Risk factors for diabetic foot ulcers: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the risk factors for developing diabetic foot ulcers (DFU).

METHODS

The Cochrane Library, PubMed, Web of Science, SinoMed, CNKI, VIP, and Wanfang Data were searched for relevant studies on DFU risk factors, and the search time frame was from database creation to March 2022. Meta-analysis was performed using RevMan 5.3.

RESULTS

A total of 26 publications were included, including 3 cohort studies, 22 case-control studies, and one cross-sectional study. Meta-analysis showed that advanced age [MD = 6.04, 95% CI (3.92, 8.16)], male [OR = 1.84, 95% CI (1.48, 2.29)], elevated body mass index [MD = 1.58, 95% CI (0.47, 2.69)], prolonged duration of diabetes [MD = 2.72, 95% CI (2.33, 3.11)], comorbid nephropathy [OR = 3.15, 95% CI (2.68, 4.60)], comorbid neuropathy [OR = 4.80, 95% CI (2.79, 8.27)], comorbid retinopathy [OR = 3.37, 95% CI (2.26, 5.02)], elevated systolic blood pressure [OR = 8.19, 95% CI (6.33, 10.05)], elevated fasting glucose [MD = 1.60, 95% CI (0.21, 3.00)], elevated glycated hemoglobin [MD = 1.24, 95% CI (0.94, 1.54)], elevated triglycerides [MD = 0.44 (95% CI (0.15, 0.73)], elevated fibrinogen [MD = 1.35, 95% CI (0.62, 2.08)], elevated white blood cell count [MD = 2.56, 95% CI (2.24, 2.88)], elevated C-reactive protein [MD = 15.08, 95% CI (8.03, 22.13)], decreased ankle-brachial ratio [MD = -0.26, 95% CI (-0.36, -0.16)], and decreased total protein levels [MD = -4.58, 95% CI (-6.91, -2.25)] were risk factors for developing DFU (p < 0.05), and increased HDL cholesterol levels [MD = -0.22, 95% CI (-0.36, -0.08)] were protective factor for developing DFU (p < 0.05).

CONCLUSION

There are many risk factors for developing of ulcers in the diabetic feet, and early prevention and intervention should be performed as early as possible to assess the risk of developing diabetic foot patients.

Coupling Oxygen Vacancy Gradient Distribution and Flexoelectric Effect for Enhanced Photovoltaic Performance in Bismuth Ferrite Films

Although the anomalous ferroelectric photovoltaic effect of Bismuth ferrite (BiFeO3) has recently drawn widespread attention, the very low photocurrent density and thus the poor power conversion efficiency severely hinders its...

[Current status and thoughts of non-surgical treatment of knee osteoarthritis]

Knee osteoarthritis (KOA) is a worldwide disease, and also the main cause of pain and disability in the motor system. Due to the aging population in China, extension of life expectancy and increased number of obese people, the number of people affected by KOA continues to surge. Neither surgical nor non-surgical treatment can change the disease process, but these interventions can reduce pain and disability. The treatment principle of KOA is to start with non-surgical treatment, which has been considered as the first choice for KOA patients due to its advantages of less complications, minimal invasiveness, and low medical cost. This article describes the non-surgical treatment of KOA, aiming to provide new insights into the clinical treatment of KOA.

[Misdiagnosis analysis: 120 patients with nasal extranodal NK/T cell lymphoma in head and neck]

