Non-coding RNAs in diabetic foot ulcer- a focus on infected wounds.

Diabetes mellitus is associated with a wide range of neuropathies, vasculopathies, and immunopathies, resulting in many complications. More than 30% of diabetic patients risk developing diabetic foot ulcers (DFUs). Non-coding RNAs (ncRNAs), including microRNAs (miRNAs), long non-coding RNAs (lncRNAs), and circular RNAs (circRNAs), play essential roles in various biological functions in the hyperglycaemic environment that determines the development of DFU. Ulceration results in tissue breakdown and skin barrier scavenging, thereby facilitating bacterial infection and biofilm formation. Many bacteria contribute to diabetic foot infection (DFI), including Staphylococcus aureus (S. aureus) et al. A heterogeneous group of "ncRNAs," termed small RNAs (sRNAs), powerfully regulates biofilm formation and DFI healing. Multidisciplinary foot care interventions have been identified for nonhealing ulcers. With an appreciation of the link between disease processes and ncRNAs, a novel therapeutic model of bioactive materials loaded with ncRNAs has been developed to prevent and manage diabetic foot complications.

Antisense yycF and BMP-2 co-delivery gelatin methacryloyl and carboxymethyl chitosan hydrogel composite for infective bone defects regeneration.

Repairing infected bone defects remains a challenge in clinical work. Intractable bacterial infections and insufficient osseointegration are major concerns for infected bone defects. To address these issues, we developed a gelatin methacryloyl (GelMA) and carboxymethyl chitosan (CMCS) composite hydrogel with BMP-2 growth factor and GO based antisense technology supported by a PLGA spring. In vitro, photo-crosslinked GelMA composite hydrogels shown excellent biocompatibility and degradability. Relying on the release of BMP-2 from the composite hydrogel provides osteogenic effects. The antisense yycF and BMP-2 were released with the degradation of GelMA and CMCS composite hydrogel. In terms of antimicrobial properties, CMCS, GO and post-transcriptional regulatory antisense yycF from the composite hydrogel synergistically kill S. aureus. In vivo, we implanted the composite hydrogel in a rat model of S. aureus infected femur defect, effectively accelerating bone healing in an infectious microenvironment. This research provides a novel biomaterial that is both antimicrobial and promotes bone regeneration, with the potential to treat infected bone defects.

Accelerated Healing of Infected Diabetic Wounds by a Dual-Layered Adhesive Film Cored with Microsphere-Loaded Hydrogel Composite Dressing.

Diabetic wounds, a prevalent chronic disease, are associated with older age. The hyperglycemic microenvironment in diabetic wounds significantly reduces the immune system, inducing bacterial invasion. The coupling of tissue repair and antibacterial treatment is critical for infected diabetic ulcer regeneration. In this study, a dual-layered sodium alginate/carboxymethyl chitosan (SA/CMCS) adhesive film cored with an SA-bFGF microsphere-loaded small intestine submucosa (SIS) hydrogel composite dressing with a graphene oxide (GO)-based antisense transformation system was developed to promote infected diabetic wound healing and bacterial eradication. Initially, our injectable SIS-based hydrogel composite stimulated angiogenesis, collagen deposition, and immunoregulation in diabetic wound repair. The GO-based transformation system subsequently inhibited bacterial viability in infected wounds by post-transformation regulation. Meanwhile, the SA/CMCS film provided stable adhesion covering the wound area to maintain a moist microenvironment, which promoted in situ tissue repair. Our findings provide a promising clinical translation strategy for promoting the healing of infected diabetic wounds.

[Effectiveness comparison of open reduction and internal fixation for open and closed ankle Logsplitter fractures].

Objective: To investigate the effectiveness of open reduction and internal fixation on high-energy ankle Logsplitter injuries (a kind of transsyndesmotic ankle fracture dislocation), and compare the prognosis between open and closed Logsplitter fracture. Methods: The clinical data of 36 Logsplitter fractures treated with open reduction and internal fixation between April 2011 and May 2016 were retrospectively analyzed. Among them, 15 cases were open fracture and dislocation (open group) and 21 cases were closed fracture and dislocation (closed group). There was no significant difference between the two groups in gender, age, combined injury, injury to hospital admission time, and other general data ( P>0.05), with comparability. The wound healing, ankle mobility recovery, complications, and fracture healing were observed after operation. The ankle function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) score. Results: Both groups were followed up 12-29 months (mean, 19 months). There was no significant difference in the follow-up time between the open group and the closed group ( t=1.169, P=0.251). In the open group, there were 3 cases of postoperative infection, 3 cases of nonunion, and 5 cases of post-traumatic osteoarthritis; the above complications occurred in 1 case in the closed group; there was no significant difference in complications between the two groups ( P=0.41) except post-traumatic osteoarthritis ( P=0.02). At last follow-up, there was no significant difference in AOFAS score between the two groups ( t=1.981, P=0.056). According to AOFAS score criterion, the results were good in 10 cases and general in 5 cases in the open group, and good in 13 cases and general in 8 cases in the closed group, showing no significant difference ( P=0.45). There was no significant difference in the fracture healing time and ankle flexion, dorsal extension, varus, and valgus motion between the two groups ( P>0.05). Conclusion: Open reduction and internal fixation for open or closed Logsplitter fractures can achieve satisfactory results, improve fracture healing rate, effectively reduce the incidence of complications, and improve ankle function.

[Biomechanical effect of anteromedial coronoid facet fracture and lateral collateral ligament complex injury on posteromedial rotational stability of elbow].

Objective: To investigate the effect of anteromedial coronoid facet fracture and lateral collateral ligament complex (LCLC) injury on the posteromedial rotational stability of the elbow joint. Methods: The double elbows were obtained from 4 fresh adult male cadaveric specimens. Complete elbow joint (group A, n=8), simple LCLC injury (group B, n=4), simple anteromedial coronoid facet fracture (group C, n=4), and LCLC injury combined with anteromedial coronoid facet fracture (group D, n=8). The torque value was calculated according to the load-displacement curve. Results: There was no complete dislocation of the elbow during the experiment. The torque values of groups A, B, C, and D were (10.286±0.166), (5.775±0.124), (6.566±0.139), and (3.004±0.063) N·m respectively, showing significant differences between groups ( P<0.05). Conclusion: Simple LCLC injury, simple anteromedial coronoid facet fracture, and combined both injury will affect the posteromedial rotational stability of the elbow.