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OBJECTIVE@#To investigate the clinical characteristics of lower extremity arterial disease (LEAD) and its risk factors in patients with diabetic foot ulcer (DFU).@*METHODS@#We retrospectively collected the clinical and follow-up data of 650 patients with DFU treated in the Department of Endocrinology and Metabolism of Nanfang Hospital between January, 2017 and December, 2019. We compared the data between patients who had LEAD and those without LEAD and used a multivariate logistic regression model to analyze the risk factors of LEAD in DFU patients.@*RESULTS@#Among the 650 DFU patients, 470 (72.4%) had LEAD. The patients were followed up for a mean of 3.5 months, and the mean healing time of DFU was 2.55 months; healing of DFU occurred in 453 patients and 183 patients received amputation. The patients with LEAD and those without LEAD differed significantly in age, hospitalization costs, diastolic blood pressure (DBP), glycated hemoglobin, blood lipid levels, disease course, ankle brachial index, healing time, smoking history, clinical outcomes, Wagner grade and imaging results (P < 0.05). Multivariate logistic regression analysis identified age (OR=1.070, 95% CI: 1.049-1.091), smoking history (OR= 2.013, 95% CI: 1.268-3.195), and a decreased DBP (OR=0.980, 95% CI: 0.963-0.997) as independent risk factors for LEAD in DFU patients. A prolonged healing time was a prominent clinical feature of DFU complicated by LEAD.@*CONCLUSION@#DFU patients have a high incidence of LEAD, which leads to high rates of disability and mortality and is associated with an advanced age, high smoking rate and longer healing time. A decreased DBP is also a risk factor for LEAD in DFU patients.
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Humans , Amputation, Surgical , Diabetes Mellitus , Diabetic Foot/epidemiology , Lower Extremity , Retrospective Studies , Risk FactorsABSTRACT
Abstract@#The outbreak of tuberculosis in campus shows a profound impact on academic learning and mental health of students, which might result in more serious social problems. The present editorial addresses weak links in the school tuberculosis prevention and control. Disease prevention and control institutions, medical institutions, education administrative departments and schools need to clarify work responsibilities, strictly implement the school tuberculosis prevention and control laws, regulations and management guidelines, and coordinate with multiple departments, with the aim to strengthen early warning capacity for campus tuberculosis, improve tuberculosis screening and risk assessment of relevant personnel, and implement the health checkup of schools and faculty, as well as the screening, diagnosis, registration, treatment and follow up of students cases. To further improve tuberculosis control across China, strengthening the awareness of tuberculosis prevention and control among institutions and the public, and improving adherence to tuberculosis treatment, as well as moving forward from passive to active tuberculosis monitoring and early prevention, reducing the occurrence of tuberculosis outbreak in school should be prioritized, so as to promote the smooth development of tuberculosis prevention and control work in China.
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Objective: To study on the changes of serum small metabolites in patients with lung cancer and pneumonia, assess the performance of these metabolites on differential diagnosis between lung cancer and pneumonia, and establish diagnostic model. Methods: Liquid chromatography tandem mass spectrometry(LC-MS/MS) was applied to test the serum metabolites, including 13 amino acids and 15 bile acids, of 95 patients with lung cancer, 69 patients with pneumonia and 90 healthy people. T test and Mann-Whitney U test were used to analyze the differences among the three groups. Binary logistic regression was applied to screen valuable indexes and establish diagnostic model. The receiver operating characteristic curve (ROC) was used to compare the differential diagnostic value of single index and diagnostic model. Results: Compared with the control group, 3 kinds of amino acids and 7 kinds of bile acids were decreased significantly, while 1 kind of amino acid and 2 kinds of bile acids were increased significantly in pneumonia patients. 6 kinds of amino acids and 2 kinds of bile acids were decreased significantly, while 2 kinds of amino acids and 4 kinds of bile acids were increased significantly in lung cancer patients. Deoxycholic acid was the most valuable metabolite in differential diagnosis. Citrulline, phenylalanine and deoxycholic acid were screened to establish differential diagnostic model of lung cancer and pneumonia. The area under curve (AUC) of the model was 0.829, and the Cut-Off value was 0.55, while the sensitivity was 76.8%, the specificity was 79.7%, and the coincidence rate was 78.3%. Conclusion: This study revealed that some small metabolites in serum of the patients with pneumonia and lung cancer have changed significantly. The diagnostic model composed of some metabolites has the potential value to assist differential diagnosis of lung cancer and pneumonia.
