Considering the effect of temperature and process variations, the inputs and clock signals combination sleep state dependent leakage current characteristics is analyzed and the optimal sleep state is examined in sub-6...Considering the effect of temperature and process variations, the inputs and clock signals combination sleep state dependent leakage current characteristics is analyzed and the optimal sleep state is examined in sub-65nm dual threshold voltage （V1） footed domino circuits. HSPICE simulations based on 65nm and 45nm BSIM4 models show that the proposed CLIL state （the clock signal and inputs are all low） is the optimal state to reduce the leakage current of the high fan-in footed domino circuits at high temperature and almost all footed domino circuits at room temperature, as compared to the conventional CHIL state （the clock signal is high and inputs are all low） and the CHIH state （the clock signal and inputs are all high）. Further, the influence of the process variations on the leakage current characteristics of the dual V1 footed domino circuits is evaluated. At last, temperature and process variation aware new low leakage current setup guidelines are provided.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therape...BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.展开更多
Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic ...Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic management,DFUs,foot lesions,proper care for injuries,diet,and surgery.Certain reasonably priced treatments,such as hyperbaric oxygen and vacuum-assisted closure therapy,are also available for DFUs,along with modern wound care products and techniques.Nonetheless,DF care(cleaning,applying antimicrobial cream when wounded,and foot reflexology),blood glucose monitoring to control diabetes,and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs.Between 50%and 80%of DF infections are preventable.Regardless of the intensity of the lesion,it needs to be treated carefully and checked daily during infection.Tissue regeneration can be aided by cleaning,dressing,and application of topical medicines.The choice of shoes is also important because it affects blood circulation and nerve impulses.In general,regular check-ups,monitoring of the patient’s condition,measuring blood glucose levels,and providing frequent guidance regarding DFU care are crucial.Finally,this important clinical problem requires involvement of multiple professionals to properly manage it.展开更多
Nausea and vomiting are physiological responses that react to various bodily conditions and play a protective function.Medicinal and nonmedicinal methods,including complementary medicine,treat nausea and vomiting.The ...Nausea and vomiting are physiological responses that react to various bodily conditions and play a protective function.Medicinal and nonmedicinal methods,including complementary medicine,treat nausea and vomiting.The current research aims to investigate the effectiveness of foot reflexology as a complementary medicine method for nausea and vomiting.Based on PRISMA 2020,PubMed,Web of Science,and Scopus were searched until October 2,2024,using a search strategy approved by two researchers.Only randomized controlled trial studies were included in this research.No limitations or filters were applied.The inclusion criteria were selected based on the PICOS framework,and the studies were evaluated according to the National Institutes of Health quality assessment tool,which is related to controlled intervention,and were evaluated by two researchers.Finally,six studies were included in this review.Eighty-four percent of studies were conducted in Asia.Three records are from Iran,and two are from Turkey,and one is from France.The results showed that nausea and vomiting improved in all studies.In most studies(67%),four sessions or less led to improved outcomes.Rhodes index of nausea,vomiting,and retching and visual analog scale were utilized to assess nausea and vomiting.The current systematic review indicated that foot reflexology as a noninvasive intervention could improve nausea and vomiting in patients with cancer problems,pregnancy,hemodialysis,and laparoscopic cholecystectomy。展开更多
