{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T11:14:57Z","timestamp":1783509297225,"version":"3.55.0"},"reference-count":40,"publisher":"MDPI AG","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:p>\n                    <jats:bold>Background:<\/jats:bold>\n                    The incidence of diabetic foot infections is increasing due to the rising number of persons with diabetes and the prolonged life expectancy. It is vital to differentiate soft-tissue infection (STI) from diabetic foot osteomyelitis (DFO), as treatment modalities and durations vary widely, but this can be challenging. We aimed to assess the blood concentration levels of the high mobility group box 1 protein (HMGB-1) in STI and DFO compared to healthy subjects, and to investigate whether this protein could contribute to differentiating STI from DFO.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:<\/jats:bold>\n                    Data from patients with suspected soft-tissue infection or diabetic foot osteomyelitis and healthy volunteers were prospectively recorded. Mean C-reactive protein, erythrocyte sedimentation rate, white blood cell, and HMGB-1 values in the groups were analyzed. Cut-off values of HMGB-1 between the three groups were also determined. A three-phase bone scintigraphy was accepted as the diagnostic method for differentiating STI and DFO.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:<\/jats:bold>\n                    A total of 92 volunteers, were included in the study. Group 1 comprised 28 healthy individuals who composed the control group. Group 2 comprised the 35 patients diagnosed with STI, and Group 3 comprised 29 patients diagnosed with DFO. The HMGB-1 was significantly higher in DFO. The sensitivity, specificity, and accuracy of HMGB-1 in differentiating between STI and DFO was 55%, 94%, and 77%, respectively.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:<\/jats:bold>\n                    We concluded that measurement of the serum HMGB-1 level could be an adjunctive test in the differential diagnosis of diabetic foot infections.\n                  <\/jats:p>","DOI":"10.7547\/22-209","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T10:11:41Z","timestamp":1737972701000},"source":"Crossref","is-referenced-by-count":0,"title":["The Role of Serum HMGB-1 Level in Differentiating the Soft-Tissue Infection From Diabetic Foot Osteomyelitis"],"prefix":"10.3390","volume":"114","author":[{"given":"Ibrahim Halil","family":"Rizvanoglu","sequence":"first","affiliation":[{"name":"NCR International Hospital, Gaziantep, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00dcmit","family":"Cinkir","sequence":"additional","affiliation":[{"name":"Medical Point Gaziantep Hospital, Gaziantep, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vuslat","family":"Bosnak","sequence":"additional","affiliation":[{"name":"Medical Point Gaziantep Hospital, Gaziantep, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuri","family":"Orhan","sequence":"additional","affiliation":[{"name":"Medical Point Gaziantep Hospital, Gaziantep, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Necla","family":"Benlier","sequence":"additional","affiliation":[{"name":"Sanko University School of Medicine, Gaziantep, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"F\u00fcsun","family":"Kokcu","sequence":"additional","affiliation":[{"name":"Medical Point Gaziantep Hospital, Gaziantep, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"B1","series-title":"Diabetes Res Clin Pract","first-page":"271","article-title":"IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045","volume":"138","author":"Cho NH","year":"2018","unstructured":"Cho NH, Shaw JE, Karuranga S, et al: IDF Diabetes Atlas: Global estimates of diabetes prevalence for 2017 and projections for 2045. Diabetes Res Clin Pract 138: 271, 2018."