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Objective@#To investigate the clinical effect of one-stage revision combined with intra-articular injection of antifungal agents in the treatment of chronic periprosthetic fungal infection.@*Methods@#A retrospective analysis of 11 patients(4 hips, 7 knees) admitted with chronic periprosthetic fungal infection at Department of Orthopaedics, First Affiliated Hospital of Xinjiang Medical University from January 2004 to April 2016.There were males and females with an age of 67 years (range:47-77 years). Each patient underwent single-stage revision including aggressive soft-tissue debridement. Liquid samples and tissue samples were immediately sent to the microbiology laboratory for drug sensitivity testing and histological analysis. Removed the infected components and cement thoroughly, pouring powdered vancomycin into the medullary cavity and direct intra-articular injection of fungussensitive antibiotics. The patients with infected hips received an uncemented prosthesis and 0.5 g of gentamicin loaded commercial cement was received by the patients with infected knee.After that, a new prosthesis was implanted.Long-term combination therapy of antibacterial agents and antifungal agents were given after operation. Recurrence of infection and clinical outcomes were evaluated. The follow-up period was 5 years (range: 2-12 years).@*Results@#One patient died of acute heart failure on the eighth postoperative day.Three infection cases were recurred.Eight cases had satisfactory outcomes and required no additional surgical or medical treatment for recurrence of infection. The Harris hip score assessed preoperatively and at latest follow-up was increased from 39.25±5.12 to 79.50±4.79, the difference was statistically significant (t=-11.356, P=0.001).The Hospital for Special Surgery knee score was improved from preoperative 46.25±5.61 to final follow-up 80.50±5.06, and the difference was statistically significant (t=-9.930, P=0.002).@*Conclusion@#Treatment of chronic fungal periprosthetic joint infection with single-stage revision can be fairly effective for achieving acceptable functional outcomes.
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Objective:NRS 2002 nutritoanl risk assessment and PG-SGA scale were used to evaluate the effect of different nutritional treatments on fibula myocutaneous flap reconstruction of mandibular defect postoperative patients,and to find the appropriate timing and method of nutritional support for this kind of patients.Methods:50 cases of fibula myocutaneous flap reconstruction of mandibular defect postoperative patients were divided into two groups according to the nutritional risk assessment and the opinions of the research team including the mixed nutrition support treatment group (SPNS + EN) and the conventional nutrition support treatment group (TEN).The indexes of the patients on the day before surgery and 1,7,13 postoperative days were monitored,including lymphocyte count (LYM),serum albumin (ALB),hemoglobin (HB),potassium (K),sodium (NA),chloride (CL) and nutritional risk screening score (NRS) and other indicators to evaluate therapeutic effect of two groups.Results:The indicators showed no significant differences in the two groups before operation.For K and Na,the levels of the SPN + EN group was higher than that of the TEN group.Hemoglobin (HB) and NRS score on the 13rd day after surgery were statistically different between the two groups (P ＜ 0.05).Besides,Lymphocyte count (LYM) and chloride (CL) on the 1st and 7th after operation showed significant different,too(P ＜ 0.05).Conclusion:By nutritional risk assessment in patients with NRS 2002 before operation,PG-SGA after operation,we corrected the electrolyte and acid-base imbalance,improved stress state of postoperative patients with adjustment of nutritional therapy and intervention to timely and effectively provide plenty of energy and protein.