Foot reflexology(FR)is a Chinese-originated and non-invasive complementary therapy increasingly used by functional,alternative and para-medical professionals.Enhance attempts are made to study FR in non-functional org...Foot reflexology(FR)is a Chinese-originated and non-invasive complementary therapy increasingly used by functional,alternative and para-medical professionals.Enhance attempts are made to study FR in non-functional organic conditions.The present invited Editorial discusses the application of FR in autoimmune diseases(AD),highlighting a few successful studies demonstrating symptomatic relief and objective improvements.Despite promising results,the FR domain remains under-investigated and an urgent need to confirm and understand the effect of FR in chronic diseases,including AD,is highly recommended.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)are a significant contributor to disability and mortality in diabetic patients.Macrophage polarization and functional regulation are promising areas of research and show therapeuti...BACKGROUND Diabetic foot ulcers(DFUs)are a significant contributor to disability and mortality in diabetic patients.Macrophage polarization and functional regulation are promising areas of research and show therapeutic potential in the field of DFU healing.However,the complex mechanism,the difficulty in clinical translation,and the large heterogeneity present significant challenges.Hence,this study was to comprehensively analyze the publication status and trends of studies on macrophage polarization and DFU healing.AIM To examine the relevant literature on macrophage polarization in DFU healing.METHODS A bibliometric analysis was conducted using the Web of Science database.Relevant literature was retrieved from the Web of Science Core Collection database between 2013 to 2023 using literature visualization and analysis software(VOSviewer and CiteSpace)and bibliometric online platforms.The obtained literature was then subjected to visualization and analysis of different countries/regions,institutions,journals,authors,and keywords to reveal the research’s major trends and focus.RESULTS The number of publications on the role of macrophage polarization in DFU healing increased rapidly from 2013 to 2023,especially in the latter period.Chinese researchers were the most prolific in this field,with 217 publications,while American researchers had been engaged in this field for a longer period.Qian Tan of Nanjing Drum Tower Hospital and Qian Ding of Nanjing University were the first to publish in this field.Shanghai Jiao Tong University was the institution with the most publications(27).The keywords“bone marrow”,“adjustment,replacement,response,tissue repair”,and“activation,repair,differentiation”appeared more frequently.The study of macrophage polarization in DFU healing focused on the regulatory mechanism,gene expression,and other aspects.CONCLUSION This study through the bibliometric method reveals the research trends and development trends in this field of macrophage polarization in DFU healing from 2013 to 2023 in the Web of Science Core Collection database.The key hotspots in this field mainly include the regulation of macrophage activation,gene expression,wound tissue repair,and new wound materials.This study provides references for future research directions.展开更多
Foot reflexology is a non-invasive and safe complementary therapy that works by massaging the reflex zones of the feet and exerts systemic or whole-body regulation through meridian nerve conduction.This therapy is com...Foot reflexology is a non-invasive and safe complementary therapy that works by massaging the reflex zones of the feet and exerts systemic or whole-body regulation through meridian nerve conduction.This therapy is commonly used in the treatment of various conditions such as autism and Parkinson's disease.However,there is limited reporting on the use of foot reflexology therapy for infants with sensorineural hearing loss(SNHL).Currently,there is no definitive conclusion on how foot reflexology therapy can influence hearing.This editorial holds some guiding significance regarding this clinical issue.The aim is to present physiological evidence of how foot reflexology therapy can impact infants with SNHL,thereby enhancing clinician’s awareness of foot reflexology in treating infants with SNHL.展开更多
Diabetic foot ulcers(DFUs)represents a significant public health issue,with a rising global prevalence and severe potential complications including amputation.Traditional treatments often fall short due to various lim...Diabetic foot ulcers(DFUs)represents a significant public health issue,with a rising global prevalence and severe potential complications including amputation.Traditional treatments often fall short due to various limitations such as high recurrence rates and extensive resource utilization.This editorial explores the innovative use of acellular fish skin grafts as a transformative approach in DFU management.Recent studies and a detailed case report highlight the efficacy of acellular fish skin grafts in accelerating wound closure,reducing dressing changes,and enhancing patient outcomes with a lower socio-economic burden.Despite their promise,challenges such as limited availability,patient acceptance,and the need for further research persist.Addressing these through more extensive randomized controlled trials and fostering a multidisciplinary treatment approach may optimize DFU care and reduce the global health burden associated with these complex wounds.展开更多
