To compare the platelet enrichment ratio of platelet-rich plasma (PRP) prepared by different centrifuge methods and to compare the concentration of growth factors released from autologous platelet-rich gel (APG) with the whole blood. Methods Thirteen diabetic patients with refractory skin lesions were enrolled in APG treatment. ① Three kinds of centrifuge methods were selected for PRP by 11 diabetic patients: A(n=6): 529 × g for 4 minutes in the first centrifugeand 854 × g for 6 minutes in the second centrifuge; B (n=5): 313 × g for 4 minutes in the first centrifuge and 1 252 × g for 6 minutes in the second centrifuge; C (n=5): 176 × g for 5 minutes in the first centrifuge and 1 252 × g for 5 minutes in the second centrifuge. Platelet counted on the whole blood and PRP was determined. The APG, produced by combining the PRPwith thrombin and calcium gluconate (10 ∶ 1) was used by patients. ② PDGF-BB, TGF-β1, VEGF, EGF, and IGF-1 were measured in the APG and the whole blood using the enzyme-l inked immunosorbent assay method. Results ① The average platelet concentration was higher in group B [(1 363.80 ± 919.74) × 109/ L] than in groups A[(779.67 ± 352.39) × 109/ L)] and C[(765.00 ± 278.78) × 109/ L] and the platelet recovery rate was 75.2% ± 21.0% in group B. ② The concentration of growth factors all increased with the increasing platelet number. On average, for the whole blood as compared with APG, the PDGF-BB concentration increased from (145.94 ± 133.24) pg/mL to (503.81 ± 197.86) pg/mL (P lt; 0.05); TGF-β1 concentration increased from (3.31 ± 2.27) ng/mL to (5.67 ± 4.80) ng/mL (P lt; 0.05); IGF-1concentration increased from (14.54 ± 35.34) ng/mL to (110.56 ± 84.36) ng/mL (P lt; 0.05); and EGF concentration increased from (160.73 ± 71.10) pg/mL to (265.95 ± 138.43) pg/mL (P lt; 0.05). No increase was found for VEGF(P gt; 0.05). ③ There was positive correlation between the platelet concentration and PDGF-BB and TGF-β1 (r = 0.627, r = 0.437, P lt; 0.05). ④ Thirteen diabetic repractory dermal ulcers received APG treatment for 18 times, 9 ulcers (69.2%) and 10 sinuses (88.3%) were cured at the end of 12-week treatment. Conclusion The method ofgroup B is the best centrifuge method. A variety of growth factors are detected and released from the platelets at significant levels in APG. There is positive correlation between the platelet concentration and PDGF-BB and TGF-β1 .
Objective To identify the best therapy regimen for a patient with rare chronic leg ulcer in necrobiosis lipoidica diabeticorum (NLD). Methods We searched the Cochrane Library (Issue 3, 2006), PubMed (1966-July 2006), EMbase (1974-July 2006) and CBM (1978-July 2006) to identify relevant evidence. The quality of the retrieved studies was critically assessed. Results A total of 153 records were retrieved. No clinical guidelines, systematic reviews or clinical randomized studies were identified. Thirty treatment-related studies involving 17 interventions showed that, fumaric acid esters, oral pentoxifylline, topical use of growth factors and surgical skin flap transplant were relatively more effective and safer than conventional therapies. Conclusion After treatment with tropical granulocyte colony-stimulating factor, the patient with chronic leg ulcers was healed.
