peripheral neuropathy were followed up for 3 years to check for the presence or absence of wounds. Results: When compared with the general older adults, the patients with diabetic peripheral neuropathy had significantly lower touch-pressure sensitivity (p < 0.01), vibratory sensitivity at the distal phalanx (p < 0.01) and medial malleolus (p < 0.01), ankle dorsiflexion range of motion (p < 0.01), and metatarsophalangeal joint extension range of motion (p < 0.01). The area under the receiver operating characteristic curve with callus formation was 0.93 for the medial malleolus and 0.96 for the distal phalanx, indicating that the accuracy of the distal phalanx was higher (p < 0.01) than the medial malleolus. According to the Cox proportional hazard analysis, the vibratory sensitivity of the distal phalanx was a significant risk factor for ulcer development (p < 0.05). Conclusion: These findings suggest that the vibration sensation test, which we improved via the technique described in this study, is useful for predicting the occurrence of callus and ulcer.
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Affiliation(s)
- Yoshiyuki Yoshikawa
- Department of Rehabilitation, Faculty of Health Sciences, Naragakuen University, Nara, Japan
| | - Noriaki Maeshige
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Mikiko Uemura
- Department of Rehabilitation, Faculty of Health Science, Kansai University of Welfare Sciences, Osaka, Japan
| | - Masayuki Tanaka
- Department of Physical Therapy, Faculty of Health Sciences, Okayama Healthcare Professional University, Okayama, Japan
| | - Nobuhide Kawabe
- Faculty of Makuhari Human Care, Tohto University, Chiba, Japan
| | - Atomu Yamaguchi
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hidemi Fujino
- Department of Rehabilitation Science, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Hiroto Terashi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Zhang M, Yan J, Huang J, Ye K, Zhou P, Liu X. Prevalence and related factors of peripheral arterial disease in diabetes mellitus inpatients: a cross-sectional study in China. Endocr J 2022; 69:155-163. [PMID: 34526425 DOI: 10.1507/endocrj.ej21-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Peripheral arterialdisease (PAD) can result in diabetic foot ulcers, gangrene, and even amputation. Since most cases of PAD in diabetic patients are associated with peripheral neuropathy, the symptoms of vascular disease are easily concealed by the symptoms of neuropathy and are ignored by people, so it is critical for health care providers to screen PAD for the diabetes patients. This study was carried out to identify theprevalence and related factors of PAD in diabetes mellitus inpatients. This was a cross-sectional observational study. A total of 855 patients were enrolled in the study from December 2018 to December 2019. The patients were divided into a non-PAD group (ABI = 0.9-1.3) and a PAD group (ABI <0.9). Logistic multivariate regression analysis showed that age, LDL-C, dorsalis pedis artery pulsation (left foot), and sensory-current threshold (right foot) were related factors for peripheral arterial disease. Patients who are older and have a higher LDL-C level, abnormal dorsal foot pulse, and abnormal sensory-current threshold must be vigilant, and receive early screening for PAD diagnosis and treatment to avoid a malignant outcome. In clinical work, medical staff should actively apply PAD screening to diabetic patients, identify risk factors as early as possible, conduct early interventions, reduce the risk of PAD in patients, and avoid the occurrence of adverse outcomes.
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Affiliation(s)
- Minna Zhang
- Nursing Institute, Jinan University, Guangzhou 51000, China
| | - Junlan Yan
- Nursing Institute, Jinan University, Guangzhou 51000, China
| | - Jiewei Huang
- Department of Endocrine Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou 51000, China
| | - Kaiming Ye
- Department of Endocrine Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou 51000, China
| | - Peiru Zhou
- Department of Endocrine Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou 51000, China
| | - Xueyan Liu
- Department of Endocrine Metabolism, The First Affiliated Hospital of Jinan University, Guangzhou 51000, China
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Tronstad C, Amini M, Olesen E, Qvigstad E, Pabst O, Martinsen T, Abie SM, Martinsen ØG, Hisdal J, Jenssen TG, Kalvøy H. Diabetic Foot Assessment using Skin Impedance in a Custom Made Sensor-sock. JOURNAL OF ELECTRICAL BIOIMPEDANCE 2022; 13:136-142. [PMID: 36694878 PMCID: PMC9837869 DOI: 10.2478/joeb-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Indexed: 06/17/2023]
Abstract
Diabetic peripheral neuropathy (DPN) may lead to several changes in the skin, and some of these may influence the skin impedance spectrum. In the present study we have developed a prototype solution for skin impedance spectroscopy at selected skin sites (big toe pulp, heel and toe ball) that was tested in a pilot study on five patients with DPN and five healthy controls. At the big toe, most of the controls had markedly lower impedance than the DPN group, especially in the range of 1-100 kHz. The separation between the groups seems to be weaker at the heel and weakest at the toeball. The results may indicate that monitoring of the skin impedance spectrum may be a method for detection of skin changes associated with DPN, encouraging further studies with the big toe sensor in particular.