Diabetic foot attack(DFA)is the most severe presentation of diabetic foot disease,with the patient commonly displaying severe sepsis,which can be limb or life threatening.DFA can be classified into two main categories...Diabetic foot attack(DFA)is the most severe presentation of diabetic foot disease,with the patient commonly displaying severe sepsis,which can be limb or life threatening.DFA can be classified into two main categories:Typical and atypical.A typical DFA is secondary to a severe infection in the foot,often initiated by minor breaches in skin integrity that allow pathogens to enter and proliferate.This form often progresses rapidly due to the underlying diabetic pathophysiology of neuropathy,microvascular disease,and hyperglycemia,which facilitate infection spread and tissue necrosis.This form of DFA can present as one of a number of severe infective pathologies including pyomyositis,necrotizing fasciitis,and myonecrosis,all of which can lead to systemic sepsis and multiorgan failure.An atypical DFA,however,is not primarily infection-driven.It can occur secondary to either ischemia or Charcot arthropathy.Management of the typical DFA involves prompt diagnosis,aggressive infection control,and a multidisciplinary approach.Treatment can be guided by the current International Working Group on the Diabetic Foot/Infectious Diseases Society of America guidelines on diabetic foot infections,and the combined British Orthopaedic Foot and Ankle Society-Vascular Society guidelines.This article highlights the importance of early recognition,comprehensive management strategies,and the need for further research to establish standardized protocols and improve clinical outcomes for patients with DFA.展开更多
The prosthesis is an artificial device that can replace an organ of a human body member to restore a compromised function. It is necessary following the removal of a human organ, which can occur as a result of an illn...The prosthesis is an artificial device that can replace an organ of a human body member to restore a compromised function. It is necessary following the removal of a human organ, which can occur as a result of an illness, trauma or congenital malformation. The trans-tibia prosthesis, in particular, allows the amputee patient to recover the impaired function and regain autonomy, while facilitating their daily social integration. The trans-tibia prosthesis consists of a socket, a sleeve, connecting elements and a prosthetic foot. Each of these components plays a very important role. Among these components, the prosthetic foot usually called “SACH foot” is very often replaced due to cracking and therefore has a fairly short lifespan. At the Center for Equipment and Rehabilitation of Kabalaye (CERK), the SACH foot made using polyurethane and wood is imported and is given to patients with reduced mobility. The aim of this article is twofold, on the one hand, to make a social and pathological study of trans-tibia amputees in relation to the use of the SACH foot prosthesis, on the other hand, to compare this foot with a new prosthetic foot proposed and which is manufactured using extruded polystyrene. The result of prosthetic tests carried out on twenty-four amputees showed that the foot manufactured using extruded polystyrene is better in terms of resistance, bulk and adaptability to active amputees.展开更多
Objective:To explore the correlation between fetal foot length measured by ultrasound and gestational age.Methods:This study employed ultrasound to measure the fetal foot length,femoral length,and foot length/femoral ...Objective:To explore the correlation between fetal foot length measured by ultrasound and gestational age.Methods:This study employed ultrasound to measure the fetal foot length,femoral length,and foot length/femoral length ratio in 214 pregnant women from 12 to 40 weeks of gestation,all of whom had no pregnancy complications or obstetric complications,and whose fetuses were normal.Results:A significant positive correlation was found between fetal foot length and gestational age(r=0.967,p<0.001);a similarly significant positive correlation was observed between fetal femoral length and gestational age(r=0.972,p<0.001);and a non-significant positive correlation was noted between the foot length/femoral length ratio and gestational age(r=0.943,p<0.001).Conclusion:Ultrasound can accurately measure fetal foot length and femoral length,both of which exhibit a significant positive correlation with gestational age,making them important reference indicators for assessing fetal growth and development.展开更多
