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Diabetic foot ulcers are a common complication that occurs in approximately 15 percent of patients with diabetes mellitus. Over 60% of diabetic foot ulcers are caused by underlying neuropathy. Former studies on diabetic animals with foot wounds found that vibration platforms significantly accelerate wound healing by catalyzing epithelization, promoting angiogenesis, and enhancing muscle bulk. This result suggests that there is evidence that vibrations may accelerate diabetic neuropathic ulcer healing in human patients. However, to the best of our knowledge, the effect of vibration on the enhancements of diabetic foot ulcer healing in human patients is rarely investigated. Hence, in this work, we conducted an experimental study with human subjects to investigate whether vibration therapy, as a complement to the standard wound treatment, can accelerate the wound healing rate of diabetic neuropathic foot ulcers. In this prospective experimental study, 80 participants diagnosed with Wagner grades I–III diabetic neuropathic foot ulcers were randomly distributed to experimental (n = 40) and control groups (n = 40). Patients in the intervention group received standard wound treatment and vibration wound therapy (VWT), whereas patients in the control group retrieved only standard wound treatment. The results (p = 0.024, α = 0.05) show notable differences in the median healing rate between the intervention group (25 days, 95% CI: 20.3–29.7) and control group (33 days, 95% CI: 25.6–40.4), with the effect-size r, Cohen’s d, Glass’s Δ, and Hedges’ g, respectively, being 0.810, 2.764, 2.311, and 2.772. Moreover, the nitric oxide (NO) level, wound closure area, and wound healing score after intervention significantly differed between the two groups (p < 0.05), putting the intervention group on a higher level than the control group. Furthermore, positive associations were found between the NO level and wound healing closure rates. These findings suggested that VWT enhances diabetic neuropathic foot ulcer healing in terms of healing rate, wound closure area, healing score, and elevated NO level. Considering that no clinically adverse effects were found in the patients induced with vibration intervention, VWT can be regarded as a complementary therapy to the existing ones to accelerate the healing of DFUs.

Diabetic foot ulcer (DFU) is a major complication of diabetes and can lead to lower limb amputation if not treated early and properly. In addition to the traditional clinical approaches, in recent years, research on automation using computer vision and machine learning methods plays an important role in DFU classification, achieving promising successes. The most recent automatic approaches to DFU classification are based on convolutional neural networks (CNNs), using solely RGB images as input. In this paper, we present a CNN-based DFU classification method in which we showed that feeding an appropriate feature (texture information) to the CNN model provides a complementary performance to the standard RGB-based deep models of the DFU classification task, and better performance can be obtained if both RGB images and their texture features are combined and used as input to the CNN. To this end, the proposed method consists of two main stages. The first stage extracts texture information from the RGB image using the mapped binary patterns technique. The obtained mapped image is used to aid the second stage in recognizing DFU as it contains texture information of ulcer. The stack of RGB and mapped binary patterns images are fed to the CNN as a tensor input or as a fused image, which is a linear combination of RGB and mapped binary patterns images. The performance of the proposed approach was evaluated using two recently published DFU datasets: the Part-A dataset of healthy and unhealthy (DFU) cases [17] and Part-B dataset of ischaemia and infection cases [18]. The results showed that the proposed methods provided better performance than the state-of-the-art CNN-based methods with 0.981% (AUC) and 0.952% (F-Measure) on the Part-A dataset, 0.995% (AUC) and 0.990% (F-measure) for the Part-B ischaemia dataset, and 0.820% (AUC) and 0.744% (F-measure) on the Part-B infection dataset. •Proposed mapped binary patterns for diabetic foot ulcer (DFU) classification.•A new CNN architecture evaluated with three input types: RGB, Texture-based (LBP) and fusion of both.•Fusion of mapped binary patterns and RGB increased the performance of DFU classification.•Our proposed DFU-RGB-TEX-NET outperformed with AUC of 0.981 and F-Measure of 0.952

