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Molecular changes in diabetic foot ulcers

  • Ching-Jen Wang
    Correspondence
    Corresponding author at: The Department of Orthopedic surgery, Kaohsiung Chang Gung Memorial Hospital, 123 Ta-Pei Road, Niao-Sung Hsiang 833, Kaohsiung, Taiwan. Tel.: +886 7 733 5279; fax: +886 7 733 5515.
    Affiliations
    The Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Jih-Yang Ko
    Affiliations
    The Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Yur-Ren Kuo
    Affiliations
    The Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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  • Ya-Ju Yang
    Affiliations
    The Department of Orthopedic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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      Abstract

      Aim

      This study investigated the molecular changes of extracorporeal shockwave therapy (ESWT) and hyperbaric oxygen therapy (HBOT) in chronic diabetic foot ulcers.

      Methods

      A cohort study consisted of 39 patients (44 ulcers) in the ESWT group and 38 patients (40 ulcers) in the HBOT group with similar demographic characteristics. The ESWT group received shockwave therapy twice per week for total six treatments. The HBOT group received hyperbaric oxygen therapy daily for total 20 treatments. Biopsy was performed from the periphery of the ulcer before and after treatment. The specimens were immuno-stained, and the positive immuno-activities of vWF, VEGF, eNOS, PCNA, EGF and TUNEL expressions were examined and quantified microscopically.

      Results

      Significant increases in vWF, VEGF, eNOS, PCNA and EGF expressions and a decrease in TUNEL expression were noted after ESWT (P < 0.05), whereas the changes after HBOT were statistically not significant (P > 0.05). The differences of vWF, VEGF, eNOS, PCNA, EGF and TUNEL expressions between the two groups were comparable before treatment (P > 0.05), however, the differences became statistically significant after treatment (P < 0.05) favoring the ESWT group.

      Conclusion

      ESWT showed significant increases in angiogenesis and tissue regeneration over HBOT in diabetic foot ulcers.

      Keywords

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