BACKGROUND Sepsis is a severe complication in hospitalized patients with diabetic foot(DF),often associated with high morbidity and mortality.Despite its clinical significance,limited tools exist for early risk predic...BACKGROUND Sepsis is a severe complication in hospitalized patients with diabetic foot(DF),often associated with high morbidity and mortality.Despite its clinical significance,limited tools exist for early risk prediction.AIM To identify key risk factors and evaluate the predictive value of a nomogram model for sepsis in this population.METHODS This retrospective study included 216 patients with DF admitted from January 2022 to June 2024.Patients were classified into sepsis(n=31)and non-sepsis(n=185)groups.Baseline characteristics,clinical parameters,and laboratory data were analyzed.Independent risk factors were identified through multivariable logistic regression,and a nomogram model was developed and validated.The model's performance was assessed by its discrimination(AUC),calibration(Hosmer-Lemeshow test,calibration plots),and clinical utility[decision curve analysis(DCA)].RESULTS The multivariable analysis identified six independent predictors of sepsis:Diabetes duration,DF Texas grade,white blood cell count,glycated hemoglobin,Creactive protein,and albumin.A nomogram integrating these factors achieved excellent diagnostic performance,with an AUC of 0.908(95%CI:0.865-0.956)and robust internal validation(AUC:0.906).Calibration results showed strong agreement between predicted and observed probabilities(Hosmer-Lemeshow P=0.926).DCA demonstrated superior net benefit compared to extreme intervention scenarios,highlighting its clinical utility.CONCLUSION The nomogram prediction model,based on six key risk factors,demonstrates strong predictive value,calibration,and clinical utility for sepsis in patients with DF.This tool offers a practical approach for early risk stratification,enabling timely interventions and improved clinical management in this high-risk population.展开更多
BACKGROUND Pain often predisposes patients with diabetic foot ulcers(DFUs)to negative emotional states,such as anxiety and depression,which can significantly impair treatment outcomes and recovery.However,very few stu...BACKGROUND Pain often predisposes patients with diabetic foot ulcers(DFUs)to negative emotional states,such as anxiety and depression,which can significantly impair treatment outcomes and recovery.However,very few studies have explored the relationship between anxiety,depression,and pain in DFUs,as well as the associated risk factors.AIM To analyze the correlation between anxiety,depression,and pain in patients with DFUs and to identify the associated risk factors.METHODS This study included 106 patients diagnosed with DFUs who were admitted to Tiantai County People’s Hospital between March 2022 and March 2024.The patients’anxiety levels were evaluated using Zung’s self-rating anxiety scale(SAS),depression status was assessed using Zung’s self-rating depression scale(SDS),and pain intensity was assessed using the visual analog scale(VAS).Subsequently,correlations between SAS,SDS,and VAS scores were analyzed.Univariate and multivariate analyses were conducted to explore the risk factors that contributed to anxiety and depression in patients with DFUs.RESULTS Among the 106 patients,39.62%exhibited anxiety and 43.40%presented with depression.Most patients experiencing anxiety or depression exhibited mild symptoms,with no severe cases observed.Compared with asymptomatic patients,those with anxiety or depression had significantly higher VAS scores.Correlation analysis indicated a significant positive relationship between both SAS and SDS scores and the VAS score.Univariate analysis identified sex,age,Wagner’s grade,presence of other complications,and smoking history as factors significantly associated with anxiety and depression.Multivariate analysis further confirmed that younger age,higher Wagner’s grade,and higher VAS scores were independent predictors of anxiety and depression.CONCLUSION This study reveals a significant positive correlation between anxiety,depression,and pain in patients with DFUs.This finding suggests that timely and effective pain intervention may be beneficial in alleviating negative emotions such as anxiety and depression.In addition,younger age(<50 years),higher Wagner’s grade,and higher VAS scores increase the risk of developing anxiety and depression in this patient population.展开更多