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Affiliation(s)
- Christian Tronstad
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Maryam Amini
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Eline Olesen
- Department of Physics, University of Oslo, Oslo, Norway
| | - Elisabeth Qvigstad
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Oliver Pabst
- Department of Physics, University of Oslo, Oslo, Norway
| | - Tormod Martinsen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
| | - Sisay M. Abie
- Faculty of Ecology and Natural Resource Management, Norwegian University of Life Sciences, Oslo Ås, Norway
| | - Ørjan G. Martinsen
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Jonny Hisdal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Trond G. Jenssen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Håvard Kalvøy
- Department of Clinical and Biomedical Engineering, Oslo University Hospital, Oslo, Norway
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Yuniati R, Innelya I, Rachmawati A, Charlex HJM, Rahmatika A, Khrisna MB, Mundhofir FEP, Hario Seno KHN, Kristina TN. Application of Topical Sucralfate and Topical Platelet-Rich Plasma Improves Wound Healing in Diabetic Ulcer Rats Wound Model. J Exp Pharmacol 2021; 13:797-806. [PMID: 34429664 PMCID: PMC8374851 DOI: 10.2147/jep.s296767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 05/24/2021] [Indexed: 01/13/2023] Open
Abstract
Purpose One of the most serious and devastating complications of diabetes mellitus is diabetic ulcers. They are difficult to treat and often result in limb loss. Topical sucralfate and platelet-rich plasma have the potential to improve the healing outcomes of chronic ulcers, including diabetic ulcers. This research aims to determine the effectiveness of sucralfate and platelet-rich plasma therapy for the improvement of diabetic ulcer wound healing. Patients and Methods Ninety Wistar rats were used in this study and were classified into five groups. Four of the five groups were diabetic induced and were treated with topical sucralfate only, platelet-rich plasma only, combination of topical sucralfate and platelet-rich plasma, and diabetic control group which received standard therapy only. The non-diabetic control group did not receive any therapy. We observed macrophage amount, platelet-derived growth factor, vascular endothelial growth factor, and hypoxia-inducible factor as a biomarker. Rats were terminated after 7th and 14th days and were subjected to immunohistochemistry staining and examination. Results We found that topical sucralfate and platelet-rich plasma increase macrophage levels, vascular endothelial growth factor expression and platelet-derived growth factor expression in diabetic wound cells. We also found a reduction in hypoxia inducible factor-1α expression. Combination of topical sucralfate and platelet-rich plasma for 14 days gave the most significant improvement in terms of wound healing compared to topical sucralfate or platelet-rich plasma alone. Conclusion The combination of topical sucralfate and platelet-rich plasma therapy results in the best improvement in diabetic ulcer wound healing compared to sucralfate or platelet-rich plasma monotherapy or conventional wound healing therapy.
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Affiliation(s)
- Renni Yuniati
- Dermatology and Venereology Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Innelya Innelya
- Undergraduate Student, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Arti Rachmawati
- Undergraduate Student, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | | | - Alfi Rahmatika
- Undergraduate Student, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | - Matthew Brian Khrisna
- Dermatology and Venereology Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
| | | | | | - Tri Nur Kristina
- Microbiology Department, Faculty of Medicine, Diponegoro University, Semarang, Indonesia
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Abstract
This article discusses the effects of ageing on the skin, particularly the main structural and functional changes that occur in the epidermis and dermis that make the skin more vulnerable to damage. Specific alterations that occur with ageing include slower epidermal turnover, flattening of the epidermal-dermal junction, loss of moisture and hydration as well as reduced immunity placing the skin at increased risk of damage. The discussion will also examine common periwound complications associated with ageing including; maceration, excoriation, dry skin, hyperkeratosis, callus, contact dermatitis and eczema. Strategies to manage these problems and interventions to reduce the risk of these complications include moisturising the skin to make it more resilient, debriding keratinised and callus tissue in the periwound area, appropriate choice of dressings to manage excessive exudate, careful removal of dressings as well as treating inflammatory conditions of the periwound skin.