},{"key":"B2","series-title":"JAMA","first-page":"217","article-title":"Preventing foot ulcers in patients with diabetes","volume":"293","author":"Singh N","year":"2005","unstructured":"Singh N, Armstrong DG, Lipsky BA: Preventing foot ulcers in patients with diabetes. JAMA 293: 217, 2005."},{"key":"B3","series-title":"Curr Drug Targets","first-page":"527","article-title":"Recent Advances in Polymer-based Wound Dressings for the Treatment of Diabetic Foot Ulcer: An Overview of State-of-the-art","volume":"19","author":"Hussain Z","year":"2018","unstructured":"Hussain Z, Thu HE, Shuid AN, et al: Recent Advances in Polymer-based Wound Dressings for the Treatment of Diabetic Foot Ulcer: An Overview of State-of-the-art. Curr Drug Targets 19: 527, 2018."},{"key":"B4","series-title":"Diabetes Metab Syndr Obes","first-page":"2799","article-title":"Prevalence of diabetes mellitus, prediabetes and its associated factors in Dessie town, Northeast Ethiopia: A community-based study","volume":"12","author":"Endris T","year":"2019","unstructured":"Endris T, Worede A, Asmelash D: Prevalence of diabetes mellitus, prediabetes and its associated factors in Dessie town, Northeast Ethiopia: A community-based study. Diabetes Metab Syndr Obes 12: 2799, 2019."},{"key":"B5","series-title":"Diabetes Metab Res Rev","first-page":"163","article-title":"Expert opinion on the management of infections in the diabetic foot","volume":"28","author":"Lipsky BA","year":"2012","unstructured":"Lipsky BA, Peters EJ, Senneville E, et al: Expert opinion on the management of infections in the diabetic foot. Diabetes Metab Res Rev 28: 163, 2012."},{"key":"B6","series-title":"Int Wound J","first-page":"40","article-title":"The value of inflammatory markers to diagnose and monitor diabetic foot osteomyelitis","volume":"14","author":"Van Asten SA","year":"2017","unstructured":"Van Asten SA, Nichols A, La Fontaine J, et al: The value of inflammatory markers to diagnose and monitor diabetic foot osteomyelitis. Int Wound J 14: 40, 2017."},{"key":"B7","series-title":"J Diabetes Complications","first-page":"214","article-title":"Does treatment affect the levels of serum interleukin-6, interleukin-8 and procalcitonin in diabetic foot infection? A pilot study","volume":"26","author":"Altay FA","year":"2012","unstructured":"Altay FA, Sencan \u0130, \u015eent\u00fcrk G, et al: Does treatment affect the levels of serum interleukin-6, interleukin-8 and procalcitonin in diabetic foot infection? A pilot study. J Diabetes Complications 26: 214, 2012."},{"key":"B8","series-title":"J Foot Ankle Surg","first-page":"39","article-title":"Combined clinical and laboratory testing improves diagnostic accuracy for osteomyelitis in the diabetic foot","volume":"48","author":"Fleischer AE","year":"2009","unstructured":"Fleischer AE, Didyk AA, Woods JB, et al: Combined clinical and laboratory testing improves diagnostic accuracy for osteomyelitis in the diabetic foot. J Foot Ankle Surg 48: 39, 2009."},{"key":"B9","series-title":"Diabetologia","first-page":"347","article-title":"Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study","volume":"51","author":"Jeandrot A","year":"2008","unstructured":"Jeandrot A, Richard JL, Combescure C, et al: Serum procalcitonin and C-reactive protein concentrations to distinguish mildly infected from non-infected diabetic foot ulcers: a pilot study. Diabetologia 51: 347, 2008."},{"key":"B10","series-title":"Int J Low Extrem Wounds","first-page":"94","article-title":"The performance of serum inflammatory markers for the diagnosis and follow-up of patients with osteomyelitis","volume":"12","author":"Michail M","year":"2013","unstructured":"Michail M, Jude E, Liaskos C, et al: The performance of serum inflammatory markers for the diagnosis and follow-up of patients with osteomyelitis. Int J Low Extrem Wounds 12: 94, 2013."},{"key":"B11","series-title":"Tohoku J Exp Med","first-page":"305","article-title":"Procalcitonin as a diagnostic aid in diabetic foot infections","volume":"213","author":"Uzun G","year":"2007","unstructured":"Uzun G, Solmazgul E, Curuksulu H, et al: Procalcitonin as a diagnostic aid in diabetic foot infections. Tohoku J Exp Med 213: 305, 2007."