BACKGROUND Diabetic foot ulcers(DFUs)are a major complication of diabetes mellitus,and anemia is commonly observed in diabetic patients.However,the relationship between anemia and the risk of developing DFUs remains u...BACKGROUND Diabetic foot ulcers(DFUs)are a major complication of diabetes mellitus,and anemia is commonly observed in diabetic patients.However,the relationship between anemia and the risk of developing DFUs remains unclear.AIM To investigate the relationship between anemia and the risk of DFUs in diabetic patients through a meta-analysis.METHODS A systematic search was conducted across PubMed,Embase,and Web of Science databases to identify studies that reported the co-occurrence of anemia and DFUs in diabetic patients.The primary outcome was an association between anemia and DFU risk,expressed as odds ratios(ORs).Secondary outcomes included the risk of DFU per 1-g/dL decrease in hemoglobin and the difference in hemoglobin le-vels between patients with and without DFU.Statistical analyses were performed using random-effects models to account for heterogeneity.RESULTS Sixteen studies involving 170,949 diabetic patients were included in the analysis.The results indicated a significant association between anemia and an increased risk of DFUs(eight studies,n=166173,OR:2.72,95%CI:1.73–4.25,P<0.001;I2=93%).Subgroup analyses sup-ported consistent findings across various patient characteristics,analytic models,and study quality scores(P for subgroup differences,all>0.05).Additionally,each 1-g/dL decrease in hemoglobin was associated with an excess risk of DFUs(four studies,n=2543,OR:1.65,95%CI:1.21–2.27,P=0.002;I2=68%).Furthermore,diabetic patients with DFUs exhibited significantly lower hemoglobin levels compared to those without DFUs(nine studies,n=3986,mean difference:-2.13 g/dL,95%CI:-2.58 to-1.68,P<0.001;I2=90%).CONCLUSION Anemia can be associated with an increased risk of DFUs in diabetic patients.Monitoring and managing anemia in diabetic population may help mitigate the risk of DFUs,emphasizing the need for early interventions.Further research is required to investigate the underlying mechanisms and potential therapeutic strategies.展开更多
BACKGROUND Diabetic foot ulcers(DFU)are estimated to affect about 18.6 million people worldwide annually.The pathogenesis of DFU is complex,and the available drugs are not effective.Dl-3-n-butylphthalide(NBP)is a synt...BACKGROUND Diabetic foot ulcers(DFU)are estimated to affect about 18.6 million people worldwide annually.The pathogenesis of DFU is complex,and the available drugs are not effective.Dl-3-n-butylphthalide(NBP)is a synthetic mixture of racemates used in China for the treatment of ischemic stroke.It was initially isolated from the seeds of Apium graveolens Linn,with studies showing its potential role in treating diabetes and its complications.AIM To predict and validate the mechanism by which NBP treats DFU.METHODS Network pharmacological analysis was performed to identify pharmacological targets and signaling pathways mediating the treatment effect of NBP on DFU.In vivo and in vitro experiments were conducted to validate the therapeutic effects and mechanisms of NBP on DFU.RESULTS Network pharmacology analysis identified 26 pharmacological targets of NBP and predicted that NBP could treat DFU partially by modulating apoptosis and vascular signaling pathways.Results from animal experiments showed that NBP significantly improved DFU by increasing neovascularization and fibroblast proliferation.In vitro tests demonstrated that NBP treatment promoted the migration and proliferation of human umbilical vein endothelial cells and human dermal fibroblasts,while inhibiting the apoptosis of human umbilical vein endothelial cells,human dermal fibroblasts,and human keratinocytes cells.CONCLUSION This study found that NBP could treat DFU by decreasing the rate of apoptosis and increasing angiogenesis via the advanced glycation end products-receptor of advanced glycation end products signaling pathway and binding to the heme oxygenase 1,caspase 3,B cell leukemia/lymphoma 2,brain derived neurotrophic factor,and nuclear factor erythroid 2 L2 genes.展开更多
Dear Editor,We read with a great interest the recently published systematic review by Shamsikhani and Hosseini titled,“Foot reflexology on nausea and vomiting:A systematic review.”[1]While the authors provided a com...Dear Editor,We read with a great interest the recently published systematic review by Shamsikhani and Hosseini titled,“Foot reflexology on nausea and vomiting:A systematic review.”[1]While the authors provided a comprehensive qualitative synthesis of six studies meeting their inclusion criteria,we believe that additional quantitative analysis would strengthen the evidence base for foot reflexology in managing nausea and vomiting.We conducted a complementary meta-analysis to provide quantitative evidence supporting the qualitative findings presented in the systematic review.展开更多