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Affiliation(s)
- Samantha Holloway
- Reader, Centre for Medical Education, School of Medicine, Cardiff University, Wales
| | - Kirsty Mahoney
- Senior Tissue Viability Nurse and Clinical Operational programme improvement Lead, Welsh Wound Innovation Centre
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Esther CL, Ana Belen OA, Aranzazu RM, Gabriel GN. Foot deformities in patients with diabetic mellitus (with and without peripheral neuropathy). J Tissue Viability 2021; 30:346-351. [PMID: 33875343 DOI: 10.1016/j.jtv.2021.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 03/12/2021] [Accepted: 04/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) is one of the most common complications in diabetes mellitus. It is the disorder that most commonly affects the feet of people with diabetes. The aim of the present study is to determine the relationship between DPN and the presence of deformities in the foot. MATERIAL AND METHODS A descriptive observational study was conducted of 111 patients diagnosed with Diabetes Mellitus (DM) type 1 or 2. All participants were aged at least 18 years and were previously informed in detail about the aims and procedures of the study. RESULTS Regarding the presence of DPN, the only significant relationships were found for the right foot with the deformity of the second toe (claw, hammer or mallet) (p = 0.017, OR 0.29 [0.10-0.83]) and for the left foot with the deformity of the second toe (p = 0.048; OR: 0.37 [0.14-1.01]), third toe (p = 0.012; OR: 0.29 [0.11-0.79]) and the presence of hallux extensus (p = 0.05; OR: 8.27 [1.05-64.98]). CONCLUSIONS A significant number of foot deformities were observed among these patients with DM, regardless of the presence of DPN. These deformities should be carefully evaluated in order to determine the most appropriate treatment at an early stage, which will reduce the risk of ulceration. Although it should be use with caution to be transferrable to the general population with peripheral neuropathy.
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Affiliation(s)
- Chicharro-Luna Esther
- Department of Behavioral and Health Sciences, Miguel Hernandez University, Alicante, Spain
| | - Ortega-Avila Ana Belen
- Department of Nursing, University of Malaga, Spain; Biomedical Research Institute (IBIMA), 29010, Malaga, Spain.
| | | | - Gijon-Nogueron Gabriel
- Department of Nursing, University of Malaga, Spain; Biomedical Research Institute (IBIMA), 29010, Malaga, Spain
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Wang Y, Zhang H, Zhou M, Yi X, Duan P, Yu A, Qi B. Autologous Fat Grafting Promotes Macrophage Infiltration to Increase Secretion of Growth Factors and Revascularization, Thereby Treating Diabetic Rat Skin Defect. Diabetes Metab Syndr Obes 2020; 13:4897-4908. [PMID: 33328749 PMCID: PMC7734072 DOI: 10.2147/dmso.s286787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/13/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Diabetic skin defect is difficult to manage in surgical clinics, and there is still lack of effective treatments for diabetic skin defects. Currently, autologous fat grafting (AFG) is promising in the field of reconstructive surgery, while macrophage infiltration in autologous adipose tissue is considered vital for tissue regeneration. But AFG is rarely applied to the treatment of diabetic skin defects, and whether macrophage infiltration assists AFG to promote wound healing is still unknown. METHODS Full-thickness skin defect diabetic rats were divided into 3 groups: control group, autologous fat grafting (AFG) group and AFG with macrophage depletion (AFG+MD) group. We examined the amount of macrophages in the wounds bed and the expression level of inflammatory factors IL-10, IL-6, TNF-α, and also growth factors PDGF-β, TGF-β, IGF-1 at the same time. The content of collagen-I and α-smooth muscle actin protein in the wounds were determined by Western blot analysis. Finally, the healing of the wounds was evaluated. RESULTS The AFG group showing more rapid healing, secreting more growth factors and more obvious vascularization in the healing process, compared with the control group. But, the secretion of growth factors and the construction of extracellular matrix (ECM) in the wounds were limited when macrophages were depleted after AFG. CONCLUSION AFG promotes the infiltration of macrophages to improve the healing environment of diabetic wounds by increasing the secretion of growth factors and revascularization, which provides a potential method for the treatment of diabetic skin defects.