},{"key":"B12","series-title":"Clin Chim Acta","first-page":"36","article-title":"HMGB1, a novel inflammatory cytokine","volume":"375","author":"Yamada S","year":"2007","unstructured":"Yamada S, Maruyama I: HMGB1, a novel inflammatory cytokine. Clin Chim Acta 375: 36, 2007."},{"key":"B13","series-title":"Crit Care Med","first-page":"S472","article-title":"High mobility group box 1 (HMGB1)","volume":"33","author":"Yang H","year":"2005","unstructured":"Yang H, Tracey KJ: High mobility group box 1 (HMGB1). Crit Care Med 33: S472, 2005."},{"key":"B14","series-title":"Biochim Biophys Acta Mol Basis Dis","first-page":"3847","article-title":"Redox-active trace metal-induced release of high mobility group box 1(HMGB1) and inflammatory cytokines in fibroblast-like synovial cells is Toll-like receptor 4 (TLR4) dependent","volume":"1864","author":"Alsousi AA","year":"2018","unstructured":"Alsousi AA, Igwe OJ: Redox-active trace metal-induced release of high mobility group box 1(HMGB1) and inflammatory cytokines in fibroblast-like synovial cells is Toll-like receptor 4 (TLR4) dependent. Biochim Biophys Acta Mol Basis Dis 1864: 3847, 2018."},{"key":"B15","series-title":"Injury","first-page":"1323","article-title":"Pattern of release and relationship between HMGB-1 and IL-6 following blunt trauma","volume":"41","author":"Giannoudis PV","year":"2010","unstructured":"Giannoudis PV, Mallina R, Harwood P, et al: Pattern of release and relationship between HMGB-1 and IL-6 following blunt trauma. Injury 41: 1323, 2010."},{"key":"B16","series-title":"Clin Chim Acta","first-page":"173","article-title":"New high mobility group box 1 assay system","volume":"372","author":"Yamada S","year":"2006","unstructured":"Yamada S, Yakabe K, Ishii J, et al: New high mobility group box 1 assay system. Clin Chim Acta 372: 173, 2006."},{"key":"B17","series-title":"Clin Infect Dis","first-page":"e132","article-title":"2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections","volume":"54","author":"Lipsky BA","year":"2012","unstructured":"Lipsky BA, Berendt AR, Cornia PB, et al: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis 54: e132, 2012."},{"key":"B18","series-title":"Diabetes Care","first-page":"1288","article-title":"Risk factors for foot infections in individuals with diabetes","volume":"29","author":"Lavery LA","year":"2006","unstructured":"Lavery LA, Armstrong DG, Wunderlich RP, et al: Risk factors for foot infections in individuals with diabetes. Diabetes Care 29: 1288, 2006."},{"key":"B19","series-title":"Diabetes Care","first-page":"637","article-title":"Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study","volume":"31","author":"Senneville E","year":"2008","unstructured":"Senneville E, Lombart A, Beltrand E, et al: Outcome of diabetic foot osteomyelitis treated nonsurgically: a retrospective cohort study. Diabetes Care 31: 637, 2008."},{"key":"B20","series-title":"Diabetes Res Clin Pract","first-page":"347","article-title":"Risk factors for developing osteomyelitis in patients with diabetic foot wounds","volume":"83","author":"Lavery LA","year":"2009","unstructured":"Lavery LA, Peters EJ, Armstrong DG, et al: Risk factors for developing osteomyelitis in patients with diabetic foot wounds. Diabetes Res Clin Pract 83: 347, 2009."},{"key":"B21","series-title":"Scand J Infect Dis","first-page":"497","article-title":"The implications of the presence of osteomyelitis on outcomes of infected diabetic foot wounds","volume":"45","author":"Mutluoglu M","year":"2013","unstructured":"Mutluoglu M, Sivrioglu AK, Eroglu M, et al: The implications of the presence of osteomyelitis on outcomes of infected diabetic foot wounds. Scand J Infect Dis 45: 497, 2013."