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Dinh, Thanh

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Dinh

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Thanh

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Dinh, Thanh

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2009 - 200912010 - 20132

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Author's Publications: search.filters.isAuthorOfPublication.f033f0c5-2f2e-4f99-beb0-75628026a446

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Now showing 1 - 3 of 3
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    Mechanisms Involved in the Development and Healing of Diabetic Foot Ulceration
    (American Diabetes Association, 2012) Dinh, Thanh; Tecilazich, Francesco; Kafanas, Antonios; Doupis, John; Gnardellis, Charalambos; Leal, Ermelindo; Tellechea, Ana; Pradhan, Leena; Lyons, Thomas E.; Giurini, John; Veves, Aristidis
    We examined the role of vascular function and inflammation in the development and failure to heal diabetic foot ulcers (DFUs). We followed 104 diabetic patients for a period of 18.4 ± 10.8 months. At the beginning of the study, we evaluated vascular reactivity and serum inflammatory cytokines and growth factors. DFUs developed in 30 (29%) patients. DFU patients had more severe neuropathy, higher white blood cell count, and lower endothelium-dependent and -independent vasodilation in the macrocirculation. Complete ulcer healing was achieved in 16 (53%) patients, whereas 13 (47%) patients did not heal. There were no differences in the above parameters between the two groups, but patients whose ulcers failed to heal had higher tumor necrosis factor-α, monocyte chemoattractant protein-1, matrix metallopeptidase 9 (MMP-9), and fibroblast growth factor 2 serum levels when compared with those who healed. Skin biopsy analysis showed that compared with control subjects, diabetic patients had increased immune cell infiltration, expression of MMP-9, and protein tyrosine phosphatase-1B (PTP1B), which negatively regulates the signaling of insulin, leptin, and growth factors. We conclude that increased inflammation, expression of MMP-9, PTP1B, and aberrant growth factor levels are the main factors associated with failure to heal DFUs. Targeting these factors may prove helpful in the management of DFUs.
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    Role of Endothelial Progenitor Cells and Inflammatory Cytokines in Healing of Diabetic Foot Ulcers
    (Public Library of Science, 2013) Tecilazich, Francesco; Dinh, Thanh; Pradhan-Nabzdyk, Leena; Leal, Ermelindo; Tellechea, Ana; Kafanas, Antonios; Gnardellis, Charalambos; Magargee, Mary L.; Dejam, Andre; Toxavidis, Vasilis; Tigges, John C.; Carvalho, Eugenia; Lyons, Thomas E.; Veves, Aristidis
    Background: To evaluate changes in endothelial progenitor cells (EPCs) and cytokines in patients with diabetic foot ulceration (DFU) in association with wound healing. Methods: We studied healthy subjects, diabetic patients not at risk of DFU, at risk of DFU and with active DFU. We prospectively followed the DFU patients over a 12-week period. We also investigated similar changes in diabetic rabbit and mouse models of wound healing. Results: All EPC phenotypes except the kinase insert domain receptor (KDR)+CD133+ were reduced in the at risk and the DFU groups compared to the controls. There were no major EPC differences between the control and not at risk group, and between the at risk and DFU groups. Serum stromal-cell derived factor-1 (SDF-1) and stem cell factor (SCF) were increased in DFU patients. DFU patients who healed their ulcers had lower CD34+KDR+ count at visits 3 and 4, serum c-reactive protein (CRP) and granulocyte-macrophage colony-stimulating factor (GM-CSF) at visit 1, interleukin-1 (IL-1) at visits 1 and 4. EPCs tended to be higher in both diabetic animal models when compared to their non-diabetic counterparts both before and ten days after wounding. Conclusions: Uncomplicated diabetes does not affect EPCs. EPCs are reduced in patients at risk or with DFU while complete wound healing is associated with CD34+KDR+ reduction, suggesting possible increased homing. Low baseline CRP, IL-1α and GM-CSF serum levels were associated with complete wound healing and may potentially serve as prognostic markers of DFU healing. No animal model alone is representative of the human condition, indicating the need for multiple experimental models.
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    Foot Muscle Energy Reserves in Diabetic Patients Without and With Clinical Peripheral Neuropathy
    (American Diabetes Association, 2009) Doupis, John; Kuchibhotla, Sarada; Julliard, Walker; Gnardellis, Charalambos; Dinh, Thanh; Lyons, Thomas Edward; Rosenblum, Barry; Wang, Xiaoen; Giurini, John; Greenman, Robert L.; Veves, Aristidis
    Objective: To investigate changes in the foot muscle energy reserves in diabetic non-neuropathic and neuropathic patients. Research Design and Methods: We measured the phosphocreatinine (PCr)/inorganic phosphate (Pi) ratio, total \(^{31}\)P concentration, and the lipid/water ratio in the muscles in the metatarsal head region using MRI spectroscopy in healthy control subjects and non-neuropathic and neuropathic diabetic patients. Results: The PCr/Pi ratio was higher in the control subjects (3.23 \(\pm\) 0.43) followed by the non-neuropathic group (2.61 \(\pm\) 0.36), whereas it was lowest in the neuropathic group (0.60 \(\pm\) 1.02) (P < 0.0001). There were no differences in total \(^{31}\)P concentration and lipid/water ratio between the control and non-neuropathic groups, but both measurements were different in the neuropathic group (P < 0.0001). Conclusions: Resting foot muscle energy reserves are affected before the development of peripheral diabetic neuropathy and are associated with the endothelial dysfunction and inflammation.