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Objective Recent evidence points towards a close relationship between dysregulation of long non-coding RNA (lncRNA) and carcinogenesis and progression of various tumors including gastric cancer. The aim of this study was to investigate the expression of lncRNA DGCR5 in the gastric cancer tissue and plasma and its influence on the biological behavior of gastric cancer cells. Methods We collected tumorous and adjacent normal tissues from 96 gastric adenocarcinoma patients as well as plasma samples from 34 gastric cancer patients and another 34 healthy controls. We deter-mined the expression of DGCR5 by real-time fluorescent quantitative PCR,analyzed its correlation with the clinicopathological features of gastric cancer,observed the apoptosis, proliferation and invasiveness of the gastric cancer cells after overexpressing DGCR5, and detected the expressions of epithelial-mesenchymal transition (EMT)-associat-ed genes and proteins by Western blot. Results The expression of DGCR5 was significantly decreased in tumor tissue of the gastric canc-er patients as compared with that in the adjacent normal tissue,which was correlated with the advanced TNM stage and lymph node metastasis, and so was it in the plasma of the patients, which was also correlated with the TNM stage. The area under the ROC curve for the diagnosis of gastric cancer by the expression level of plasma DGCR5 was 0.722. Overexpressed DGCR5 induced significant apoptosis and inhibited the proliferation and invasion of gastric cancer cells,markedly promoted the expression of E-cadherin,and suppressed the expressions of N-cadherin,vimentin and Twist. Conclu-sion The expression of DGCR5 is significantly decreased in the tumor tissue and plasma of gastric cancer patients. The DGCR5 level in the plasma has a certain diagnostic value for gastric cancer. Overexpressed DGCR5 can reduce the proliferation and invasiveness of gastric cancer cells,increase their apoptosis,and inhibit EMT.
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Objective To observe the effect of every-other-day fasting(EODF)on pathology and functional recovery of rats with spinal cord clip-compression injury,and to explore the related mechanism. Methods A total of 36 Sprague-Dawley rats were randomly assigned to groups A(sham operation),B(sham operation and EODF),C(spinal cord injury)and D(spinal cord injury and EODF)with nine rats in each group.The spinal cord injury rat model in T10was established by using medical aneurysm clip in latter two groups.The motor func-tion was assessed by Basso-Beattie-Bresnahan(BBB)score one day before and one day,two,four,six,eight,ten, twelve weeks after operation;and toluidine blue staining was performed for pathological observation at twelve weeks after operation.Another 180 Sprague-Dawley rats were randomly assigned in same way.The level of tu-mor necrosis factor-α(TNF-α)and interleukin-10(IL-10)were detected with ELISA six hours,twelve hours,one day,three days and seven days after operation. Results The BBB score reached lowest on the first day in groups C and D(P<0.05),and gradually increased with time,and were higher in group D than in group C eight weeks,ten weeks and twelve weeks after operation(P<0.05). The pathology in spinal cord was less in group D than in group C.Compared with group A,the level of serum TNF-α increased twelve hours after operation(P<0.05),peaked one day after operation,and returned back seven days after operation;the level of serum IL-10 increased at each time point after operation(P<0.05).Compared with group C,the level of serum TNF-α was lower in group D one day after operation(P<0.05);the level of se-rum IL-10 was not significantly different at each time point after operation(P>0.05). Conclusion Long-term EODF can promote the hind limb motor recovery in rats with spinal cord clip-compression inju-ry,and alleviate pathological damage.EODF might inhibit acute inflammatory reaction at acute stage of spinal cord injury,which may be correlated with its neuroprotective effect.
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<p><b>OBJECTIVE</b>To analyze the characteristics of pathogenic microorganisms in the infected bone tissues in patients with diabetic foot osteomyelitis (DFO) using 16S rRNA high-throughput sequencing to facilitate rapid and accurate detection of pathogens and effective infection control.</p><p><b>METHODS</b>Between September, 2016 and April, 2017, 16 patients with DFO were admitted in our department and infected bone specimens were obtained during debridement. The pathogenic microorganisms in the specimens were identified using both 16S rRNA high-throughput sequencing and automatic blood culture analyzer, and the characteristics of the microflora were analyzed based on 16S rRNA sequencing data in comparison with the results of blood culture.</p><p><b>RESULTS</b>The results of 16S rRNA sequencing showed that bone tissues of DFO contained diverse and uniformly distributed pathogenic organisms, among which 20 (87%) dominant genera were identified with Prevotella as the most abundant pathogen. Both 16S rRNA sequencing and routine culture results suggested the domination of gram-negative bacteria among the pathogens in DFO bone tissues. 