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Affiliation(s)
- Yu Wang
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
| | - Hao Zhang
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
| | - Min Zhou
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
| | - Xinzeyu Yi
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
| | - Ping Duan
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
| | - Aixi Yu
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
- Correspondence: Aixi Yu; Baiwen Qi Wuhan University Zhongnan Hospital, 169 East Lake Road, Wuchang District, Wuhan, Hubei430071, People’s Republic of ChinaTel/Fax +86 67813120 Email ;
| | - Baiwen Qi
- Department of Orthopaedic Trauma and Microsurgery, Wuhan University Zhongnan Hospital, Wuhan, Hubei430071, People’s Republic of China
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Abstract
Ageing leads to a number of skin changes that not only place an older adult at risk of tissue damage, but can present as peri-wound problems for those with existing wounds, for example, incontinence-associated and moisture-associated dermatitis in individuals with pressure ulcers. Older adults with venous disease experience skin changes concomitant with venous hypertension, making the skin more at risk of breakdown, specifically the common complications of lipodermatosclerosis and venous eczema. In individuals with diabetic foot disease, skin changes related to autonomic neuropathy mean patients can experience dry skin that cracks easily, placing them at higher risk of infection. Common to all individuals with wounds requiring some sort of dressing is the risk of medical adhesive-related skin injury, where dressing application and removal need to be of the utmost priority to reduce the risk of injury. This article discusses some of the common peri-wound skin considerations in patients with chronic wounds.
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Affiliation(s)
- Samantha Holloway
- Reader, Programme Director MSc in Wound Healing and Tissue Repair Cardiff University School of Medicine
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Wang Y, Cao HJ, Wang LQ, Lu CL, Yan YQ, Lu H, Zhang K, Zhang HM, Liu JP. The effects of Chinese herbal medicines for treating diabetic foot ulcers: A systematic review of 49 randomized controlled trials. Complement Ther Med 2019; 44:32-43. [PMID: 31126573 DOI: 10.1016/j.ctim.2019.03.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 02/22/2019] [Accepted: 03/12/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess the effects and associated risks of Chinese herbal medicine (CHM) for diabetic foot ulcer (DFU). METHODS We systematically searched seven electronic databases for randomized controlled trials (RCTs) about Chinese herbal medicines for treating diabetic foot ulcers. The methodological quality of RCTs was assessed by the Cochrane risk of bias tool. Data was synthesized using review manager (RevMan) 5.3. Meta-analysis was conducted if the data were available. A summary of finding table was generated by The GRADEpro Guideline Development Tool (GDT) online. RESULTS Forty-nine RCTs, all conducted in China, involving 3646 participants were included. Most of the included trials had unclear or high risk of bias. Twenty-six trials could be pooled in five Meta-analyses, the remaining trials could not be pooled due to the obvious clinical heterogeneity. Only low evidence showed CHM therapy may have 42%-60.4% participants healed completely after treatment, approximately twice (RR 1.42-1.76) as much as the healed rates in conventional therapy (or plus hot water foot bath) group. Majority of the included trials reported benefit of CHM group on shortening healing time (4-23 days) and reducing ulcer wound size (at least 2 cm2). No serious adverse events were reported related to the medication in all trials. CONCLUSION Weak evidence showed benefit of CHM as add-on treatment of conventional therapy on increasing number of ulcer heals in patients with DFU. That's about twice the healing rate of the conventional treatment (or plus hot water foot bath) group. With insufficient information, we could not draw confirmative conclusion on safety of CHM administration. These findings need to be tested in further large, rigorous trials.
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Affiliation(s)
- Ying Wang
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Hui-Juan Cao
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Li-Qiong Wang
- School of acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Chun-Li Lu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Yu-Qian Yan
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Hao Lu
- Department of Endocrinology, Shuguang Hospital affiliated to Shanghai TCM University, Shanghai, 200020, China.
| | - Kang Zhang
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Hui-Min Zhang
- School of Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China.
| | - Jian-Ping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, 100029, China; Institute of Integrated Traditional Chinese Medicine and Western Medicine, Guangzhou Medical University, Guangzhou, Guangdong, 510182, China.
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Guidelines for Diabetic Foot Care: A Template for the Care of All Feet. J Wound Ostomy Continence Nurs 2019; 46:241-245. [PMID: 31083067 DOI: 10.1097/won.0000000000000532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Adiewere P, Gillis R, Imran Jiwani S, Meal A, Shaw I, Adams G. 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; 4:e00614. [PMID: 29872752 PMCID: PMC5986308 DOI: 10.1016/j.heliyon.2018.e00614] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 03/20/2018] [Accepted: 04/20/2018] [Indexed: 12/18/2022] Open
Abstract
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. CINAHL, EMBASE, MEDLINE, PSYCINFO, Cochrane Library and Evidence-Based Nursing, National Library for Health, Medica and Google Scholar were searched. Only English language studies were considered. Databases were searched from their inception to September 2017. FINDINGS Six RCTs met the inclusion criteria. Only five RCTs reported on the incidence of DFU whilst only two reported on amputation rates. There was no advantage of combining different educational approaches in preventing/reducing DFU, relative risk (RR) of 0.50 (95%CI 0.21, 1.17) (P = 0.11). Two RCTs based on foot care education alone were compared with usual care; the result showed a non-significant effect (P = 0.57) with high heterogeneity of 77%.Analysis based on intensive versus brief educational approach showed a statistically reduced risk of incidence of DFU in the intervention group when compared to the control group; (RR, 0.37, 95%CI 0.14, 1.01) (P = 0.05) with high heterogeneity of 91%. INTERPRETATION The intensive educational intervention was associated with reduced incidence of DFU.
