More studies are necessary to establish the effectiveness of Jinhuang powder in the treatment of diabetic foot

TO THE EDlTOR

This is a comment on “This is a comment on “Clinical Study of moist exposed burn ointment (MEBO) Combined with Jinhuang powder for Diabetic Foot with Infection”[1]. We were pleased that read the research article by Hong-Bo Zhan,

[1]. Their work highlights that the use of Jinhuang powder as supplement combined with MEBO as an effective and safe therapy for diabetic foot. This study provides important clues to the treatment of foot infection, ulcer.

Diabetic foot ulcers are one of the most challenging complications of diabetes[2-4]. Previous study found that a group of traditional Chinese medicine (TCM) (

, herbal medicine foot bath decoction[5], TCM injections[6,7], Chinese herbal medicine ulcer oil[8], moxibustion[9], Astragali Radix and Rehmanniae Radix Mixture[10], the peptide compounds of Wuguchong[11], Astragali Radix and Rehmanniae Radix[12,13]) played an important role in the treatment of the disease. Some study also found that interventional radiology plays a crucial role in the treatment of diabetic foot disease[14]. However, the study only focuses on Jinhuang powder has improved the efficacy and safety of MEBO in the treatment of diabetic foot. Thus, some questions still need further be discussed.

In recent years, most diabetic foot patients in China are adopting TCM and western medicine[5,15]. A series of systematic review articles showed that TCM can increase the clinical effective rate of conventional therapies by 27%[6], regulate the signaling pathways to promote diabetic wound healing[16]. An experiment on albino Wistar rats found that Astragali Radix and Rehmanniae Radix in the ratio of 2:1 significantly enhance the circulating CD34+/VEGFR2+/CD45-EPCs levels in diabetic foot ulcer[17]. Another study confirmed the effect of the peptide compounds of Wuguchong in treating diabetic ulcers to a certain extent[11]. However, therapeutic effect criterion is observing wound surface and assessing degree of pain. The research evaluation index was single and lacked objective evaluation.

Aha! they both exclaimed3. You ARE from Iraq! Tara smiled and said yes. Then she apologized to both of them for lying the day before. She explained that she had not wanted to get into an Arabic conversation with them. It had been her experience that many ESL students continued to speak their native language in ESL class, and Tara had not come to ESL class to practice her Arabic. In her opinion, ESL students should try to speak English only.

Another problem of this study was research design. It was only a single-center trial, no double blindness, no placebo group. The short duration of clinical follow-up was not sufficient to explain the efficacy of the treatment, and the safety of the treatment was not mentioned. Large multicenter, doubleblind, randomized, placebo controlled clinical trials and animal studies are necessary to determine Jinhuang powder as supplement combined with other Chinese medicine or western medicine as an effective and safe therapy for diabetic foot.

Overall, MEBO combined with Jinhuang powder is more effective than MEBO alone in treating diabetic foot. However, large-scale multi-center, double blind, randomized, placebo-controlled clinical trials and animal studies are also necessary to establish the effectiveness of Jinhuang powder in the treatment of diabetic foot.

Ya-Wen Ye 0000-0002-5099-4678; Zi-Yun Yan 0000-0002-4695-7989; Lian-Ping He 0000-0002-9627-5599; Cui-Ping Li 0000-0002-9410-1835.

The miller was shocked and answered, How could I cut off my own child s hands? Then the Evil-one threatened him and said, If thou dost not do it thou art mine, and I will take thee thyself

The visits to the church were festive occasions, but among thefisherman s house one was especially looked forward to; this was, infact, the visit of the brother of Jurgen s foster-mother, theeel-breeder from Fjaltring, near Bovbjerg. He came twice a year in acart, painted red with blue and white tulips upon it, and full ofeels; it was covered and locked like a box, two dun oxen drew it,and Jurgen was allowed to guide them.

the research work was supported by the Taizhou philosophy and social science planning project, No. 19GHZ05; and the Taizhou Science and technology planning project, No. 1902ky85.

Li CP and He LP conceived of the presented idea and provided critical feedback to the final manuscript; Li CP, Ye YW and Yan ZY wrote and revised the manuscript; Li CP and He LP approved the main conceptual ideas and proof outline; all authors provided final edits and approved the manuscript.

The authors have no conflict of interest to disclose.

China

This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BYNC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See:https://creativecommons.org/Licenses/by-nc/4.0/

Increasing attention is being given to the use of Chinese medicine for healing diabetic foot. Under the guidance of relevant theories of TCM, more studies are needed to reveal the key active components and related signal pathways of TCM in the treatment of diabetic foot ulcer, so as to promote the further research and clinical application of TCM[16].

Chang KL

That night the two hyaenas told all the rest, saying, Do you know that we have allowed ourselves to be trampled40 on by a wretched creature with nothing of the lion about him but his skin? When supper was being cooked that evening, before they all went to bed, the little hare, looking fierce and terrible in Big Lion s skin, said as usual to one of the hyaenas Go and get into the boiling water

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Chang KL

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