糖尿病足的诊断（接上篇）

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糖尿病足

压疮

造口

溃疡

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蔡道章院长

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主任医师、教授、博导，南方医科大学第三附属医院（广东省骨科医院）院长

中德骨科伤口管理学校校长

广东省骨科研究院运动医学研究所所长

广东省内运动医学专业唯一的博士研究生导师

美国哈弗大学医学院骨科访问学者

专业特长处于省内领先、国内或国际先进水平以上

2018年获得“国之名医卓越建树”荣誉称号

2017年被评为全国卫生计生系统先进工作者、广东省医学领军人才

中国医师协会运动医师分会副会长

STCOT中国部运动医学分会副主任委员

广东省医学会关节外科分会主任委员

广东省医学会运动医学会分会名誉主任委员

独立承担过国家“863”课题，主持过10余项省、部级科研项目

多份专业杂志编委
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糖尿病足

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造口

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GLP-1 receptor agonists and coronary plaques regression in diabetic patients after acute coronary syndromes 2026-05-16 00:00

Mauro Gitto1,2 · Federica Catapano1,2 · Marco Francone1,2 · Gianluca Mincione1,2 · Vincenzo Scialò1,2 ·Carlo A. Pivato1,2 · Costanza Lisi1,2 · Damiano Regazzoli1,2 · Davide Cao1,2 · Roberta Maria Fiorina1 ·Alessandra Petrelli3,4 · Loredana Bucciarelli4 · Cristian Loretelli3,4 · Gianluigi Condorelli1,2 · Paolo Fiorina3,4,5 · Giulio Stefanini1,2

Received: 4 October 2025 / Accepted: 15 October 2025 / Published online: 4 November 2025 © The Author(s) 2025

Abstract

Background Despite advances in therapeutic strategies a significant proportion of acute coronary syndrome (ACS) patients experience early coronary artery disease (CAD) progression, particularly those with diabetes.

Aim To evaluate CAD progression in diabetic patients treated with glucagon-like peptide 1 receptor agonists (GLP-1Ra) over 1 year after an ACS.

Methods Patients presenting with non–ST-elevation ACS between 2019 and 2022 were enrolled in a prospective registry and underwent serial coronary computed tomography angiography (CCTA) at baseline (after revascularization, during the index hospitalization) and at 1-year follow-up. The primary endpoint was the absolute change (1 year – baseline) in non-culprit lesion plaque burden (ΔPB) on CCTA, with the absolute change in patient percent atheroma volume (ΔPAV) as a key secondary endpoint. A comprehensive lipidomic, metabolomic, and proteomic plasma assessment was also performed in all GLP-1Ra–treated patients and four randomly selected controls.

Results Of 28 diabetic patients, 7 (25%) with 22 coronary plaques were treated with GLP-1Ra, and 21 (75%) with 65 plaques received other antidiabetic agents. In the 1-year observation frame, both ΔPB (-5.8±12.8% vs. -1.1±13.6%, p=0.041) and ΔPAV (-6.1% [-7.3, -1.8] vs. -0.7% [-2.4, 9.8], p=0.039) were significantly lower in GLP-1Ra-treated patients. Total atheroma volume also showed a numerically greater reduction in the GLP-1Ra cohort (0.7 mm³ [-2.5-8.7] vs. 25.0 mm³ [4.8–39.7]), primarily due to a decrease in plaque fibrofatty volume percentage (-2.9±10.1% vs. 1.0±6.8%, p=0.042). Lipi-domic, metabolomic, and proteomic analyses identified reductions in monoacylglycerols and triacylglycerols, increases in diacylglycerols and phosphatidylethanolamine, a shift from carbohydrate metabolism toward lipid metabolism and hormone regulation, and differential expression of proteins involved in complement activation, endothelial function, and cytoskeletal organization in GLP-1Ra–treated patients compared with controls.