Objective:The Clinicopathological characteristics and the reason of misdiagnosis about nasal extranodal NK/T cell lymphoma in head and neck（ENKTL） are analysised to raise awareness and reduce misdiagnosis. Method:One hundred and twenty patients with ENKTL, diagnosed pathologically in head and neck from May 2010 to April 2018, were analyzed retrospectively. All cases were divided into misdiagnosed group and non-misdiagnosed group according to whether there were misdiagnosis and mistreatment before diagnosis. The differences of clinicopathological characteristics between the two groups before and after diagnosis were compared. The differences of overall survival（OS） between the two groups after treatment were also compared. Result:The misdiagnosis rate of this study was 71.7%, and they were misdiagnosed as sinusitis, nasal polyps, upper respiratory tract infection and so on. On the whole, the 1-year OS, 3-year OS and 5-year OS were 77.8%, 65.9% and 49.3% respectively. There was no significant difference in sex, age, first symptom, initial site, B symptom, superficial lymph node enlargement and weight loss between two groups before diagnosis（P>0.05）, however, there were significant differences in relative specific signs, hospital grade and time from first visit to definite diagnosis（P<0.05）. The proportion of the high-level hospitals in the first visit hospital was significantly lower than that in the non-misdiagnosed group, while the time from the first visit to the final diagnosis was significantly longer than that in the non-misdiagnosed group. There was no significant difference in international prognostic index（IPI） score, expression of Ki-67, therapeutic schedule, chemotherapy regimen for patients receiving chemotherapy, and radiation dose for patients receiving radiotherapy after diagnosis between the two groups（P>0.05）, but there was a significant difference in the clinical stages of Ann Arbor between the two groups（P<0.05）. The clinical staging of the misdiagnosed group was later than that of the non-misdiagnosed group. The 1-year OS, 3-year OS and 5-year OS were 73.6%, 59.3% and 43.2% in the misdiagnosed group respectively, and 88.2%, 82.4% and 64.2% in the non-misdiagnosed group respectively. The overall survival rate in the misdiagnosis group was lower than that in the non-misdiagnosed group, and the overall survival time was lower than that in the non-misdiagnosed group. However, there was no significant difference in the overall survival rates between the early stage（Ⅰ and Ⅱ） and the advanced stage（Ⅲ and Ⅳ） of Ann Arbor（P>0.05）. Conclusion:The non-specific clinical and the complexity of pathological features of ENKTL in head and neck might cause misdiagnosis, which leads to prolonged time from first visit to definite diagnosis, thus results in disease progression, and ultimately may lead to decreased overall survival rate. To avoid the misdiagnosis and early diagnosis is very important.

[Letrozole versus gonadotropin-releasing hormone antagonist during luteal phase in the prevention of ovarian hyperstimulation syndrome: a randomized controlled trial]

Objective: To explore and compare the preventive effect of using letrozole and gonadotropin-releasing hormone (GnRH) antagonist during luteal phase of patients at high risk for ovarian hyperstimulation syndrome (OHSS). Methods: A total of 99 infertile women undergoing in vitro fertilization and embryo transfer or intracytoplasmic sperm injection with high risk for OHSS were enrolled in this randomized controlled trial.The letrozole group (n=51) received letrozole of 7.5 mg daily for 3 days;the GnRH antagonist group (n=48) were given cetrorelix of 0.25 mg subcutaneously daily for 3 days. Both groups received support therapy combined with embryo cryopreservation. The incidence of OHSS was surveyed. And the serum concentration of estradiol, LH and progesterone on days 3, 5 and 8 after oocytes retrieval were measured. Results: There were no statistical differences in terms of baseline characteristics of patients and outcomes of controlled ovarian hyperstimulation between the two groups.The incidence of moderate and severe OHSS was found no significantly difference between letrozole group [11.8%(6/51)] and GnRH antagonist group [10.4%(5/48);P>0.05]. The estradiol concentration of the indicated days on days 3,5 and 8 after oocytes retrieval in letrozole group and GnRH antagonist group were (1 417±3 543) versus (15 210±9 921) pmol/L, (1 692±4 330) versus (18 680±11 567) pmol/L, (239±336) versus (3 582±5 427) pmol/L, respectively;compared with GnRH antagonist group, the estradiol level was significantly lower in the letrozole group (all P<0.01). The luteinizing hormone level in the letrozole group were (0.46±0.40), (0.56±0.55)and (0.67±0.58) U/L on days 3,5 and 8 after oocytes retrieval, which were significantly higher than those of GnRH antagonist group [(0.28±0.28), (0.30±0.19) and (0.45±0.37) U/L, respectively; all P<0.05]. There was no obvious differences on progesterone levels between letrozole group and GnRH antagonist group (all P>0.05),and on days 8 after oocytes retrieval,the level of progesterone in each group were significantly lower than those on day 3 and 5 after oocytes retrieval (P<0.05). Conclusion: Letrozole has the same efficiency as GnRH antagonist for the prevention of OHSS, faster and cheaper to use, but its efficacy seems not to be related to the suppression of steroidogenic during the luteal phase.

