scholarly journals Assessment of Hydroxyproline Levels in Non-Ischemic Diabetic Foot Ulcers During Recovery. A Prospective Case-Control Study

2015 ◽  
Vol 22 (4) ◽  
pp. 361-366
Author(s):  
Seyed Mansour Alamshah ◽  
Aliasghar Hemmati ◽  
Zahra Nazari
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Normal Skin ◽  
Repair Process ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Control Groups ◽  
Mean Values ◽  
The Mean ◽  
Medical University

Abstract Background and aims: Proline hydroxylation is essential for collagen synthesis in wound healing. Therefore, hydroxyproline quantification may be a suitable marker of wound healing in diabetic tissue. Material and method: This is a prospective casecontrol clinical study including 90 referral patients from our clinics in Golestan hospital affiliated to Jundishapour Medical University, Ahwaz-Iran, during a period of 18 months. Three groups were recruited: intervening diabetics with non-ischemic foot ulcers, diabetics without foot ulcers (normal diabetics) and non-diabetics without foot ulcers (normal non-diabetics) as control groups (n=30 per group). 500 mg of granulation tissue from ulcers after treatment and 500 mg of normal skin from both control groups were taken for the measurement of hydroxyproline levels. Results: 13 (43.3%) males and 17 (56.7%) females in trial group were analysed. There was no significant differences in age, gender, and BMI between groups. Mean hydroxyproline concentration in wound granulation tissue (140.44 μg/g) was statistically different from the mean concentration in the skin content of normal diabetics (173.22 g/g,) and the skin content of nondiabetics (178.83 μg/g) (p=0.001). There were no statistically significant differences between the mean values of normal diabetics and non-diabetics (p=0.63). Conclusion: Our results showed the presence of a lower quantity of hydroxyproline in diabetic patients with foot ulcers compared to control groups. This raises the issue of its effectiveness in delaying the repair process in diabetics. Therefore, compensating for tissue hydroxyproline deficit can be a clue in improving diabetic tissue repair.

Healing of Diabetic Neuroischemic Foot Wounds With vs Without Wound-Targeted Revascularization: Preliminary Observations From an 8-Year Prospective Dual-Center Registry

2019 ◽  
Vol 27 (1) ◽  
pp. 20-30 ◽  
Author(s):  
Vlad-Adrian Alexandrescu ◽  
Sophie Brochier ◽  
Augustin Limgba ◽  
Severine Balthazar ◽  
Hafid Khelifa ◽  
...  
Keyword(s):  
Wound Healing ◽  
Limb Salvage ◽  
Foot Ulcers ◽  
Diabetic Patients ◽  
Technical Success ◽  
Free Survival ◽  
Limb Preservation ◽  
The Mean ◽  
Mean Time

Purpose: To assess the clinical efficacy of endovascular angiosome-oriented wound-targeted revascularization (WTR) vs indirect (wound-indifferent) revascularization (IR) in diabetic patients with neuroischemic foot ulcers. Materials and Methods: Between April 2009 and July 2017, 167 diabetic patients (mean age 72.8 years; 137 men) with chronic limb-threatening ischemia (Rutherford category 5) and foot wounds (Wagner 2–4) in 194 limbs were prospectively registered and scheduled for primary infragenicular endovascular treatment. Specific angiosome source artery reperfusion sustained by patent foot arches or arterial-arterial connections was attempted initially. If this approach failed, topographic revascularization via available collaterals (WTRc) and IR were sequentially attempted. Results: Reperfusion was successful in 176 (91%) of 194 limbs (113 with WTR, 28 with WTRc, and 35 with IR); the global angiosome-oriented technical success (WTR and WTRc) was 73% (141/194). The mean follow-up was 10.9±0.7 months (range 3–12.5). Over 1 year, 102 (58%) of the 176 successfully treated limbs experienced wound healing [79/113 (70%) in the WTR group, 15/28 (54%) in the WTRc group, and 7/35 (20%) in the IR group; p=0.011]. The mean time to healing was 6.8±0.4 months in the WTR group, 7.9±0.6 months in the WTRc group, and 9.8±0.7 months in the IR group (p=0.001). Relapses were noted in 18 (16%) WTR limbs, 5 (18%) WTRc limbs, and 6 (17%) IR limbs. Comparison between WTR and IR and WTRc vs IR showed improved cicatrization in the angiosome-oriented groups (p<0.05). Major adverse limb events (MALE) and limb salvage were different between WTR and WTRc and between WTR and IR groups (p<0.05), while WTRc vs IR was not. Amputation-free survival was not influenced by the revascularization strategy (p=0.093). Conclusion: Wound healing in diabetic patients with chronic limb-threatening ischemia appeared to be improved by intentional wound-targeted revascularization, but no uniform benefit concerning MALE or limb preservation was observed. IR still represents an alternative for limb salvage in cases in which angiosome-guided revascularization fails.

