Fifty percent of diabetics (7% of general population) suffer from peripheral arterial occlusive disease, which may lead to amputation due to critical limb ischemia (CLI). The aim of our study was to prevent major limb amputation (MLA) in this group of patients using a local application of autologous bone marrow stem cells (ABMSC) concentrate. A total of 96 patients with CLI and foot ulcer (FU) were randomized into groups I and II. Patients in group I (n = 42, 36 males, 6 females, 66.2 ± 10.6 years) underwent local treatment with ABMSC while those in group II (n = 54, control, 42 males, 12 females, 64.1 ± 8.6 years) received standard medical care. The frequency of major limb amputation in groups I and II was 21% and 44% within the 120 days of follow up, respectively (p < 0.05). Only in salvaged limbs of group I both toe pressure and toe brachial index increased (from 22.66 ± 5.32 to 25.63 ± 4.75 mmHg and from 0.14 ± 0.03 to 0.17 ± 0.03, respectively, mean ± SEM). The CD34+ cell counts in bone marrow concentrate (BMC) decreased (correlation, p = 0.024) with age, even though there was no correlation between age and healing. An unexpected finding was made of relative, bone marrow lymphopenia in the initial bone marrow concentrates in patients who failed ABMSC therapy (21% of MLA). This difference was statistically significant (p < 0.040). We conclude ABMSC therapy results in 79% limb salvage in patients suffering from CLI and FU. In the remaining 21% lymphopenia and thrombocytopenia were identified as potential causative factors, suggesting that at least a partial correction with platelet supplementation may be beneficial.

Supported by Ministry of Health, Czech Republic-conceptual development of research organization (FNOs/2014, project number 20). Graphical abstract Median postoperative pain from 0 to 10 days by group.

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ABSTRACT. Bounded commutative residuated lattice ordered monoids (R -monoids) are a common generalization of, e.g., Heyting algebras and BL-algebras, i.e., algebras of intuitionistic logic and basic fuzzy logic, respectively. , also algebras of logics behind fuzzy reasoning can be considered as particular cases of bounded commutative R -monoids. Namely from this point of view, M V -algebras, an algebraic counterpart of the Lukasiewicz infinitevalued propositional logic, are precisely bounded commutative R -monoids satisfying the double negation law. Further, BL-algebras, an algebraic semantics of the Há j e k basic fuzzy logic, are just bounded commutative R -monoids isomorphic to subdirect products of linearly ordered commutative R -monoids. Heyting algebras (duals to Brouwerian algebras), i.e. algebras of intuitionistic logic, are characterized as bounded commutative R -monoids with idempotent multiplication.2000 M a t h e m a t i c s S u b j e c t C l a s s i f i c a t i o n: Primary 06D35, 06F05. K e y w o r d s: residuated -monoid, residuated lattice, BL-algebra, MV -algebra.

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