Preparation and physical properties of a Cr3Al film with a DO3 structure

A Cr₃Al compound with a DO₃ structure has previously been predicted to be nearly half metal and a promising spintronics material; however, its synthesis has not been reported. Here, a Cr₃Al compound with a DO₃ structure is successfully prepared in thin-film form by the magnetron sputtering method. It was found that the substrate temperature is crucial to the atomic ordering, thin-film density and lattice constant. The lattice constant varies with different substrate temperatures and is smaller than the theoretical equilibrium lattice constant. Theoretical investigations on the electronic structures and magnetic properties indicate that the Cr₃Al compound with a DO₃ structure is a rare material with zero-gap half-metallic characteristics under an experimental lattice constant of 5.83 Å. The experimental result is in agreement with the theoretical results in magnetization, and the Cr₃Al compound synthesized in this work exhibits semi-metallic-like electrical transport characteristics and positive magnetoresistance of greater than 2% in the temperature range 2-250 K.

[Association of vitamin D receptor and its genetic polymorphisms with nasopharyngeal carcinoma]

Objective:To investigate the gene expression and polymorphisms of vitamin D receptor (VDR) in nasopharyngeal carcinoma. Method:The expression of VDR mRNA was detected by fluorescent quantitative PCR in PBMC from 48 patients with nasopharyngeal carcinoma and 48 controls. The FokI and ApaI loci of all subjects were detected by TaqMan-MGB fluorescent probe PCR. Result:The VDR mRNA △Ct value was 9.32±0.91 and 7.31±1.04 in nasopharyngeal carcinoma patients and controls, respectively. Using multivariate Logistic regression analysis, the results showed that the distribution of FokI point Ff genotype in the case group was significantly higher than that in the control group (adjusted OR=1.97, 95%CI=1.33-2.91). No difference was found between the control group and the patient group at ApaI loci. Further haplotype analysis was used to find that compared with fa haplotypes, the distribution of FokI Ff genotype in the case group was significantly higher than that in the healthy control group (adjusted OR=0.65, 95%CI=0.48-0.87). There were significant differences in the gene expression level of VDR among the patients with the different genotypes of FokI loci (F=194.5, P<0.01). Conclusion:Genetic variants of the VDR gene are closely associated with nasopharyngeal carcinoma.

Anti-site-induced diverse diluted magnetism in LiMgPdSb-type CoMnTiSi alloy

The effect of three kinds of anti-site disorder to electronic structure and magnetic properties of the LiMgPdSb-type CoMnTiSi alloy are investigated. It was found the Mn-Ti anti-site disorder can induce the diluted magnetism in CoMnTiSi matrix. The magnetic structure has an oscillation between the ferromagnetic and antiferromagnetic states with the different degree of Mn-Ti anti-site disorder. Two novel characteristics: the diluted antiferromagnetic half-metallicity and the diluted zero-gap half-metallity are found in the different degree range of the Mn-Ti anti-site disorder. The Co-Mn and Co-Ti anti-site disorder have little effect on the magnetic properties. The width of energy gap and the intensity of DOS at the Fermi level can be adjusted by the degree of Co-Mn or Co-Ti anti-site disorder. The independent control to the carrier concentration and magnetization can be realized by introducing the different anti-site disorder.

Tuneable Magnetic Phase Transitions in Layered CeMn2Ge(2-x)Six Compounds

The structural and magnetic properties of seven CeMn2Ge(2-x)Six compounds with x = 0.0-2.0 have been investigated in detail. Substitution of Ge with Si leads to a monotonic decrease of both a and c along with concomitant contraction of the unit cell volume and significant modifications of the magnetic states - a crossover from ferromagnetism at room temperature for Ge-rich compounds to antiferromagnetism for Si-rich compounds. The magnetic phase diagram has been constructed over the full range of CeMn2Ge(2-x)Six compositions and co-existence of ferromagnetism and antiferromagnetism has been observed in CeMn2Ge1.2Si0.8, CeMn2Ge1.0Si1.0 and CeMn2Ge0.8Si1.2 with novel insight provided by high resolution neutron and X-ray synchrotron radiation studies. CeMn2Ge(2-x)Six compounds (x = 0, 0.4 and 0.8) exhibit moderate isothermal magnetic entropy accompanied with a second-order phase transition around room temperature. Analysis of critical behaviour in the vicinity of TC(inter) for CeMn2Ge2 compound indicates behaviour consistent with three-dimensional Heisenberg model predictions.