scholarly journals Effects of Laser at 810 Nm on Wound Healing in Albino Mice

2020 ◽  
pp. 23-33
Author(s):  
Mawada M. Funjan
Keyword(s):  
Wound Healing ◽  
Laser Therapy ◽  
Granulation Tissue ◽  
Near Infrared ◽  
Histological Evaluation ◽  
Control Groups ◽  
Respective Control ◽  
Healing Response ◽  
Wound Healing Response ◽  
Albino Mice

Many researches focused on laser therapy of wound healing in different animal models due to the lack of a standard protocol in the application of such phototherapy. Objective:  To study the effects of 810nm laser at a constant irradiance of 41.63 mw/cm2 and exposure (illumination) time of 5,15  minutes on wounds created on Albino mice (BALB/c).      Skin wound with elliptic shape and full thickness was created on the dorsal side of  ‘45 mature male albino mice. Irradiated animals were divided into two main groups based on irradiation time, the first was irradiated for 5 min and the second for 15 min, each was subdivided into three subgroups (n=5) according to number of treatment days (3, 5 and 10 days).   Both treated and respective control (n=15) subgroups were sacrificed on days 3, 5 and 10 posttreatment.  Laser therapy was applied using a 810 nm diode laser with a continuous wave, an output power of 400 mw, and irradiance of 41.63. The 5 min dose was 12 .5 J/cm2, whereas the 15 min dose was 37.4 J/cm2. The shape of the laser beam was fitted with a convex lens as ‘beam expander’ to irradiate a circular area of 3.4 cm diameter. Laser therapy was started after surgery and repeated for 3, 5 and 10 days, while its effects were examined by histological evaluation. Results:  At day 3 of treatment with near infrared 810nm laser at doses of 12.5J/cm² and 37.4J/cm², there was no evidence of wounds healing in irradiated groups which showed no differences with the respective control groups. At day 5 of treatment, the results showed an important increase in the scores of the parameters of wound healing (formation of granulation tissue and collagen deposition) in the irradiated groups. Near infrared 810nm laser had photobiostimulation effects on wound healing at irradiance of 41.63mW/cm² and doses of 12.5J/cm² for 5 minutes and 37.4J/cm² for 15 minutes exposure time. A complete picture of wound healing response appeared in all irradiated groups within 10 days of treatment, as expressed by complete ‘re-epithelialization’, moderate granulation tissue formation, and presence of collagen fibers, while incomplete wound healing response was observed in un-irradiated control groups within the same period. The study showed that 810 nm laser therapies had significant effects on wound healing, especially at a dose of 37.4J/cm².

Identification and Drug Sensitivity of Aerobic Bacterial Isolates from Diabetic Foot Ulcers of Sudanese Patients: a Cross sectional study

2020 ◽  
Author(s):  
saada Mohamed nour ◽  
Maowia Mukhtar ◽  
Mohamed Elmakk ◽  
Elshibli Mohamed Elshibli ◽  
Walyeldin Elnour Elfakey ◽  
...  
Keyword(s):  
Diabetic Foot ◽  
Diffusion Method ◽  
Foot Ulcers ◽  
Aerobic Bacteria ◽  
Diabetic Patients ◽  
Gram Negative Bacteria ◽  
Female Ratio ◽  
Gram Negative ◽  
The Mean ◽  
Grade 3

