糖尿病足的诊断（接上篇）

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糖尿病足

压疮

造口

溃疡

烧伤
蔡道章院长

Custom Mod Mega1

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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A global view of pediatric urology 2026-09-08 00:00

Catherine R. deVries *

Summary

Over the course of approximately 60 years, the field of pediatric urology has evolved as a convergence of pediatric surgery, urology, and plastic surgery to address congenital anomalies of the urinary tract and genitalia in children. Guide-lines for training and certification are narrowing in high-income countries (HICs) at the same time as the fertility rate is declining and the prevalence of complex genitourinary (GU) conditions is decreasing. In low-and middle-income countries (LMICs), health systems for large populations are currently in a state of stress. Here we briefly review the history of pediatric urology as a surgical subspecialty, identify unmet needs especially in LMICs and place the field in the context of a global surgical ecosystem.

Methods

The English language literature on workforce trends in pediatric urology, pediatric surgery and urology was reviewed as well as development of the emerging field of global surgery. Global surgery looks at the social, economic and political context of health systems as well as unmet clinical need. World trends in fertility rates were reviewed to identify regions of workforce surplus and gaps, supply chain needs, infrastructure and systems strengths and weaknesses.

Results

The proliferation of training programs in pediatric surgery and specialties in high-income countries (HICs) coupled with declining birth rates has led to a saturation of specialists and declining surgical case load. In LMICs, while the birth rate has also been declining, surgical specialization has not progressed. In the lowest income countries, especially in sub-Saharan Africa, training in pediatric surgical specialties and urology is rare. The broad workforce that supports surgical care, such as anesthesia, intensivist pediatrics, radiology, laboratory, and nursing face similar challenges. Supply chains for specialized pediatric urological surgery are weak.

Conclusion

There is an evolving maldistribution of pediatric surgical and pediatric urological workforce globally, with too few practitioners in LMICs and too many in HICs. The high cost of specialized equipment limits access to quality care, and the supply chain for consumables and medication is patchy. In LIC’s, basic community-based infrastructure for health including reliable electricity is lacking. Recent experience with Covid and environmental disasters has highlighted that even in HICs surgical resilience can be challenged. This is an opportunity to consider the state of children’s urological care globally and to build resilience by identifying and addressing strengths and gaps.

Effects of hypochlorous acid mouthwash on salivary bacteria including Staphylococcus aureus in patients with periodontal disease: a randomized controlled trial 2026-09-07 00:00

Ying‑Chu Lin¹ , Cheng‑Feng Tsai^1,2* and Hsiao‑Ling Huang^3*

Abstract

Background The effects of a low concentration of hypochlorous acid (HOCl) mouthwash on salivary bacteria remained unclear. We aimed to evaluate the antibacterial effects of 100 ppm HOCl mouthwash on salivary bacteria, including Staphylococcus aureus (S. aureus), in patients with periodontal disease (PD).

Methods Patients with PD were randomized into mouthwash-only (MW, n=26) and mouthwash with periodon‑tal flosser (MWPF, n=27) groups. Patients without PD were selected for the control group (n=30). S. aureus culture and saliva samples (before and after the intervention) were collected for bacterial DNA extraction. A real-time poly‑ merase chain reaction assay and serial dilutions of S. aureus culture and saliva samples were used to measure the salivary bacteria total count (SBTC) and confirm the antibacterial effects of the mouthwash using S. aureus.

Results No significant difference in demographic data was observed among the three groups. Before the intervention, the baseline SBTC of the MW and MWPF groups was significantly higher than that of the control group. After the mouthwash rinses, the SBTC data significantly changed in the MW and MWPF groups only (by 62.4% and 77.4%, respectively). After the base-2 log-transformation of the SBTC data, a similar trend was observed. Linear regression revealed that baseline SBTC and the MWPF intervention significantly affected SBTC reduction percentage by volume. After incubation with 10% (v/v) of mouthwash, the survival rates of 106 and 107 colony-forming units/mL of S. aureus were 0.51%±0.06% and 1.42%±0.37%, respectively.

Conclusions These study results indicated that 100 ppm HOCl mouthwash treatment could effectively reduce SBTC in patients with PD and the abundance of S. aureus. It provides that the HOCl mouthwash can be an option for individuals to help control SBTC, especially in patients with PD.

Trial registration The study protocol was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-F(I)-20200042) on 20/03/2020 and retrospectively registered at ClinicalTrial.gov (NCT05372835) on 13/05/2022.

Keywords Antibacterial ability, Total bacterial count, Hypochlorous acid, Mouthwash, Intervention, Bacterial growth estimation
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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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A global view of pediatric urology 2026-09-08 00:00

Catherine R. deVries *

Summary

Over the course of approximately 60 years, the field of pediatric urology has evolved as a convergence of pediatric surgery, urology, and plastic surgery to address congenital anomalies of the urinary tract and genitalia in children. Guide-lines for training and certification are narrowing in high-income countries (HICs) at the same time as the fertility rate is declining and the prevalence of complex genitourinary (GU) conditions is decreasing. In low-and middle-income countries (LMICs), health systems for large populations are currently in a state of stress. Here we briefly review the history of pediatric urology as a surgical subspecialty, identify unmet needs especially in LMICs and place the field in the context of a global surgical ecosystem.

Methods

The English language literature on workforce trends in pediatric urology, pediatric surgery and urology was reviewed as well as development of the emerging field of global surgery. Global surgery looks at the social, economic and political context of health systems as well as unmet clinical need. World trends in fertility rates were reviewed to identify regions of workforce surplus and gaps, supply chain needs, infrastructure and systems strengths and weaknesses.