Driving magnetostructural transitions in layered intermetallic compounds

We report the dramatic effect of applied pressure and magnetic field on the layered intermetallic compound Pr(0.5)Y(0.5)Mn(2)Ge(2). In the absence of pressure or magnetic field this compound displays interplanar ferromagnetism at room temperature and undergoes an isostructural first order magnetic transition (FOMT) to an antiferromagnetic state below 158 K, followed by another FOMT at 50 K due to the reemergence of ferromagnetism as praseodymium orders (T(C)(Pr)). The application of a magnetic field drives these two transitions towards each other, whereas the application of pressure drives them apart. Pressure also produces a giant magnetocaloric effect such that a threefold increase of the entropy change associated with the lower FOMT (at T(C)(Pr)) is seen under a pressure of 7.5 kbar. First principles calculations, using density functional theory, show that this remarkable magnetic behavior derives from the strong magnetoelastic coupling of the manganese layers in this compound.

The magnetocaloric effect and critical behaviour of the Mn(0.94)Ti(0.06)CoGe alloy

Structural, magnetic and magnetocaloric properties of the Mn(0.94)Ti(0.06)CoGe alloy have been investigated using x-ray diffraction, DC magnetization and neutron diffraction measurements. Two phase transitions have been detected, at T(str) = 235 K and T(C) = 270 K. A giant magnetocaloric effect has been obtained at around T(str) associated with a structural phase transition from the low temperature orthorhombic TiNiSi-type structure to the high temperature hexagonal Ni(2)In-type structure, which is confirmed by neutron study. In the vicinity of the structural transition, at T(str), the magnetic entropy change, -ΔS(M) reached a maximum value of 14.8 J kg(-1) K(-1) under a magnetic field of 5 T, which is much higher than that previously reported for the parent compound MnCoGe. To investigate the nature of the magnetic phase transition around T(C) = 270 K from the ferromagnetic to the paramagnetic state, we performed a detailed critical exponent study. The critical components γ, β and δ determined using the Kouvel-Fisher method, the modified Arrott plot and the critical isotherm analysis agree well. The values deduced for the critical exponents are close to the theoretical prediction from the mean-field model, indicating that the magnetic interactions are long range. On the basis of these critical exponents, the magnetization, field and temperature data around T(C) collapse onto two curves obeying the single scaling equation M(H,ε) = ε(β)f ± (H/ε(β+γ)).

Iron doped hexagonal ErMnO3: structural, magnetic, and dielectric properties

The single phase ErFe(x)Mn1-xO3 (0 < or = x < or = 0.15) compounds were synthesized by the solid-state reaction method. The doping effects on the crystal structural, magnetic, thermal, and dielectric properties were systematically investigated. The XRD patterns show all samples crystallize in the hexagonal structure with P6(3)cm space group. The lattice parameters a and c first decrease with doping, which is followed by a subsequent increase at higher doping levels. Although both the Fe3+ and Mn3+ ions remain stable in high spin trivalent states in all samples, the magnetization is weakened with increasing Fe contents. The heat capacity data shows the antiferromagnetic transition slightly shifts from 77 K for ErMnO3 to 80 K for ErFe015Mn0.85O3, which can not be observed in the magnetic susceptibility data. The real part of complex impedance of these samples rises as the doping level increases, indicating the enhancement of insulativity of doped samples.

[Classification of the orbital margin fractures]

OBJECTIVE

To study the classification of the orbital margin fractures.

METHODS

There are 65 cases of the orbital margin fractures classified by Reduction-Orbital-Classification from January 1995 to December 1999 in Macau Conde de Sao Juanuario Hospital.

RESULTS

The 65 cases are classified into six type: I Stable orbital fracture, II Orbital floor (blow-out) fracture, III Orbital-zygomatic fracture, IV Orbital-naso-maxillary fracture, V Comminuted fracture of the inferior orbital rim, VI Complex orbital fractures.

CONCLUSION

The Reduction-Orbital-Classification are a complete, precise, practical, simple way for the orbital fractures; It not only presents the exist of the orbital margin fractures but also means the Classification for convenience of the treatment and treatment guiding the classification.