},{"key":"B22","series-title":"Diabetes Metab Res Rev","first-page":"45","article-title":"IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes","volume":"32","author":"Lipsky BA","year":"2016","unstructured":"Lipsky BA, Arag\u00f3n-S\u00e1nchez J, Diggle M, et al: IWGDF guidance on the diagnosis and management of foot infections in persons with diabetes. Diabetes Metab Res Rev 32: 45, 2016."},{"key":"B23","series-title":"Open Forum Infect Dis","first-page":"ofu060","article-title":"Diagnosing diabetic foot osteomyelitis: narrative review and a suggested 2-step score-based diagnostic pathway for clinicians","volume":"1","author":"Markanday A","year":"2014","unstructured":"Markanday A: Diagnosing diabetic foot osteomyelitis: narrative review and a suggested 2-step score-based diagnostic pathway for clinicians. Open Forum Infect Dis 1: ofu060, 2014."},{"key":"B24","series-title":"Eur J Nucl Med","first-page":"132","article-title":"Contribution of technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy to the diagnosis of diabetic foot infection","volume":"25","author":"Devillers A","year":"1998","unstructured":"Devillers A, Moisan A, Hennion F, et al: Contribution of technetium-99m hexamethylpropylene amine oxime labelled leucocyte scintigraphy to the diagnosis of diabetic foot infection. Eur J Nucl Med 25: 132, 1998."},{"key":"B25","series-title":"Foot Ankle Int","first-page":"10","article-title":"Prospective study of bone, indium-111-labeled white blood cell, and gallium-67 scanning for the evaluation of osteomyelitis in the diabetic foot","volume":"17","author":"Johnson JE","year":"1996","unstructured":"Johnson JE, Kennedy EJ, Shereff MJ, et al: Prospective study of bone, indium-111-labeled white blood cell, and gallium-67 scanning for the evaluation of osteomyelitis in the diabetic foot. Foot Ankle Int 17: 10, 1996."},{"key":"B26","series-title":"J Foot Ankle Surg","first-page":"2","article-title":"Rapid diagnosis of pedal osteomyelitis in diabetics with a technetium-99m-labeled monoclonal antigranulocyte antibody","volume":"42","author":"Palestro CJ","year":"2003","unstructured":"Palestro CJ, Caprioli R, Love C, et al: Rapid diagnosis of pedal osteomyelitis in diabetics with a technetium-99m-labeled monoclonal antigranulocyte antibody. J Foot Ankle Surg 42: 2, 2003."},{"key":"B27","series-title":"Semin Nucl Med","first-page":"52","article-title":"Nuclear medicine and diabetic foot infections","volume":"39","author":"Palestro CJ","year":"2009","unstructured":"Palestro CJ, Love C: Nuclear medicine and diabetic foot infections. Semin Nucl Med 39: 52, 2009."},{"key":"B28","series-title":"Diabet Med","first-page":"738","article-title":"Diagnosis and assessment of peripheral arterial disease in the diabetic foot","volume":"32","author":"Brownrigg JR","year":"2015","unstructured":"Brownrigg JR, Schaper NC, Hinchliffe RJ: Diagnosis and assessment of peripheral arterial disease in the diabetic foot. Diabet Med 32: 738, 2015."},{"key":"B29","series-title":"Diabetologia","first-page":"18","article-title":"High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study","volume":"50","author":"Prompers L","year":"2007","unstructured":"Prompers L, Huijberts M, Apelqvist J, et al: High prevalence of ischaemia, infection and serious comorbidity in patients with diabetic foot disease in Europe. Baseline results from the Eurodiale study. Diabetologia 50: 18, 2007."},{"key":"B30","series-title":"JAPMA","first-page":"227","article-title":"Is scintigraphy a guideline method in determining amputation levels in diabetic foot?","volume":"104","author":"Baykal YB","year":"2014","unstructured":"Baykal YB, Yaman E, Burc H, et al: Is scintigraphy a guideline method in determining amputation levels in diabetic foot? JAPMA 104: 227, 2014."},{"key":"B31","series-title":"AJR Am J Roentgenol","first-page":"9","article-title":"The scintigraphic diagnosis of osteomyelitis","volume":"158","author":"Schauwecker DS","year":"1992","unstructured":"Schauwecker DS: The scintigraphic diagnosis of osteomyelitis. AJR Am J Roentgenol 158: 9, 1992."