Conclusions In diabetic patients with ACS, GLP-1Ra therapy was associated with a significant regression in coronary plaque burden at 1 year, supported by favorable lipidomic, metabolomic, and proteomic changes. These findings suggest a potential role for GLP-1Ra in modifying atherosclerosis progression beyond glycemic control.

Keywords GLP-1 receptor agonists · Diabetes mellitus · Coronary artery disease · Acute coronary syndrome · Plaque regression

Anxiety, social responsiveness, and grit among patients with KCNJ11- related neonatal diabetes compared to unaffected siblings 2026-05-15 00:00

Jui M. Desai1 · Lisa R. Letourneau-Freiberg1 · Kristen E. Wroblewski2 · Megan N. Scott3 · Michael E. Msall4 · Siri Atma W. Greeley1,4

Received: 27 February 2025 / Accepted: 4 October 2025 / Published online: 27 January 2026 © The Author(s) 2026

Abstract

Aims Neonatal diabetes mellitus (NDM) occurs before 6–12 months of age and is commonly caused by activating mutations in KCNJ11 (KCNJ11-NDM) or ABCC8. Because of brain expression of these mutant ATP-dependent potassium channels, a spectrum of divergent neurodevelopmental difficulties have been described, including developmental delay, epilepsy, and neonatal diabetes (DEND). However, information on anxiety, social responsiveness, and grit is limited.

Methods Individuals with KCNJ11-NDM (N= 12) and their unaffected siblings (N=12) were recruited through the Uni-versity of Chicago Monogenic Diabetes Registry and participants or their parent/caregiver completedthe Screen for Adult/ Child Anxiety Related Disorder (SCAARED/SCARED), the Social Responsiveness Scale, Second Edition (SRS-2), and the Grit Scale.

Results Mean SRS-2 scores were significantly different between KCNJ11-NDM and sibling controls (P= <0.001 ), with 7/10 affected participants, and 0 /11 siblings, having scores suggestive of autism spectrum disorder (ASD). Differences in anxiety (P=0.69) and grit (P=0.46) were not significant when compared to sibling controls; however, 58% (7/12) of KCNJ11-NDM participants and 40% (4/10) of sibling controls had scores indicating an anxiety disorder by either self- or parent-report.

Conclusions Our results agree with previous studies suggesting significant difficulties with social functioning in KCNJ11- NDM, with 7/10 participants having scores suggestive of ASD, strongly reinforcing the need for early neurodevelopmental screening to allow for prompt support. Our report adds to the knowledge of this population in finding robust grit scores but with a high level of anxiety in both KCNJ11-NDM and unaffected siblings. Although families affected by KCNJ11-NDM may have a high risk of anxiety disorders, it is encouraging that affected and unaffected children exhibit robust self-resiliency that will help support functioning through the challenges of life. Study of additional individuals will help to clarify specific challenges, long-term outcomes, and best approaches for monitoring and support.

Keywords Diabetes mellitus · Potassium channels · Brain · Anxiety · Resilience · Genetics
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糖尿病足的诊断（接上篇）

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18 10月 2019

Author : 伤口世界

原创：胡海涛负压引流与创面修复

世界卫生组织(WHO)定义:糖尿病足是指糖尿病患者由于合并神经病变及各种不同程度末梢血管病变而导致下肢感染、溃疡形成和(或)深部组织的破坏。

三个必须条件，缺一不可：

糖尿病患者；
合并神经病变及不同程度末梢血管病变；
下肢感染、溃疡形成或深部组织坏死；

该患者疼痛明显、足背动脉博动好，不符合糖尿病足诊断标准2、3，所以排除糖尿病足诊断。伤口内见到痛风石、CT看到切口区域关节周围痛风结节较多，按痛风结节诊治方案处理，伤口愈合。

糖尿病足鉴别诊断：糖尿病患者合并痛风结节破溃、下肢动脉硬化闭塞、血栓闭塞性脉管炎等。

最后提醒：遇到糖尿病患者足溃疡时，第一步是诊断，第二步是鉴别诊断，尤其当治疗效果不好时，得再次思考这两个问题。

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GLP-1 receptor agonists and coronary plaques regression in diabetic patients after acute coronary syndromes 2026-05-16 00:00

