Foam dressing and micropower vacuum dressing promote diabetic foot ulcer wound healing by activating the PI3K/AKT/mTOR pathway in rats.

Foam dressing (FD) and micropower vacuum dressing (MVD) have been applied in the treatment of diabetic foot ulcer (DFU). However, research about the mode of action on the efficacy of the two dressings is extremely rare. This study proposed to explore the mechanism involved in diabetic wound healing under FD or MVD treatment. Macroscopical study was performed to evaluate the effectiveness of FD and MVD on wound healing in a rat model of DFU. Morphological analysis in the wound skin tissue was conducted by hematoxylin and eosin staining. Meanwhile, inflammatory cytokines in serum were measured by enzyme linked immunosorbent assay. The protein expression of phosphatidylinositol 3 kinase, protein kinase B and mammalian target of rapamycin (PI3K/AKT/mTOR) and their phosphorylation levels were determined by western blotting. We found that wound healing in rats with DFU was enhanced with the application of FD and MVD. The therapeutic efficacy of FD was superior to MVD. Compared with diabetic foot group, the concentrations of inflammatory cytokines, tumor necrosis factor alpha, interleukin-1ß and interleukin-6, were significantly down-regulated. Besides, the phosphorylation levels of PI3K, AKT and mTOR were up-regulated under FD or MVD treatment. We demonstrated that the treatment of FD and MVD effectively promoted the wound skin healing through activating the PI3K/AKT/mTOR pathway. Our research may provide a new idea for exploring the mode of action of dressing application in healing of DFU.

Relationship between age of pregnant women with gestational diabetes mellitus and mode of delivery and neonatal Apgar score.

BACKGROUND: Gestational diabetes mellitus (GDM) refers to abnormal glucose tolerance during pregnancy, and it is often accompanied by obvious changes in glucose and lipid metabolism, and associated with adverse pregnancy outcomes. The incidence of fetal distress, polyhydramnios, puerperal infection, premature delivery, and macrosomia in pregnant women with GDM are higher than in those without GDM. AIM: To analyze the relationship between age of pregnant women with GDM and mode of delivery and neonatal Apgar score. METHODS: A total of 583 pregnant women with GDM who delivered in the Department of Obstetrics at our hospital between March 2019 and March 2022 were selected. Among them, 377 aged < 35 years were selected as the right age group and 206 aged > 35 years were selected as the older group. The clinical data of the two groups were collected, and the relationship between age of the pregnant women with GDM and mode of delivery, maternal and neonatal outcomes, and neonatal Apgar score were compared. In the older group, 159 women were classed as the adverse outcome group and 47 as the good outcome group according to whether they had adverse maternal and infant outcomes. The related factors of adverse maternal and infant outcomes were analyzed through logistic regression. RESULTS: The number of women with assisted pregnancy, ≤ 37 wk gestation, ≥ 2 pregnancies, one or more deliveries, and no pre-pregnancy blood glucose screening in the older group were all higher than those in the right age group (P < 0.05). The natural delivery rate in the right age group was 40.85%, which was higher than 22.33% in the older group (P < 0.05). The cesarean section rate in the older group was 77.67%, which was higher than 59.15% in the right age group (P < 0.05). The older group had a higher incidence of polyhydramnios and postpartum hemorrhage, and lower incidence of fetal distress than the right age group had (P < 0.05). There was no significant difference in neonatal weight between the two groups (P > 0.05). The right age group had higher Apgar scores at 1 and 5 min than the older group had (P < 0.05). Significant differences existed between the poor and good outcome groups in age, education level, pregnancy mode, ≤ 37 wk gestation, number of pregnancies, and premature rupture of membranes (P < 0.05). Logistic regression showed that age, education level and premature rupture of membranes were all risk factors affecting the adverse outcomes of mothers and infants (P < 0.05). CONCLUSION: Delivery mode and Apgar score of pregnant women with GDM are related to age. Older age increases the adverse outcome of mothers and infants.

Effect of Micropower Vacuum Dressing on Promoting Wound Healing in Patients with I-II Diabetic Foot.