Objective To evaluate the efficacy and safety of Bismuth Subgallate/Borneol (SuileTM) (BSB) dressing in the treatment of diabetic foot ulcers. Method s A two-center, randomized controlled parallel-group comparison study was conducted. Between September 2005 and November 2006, 35 patients with nonhealing diabetic foot ulcer (Wagner 2-3 grade) were recruited and divided randomly into the test group (BSB group, n=25) and control group (IG group, n=10). There was no significant difference in general data between 2 groups (P gt; 0.05). Based on the comprehensive therapy of diabetic foot, ulcers were topically treated by SuileTM dressing and Intrasite gel in the BSB group and IG group, respectively. The ulcer area was measured once a week. Ulcer bleeding was observed and acceptance of the dressing was inquired each week. Results Of the patients, 22 patients in the BSB group and 8 in the IG group completed the clinical trial. Intention to treat (ITT) analysis indicated that the results were excellent in 19 (76%) cases, good in 3 cases (12%), fair in 1 case (4%), and poor in 2 cases (8%) in the BSB group. In the IG group, the results were excellent in 8 cases (80%) cases, fair in 1 case (10%), and poor in 1 case (10%). Per-protocol (PP) analysis showed that the results were excellent in 19 cases (86%) and good in 3 cases (14%) in the BSB group, and were excellent in 8 cases (100%) in the IG group. The results of ITT and PP analysis all showed no significant difference between 2 groups (P gt; 0.05). The change trend of ulcer areas in the BSB group was similar to that in the IG group. There was no significant difference in the hemostatic effect between 2 groups (P gt; 0.05) and the patients were more likely to accept BSB dressings. Conclusion BSB dressings is an effective, safe, and generally well-tolerated therapy dressing in the treatment of diabetic foot ulcers.
【摘要】 目的 探讨胰岛素强化治疗对2型糖尿病（type 2 diabetes mellitus，T2DM）患者血清脂联素（adiponectin，APN）的影响。 方法 2007年7—12月，研究纳入连续使用胰岛素治疗至少3个月但血糖控制欠佳[6.5%≤糖化血红蛋白（hemoglobin A1c， HbA1c）≤11.0%]的T2DM患者40例，其中男18例，女22例；年龄29~〖JP2〗69岁；平均诊断T2DM病史11年。治疗方案为进行16周的胰岛素强化治疗，血糖控制目标为空腹血糖≤7 mmol/L，〖JP〗餐后2 h血糖≤8 mmol/L。分别于强化治疗前、强化治疗4周后及强化治疗16周后测定HbA1c以及血清APN水平。 结果 与强化治疗前相比，胰岛素治疗4周后空腹及三餐后2 h血糖明显下降（Plt;0.05），但HbA1c和血清APN水平差异无统计学意义（Pgt;0.05）；强化16周后，HbA1c水平明显低于治疗前和治疗4周后且差异具有统计学意义（Plt;0.05），APN水平高于治疗前和治疗4周后且差异有统计学意义（Plt;0.05）。体质量指数在强化治疗16周后明显增加且与强化治疗前和强化治疗后4周相比差异具有统计学意义（Plt;0.05）。APN与空腹血糖（b=-0.225，P=0.013）、早餐后2 h血糖（b=-0.229，P=0.012）呈负相关。 结论 胰岛素强化治疗可以提高T2DM患者血清APN水平。【Abstract】 Objective To investigate the effect of intensive insulin therapy on serum adiponectin (APN) level in patients with type 2 diabetes mellitus (T2DM). Methods Forty patients with T2DM who had undergone insulin therapy for at least three months but with their blood glucose poorly controlled [glycosylated hemoglobin Alc (HbA1c) level ranged from 6.5% to 10.0%] from July to December 2007 were enrolled in this study. There were 18 males and 22 females with their age ranged from 29 to 69 years. They had an average time of T2DM history of 11 years. Intensive insulin therapy was carried out for 16 weeks with a target of less than 7 mmol/L for fasting blood glucose and 8 mmol/L for postprandial blood glucose. HbA1c and serum adiponectin concentrations were detected at baseline, at week 4 after intensive therapy and at the end of the study. Results After 4 weeks of intensive blood glucose control, fasting and postprandial blood glucose levels decreased significantly (Plt;0.05), but the HbA1c and serum APN concentrations did not reduce remarkably (Pgt;0.05). After 16 weeks of treatment, the level of HbA1c was significantly lower than those at baseline and 4 weeks after treatment (Plt;0.05), and serum APN concentration increased significantly (Plt;0.05), compared with those two time points. However, an evident increase of body mass index (BMI) was found while compared with BMI at baseline and 4 weeks after treatment (Plt;0.05). The linear regression analysis indicated that APN was negatively associated with fasting blood glucose (b=-0.225,P=0.013) and blood glucose level 2 hours after breakfast (b=-0.229,P=0.012). Conclusion Intensive insulin therapy can improve serum adiponectin level in type-2 diabetic patients.