},{"key":"B32","series-title":"Med Sci Monit","first-page":"Cr307","article-title":"The diagnosis of diabetic foot osteomyelitis: examination findings and laboratory values","volume":"15","author":"Ertugrul BM","year":"2009","unstructured":"Ertugrul BM, Savk O, Ozturk B, et al: The diagnosis of diabetic foot osteomyelitis: examination findings and laboratory values. Med Sci Monit 15: Cr307, 2009."},{"key":"B33","series-title":"Diabetes Res Clin Pract","first-page":"53","article-title":"Can procalcitonin predict bone infection in people with diabetes with infected foot ulcers? A pilot study","volume":"94","author":"Mutluo\u011flu M","year":"2011","unstructured":"Mutluo\u011flu M, Uzun G, \u0130pcio\u011flu OM, et al: Can procalcitonin predict bone infection in people with diabetes with infected foot ulcers? A pilot study. Diabetes Res Clin Pract 94: 53, 2011."},{"key":"B34","series-title":"JAMA","first-page":"806","article-title":"Does this patient with diabetes have osteomyelitis of the lower extremity?","volume":"299","author":"Butalia S","year":"2008","unstructured":"Butalia S, Palda VA, Sargeant RJ, et al: Does this patient with diabetes have osteomyelitis of the lower extremity? JAMA 299: 806, 2008."},{"key":"B35","series-title":"Diabetes Metab Res Rev","first-page":"S42","article-title":"Principles and practice of antibiotic therapy of diabetic foot infections","volume":"16","author":"Lipsky BA","year":"2000","unstructured":"Lipsky BA, Berendt AR: Principles and practice of antibiotic therapy of diabetic foot infections. Diabetes Metab Res Rev 16: S42, 2000."},{"key":"B36","series-title":"JAPMA","first-page":"402","article-title":"How and why to surgically debride neuropathic diabetic foot wounds","volume":"92","author":"Armstrong DG","year":"2002","unstructured":"Armstrong DG, Lavery LA, Vazquez JR, et al: How and why to surgically debride neuropathic diabetic foot wounds. JAPMA 92: 402, 2002."},{"key":"B37","series-title":"Curr Diab Rep","first-page":"3","article-title":"Diabetic foot infections: an update in diagnosis and management","volume":"17","author":"Grigoropoulou P","year":"2017","unstructured":"Grigoropoulou P, Eleftheriadou I, Jude EB, et al: Diabetic foot infections: an update in diagnosis and management. Curr Diab Rep 17: 3, 2017."},{"key":"B38","series-title":"JAPMA","first-page":"2","article-title":"Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections","volume":"103","author":"Lipsky BA","year":"2012","unstructured":"Lipsky BA, Berendt AR, Cornia PB, et al: 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. JAPMA 103: 2, 2013."},{"key":"B39","series-title":"Diabetes Metab Res Rev","first-page":"254","article-title":"Pitfalls in diagnosing diabetic foot infections","volume":"32","author":"Peters EJ","year":"2016","unstructured":"Peters EJ: Pitfalls in diagnosing diabetic foot infections. Diabetes Metab Res Rev 32: 254, 2016."},{"key":"B40","series-title":"Diabetes Metab Res Rev","first-page":"e3280","article-title":"Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update)","volume":"36","author":"Lipsky BA","year":"2020","unstructured":"Lipsky BA, Senneville \u00c9, Abbas ZG, et al: Guidelines on the diagnosis and treatment of foot infection in persons with diabetes (IWGDF 2019 update). Diabetes Metab Res Rev 36: e3280, 2020."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"link":[{"URL":"https:\/\/japmaonline.org\/view\/journals\/apms\/114\/6\/22-209.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/114\/6\/22-209.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/japmaonline.org\/downloadpdf\/journals\/apms\/114\/6\/22-209.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T10:19:53Z","timestamp":1783505993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/114\/6\/22209"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,11]]},"references-count":40,"journal-issue":{"issue":"6"},"URL":"https:\/\/doi.org\/10.7547\/22-209","relation":{},"ISSN":["8750-7315"],"issn-type":[{"value":"8750-7315","type":"print"}],"subject":[],"published":{"date-parts":[[2024,11]]}}}