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With multi-drug-resistant bacteria being more prevalent over years, diabetic foot complicated with multi-drug-resistant bacteria infection emerges as a significant challenge for clinicians and patients. Diabetic foot is predisposed to multi-drug resistant bacterial infection. Growing body of evidence shows that ulcer type, ulcer grade, ulcer area, history of antibiotics treatment, previous hospitalization history, osteomyelitis, and proliferative retinopathy are risk factors. Among multi-drug-resistant bacteria, methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase-producing bacteria are the most common strains. Infection with multiple drug-resistant bacteria contributes to the amputation rate and mortality in patients with diabetic foot ulcers. The aim of this review is to give an update on multi-drug resistant bacteria infection and clinical outcome of diabetic foot, with a goal to improve clinical awareness and management.
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Objective:To investigate the long-term effect of the implantation of human umbilical cord-derived mesenchymal stem cells (HUC-MSCs) for type 1 diabetes mellitus.Methods:Fifteen patients with type 1 diabetes mellitus were treated with HUC-MSCs from September 2009 to December 2011 at Department of Endocrinology and Metabolism, the Second People′s Hospital. Patients were followed-up for 10 years and the parameters were collected including fasting blood glucose, HbA 1C, mean amplitude of glycemic excursions (MAGE), fasting C-peptide, daily insulin doses and glutamic acid decarboxylase antibody (GADA). Results:Among 15 patients, 1 patient (6.67%) was found with breast cancer. All patients with type 1 diabetes mellitus decreased daily insulin doses due to frequent hypoglycemia one week later. Six months later, 4 patients (26.67%) stopped insulin injection. While among the 4 patients, 1 patient (6.67%) had not yet used insulin until today and GADA was negative, the other 3 patients (20.00%) restarted insulin within 3-5 years after implantation with significantly less daily insulin doses [(18.00±1.00)U vs (29.00±1.73)U, P<0.01]. The remaining 11 patients (73.33%) with type 1 diabetes mellitus who did not stop insulin also had significantly lower daily insulin doses [(18.09±0.83)U vs (29.64±0.89)U, P<0.01]. The level of MAGE was signicantly decreased compared to those of pre-implantation [(6.14±0.25)mmol/L vs (9.72±0.32)mmol/L, P <0.01], while fasting C-peptide level was significantly improved[(0.91±0.03)nmol/L vs (0.11±0.01)nmol/L, P <0.01]. There were no significant differences in fasting blood glucose and HbA 1C before and after implantation. Conclusions:The implantation of HUC-MSCs for the treatment of type 1 diabetes mellitus can restore the function of islet β cells, decrease daily insulin doses and reduce blood glucose fluctuations in the long term. Although precise mechanisms are unknown, this therapy is expected to be an effective strategy for treatment of type 1 diabetes mellitus.
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Objective:To investigate the effect of virtual-simulation laparoscopic training system in the training of basic skills of endoscopic surgery in trainees with different clinical experience.Method:s Eight refresher physicians, eight residents who received standardized residency training, and eight undergraduate interns in five-year clinical medicine were selected. All of them received the training of endoscopic operations with the laparoscopic training box and the virtual-simulation laparoscopic training system for 30 minutes every day for 4 weeks. Data analyses were performed using SPSS 19.0 and t-test was adopted to compare the scores before and after training among the three groups.Result:s Before training, there were significant differences in endoscopic operations between the undergraduate intern group and the other two groups ( P<0.05); after 4 weeks of training, all three groups had significant increases in the scores and spent less time on training items ( P<0.05). There was no significant difference in simple operations among the three groups ( P>0.05), and the undergraduate intern group had a significantly higher score of complex operations than did the standardized residency training group and the refresher physician group ( P<0.05). Conclusion:The virtual-simulation laparoscopic training system can improve the laparoscopic skills of clinical trainees at different levels, therefore, it is worth being promoted in the teaching of clinical skills.