Objective: Discuss the effectiveness and value of micropower vacuum dressing (MVD) in promoting the healing of I-II grades diabetic foot wounds. Methods: Sixty patients diagnosed with diabetic foot ulcers and Wagner grades I-II were selected and randomly divided into the control group and experimental group, with 30 cases in each group. The control group was covered with conventional treatments and petrolatum gauze dressings, and the experimental group was treated with MVD on the basis of conventional reatments. The therapeutic effects of the two groups were observed, including healing rate, ulcer area reduction rate, ulcer healing time, dressing change times, ulcer recurrence rate, adverse events, and so on. Results: The healing rate (100%) of the experimental group was higher than that of the control group (56.7%); the wound reduction rate was higher than that of the control group (P < 0.05); the healing time, the number of dressing changes, and the 1-month recurrence rate were all low in the control group (P < 0.05). The incidence of adverse reactions in the experimental group (6.7%) was lower than that in the control group (46.7%) (P < 0.05). Conclusion: MVD has significant effects in the treatment of I-II grades diabetic foot wounds and has few adverse reactions. It is an effective new method that can promote the growth of granulation tissue and epithelium and promote wound healing.

Induction of long-term glycemic control in a type 2 diabetic patient for 11 years by intensive lifestyle intervention.

Can diabetes be reversed? Yes! The weight loss due to intensive lifestyle intervention leads to the recovery of islet ß cell function, thus changing the natural course of type 2 diabetes.

Comparative efficacy of bariatric surgery for type 2 diabetes mellitus: A protocol for systematic review and network meta-analysis.

BACKGROUND: The comparative efficacy of bariatric surgical procedures for type 2 diabetes mellitus (T2DM) has not been completely elucidated. To investigate this question, we conduct a systematic review and network meta-analysis. METHODS: The protocol followed preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) checklist. Two review authors will independently search the PubMed, Embase (Ovid), and the Cochrane Central Register of Controlled Trials databases. The primary outcome is T2DM remission. The secondary outcomes include BMI, HbA1c (%), and percentage excess weight loss (% EWL). Results from the network meta-analysis will be presented as summary relative effect sizes (WMD or RR) and relative 95% CIs for each possible pair of treatments. Outcomes will be combined based on different periods of follow-up (12 months, 36 months, and 60 months). RESULTS: The results will provide useful information about the efficacy of bariatric surgical procedures in patients with T2DM. CONCLUSION: The findings of the study will be disseminated through peer-reviewed journal. INPLASY REGISTRATION NUMBER: INPLASY202050053.

Type A insulin resistance syndrome misdiagnosed as polycystic ovary syndrome: a case report.

BACKGROUND: Type A insulin resistance syndrome, one type of the hereditary insulin resistance syndromes, is a rare disorder. Patients with type A insulin resistance syndrome are nonobese and demonstrate severe hyperinsulinemia, hyperandrogenism, and acanthosis nigricans. The clinical features are more severe in affected females than in males, and they mostly become apparent at the age of puberty. In many cases, when severe insulin resistance is covered up by other signs or symptoms of type A insulin resistance syndrome, patients are often easily misdiagnosed with other diseases, such as polycystic ovary syndrome. CASE PRESENTATION: Our patient was a 27-year-old Han Chinese woman who sought treatment because of a menstrual disorder and hirsutism. Tests showed that her levels of insulin and testosterone were elevated, and gynecological color Doppler ultrasound suggested multiple cystic changes in the bilateral ovaries. After a diagnosis of polycystic ovary syndrome was made, pulsatile gonadotropin-releasing hormone therapy and metformin were administered, but the patient's symptoms did not improve in 1 year of follow-up. Considering that the previous diagnosis might have been incorrect, venous blood samples were collected from the patient and her relatives for genetic analysis. Subsequently, using Illumina sequencing, it was found that the proband, her father, and two brothers all had the c.3601C>T heterozygous missense mutation in exon 20 of the insulin receptor gene. The diagnosis was corrected to type A insulin resistance syndrome, and the patient's treatment was modified. CONCLUSION: We report a case of a young woman with type A insulin resistance syndrome that was misdiagnosed as polycystic ovary syndrome. We discuss the causes, clinical features, diagnosis, and treatment of type A insulin resistance syndrome to improve the recognition of the disease and reduce its misdiagnosis. Female patients with high androgen levels and severe hyperinsulinemia should be considered for the possibility of hereditary insulin resistance syndromes (such as type A insulin resistance syndrome). Gene sequencing helps in making an early diagnosis and developing a targeted treatment strategy.