ObjectiveTo assess the risk of diabetic foot ulcer (DFU) and find out its associated factors among subjects with type 2 diabetes (T2D) of Bangladesh.Design, setting and participantsThis cross-sectional study recruited 1200 subjects with T2D who visited 16 centres of Health Care Development Project run by Diabetic Association of Bangladesh.Primary and secondary outcome measuresRisk of DFU was assessed using a modified version of International Working Group on the Diabetic Foot (IWGDF) Risk Classification System. The modified system was based on five parameters, namely peripheral neuropathy (PN), peripheral arterial diseases (PAD), deformity, ulcer history and amputation. The risks were categorised as group 0 (no PN, no PAD), group 1 (PN, no PAD and no deformity), group 2A (PN and deformity, no PAD), group 2B (PAD), group 3A (ulcer history) and group 3B (amputation). The associated factors of DFU risk were determined using multinomial logistic regression for each risk category separately.ResultsOverall, 44.5% of the subjects were found ‘at risk’ of DFU. This risk was higher among men (45.6%) than women and among those who lived in rural areas (45.5%) as compared with the urban population. According to IWGDF categories, the risk was distributed as 55.5%, 4.2%, 11.6%, 0.3%, 20.6% and 7.9% for group 0, group 1, group 2A, group 2B, group 3A and group 3B, respectively. The associated factors of DFU (OR >1) were age ≥50 years, rural area, low economic status, insulin use, history of trauma, diabetic retinopathy and diabetic nephropathy.ConclusionA significant number of the subjects with T2D under study were at risk of DFU, which demands an effective screening programme to reduce DFU-related morbidity and mortality.

Diabetic foot ulcers (DFU) represent one of the most common side effects of diabetes, significantly impacting patients' quality of life and imposing considerable financial burdens on families and society at large. Despite advancements in therapies targeting lower limb revascularization and various medications and dressings, outcomes for patients with severe lesions remain limited. A recent breakthrough in DFU treatment stems from the development of mesenchymal stem cells (MSCs). MSCs have shown promising results in treating various diseases and skin wounds due to their ability for multidirectional differentiation and immunomodulation. Recent studies highlight that MSCs primarily repair tissue through their paracrine activities, with exosomes playing a crucial role as the main biologically active components. These exosomes transport proteins, mRNA, DNA, and other substances, facilitating DFU treatment through immunomodulation, antioxidant effects, angiogenesis promotion, endothelial cell migration and proliferation, and collagen remodeling. Mesenchymal stem cell-derived exosomes (MSC-Exo) not only deliver comparable therapeutic effects to MSCs but also mitigate adverse reactions like immune rejection associated with MSCs transplantation. This article provides an overview of DFU pathophysiology and explores the mechanisms and research progress of MSC-Exo in DFU therapy.

We performed a meta‐analysis to evaluate the effect of low‐frequency ultrasound as an added treatment for chronic wounds. A systematic literature search up to May 2022 was performed and 838 subjects with chronic wounds at the baseline of the studies; 412 of them were using the low‐frequency ultrasound (225 low‐frequency high‐intensity contact ultrasound for diabetic foot wound ulcers, and 187 low‐frequency low‐intensity non‐contact ultrasound for a venous leg wound ulcers), and 426 were using standard care (233 sharp debridements for diabetic foot wound ulcers and 193 sham treatments for venous leg wound ulcers). Odds ratio (OR), and mean difference (MD) with 95% confidence intervals (CIs) were calculated to assess the effect of low‐frequency ultrasound as an added treatment for chronic wounds using the dichotomous, and contentious methods with a random or fixed‐effect model. The low‐frequency high‐intensity contact ultrasound for diabetic foot wound ulcers had significantly lower non‐healed diabetic foot wound ulcers at ≥3 months (OR, 0.37; 95% CI, 0.24‐0.56, P < .001), a higher percentage of diabetic foot wound ulcers area reduction (MD, 17.18; 95% CI, 6.62‐27.85, P = .002) compared with sharp debridement for diabetic foot wound ulcers. The low‐frequency low‐intensity non‐contact ultrasound for a venous leg wound ulcers had a significantly lower non‐healed venous leg wound ulcers at ≥3 months (OR, 0.31; 95% CI, 0.15‐0.62, P = .001), and higher percentage venous leg wound ulcers area reduction (MD, 18.96; 95% CI, 2.36‐35.57, P = .03) compared with sham treatments for a venous leg wound ulcers. The low‐frequency ultrasound as an added treatment for diabetic foot wound ulcers and venous leg wound ulcers had significantly lower non‐healed chronic wound ulcers at ≥3 months, a higher percentage of chronic wound ulcers area reduction compared with standard care. The analysis of outcomes should be with caution because of the low sample size of all the 17 studies in the meta‐analysis and a low number of studies in certain comparisons.