Abstract Background Diabetic foot ulcer infection cause great morbidity and mortality among diabetic patients and is a major cause of lower extremity amputation worldwide. This study aimed to determine the profile of aerobic bacteria and their antibiotic sensitivity patterns in diabetic foot infections (DFI) among different Wagner's grades. Methods This study was conducted during December 2017 - March 2018 in a Diabetic Center, Sudan. A total of 152 diabetic patients with different grades of foot ulcers were randomly enrolled in the study. The patients were grouped using Wagner's classification. Tissue biopsies and deep swabs were collected from the ulcers for aerobic cultures. The cultured isolates were identified using phenotypic and biochemical properties and their sensitivity to commonly used antibiotics, Colistin, Aikacin, Ciprofloxacin, Augmentin, Ceftazideme, Gentamicin, Clindamycin, Ceftriaxone Meropenum. Cotrimoxazole, Erythomycin, Oxacillin and Vancomycin. Fusidic acid, Imepenem, and Piperacillin was tested using the Kirby Bauer disk diffusion method. Results The mean age of the patients was 54.31 (SD ± 12.1) years, male to female ratio of 8: 1. The mean duration of diabetes was 14 (SD ± 8) years. The ulcers varied in duration from 1 day to 10 years. of 152 samples 181 aerobic bacteria were isolated. Cultures yielded 1-3 isolate per culture. The maximum number was isolated from grade 3 group followed by long standing ulcer LSU group 50.8% and 28% respectively. Polymicrobial infection was higher in LSU (30.4%). The isolates were mostly Gram-negative bacteria. The most frequent were proteus spp. (35.3%), S. aureus MRSA 14.4% and Coliform 12.2% respectively. The most common isolates in grade 3 were P. Mirablis, Staphylococcus and Coliform and in long standing ulcers were P. Mirablis, S. aureus MRSA and Coagulase negative staphylococcus respectively. Conclusion Gram-negative bacteria were more prevalent and the most frequent pathogens were Proteus spp. The most common polymicrobial infections were due to P. mirablis with; P. aerginosa, S. MRSA and Coliform respectively . Gram negative rods were sensitive to Amikacin, (80.6) %) while the highest sensitivity of Gram positive was to Imepnem (85%). Most of the isolates were sensitive to Meropenem. No significant relation between Wagner grades and neuropathy was detected.

scholarly journals Dynamic balance and neuropathic changes following ankle proprioceptive training in type II diabetic patients with peripheral neuropathy

2021 ◽  
Keyword(s):  
Peripheral Neuropathy ◽  
Stability Index ◽  
Diabetic Patients ◽  
Type Ii ◽  
Light Touch ◽  
Mean Values ◽  
Proprioceptive Training ◽  
Touch Sensation ◽  
The Mean ◽  
Anterior Posterior

Introduction: Peripheral neuropathy is one of the major complications of type II diabetes mellitus. Lower limb proprioceptive impairments due to neuropathy can lead to balance disorders in these patients. The present study aimed to investigate postural stability and neuropathic changes following ankle proprioceptive training in type II diabetic patients with moderate neuropathy. Materials and Methods: The present study was conducted on 24 type II diabetic patients with moderate neuropathy (9 females and 15 males) aged 40-65 years (with a mean age of 57.25 years). The treatment consisted of ankle proprioceptive training by the balance board and rocker for 10 consecutive days. Balance indices, including Overall Stability Index (OSI), Anterior-Posterior Stability Index (APSI), and Medial-Lateral Stability Index (MLSI), were measured with Biodex system before and after the treatment, as well as two weeks after treatment in two conditions: condition1: Eyes open, head straight, without using trunk, pelvis, thigh, and knee constrained orthosis. Condition 2: Eyes closed, head back (hyperextension), with using trunk, pelvis, thigh, and knee constrained orthosis. Plate-based Biodex stability was fixed at levels 6 and 8 for condition1 and level 8 for condition 2. The severity of neuropathy was assessed using Valk and Michigan questionnaires, as well as light touch sensation. The analysis of variance with repeated measure was used to evaluate alterations in the stability of patients. Furthermore, the correlation of neuropathic changes and stability parameters were assessed by the Pearson correlation coefficients. Results: Significant improvements were observed in OSI in all tests of condition 1 (Biodex Balance System (BBS) at level 8 (P=0.001) and level 6 (P=0.017), as well as test conditions 2 (level 8; P=0.004). After the treatment, at stability level 8, a significant improvement in the mean values of postural sways in the Anterior-Posterior (AP) direction demonstrated that the ankle strategy was improved in the patients. After the treatment, the scores of the Valk (P=0.02) and Michigan (P=0.001) questionnaires were significantly decreased. After two weeks of follow-up, the observed improvement was maintained in the mean values of balance indices (OSI, APSI) and neuropathy due to treatment. Conclusion: As evidenced by the obtained results, 10 sessions of targeted ankle proprioceptive training improved stability, neuropathy, and light touch sensation of the foot in type II diabetic patients with moderate neuropathy. Foot somatosensory information is one of the most important causes of balance alterations in these patients

scholarly journals Clinical and Hematological Profiles of Malaysian Ponies Experimentally Infected with a Field Strain of Trypanosoma evansi