Mauro Gitto1,2 · Federica Catapano1,2 · Marco Francone1,2 · Gianluca Mincione1,2 · Vincenzo Scialò1,2 ·Carlo A. Pivato1,2 · Costanza Lisi1,2 · Damiano Regazzoli1,2 · Davide Cao1,2 · Roberta Maria Fiorina1 ·Alessandra Petrelli3,4 · Loredana Bucciarelli4 · Cristian Loretelli3,4 · Gianluigi Condorelli1,2 · Paolo Fiorina3,4,5 · Giulio Stefanini1,2

Received: 4 October 2025 / Accepted: 15 October 2025 / Published online: 4 November 2025 © The Author(s) 2025

Abstract

Background Despite advances in therapeutic strategies a significant proportion of acute coronary syndrome (ACS) patients experience early coronary artery disease (CAD) progression, particularly those with diabetes.

Aim To evaluate CAD progression in diabetic patients treated with glucagon-like peptide 1 receptor agonists (GLP-1Ra) over 1 year after an ACS.

Methods Patients presenting with non–ST-elevation ACS between 2019 and 2022 were enrolled in a prospective registry and underwent serial coronary computed tomography angiography (CCTA) at baseline (after revascularization, during the index hospitalization) and at 1-year follow-up. The primary endpoint was the absolute change (1 year – baseline) in non-culprit lesion plaque burden (ΔPB) on CCTA, with the absolute change in patient percent atheroma volume (ΔPAV) as a key secondary endpoint. A comprehensive lipidomic, metabolomic, and proteomic plasma assessment was also performed in all GLP-1Ra–treated patients and four randomly selected controls.

Results Of 28 diabetic patients, 7 (25%) with 22 coronary plaques were treated with GLP-1Ra, and 21 (75%) with 65 plaques received other antidiabetic agents. In the 1-year observation frame, both ΔPB (-5.8±12.8% vs. -1.1±13.6%, p=0.041) and ΔPAV (-6.1% [-7.3, -1.8] vs. -0.7% [-2.4, 9.8], p=0.039) were significantly lower in GLP-1Ra-treated patients. Total atheroma volume also showed a numerically greater reduction in the GLP-1Ra cohort (0.7 mm³ [-2.5-8.7] vs. 25.0 mm³ [4.8–39.7]), primarily due to a decrease in plaque fibrofatty volume percentage (-2.9±10.1% vs. 1.0±6.8%, p=0.042). Lipi-domic, metabolomic, and proteomic analyses identified reductions in monoacylglycerols and triacylglycerols, increases in diacylglycerols and phosphatidylethanolamine, a shift from carbohydrate metabolism toward lipid metabolism and hormone regulation, and differential expression of proteins involved in complement activation, endothelial function, and cytoskeletal organization in GLP-1Ra–treated patients compared with controls.

Conclusions In diabetic patients with ACS, GLP-1Ra therapy was associated with a significant regression in coronary plaque burden at 1 year, supported by favorable lipidomic, metabolomic, and proteomic changes. These findings suggest a potential role for GLP-1Ra in modifying atherosclerosis progression beyond glycemic control.

Keywords GLP-1 receptor agonists · Diabetes mellitus · Coronary artery disease · Acute coronary syndrome · Plaque regression
Anxiety, social responsiveness, and grit among patients with KCNJ11- related neonatal diabetes compared to unaffected siblings 2026-05-15 00:00

Jui M. Desai1 · Lisa R. Letourneau-Freiberg1 · Kristen E. Wroblewski2 · Megan N. Scott3 · Michael E. Msall4 · Siri Atma W. Greeley1,4

Received: 27 February 2025 / Accepted: 4 October 2025 / Published online: 27 January 2026 © The Author(s) 2026

Abstract

Aims Neonatal diabetes mellitus (NDM) occurs before 6–12 months of age and is commonly caused by activating mutations in KCNJ11 (KCNJ11-NDM) or ABCC8. Because of brain expression of these mutant ATP-dependent potassium channels, a spectrum of divergent neurodevelopmental difficulties have been described, including developmental delay, epilepsy, and neonatal diabetes (DEND). However, information on anxiety, social responsiveness, and grit is limited.