Diabetes mellitus (DM) can cause chronic foot issues and severe infections, including Diabetic Foot Ulcers (DFUs) that heal slowly due to insufficient blood flow. A recurrence of these ulcers can lead to 84% of lower limb amputations and even cause death. High-risk diabetes patients require expensive medications, regular check-ups, and proper personal hygiene to prevent DFUs, which affect 15–25% of diabetics. Accurate diagnosis, appropriate care, and prompt response can prevent amputations and fatalities through early and reliable DFU detection from image analysis. We propose a comprehensive deep learning-based system for detecting DFUs from patients’ feet images by reliably localizing ulcer points. Our method utilizes innovative model ensemble techniques—non-maximum suppression (NMS), Soft-NMS, and weighted bounding box fusion (WBF)—to combine predictions from state-of-the-art object detection models. The performances of diverse cutting-edge model architectures used in this study complement each other, leading to more generalized and improved results when combined in an ensemble. Our WBF-based approach combining YOLOv8m and FRCNN-ResNet101 achieves a mean average precision (mAP) score of 86.4% at the IoU threshold of 0.5 on the DFUC2020 dataset, significantly outperforming the former benchmark by 12.4%. We also perform external validation on the IEEE DataPort Diabetic Foot dataset which has demonstrated robust and reliable model performance on the qualitative analysis. In conclusion, our study effectively developed an innovative diabetic foot ulcer (DFU) detection system using an ensemble model of deep neural networks (DNNs). This AI-driven tool serves as an initial screening aid for medical professionals, augmenting the diagnostic process by enhancing sensitivity to potential DFU cases. While recognizing the presence of false positives, our research contributes to improving patient care through the integration of human medical expertise with AI-based solutions in DFU management.

Diabetic foot ulcers (DFUs) are severe complications of diabetes that often lead to major amputations. Despite care advancements, approximately 50% of minor amputations do not heal, resulting in major amputations and increased mortality. This study evaluated the effectiveness of adipose‐derived stem cells (ASCs) obtained through superficial enhanced fluid fat injection (SEFFI) in improving healing rates after minor amputations in DFUs. It was a prospective, single‐arm, observational cohort study. The patients were monitored for half a year using monthly assessments. The primary endpoint was the healing rate of the amputation stumps after minor amputations coupled with ASC injections. Secondary endpoints included safety, feasibility, adverse events and analysis of variables associated with healing including the analysis of the injected mesenchymal adipose stem cell populations. Of the 256 screened patients, 40 were enrolled. At 6 months, 55% of the treated stumps had healed completely. The median healing time was 69 days. Technical success was achieved in all cases without device‐related complications. Multivariable Cox models identified haemodialysis, opioid use and the injected number of CD45‐positive cells as risk factors for healing failure. CD73 expression was positively associated with healing. The SEFFIDiFA trial demonstrated a promising 69% healing probability at 6 months post‐amputation. This minimally invasive approach showed a higher healing rate with fewer complications. This study supports the potential of ASCs in enhancing wound healing in DFUs and highlights the importance of CD73 expression for successful outcomes. Further research is warranted to validate these findings and optimise the technique.