2018 ◽  
Vol 6 (1) ◽  
pp. 7-16 ◽  
Author(s):  
E.I. Elshafie ◽  
R.A. Sani ◽  
R. Sharma ◽  
I.A. Abubakar
Keyword(s):  
Clinical Signs ◽  
Local Strain ◽  
Negative Control ◽  
Trypanosoma Evansi ◽  
Control Groups ◽  
Mean Values ◽  
Infection Period ◽  
Infection Treatment ◽  
The Mean ◽  
Cell Counter

Background: No outbreak has been reported on Trypanosoma evansi infection in Malaysia ponies since 1983, and little is known about the interaction between T. evansi and ponies in the country. Therefore, an experimental study was designed to evaluate the pathogenicity of a local strain of T. evansi in the local ponies. Method: For this purpose, four healthy local ponies were inoculated with 102 live trypanosomes/kg body weight, whereas two ponies served as negative control. Blood samples and rectal temperature were collected on alternate days from both groups for 54 days. Physical examination comprised visible mucous membrane and any appearance of clinical signs were observed daily. The number of trypanosomes was estimated using the Neubauer haemocytometer method. Complete haemogram measurements were performed immediately using an automated blood cell counter and the data obtained was evaluated using the general linear model as linear regression. All infected ponies were salvaged treated with 7 mg/kg of diminazene diaceturate. Results: The four infected ponies developed parasitaemia on the 4th day post-infection (DPI), whereas the first high mean of parasites count was recorded on the 8th DPI. Parasitaemia was detected at a level that fluctuated throughout the infection period (30 days) in all infected ponies with a mean of 13.5x106 trypanosomes/ml blood on the 30th DPI. Successive peaks of pyrexia were accompanied by the peaks of parasitaemia and the highest temperature (39.4°C) was observed on the 20th DPI. Excessive weakness and a reduction of appetite fluctuated in the infected ponies during the infection and one animal died unexpectedly on the 23rd DPI. The mean values for RBC, PCV, Hb and thrombocyte count were significantly lower in the infected ponies than the control groups. Neutrophil and eosinophil were significantly declined after the onset of parasitaemia, whereas monocyte increased significantly in the infected group. Conclusion: The appearance of clinical signs and changes in haematological parameters suggests that Malaysian local ponies are susceptible to T. evansi infection. Treatment of the infected ponies with the recommended dosage of diminazene diaceturate was successful in the surviving ponies.

scholarly journals Observational study of the effects of silver-based dressing materials in 50 cases of diabetic foot ulcers

2019 ◽  
Vol 6 (2) ◽  
pp. 508
Author(s):  
Rushabh Maisuria ◽  
Jawansing Manza ◽  
Devendra Chaudhari ◽  
Divyang Dave
Keyword(s):  
Wound Healing ◽  
Observational Study ◽  
Granulation Tissue ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Foot Ulcer ◽  
Purulent Discharge ◽  
Diabetic Patients ◽  
Wide Range ◽  
Dressing Materials

Background: Diabetic foot remains the most common chronic medical problem being the most common cause of the hospital visit and/or admission, amongst the diabetic patients. Topical antimicrobial dressings, including those that contain silver are used to prevent or manage infection in a wide range of wounds.Methods: This is the prospective, observational study which included 50 cases of diabetic foot ulcer patients and effects of silver-based dressing materials will be evaluated.Results: After application of silver based dressing materials for two weeks, wound was evaluated on the basis of discharge from the wound, healing rate, appearance of the granulation tissue and culture and sensitivity report which showed that out of 50 cases studied, 3 cases (6%) had purulent discharge from the wound, absent granulation tissue, culture report showed presence of micro-organism and thus poor healing rate while other 47 cases (94%) had minimal/serous discharge, presence of healthy granulation tissue, no organism on culture report and thus good healing rate.Conclusions: Silver based dressing materials are effective in terms of promoting wound healing and more patient compliance.