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Affiliation(s)
- P. Adiewere
- The University of Nottingham, School of Health Sciences, B Floor, South Block Link, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - R.B. Gillis
- The University of Nottingham, School of Health Sciences, B Floor, South Block Link, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - S. Imran Jiwani
- The University of Nottingham, School of Health Sciences, B Floor, South Block Link, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - A. Meal
- The University of Nottingham, School of Health Sciences, B Floor, South Block Link, Queen's Medical Centre, Nottingham, NG7 2HA, UK
| | - I. Shaw
- The University of Nottingham, Faculty of Social Sciences, University Park, Nottingham, NG7 2RD, UK
| | - G.G. Adams
- The University of Nottingham, School of Health Sciences, B Floor, South Block Link, Queen's Medical Centre, Nottingham, NG7 2HA, UK
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Zhong A, Li G, Wang D, Sun Y, Zou X, Li B. The risks and external effects of diabetic foot ulcer on diabetic patients: A hospital-based survey in Wuhan area, China. Wound Repair Regen 2017; 25:858-863. [PMID: 29052949 DOI: 10.1111/wrr.12589] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/18/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Aimei Zhong
- Department of Plastic Surgery; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Gongchi Li
- Department of Hand Surgery; Union Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Dan Wang
- Department of Wound Repair Surgery; Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Yi Sun
- School of Public Health; Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Xinghua Zou
- Department of Wound Repair Surgery; Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
| | - Binghui Li
- Department of Wound Repair Surgery; Liyuan Hospital, Tongji Medical College, Huazhong University of Science and Technology; Wuhan China
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Wang M, Yang G, Jiang X, Lu D, Mei H, Chen B. Peroxisome Proliferator-Activated Receptor-γ Coactivator-1α (PGC-1α) Regulates the Expression of B-Cell Lymphoma/Leukemia-2 (Bcl-2) and Promotes the Survival of Mesenchymal Stem Cells (MSCs) via PGC-1α/ERRα Interaction in the Absence of Serum, Hypoxia, and High Glucose Conditions. Med Sci Monit 2017; 23:3451-3460. [PMID: 28711948 PMCID: PMC5525574 DOI: 10.12659/msm.902183] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 12/08/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND To study the effect of estrogen-related receptor α (ERRα) and peroxisome proliferator-activated receptor-γ coactivator-1α (PGC-1α) on mesenchymal stem cells (MSCs) apoptosis, and further investigated its detailed molecular mechanisms in the absence of serum, hypoxia, and high glucose conditions. MATERIAL AND METHODS In our study, we first evaluated the expression rates of CD14, CD34, CD45, CD44, CD29, and Sca-1 surface markers on MSCs by flow cytometry. Then, the ability of osteogenic and fatty differentiation of MSCs was determined by osteogenic differentiation and adipogenesis reagent kit. Next, Annexin V-APC/7-AAD apoptosis kit was used for detecting the apoptosis rate of MSCs. RT-PCR and Western blotting were used for detection of mRNA expression and proteins expression, respectively. RESULTS Our data showed that the MSCs used in our study were capable of self-renewal and differentiating into many cell lineages, such as osteogenic differentiation and adipogenesis. Our results further showed that over-expression of PGC-1α could protect MSCs from apoptosis induced by rotenone. We also found that PGC-1α over-expression could enhance the expression of anti-apoptotic gene Bcl-2, and inhibit the expression of pro-apoptotic gene Bax in MSCs. In addition, our data demonstrated that PGC-1α could induce upregulation of Bcl-2 and further promote the survival of MSCs by interacting with ERRα. CONCLUSIONS In the absence of serum, hypoxia and high glucose conditions, PGC-1α can regulate the expression of Bcl-2 and promote the survival of MSCs via PGC-1α/ERRα interaction.
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Affiliation(s)
- Min Wang
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Guangxin Yang
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Xiaoyan Jiang
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Debin Lu
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
| | - Hao Mei
- Center of Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT, U.S.A
| | - Bing Chen
- Department of Endocrinology, Southwest Hospital, Third Military Medical University, Chongqing, P.R. China
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