Background There are few studies investigating the characteristics, risk factors and socioeconomic status of patients with non-diabetic foot ulcers. The aim of this study was to explore the characteristics of non-diabetic foot ulcers in a large tertiary referral outpatient hospital setting in Western Sydney, Australia. Methods From 2011 to 2013, data from 202 patients with non-diabetic foot ulcers during their initial visit were retrospectively extracted for analysis from Westmead Hospital’s Foot Wound Clinic Registry. Data including demographics, socioeconomic status and foot ulcer characteristics were recorded on a standardised data collection form. Results Demographics and physical characteristics were: 54 % male, median age 78 years [interquartile range (IQR): 64–87], median body mass index (BMI) of 23.8 kg/m 2 (IQR: 20–26.9), 35 % had loss of protective sensation and the median postcode score for socioeconomic status was 996 (IQR: 935–1034). Foot ulcer characteristics were: median cross-sectional area of 1.2 cm 2 (IQR: 0.3–5.0), 30.5 % plantar and 27 % dorsal, 22.1 % University of Texas (UT) Wound Classification for Diabetic Foot Ulcers Grade of 1C-3C (with ischaemia). Conclusions Unlike diabetic foot ulcers, non-diabetic foot ulcers largely affected older males and females. In accordance with diabetic foot ulcer characteristics, socioeconomic status was not related to non-diabetic foot ulcers in Western Sydney. Based on the findings of this study the epidemiological pattern of non-diabetic foot ulceration and its pathogenesis requires further investigation.

Diabetes mellitus (DM) is a significant global health problem, with over 537 million adults affected in 2021. A crucial complication of DM is diabetic foot ulcers (DFUs), which result from nerve damage and impaired circulation, leading to loss of function and high medical costs. The role of pharmacists in managing diabetes and DFUs has evolved from strictly dispensing medication to being healthcare providers that are actively involved in patient education on glycaemic control, wound care strategies, and promotion of medication adherence. Treatment of DFUs is mainly focused on maintaining a moist wound environment, preventing infection and pressure offloading. This article highlights the essential role of pharmacists in a multidisciplinary healthcare team to enhance patient outcomes by applying their expertise to reduce diabetes-related complications such as DFUs.

Aim: To clarify the relationship between serum uric acid (UA) and glycosylated hemoglobin (UA/HbAlc) ratio and all-cause mortality in patients with diabetic foot ulcers (DFUs). Methods: A total of 172 inpatients with DFUs (PEDIS grades 2-4) were eligible for inclusion in this study from 2018 to 2023. This was a retrospective, longitudinal cohort study. All subjects were followed up every 6 months for a median of 60 months. According to the cutoff value of the UA/HbAlc ratio of 39.07 obtained from ROC analysis, the participants were divided into two groups: low-level ([less than or equal to] 39.07, n = 107) and high-level (> 39.07, n = 65) groups. The correlation between UA/HbAlc ratio and all-cause mortality was also evaluated by Cox regression analysis TheKaplan-Meier survival curve analysis and Log rank tests were used to assess the incidence rates of all-cause mortality. The contribution rate of risk factors was estimated by the population-attributable risk percentage (FAR%) analysis. Results: ROC analysis showed that the optimal cutoff values for UA and the UA/HbAlc ratio were 372 [micro]mol/L and 39.07, respectively. Multivariate Cox regression analysis indicated that a high UA/HbAlc ratio (HR =4.63; 95% CI = 2.004-10.7, P < 0.001) was independently associated with a high risk of all-cause mortality in patients with DFUs. Stratified analysis indicated that subjects aged [greater than or equal to] 60 years had a greater risk of all-cause mortality associated with a high UA/HbAlc ratio (HR = 4.450; 95% CI = 1.711-11.574, P = 0.002). Kaplan-Meier survival analysis showed that all-cause mortality had a significant positive association with a high UA/HbAlc ratio (log-rank, P < 0.001) and a significant negative correlation with the lowered HbAlc level (< 6.5%) after a follow-up of 32 months (log-rank, P < 0.001). The population attributable risk percentage (FAR%) analysis suggested that the contribution rate of the high-level UA/HbAlc ratio to all-cause mortality was 33.7%, which was much greater than the 19.69% of UA. Conclusion: In brief, our study showed that for every 1.0% increase in the UA/HbAlc ratio, the all-cause mortality rate in elderly patients with DFUs aged > 60 years increased by 3.45-fold. For elderly patients with DFUs, a safe and effective strategy to reduce all-cause mortality is to strictly control serum UA levels to < 372 |xmol/L and appropriately loosen the control goal of HbAlc to > 6.5%. Keywords: diabetic foot ulcer, uric acid to glycosylated hemoglobin ratio, all-cause mortality