scholarly journals A study to assess anemia and hypoalbuminemia in diabetic patients with ulcers

2021 ◽  
Vol 8 (8) ◽  
pp. 2324
Author(s):  
Devaprashanth M. ◽  
B. S. Ramesh ◽  
Pushpa Satish Kumar
Keyword(s):  
Wound Healing ◽  
Diabetic Foot ◽  
Nutritional Deficiencies ◽  
Foot Ulcers ◽  
Public Health Issue ◽  
Diabetic Patients ◽  
Age Group ◽  
Diabetic Foot Ulcers ◽  
Female Patients ◽  
Male Patients

Background: Diabetic foot is a severe public health issue. Nutrition is important in the repair of soft tissue injuries and wound healing and specific nutrients have been shown to enhance wound healing. Anemia and hypoalbuminemia are among the commonly encountered deficiencies in patients. Early detection of nutritional deficiencies and their prompt treatment is imperative for the effective management of diabetic foot ulcers. The aim of the study was to investigate the prevalence of anemia and hypoalbuminemia in diabetic foot patients presenting at our institution.Methods: Hemoglobin and albumin levels of 175 patients with diabetic foot were collected. Data was tabulated and analysed with descriptive statistics.Results: Hemoglobin varied from 6.5 g/dl to15 g/dl (10.5±2.3 g/dl). 116 (66.28%) patients had anemia. Among the 66 female patients, 43 (65.15%) had anemia. Among the 109 male patients, 73 (66.97%) had anemia. 11 of the 29 patients aged less than 40 had anemia (37.93%), while 105 of the 146 (71.91%) patients above 40 years had anemia. Albumin levels ranged from 1.6 g/dl to 5.4 g/dl (3.3±1.06 g/dl). 93 (53.14%) patients had hypoalbuminemia. 33 of the 66 female patients (50%) had hypoalbuminemia. 60 (55.04%) of the 109 male patients had hypoalbuminemia. 4 of the 29 (13.79%) patients below 40 years had hypoalbuminemia 89 of the 146 patients (60.9%) above 40 years had hypoalbuminemia.Conclusions: Anemia and hypoalbuminemia are common in patients with diabetic foot ulcers, with males being more commonly affected by both than females and older age group being more commonly affected than younger age group. 

scholarly journals Some hematimetric findings in human Giardia lambia infection

1996 ◽  
Vol 38 (2) ◽  
pp. 91-95 ◽  
Author(s):  
Jairo Ivo dos Santos ◽  
Cidônia de Lourdes Vituri
Keyword(s):  
Giardia Lamblia ◽  
Mean Corpuscular Volume ◽  
Hemoglobin Concentration ◽  
Absolute Number ◽  
Control Groups ◽  
Mean Values ◽  
Significant Difference ◽  
The Mean ◽  
And Control ◽  
Eosinophil Counts

Up to now few reports about haematological alterations induced by Giardia lamblia infection have been described. Because there are questions on this matter still not answered, we carried out a study to evaluate some erythrometric and leucometric parameters in a sample that consisted of 55 patients exclusively infected with G. lamblia and of 55 sex and age matched parasite-free individuals. The haematological parameters evaluated were: mean corpuscular volume (MCV), hemoglobin concentration, and relative and absolute number of eosinophils and lymphocytes. No significant differences in the mean values of MCV, hemoglobin levels and absolute relative lymphocyte numbers between the two groups could be detected. When the giardiasis and control groups were separated by pediatric (0-18 years old) and adult (older than 18 years) classes, a very significant difference in both relative and absolute number of eosinophils in the adult class was observed. With respect of the pediatric class, no differences, either in relative and absolute number of eosinophils, could be observed. Our findings suggest that, during G. lamblia infection, some kind of parasite allergen(s) could be secreted and be responsible for the increasing of eosinophil counts in peripheral blood of adults.

scholarly journals The effect of self-management education through weblogs on the quality of life of diabetic patients