Objective To assess health equity in the Yangtze River region to improve understanding of the correlation between hand, foot, and mouth disease(HFMD) and socioeconomic factors.Methods From 2014–2016, data on HFMD inc...Objective To assess health equity in the Yangtze River region to improve understanding of the correlation between hand, foot, and mouth disease(HFMD) and socioeconomic factors.Methods From 2014–2016, data on HFMD incidence, population statistics, economic indicators, and meteorology from 26 cities along the Yangtze River were analyzed. A multi-city random-effects metaanalysis was performed to study the relationship between temperature and HFMD transmission, and health equity was assessed with respect to socio-economic impact.Results Over the study period, 919,458 HFMD cases were reported, with Shanghai(162,303) having the highest incidence and Tongling(5,513) having the lowest. Males were more commonly affected(male-to-female ratio, 1.49:1). The exposure-response relationship had an M-shaped curve, with two HFMD peaks occurring at 4 ℃ and 26 ℃. The relative risk had two peaks at 1.30 ℃(1.834, 95% CI:1.204–2.794) and 31.4 ℃(1.143, 95% CI: 0.901–1.451), forming an M shape, with the first peak higher than the second. The most significant impact of temperature on HFMD was observed between –2 ℃ and18.1 ℃. The concentration index(0.2463) indicated moderate concentration differences, whereas the Theil index(0.0418) showed low inequality in distribution.Conclusion The incidence of HFMD varied across cities, particularly with changes in temperature.Economically prosperous areas showed higher risks, indicating disparities. Targeted interventions in these areas are crucial for mitigating the risk of HFMD.展开更多
Introduction: Foot amputation in a diabetic patient is a real public health problem due to its functional and psychological repercussions. The objective was to study the factors associated with amputation in patients ...Introduction: Foot amputation in a diabetic patient is a real public health problem due to its functional and psychological repercussions. The objective was to study the factors associated with amputation in patients monitored for a diabetic foot in the internal medicine hospitalization of the Abass Ndao University Hospital Center (CHU) in Dakar. Methods: This was a retrospective, descriptive and analytical study conducted from the records of hospitalized patients over a 24-month period. The analysis included a descriptive phase, followed by a bivariate phase completed by logistic modeling following a descending procedure. Results: Of 1499 hospitalized patients, 224 cases had diabetic foot (14.9%). Among the cases of diabetic foot, 198 patients met the inclusion criteria. Their mean age was 61.7 ± 11.3 years, the sex ratio (M/F) was 1.2. Other associated cardiovascular risk factors were high blood pressure (54.0% 107 cases), and smoking (10.9% 21 cases). A history of lower limb amputation was found in 21.2% (42 cases). It was type 2 diabetes in 184 cases (92.9%) and the mean blood sugar was 2.7 ± 1.3 g/l. Chronic complications included neuropathy in 112 cases (78.3%), arteriopathy in 172 cases (86.9%), and chronic kidney disease in 167 cases (84.4%). The mean consultation time was 47.6 days. The main lesions were gangrene (64.6%), ulcer (24.7%), phlegmon (5.6%), and necrotizing fasciitis (5.1%). According to the University of Texas classification, patients presented with a stage D lesion (86.4%), grade 3 (51.0%). The hospital prevalence of amputation was 57.6% (114 cases), including major amputation in 55.1% (109 cases). The mortality rate was 36.4% (72 cases). Risk factors for amputation were peripheral arterial disease (ORa = 4.96 [1.33 - 18.43] p = 0.017), foot gangrene (Ora = 3.16 [1.24 - 8.04] p = 0.016) and Texas classification grade 3 (ORa = 17.49 [1.67 - 190] p = 0.019). Conclusion: The prevalence of foot and amputations remains a health problem. Reducing amputations will necessarily require strengthening prevention through education and early monitoring of diabetic patients.展开更多