16S rRNA sequencing, compared with routine culture, yielded a higher positivity rate (100% vs 88.24%) and detected a greater average number of pathogens (12.56 vs 1.50) and a higher proportion of gram-negative bacteria (67.16% vs 50.00%) in the samples. 16S rRNA sequencing detected nearly all the pathogens identified by routine culture except for Escherichia coli, Serratia marcescens and Enterobacter cloaca, and identified 13 genera that failed to be detected by routine culture, including the obligate or strict anaerobes Anaerococcus, Veillonella, Bacteroides, Fusobacterium, Porphyromonas, Finegoldia, Prevotella, Peptostreptococcus, Parvimonas, Peptoniphilus and Bulleidia. Routine culture did not detect any anaerobes in the samples but identified multidrug-resistant strains in as many as 58.33% of the pathogens.</p><p><b>CONCLUSIONS</b>16S rRNA high-throughput sequencing is capable of demonstrating the diversity and abundance of microflora in DFO bone tissues, where diverse and uniformly distributed pathogens can be detected with a discrete distribution of the dominant genera, most of which are gram-negative. Compared with routine culture method, 16S rRNA sequencing allows more convenient and accurate identification of the pathogens (especially gram-negative bacteria and anaerobes), and can be useful in clinical decision on appropriate treatment of DFO.</p>
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Objective To analyze the causes of poor compliance of elderly patients with diabetes mellitus , and put forward corresponding countermeasures to control blood glucose level and delay the occurrence of complications .Methods A total of 113 elderly patients with type 2 diabetes mellitus aged 60 years and over were recruited in endocrinology department of our hospital.The self-made questionnaire was used to investigate the compliance and the factors that affected the compliance.Results There were 48 patients (42.48%) with good compliance and 65 patients (57.52%) with poor compliance.Univariate analysis showed that the level of education, monthly income, drug types, understanding of diabetes-related knowledge and whether the elderly living alone affected compliance ( P<0.05 ) .Multivariate Logistic regression analysis showed that patients with low education level, poor monthly income, medication types and living alone were the main factors that influence the compliance of elderly patients with diabetes mellitus (P<0.05).And the level of education, monthly income level and the compliance of diabetic medication was positively correlated, medication types and living alone and diabetes compliance were negatively correlated (P<0.05).Conclusion The low level of education, poor monthly income, medication types and living alone are the main factors that affect the compliance of elderly patients with diabetes.The social and family support can effectively improve the compliance of elder patients with diabetes.
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<p><b>OBJECTIVE</b>To investigate foot biomechanics characteristic of patients with type 2 diabetes mellitus.</p><p><b>METHODS</b>This study was conducted among 303 patients with type 2 diabetes. The whole foot was divided into 10 regions, namely the first toe (T1); the second to fifth toes (T2-5); the first, second, third, fourth, and fifth metatarsals (M1, M2, M3, M4, and M5, respectively); midfoot (MF), and the heel medial (HM). Foot arch index, foot angle and maximum peak pressure (MPP) of the 10 regions were measured using a Footscan gait system.</p><p><b>RESULTS</b>The maximum peak pressure of 10 regions decreased in the order of M3>M2>HM>M4>HL>M1>M5>T1>ML>T2-5 for the left foot, and in the order of M3>M2>HM>M4>HL>M1>M5>T1>ML>T2-5 for the right foot. The MPP in M1 region was higher in the right than in the left foot (P<0.05). The MPP in M3, M4, M5, and MF was higher in the left than in the right foot (P<0.05). The percentage of high-risk foot (defined by a total plantar pressure ≥70 N/cm) was 34% on the left and 17.7% on the right. An increased BMI was associated with a significant increase in high-risk foot, but not for the right foot in underweight patients. Foot flat phase was extended and forefoot push-off phase shortened in stance phase in the patients. Compared with the right foot, the left foot showed a significantly increased foot arch index and increased low and high arch rates with a decreased normal arch rate. Total plantar pressure was higher in of the left high arch foot than in normal arch foot. The foot angle was significantly larger on the right than on the left. The bilateral total plantar pressures were significantly greater in male patients (P<0.05) and increased with age but were not associated with the duration of DM, foot angle, or glycosylated hemoglobin level.</p><p><b>CONCLUSION</b>Diabetic patients have obvious alterations in foot biomechanics with abnormalities of the plantar pressure, and the percentage of high-risk foot increases in overweight and obese patients, suggesting the need of body weight control in these patients when administering offloading treatment for prevention of diabetic foot ulcer.</p>