The system of osteoprotegrin (OPG)/ligand of NF-kB receptor activator (RANKL) in patients with diabetes mellitus, mediacalcinosis and obliteratingatherosclerosis of lower leg arteries

Aim. To study the OPG/RANKL system in patients with diabetes mellitus, mediacalcinosis and obliterating atherosclerosis of lower leg arteries. Materials and methods. The study enrolled 70 patients including 20 with manifest diabetic neuropathy (DN) and mediacalcinosis of lower leg arteries(group 1). 29 patients with diabetes mellitus (DM) and clinical manifestations of obliterating atherosclerosis of lower leg arteries comprised group 2. Thecontrol group 3 consisted of 30 subjects without disturbances of carbohydrate metabolism. Immunoassays with Alkphase-B (Metra biosystems, USA),Osteoprotegrin (Biomedica, Austria), and sRANKL(Biomedica, Austria) kits were used to detect serum markers of bone formation (alkaline phosphatase(AP), OPG, and RANKL respectively). The patients underwent examination by digital X-ray of affected joints in frontal and lateral projections using anAxiom Iconos R 200 apparatus (Siemens, Germany). Bone mineral density (BMD) was measured by dual energy X-ray absorptiometry (Expert 1188,Lunar, USA). Ultrasound duplex scanning of lower leg arteries was performed with Sonoc-5500 (Agilent, USA). Results. OPG levels in diabetic patients were significantly higher than in controls (

Sistema osteoprotegerin (OPG) -ligand retseptora-aktivatora yadernogo faktora kappa-V (RANKL) pri diabeticheskoy neyroosteoartropatii i obliteriruyushchem ateroskleroze arteriy nizhnikh konechnostey

Экспериментальные и клинические исследования свидетельствуют о том, что система OPG/RANKL не только регулирует ремоделирование костной ткани, но и принимает участие в развитии патологии сосудов. В связи с этим приобретает актуальность разработка терапевтических исходов, направленных на увеличение концентрации OPG в костной ткани и сосудистой стенке

Osnovnye printsipy lecheniya diabeticheskoyneyroosteoartropatii

Диабетическая нейроостеоартропатия (артропатия Шарко, ДНОАП) является одним из поздних осложнений сахарного диабета (СД), которое сопровождается асептической деструкцией костного скелета стопы на фоне выраженной диабетической нейропатии. Частота развития ДНОАП колеблется от 1,5% среди всех больных СД до 50% среди пациентов с диабетической нейропатией. Учитывая то, что продолжительность жизни больных СД растет, увеличивается и частота ДНОАП. Несмотря на то, что характерные изменения при ДНОАП были описаны более ста лет назад, до сих пор не существует однозначных данных о распространенности, патогенезе и наиболее эффективной тактике лечения больных с этой патологией

Clinical Efficacy and Safety of a New Method for Pressure Off-load for Patients with Diabetic Foot Syndrome: Ankle-foot Pneumoorthosis with TM Orlett

Aim. The purpose of this study was to assess the clinical efficacy, safety and consumer properties of ankle-foot pneumoorthosis with a HAS-337 TM Orlett compared with non-removable total contact cast (TCC) immobilization. Materials and methods. Our study included 40 patients with diabetes mellitus type 1 (DM1) and type 2 (DM2) with neuropathic diabetic foot syndrome and chronic uninfected wounds of the plantar surface of the forefoot, with wound duration of at least 3 weeks, wound areas not less than 1 cm2 and wound depths not more than stage II based on Wagner?s classification. We excluded patients with infected wounds, osteomyelitis, Charcot osteoarthropathy or peripheral vascular disease. Our test group included 20 patients who received pressure off-load using ankle-foot pneumoorthosis with a HAS-337 TM Orlett. For a control group (n = 20), pressure off-load was achieved using TCC immobilization. Both groups were comparable with regard to age, gender, duration and degree of diabetes compensation and by original wound defect sizes (p >0.05). The study duration was 6 months. Plantar pressure was measured inside the orthosis or TCC and was compared with test shoe measurements. Our major criteria for pressure relief were reduced pressures in the wound area and the whole foot and the rate of wound healing. Results. At the end of the 6-month period, complete healing of all ulcers was achieved. The average healing time was 46.1?19.0 days for the test group and was 48.3?20.5 days for the control group (p >0.05). Two patients who wore pneumoorthosis with HAS-337 were discontinued upon patient request. With pneumoorthosis, the maximum peak pressure on the foot and wound defect areas was reduced by 26% and 57%, respectively. The pressure/time integral decreased on average by 41% (p >0.05). Furthermore, in the midfoot area with pneumoorthosis, the maximum pressure increased by 48% and the pressure/time integral increased by 47%. Conclusions. Using pneumoorthosis with HAS-337 was an effective and safe method for pressure off-load, resulting in 100% healing of uninfected neuropathic ulcers of the plantar surface of the forefoot. However, pneumoorthosis with HAS-337 is not recommended for those patients with wound defects in the midfoot and heel areas

Pedographic and clinical assessment of total contact cast immobilization in diabetic foot syndrome

Aim. To estimate offloading efficiency of total contact cast (TCC) and determine factors, affecting trophic ulcer response to treatment with TCC, as well as ways of their compensation. Methods. 30 patients, receiving an outpatient treatment with TCC for diabetic foot syndrome, underwent routine clinical examination, pedography and walking activity monitoring. We assessed degree of pressure reduction on the planta and the lesion area in particular, in its correlation with treatment outcome. Results. According to pedography data, TCC reduced peak pressure (maximum for all plantar zones) for 20% (from -70% to 84%) and pressure in the lesion area for 55% (-100%; +359%). Similar change was observed for "pressure-time" integral. Percentage of patients with peak pressure in ulceration are