Methods Individuals with KCNJ11-NDM (N= 12) and their unaffected siblings (N=12) were recruited through the Uni-versity of Chicago Monogenic Diabetes Registry and participants or their parent/caregiver completedthe Screen for Adult/ Child Anxiety Related Disorder (SCAARED/SCARED), the Social Responsiveness Scale, Second Edition (SRS-2), and the Grit Scale.

Results Mean SRS-2 scores were significantly different between KCNJ11-NDM and sibling controls (P= <0.001 ), with 7/10 affected participants, and 0 /11 siblings, having scores suggestive of autism spectrum disorder (ASD). Differences in anxiety (P=0.69) and grit (P=0.46) were not significant when compared to sibling controls; however, 58% (7/12) of KCNJ11-NDM participants and 40% (4/10) of sibling controls had scores indicating an anxiety disorder by either self- or parent-report.

Conclusions Our results agree with previous studies suggesting significant difficulties with social functioning in KCNJ11- NDM, with 7/10 participants having scores suggestive of ASD, strongly reinforcing the need for early neurodevelopmental screening to allow for prompt support. Our report adds to the knowledge of this population in finding robust grit scores but with a high level of anxiety in both KCNJ11-NDM and unaffected siblings. Although families affected by KCNJ11-NDM may have a high risk of anxiety disorders, it is encouraging that affected and unaffected children exhibit robust self-resiliency that will help support functioning through the challenges of life. Study of additional individuals will help to clarify specific challenges, long-term outcomes, and best approaches for monitoring and support.

Keywords Diabetes mellitus · Potassium channels · Brain · Anxiety · Resilience · Genetics
A high-quality RNA-yielding protocol for laser capture microdissection of transplanted stem cell-derived Islets of Langerhans 2026-05-14 00:00

Daniel Norman1 · Joey Lau1

Received: 22 March 2025 / Accepted: 18 January 2026 © The Author(s) 2026

Abstract

Background Laser capture microdissection (LCM) followed by RNA-sequencing is a powerful, widely applicable tool to analyze the transcriptome in regions of a tissue. Protocols for LCM of transplanted islets of Langerhans, particularly stem cell-derived islets (SC-islets) that have evaluated RNA quality, are lacking. This study demonstrates a robust protocol for LCM of SC-islets in multiple organ sites, generating high quality RNA.

Method SC-islets were transplanted to five organ sites in immunodeficient NOG-mice. Graft-containing organs were then sectioned, fixed in 75% ethanol, stained with the alcohol-based stain cresyl violet, and dehydrated before performing LCM. RNA was then extracted, and quality control was performed.

Results High RIN scores (RNA Integrity Number) were obtained from all organ sites, with the pancreas showing the most robust results, despite its known challenges due to high RNase content. Conversely, organs with small or dispersed grafts, such as the liver and omentum, exhibited lower RIN scores. This is likely due to the size of the dissected area correlating positively with RIN scores, potentially due to a more time-consuming LCM in these sites.

Conclusion Using this novel protocol, high-quality RNA from transplanted SC-islets can be obtained. Smaller and spread-out grafts pose a challenge in obtaining higher quality RNA, although possible.

Keywords Laser capture microdissection · Stem cell-derived islets · RNA quality · Transplantation · Type 1 diabetes

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2019广东省医疗行业协会伤口管理分会年会

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2019年6月15日中国广州
主办单位：广东省医疗行业协会伤口管理分会

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主任医师、教授、博导，南方医科大学第三附属医院（广东省骨科医院）院长