Diabetic neuropathy (DN) and impaired wound healing in diabetic foot ulcers(DFUs) are major complications of diabetes mellitus, driven by complex molecularmechanisms, including epigenetic modifications. Recent researc...Diabetic neuropathy (DN) and impaired wound healing in diabetic foot ulcers(DFUs) are major complications of diabetes mellitus, driven by complex molecularmechanisms, including epigenetic modifications. Recent research highlights therole of epigenetic markers including DNA methylation, histone modifications,and non-coding RNAs in regulating inflammatory responses, neuronal degeneration,and tissue repair. This review explores the epigenetics of DN and DFUs,emphasizing key regulatory pathways that influence disease progression andwound healing outcomes. Genome-wide DNA methylation studies reveal acceleratedepigenetic aging and metabolic memory effects in DN, contributing tosensory neuron dysfunction and neuropathic pain. Epigenetic dysregulation ofinflammatory mediators such as Toll-like receptors and the Nod-like receptorfamily, pyrin domain-containing 3 inflammasome further exacerbates neuronaldamage and delays wound healing. Additionally, histone deacetylases play apivotal role in oxidative stress regulation via the Nrf2 pathway, which is critical for both neuronal protection and angiogenesis in DFUs. Non-coding RNAs, particularly microRNAs (miRNAs),long non-coding RNAs (lncRNAs), and circular RNAs, are emerging as central regulators of the epigeneticcrosstalk between DN and DFUs. Several miRNAs, including miR-146a-5p and miR-518d-3p, are implicated inneuropathy severity, while lncRNAs such as nuclear enriched abundant transcript 1 modulate angiogenesis andwound repair. Cellular reprogramming of DFU fibroblasts has also been shown to induce pro-healing miRNAsignatures, offering potential therapeutic avenues. Furthermore, recent whole-genome and transcriptomic analysesof DFU-derived monocytes and Charcot foot lesions reveal unique epigenetic signatures that may serve as biomarkersfor early detection and personalized interventions. This epigenetic interplay between DN and DFUpathogenesis not only enhances our knowledge of disease mechanisms but also opens avenues for targetedepigenetic therapies to improve clinical outcomes.展开更多
BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset D...BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.METHODS We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021.A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors.Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions.The Cox model was further employed to evaluate the impact of risk factors on DF.The area under the curve(AUC)was measured to evaluate the accuracy of the prediction model.RESULTS Seventy-five diabetic inpatients experienced DF.The incidence density of DF was 4.5/1000 person-years.A long duration of diabetes,lower extremity arterial disease,lower serum albumin,fasting plasma glucose(FPG),and diabetic nephropathy were independently associated with DF.Among these risk factors,the serum albumin concentration was inversely associated with DF,with a hazard ratio(HR)and 95%confidence interval(CI)of 0.91(0.88-0.95)(P<0.001).Additionally,a U-shaped nonlinear relationship was observed between the FPG level and DF.After adjusting for other variables,the HRs and 95%CI for FPG<4.4 mmol/L and≥7.0 mmol/L were 3.99(1.55-10.25)(P=0.004)and 3.12(1.66-5.87)(P<0.001),respectively,which was greater than the mid-range level(4.4-6.9 mmol/L).The AUC for predicting DF over 3 years was 0.797.CONCLUSION FPG demonstrated a U-shaped relationship with DF.Serum albumin levels were negatively associated with DF.The prediction nomogram model of DF showed good discrimination ability using diabetes duration,lower extremity arterial disease,serum albumin,FPG,and diabetic nephropathy(Clinicaltrial.gov NCT05519163).展开更多
基金supported by the2008Science and Research Foundation of Hebei Education Depart ment(No.2008308)~~
文摘Considering the effect of temperature and process variations, the inputs and clock signals combination sleep state dependent leakage current characteristics is analyzed and the optimal sleep state is examined in sub-65nm dual threshold voltage （V1） footed domino circuits. HSPICE simulations based on 65nm and 45nm BSIM4 models show that the proposed CLIL state （the clock signal and inputs are all low） is the optimal state to reduce the leakage current of the high fan-in footed domino circuits at high temperature and almost all footed domino circuits at room temperature, as compared to the conventional CHIL state （the clock signal is high and inputs are all low） and the CHIH state （the clock signal and inputs are all high）. Further, the influence of the process variations on the leakage current characteristics of the dual V1 footed domino circuits is evaluated. At last, temperature and process variation aware new low leakage current setup guidelines are provided.
基金Hubei Province Top Medical Youth Talent Program,Wuhan Knowledge Innovation Special Basic Research Project,No.2023020201020558Clinical Research Project of Affiliated Hospital of Guangdong Medical University,No.LCYJ2021B004 and No.LCYJ2019B010Science and Technology Plan Project of Zhanjiang,No.2022A01191.
文摘BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.
基金Supported by the King Salman Center for Disability Research,No.KSRG-2023-407.