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Amal Mohammad Rasoul ◽  
Rostam Jalali ◽  
Alireza Abdi ◽  
Nader Salari ◽  
Mehrali Rahimi ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Management Education ◽  
T Test ◽  
Self Management ◽  
Diabetic Patients ◽  
Control Groups ◽  
Patients With Diabetes ◽  
The Mean ◽  
And Control

Abstract Background Self-management education of diabetes which is one of the most important noncommunicable diseases worldwide involves facilitating knowledge, skills, and ability required for self-care in these patients. Concerning the progressive growth of use of Internet for educating patients and absence of different studies about education through use of weblogs in patients with diabetes in Iran, the present study was conducted with the aim of determining the effect of self-management education through weblogs on the quality of life of affect the patients. Methods This study was performed as intervention on patients referring to diabetes clinic of Talghani hospital in Kermanshah in winter 2018 and spring 2019. The samples consisted of 98 patients with diabetes chosen through available sampling and randomly assigned into study and control groups. For data collection, diabetes quality of life (DQOL) short form clinical questionnaire, Persian version, was used. The intervention involved training self-management conducted through 60 sessions via a designed weblog. The obtained information was introduced into SPSS 21, and analyzed through Mann-Whitney, t-test, and paired t-test. Results According to the results of this study, the mean age of the examined patients was 32.1 ± 4.9 years, where the major participants were male (n = 52 in the test group, 52.5%). The results showed that after the intervention, the test and control groups were different in terms of anthropometric variables and metabolic indicators; the mean waist circumference in the test and control groups was 98.6 ± 9.8 and 101.5 ± 7.8, respectively; the mean FBS following the intervention in the test and control groups was 131.08 ± 16.04 and 238.2 ± 40, respectively; and the mean BMI postintervention in the test and control groups was obtained as 27.3 ± 3.4 and 30.1 ± 3.8 respectively, where these differences were significant according to independent t-test (p < 0.05). The mean score of quality of life postintervention in the test and control groups was obtained as 56.1 and 49.9 respectively; according to Mann-Whitney test, the difference between the two groups was significant (p < 0.05). Conclusion The results of the present study revealed the positive effect of weblog based self-management on the quality of life of patients with diabetes following the intervention. Further, reduced levels of FBS, BMI, as well as systolic and diastolic blood pressure were also observed, which could be due to increased awareness of patients about their abilities, its risks, as well as the ways to control and treat it.

scholarly journals Topically Applied Connective Tissue Growth Factor/CCN2 Improves Diabetic Preclinical Cutaneous Wound Healing: Potential Role for CTGF in Human Diabetic Foot Ulcer Healing

2015 ◽  
Vol 2015 ◽  
pp. 1-10 ◽  
Author(s):  
F. R. Henshaw ◽  
P. Boughton ◽  
L. Lo ◽  
S. V. McLennan ◽  
S. M. Twigg
Keyword(s):  
Wound Healing ◽  
Granulation Tissue ◽  
Ulcer Healing ◽  
Diabetic Foot ◽  
Healing Rate ◽  
Foot Ulcer ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Wound Fluid ◽  
Diabetic Wounds

Aims/Hypothesis. Topical application of CTGF/CCN2 to rodent diabetic and control wounds was examined. In parallel research, correlation of CTGF wound fluid levels with healing rate in human diabetic foot ulcers was undertaken.Methods. Full thickness cutaneous wounds in diabetic and nondiabetic control rats were treated topically with 1 μg rhCTGF or vehicle alone, on 2 consecutive days. Wound healing rate was observed on day 14 and wound sites were examined for breaking strength and granulation tissue. In the human study across 32 subjects, serial CTGF regulation was analyzed longitudinally in postdebridement diabetic wound fluid.Results. CTGF treated diabetic wounds had an accelerated closure rate compared with vehicle treated diabetic wounds. Healed skin withstood more strain before breaking in CTGF treated rat wounds. Granulation tissue from CTGF treatment in diabetic wounds showed collagen IV accumulation compared with nondiabetic animals. Woundα-smooth muscle actin was increased in CTGF treated diabetic wounds compared with untreated diabetic wounds, as was macrophage infiltration. Endogenous wound fluid CTGF protein rate of increase in human diabetic foot ulcers correlated positively with foot ulcer healing rate (r=0.406;P<0.001).Conclusions/Interpretation. These data collectively increasingly substantiate a functional role for CTGF in human diabetic foot ulcers.

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