Results

The proliferation of training programs in pediatric surgery and specialties in high-income countries (HICs) coupled with declining birth rates has led to a saturation of specialists and declining surgical case load. In LMICs, while the birth rate has also been declining, surgical specialization has not progressed. In the lowest income countries, especially in sub-Saharan Africa, training in pediatric surgical specialties and urology is rare. The broad workforce that supports surgical care, such as anesthesia, intensivist pediatrics, radiology, laboratory, and nursing face similar challenges. Supply chains for specialized pediatric urological surgery are weak.

Conclusion

There is an evolving maldistribution of pediatric surgical and pediatric urological workforce globally, with too few practitioners in LMICs and too many in HICs. The high cost of specialized equipment limits access to quality care, and the supply chain for consumables and medication is patchy. In LIC’s, basic community-based infrastructure for health including reliable electricity is lacking. Recent experience with Covid and environmental disasters has highlighted that even in HICs surgical resilience can be challenged. This is an opportunity to consider the state of children’s urological care globally and to build resilience by identifying and addressing strengths and gaps.
Effects of hypochlorous acid mouthwash on salivary bacteria including Staphylococcus aureus in patients with periodontal disease: a randomized controlled trial 2026-09-07 00:00

Ying‑Chu Lin¹ , Cheng‑Feng Tsai^1,2* and Hsiao‑Ling Huang^3*

Abstract

Background The effects of a low concentration of hypochlorous acid (HOCl) mouthwash on salivary bacteria remained unclear. We aimed to evaluate the antibacterial effects of 100 ppm HOCl mouthwash on salivary bacteria, including Staphylococcus aureus (S. aureus), in patients with periodontal disease (PD).

Methods Patients with PD were randomized into mouthwash-only (MW, n=26) and mouthwash with periodon‑tal flosser (MWPF, n=27) groups. Patients without PD were selected for the control group (n=30). S. aureus culture and saliva samples (before and after the intervention) were collected for bacterial DNA extraction. A real-time poly‑ merase chain reaction assay and serial dilutions of S. aureus culture and saliva samples were used to measure the salivary bacteria total count (SBTC) and confirm the antibacterial effects of the mouthwash using S. aureus.

Results No significant difference in demographic data was observed among the three groups. Before the intervention, the baseline SBTC of the MW and MWPF groups was significantly higher than that of the control group. After the mouthwash rinses, the SBTC data significantly changed in the MW and MWPF groups only (by 62.4% and 77.4%, respectively). After the base-2 log-transformation of the SBTC data, a similar trend was observed. Linear regression revealed that baseline SBTC and the MWPF intervention significantly affected SBTC reduction percentage by volume. After incubation with 10% (v/v) of mouthwash, the survival rates of 106 and 107 colony-forming units/mL of S. aureus were 0.51%±0.06% and 1.42%±0.37%, respectively.

Conclusions These study results indicated that 100 ppm HOCl mouthwash treatment could effectively reduce SBTC in patients with PD and the abundance of S. aureus. It provides that the HOCl mouthwash can be an option for individuals to help control SBTC, especially in patients with PD.

Trial registration The study protocol was approved by the Institutional Review Board of Kaohsiung Medical University Hospital (KMUHIRB-F(I)-20200042) on 20/03/2020 and retrospectively registered at ClinicalTrial.gov (NCT05372835) on 13/05/2022.

Keywords Antibacterial ability, Total bacterial count, Hypochlorous acid, Mouthwash, Intervention, Bacterial growth estimation
次氯酸消毒剂在骨科术后切口愈合中的应用：一项实效性随机对照试验 2026-09-05 00:00

张燕１，朱迪１，孙磊１，王任贤２

（１．徐州仁慈医院感染管理科，江苏徐州２４１００４；２．台湾防疫学会，台湾台中４０４４７）

［摘要］目的探讨次氯酸应用于外科术后切口愈合及减少术后切口感染的临床效果。方法纳入某三级甲等医院足踝外科住院患者，按手术时序进行分组：第一阶段（２０２４年１０月１６日—１２月１６日）为对照组，采用４５００～５５００ｍｇ／Ｌ碘伏消毒术后切口；第二阶段（２０２４年１２月１７日—２０２５年２月１７日）为试验组，采用（１１０±１６．５）ｍｇ／Ｌ次氯酸消毒术后切口。术后第１、３、５、７、１０、１４天进行切口消毒、指标评价并记录。主要结局指标为手术部位感染，次要指标包括术后４８ｈ红肿、过敏及疼痛程度评分。结果对照组感染发病率为０．９６％，术后４８ｈ红肿发生率为１６．９９％，疼痛评分（１．４１±０．４９）分；试验组未发生感染，术后４８ｈ红肿发生率为９．５８％，疼痛评分为（１．３６±０．４８）分。两组感染发病率及疼痛评分差异均无统计学意义（均犘＞０．０５），红肿发生率差异具有统计学意义（犘＝０．００６）。按切口类型进行分层分析显示，开放性外伤亚组中，对照组感染发病率为３．１９％，红肿发生率为２９．７９％，疼痛评分为（１．６２±０．４９）分；试验组术后４８ｈ红肿发生率为８．１４％，疼痛评分为（１．４１±０．４９）分，两组感染发病率差异无统计学意义（犘＞０．０５），红肿发生率（犘＜０．００１）及疼痛程度评分（犘＝０．００５）差异均有统计学意义。闭合性外伤亚组中，各结局指标组间比较差异均无统计学意义（均犘＞０．０５）。结论次氯酸溶液在闭合性外伤术后切口应用的效果与碘伏相当；在开放性外伤术后应用中，其控制术后红肿发生及疼痛的效果优于碘伏。

［关键词］次氯酸；碘伏；骨科；切口愈合；实效性随机对照试验

［中图分类号］Ｒ１８１．３＋２Ｒ１８７＋．１

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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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Custom Mod Mega1

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