| OBJECTIVEIn today's society, chronic wounds increase rapidly with proceeding of industrialization and ageing of population and it represent a major health care burden in whole wolde. Though there have many ways to treating for this kinds of patients, like as debridement, compressing, Antimicrobials and different kinds of dressings, even lots of new products as Hydrogels, Hydrocolloids, Alginates, Collagens, Growth factors and Skin substitutes as well, to choose for chronic wound patients, but physician felt so deeply depression for clinical results and baffled with inconsistent conclusions from different studies. From resent studies's reports, well healing of chronic wound not only requires good nutrition, immune status, proper circulation, but also shows closed relationship with local wound environment, activated status of pluripotent stem cells in wound base. Chronic wounds healing is controlled and influenced by a complicated system which involved multi-tread feedback, involved positive and negative regulation, and interactional relationship with all types of cytokines and tissues. There have many clinical and basical relative studies at resent, most of them are focus on niche and multipotent stem cell. Although some studies made very good conclusions, but some of their results show contradictory with each others. So, we still need more evidences and researching to support clinical practice. The study systematical review bioengineered skin for diabetic foot ulcers by Meta-analysis, investigated effectiveness of Ionic silver dressing+Hydrogels for diabetic foot ulcers in semi-randomized controlled trail, and analysis the correlation between osmotic pressure and lab-data with a cross-sectional study. Maybe some inspirational ideas will reveal. METHODSThe comprehensive search strategies of various electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, CBMWeb, CNKI, and VIP) were used for this study to evaluate the efficiency and safety between Tissue-Engineered Skin (TES) and conventional treatment (CT) in patients with Diabetic Foot Ulcer (DFU). In addition, manual searched reference lists from original studies and review articles. Only randomized controlled trials included (RCT) our searching criteria but not limited language. Upon strictly included and excluded standard, the data of wound closure, recurernce and the occurrence of complication and adverse severe events were collect from 7 studies.Forty three Diabetic Foot Ulcers patients, who are hospitalized in our hospital from February 2007 to June 2008, were selected and divided into two groups semi-randomly. The patients from group A were treated with Ionic silver dressing+ Hydrogels and patients from controlled group B were treated with basic method. Dynamic data of wound closure, germiculture and average period of antibiotic using were collected in study period.The data of osmotic pressure, vital sign, and biochemistry test were collected from case history of 1000 patients which is choosing from October 2007 to June 2010 in our hospital were collected to analysis. The patients who was diagnosis with Craniocerebral Trauma, Digestive Carcinoma, Posthepatitic Cirrhosis, Congenital Heart Disease, Glomerular Nephritis, Appendicitis is 100 respectively, and Diabetes Mellitus patients and Nephrotic Syndrome is 350 and 50 respectively among whole cases. We use SPSS 16.0 software to analysis data.RESULTSSeven trials were included, which all were Randomized controlled trials and duration of DFU over 6 weeks. There were 880 participants met inclusion criteria in all studies, and all patients were taken pretreated procedure and treated by TES (human skin equivalent, living skin equivalents, or bioengineered skin, Such as Graftskin, Dermagraft, Graft-jacket) for 12 weeks. All trails had two groups treatment vs. control groups, but two trails divided treatment group into 3 different dosage and 2 different ulcer allocation subgroup, respectively. Meta-analysis result shows that:significant differences in the rate of complete wound closure (P<0.0001, 95%CI,0.08-0.20), and in the occurrence of complication and adverse severe events (ASE) (P=0.008,95%CI,-0.06,-0.01) between TES treated patients and convention treated patients.Ionic silver dressing+Hydrogels could control wound infection, promote wound granulation and epithelium regeneration and lessen inflammatory reaction. In treating group, the average wound healing time decreased to 53.18±9.49 days from 66.86±7.90days in control group (p<0.05). Significant differences also found in germiculture and the average period of antibiotic using between two groups.In the study,Ionic silver dressing+Hydrogels also shows very well for wound bed preparatian.Osnotic pressure of patients who is diabetes mellitus and glomerular nephritis shows significant differences with other six types of patients (Craniocerebral Trauma, Digestive Carcinoma, Posthepatitic Cirrhosis, Congenital Heart Disease, Appendicitis, and Nephrotic Syndrome). Osmotic pressure shows positive correlation with patient's age and blood pressure (R=0.108,0.351,0.305; P=0.009,0.000,0.000 respectively), and negative correlation with heart rate (-0.107, P=0.010). Significant correlation also found between osmotic pressure and blood coagulation system. With Cox Multivariate Regression analysis,8 variables were entered in Model 8 (R=0.962, F=603.830, P< 0.001), they are Creatinine, Na++, K+, neutrophile granulocyte, uric acid, hemoglobin, white blood cell, Ca++. Most predisposing factora of chronic wounds had very closed relationship with the change of osmotic pressure in the study, but what effectiveness of total osmotic pressure and local osmotic pressure should be get more researching works.CONCLUSIONSThe review shows Bioengineered Skin improve completed closure of DFU compared CT, and is more effective in reducing side effects.Ionic silver dressing+Hydrogels is efficacious in treating group of diabetic foot ulcer.Osmotic pressure is very important index to make internal environment stable, and has closed correlation with age, type of disease, blood pressure, heart rate, blood coagulation system and metabolic system.
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