文摘Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic management,DFUs,foot lesions,proper care for injuries,diet,and surgery.Certain reasonably priced treatments,such as hyperbaric oxygen and vacuum-assisted closure therapy,are also available for DFUs,along with modern wound care products and techniques.Nonetheless,DF care(cleaning,applying antimicrobial cream when wounded,and foot reflexology),blood glucose monitoring to control diabetes,and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs.Between 50%and 80%of DF infections are preventable.Regardless of the intensity of the lesion,it needs to be treated carefully and checked daily during infection.Tissue regeneration can be aided by cleaning,dressing,and application of topical medicines.The choice of shoes is also important because it affects blood circulation and nerve impulses.In general,regular check-ups,monitoring of the patient’s condition,measuring blood glucose levels,and providing frequent guidance regarding DFU care are crucial.Finally,this important clinical problem requires involvement of multiple professionals to properly manage it.
文摘Nausea and vomiting are physiological responses that react to various bodily conditions and play a protective function.Medicinal and nonmedicinal methods,including complementary medicine,treat nausea and vomiting.The current research aims to investigate the effectiveness of foot reflexology as a complementary medicine method for nausea and vomiting.Based on PRISMA 2020,PubMed,Web of Science,and Scopus were searched until October 2,2024,using a search strategy approved by two researchers.Only randomized controlled trial studies were included in this research.No limitations or filters were applied.The inclusion criteria were selected based on the PICOS framework,and the studies were evaluated according to the National Institutes of Health quality assessment tool,which is related to controlled intervention,and were evaluated by two researchers.Finally,six studies were included in this review.Eighty-four percent of studies were conducted in Asia.Three records are from Iran,and two are from Turkey,and one is from France.The results showed that nausea and vomiting improved in all studies.In most studies(67%),four sessions or less led to improved outcomes.Rhodes index of nausea,vomiting,and retching and visual analog scale were utilized to assess nausea and vomiting.The current systematic review indicated that foot reflexology as a noninvasive intervention could improve nausea and vomiting in patients with cancer problems,pregnancy,hemodialysis,and laparoscopic cholecystectomy。
文摘Foot reflexology(FR)is a Chinese-originated and non-invasive complementary therapy increasingly used by functional,alternative and para-medical professionals.Enhance attempts are made to study FR in non-functional organic conditions.The present invited Editorial discusses the application of FR in autoimmune diseases(AD),highlighting a few successful studies demonstrating symptomatic relief and objective improvements.Despite promising results,the FR domain remains under-investigated and an urgent need to confirm and understand the effect of FR in chronic diseases,including AD,is highly recommended.
基金Supported by the Qilu Medical School Traditional Chinese Medicine Academic School Inheritance Project,No.93 LW[2022]Construction Project of the Inheritance Studio of National Famous Traditional Chinese Medicine Experts,Traditional Chinese Medicine Teaching Letter No.75[2022]Qilu Health and Fitness Talents in 2019,No.3 LWRZ[2020].
文摘BACKGROUND Diabetic foot ulcers(DFUs)are a significant contributor to disability and mortality in diabetic patients.Macrophage polarization and functional regulation are promising areas of research and show therapeutic potential in the field of DFU healing.However,the complex mechanism,the difficulty in clinical translation,and the large heterogeneity present significant challenges.Hence,this study was to comprehensively analyze the publication status and trends of studies on macrophage polarization and DFU healing.AIM To examine the relevant literature on macrophage polarization in DFU healing.METHODS A bibliometric analysis was conducted using the Web of Science database.Relevant literature was retrieved from the Web of Science Core Collection database between 2013 to 2023 using literature visualization and analysis software(VOSviewer and CiteSpace)and bibliometric online platforms.The obtained literature was then subjected to visualization and analysis of different countries/regions,institutions,journals,authors,and keywords to reveal the research’s major trends and focus.RESULTS The number of publications on the role of macrophage polarization in DFU healing increased rapidly from 2013 to 2023,especially in the latter period.Chinese researchers were the most prolific in this field,with 217 publications,while American researchers had been engaged in this field for a longer period.Qian Tan of Nanjing Drum Tower Hospital and Qian Ding of Nanjing University were the first to publish in this field.Shanghai Jiao Tong University was the institution with the most publications(27).The keywords“bone marrow”,“adjustment,replacement,response,tissue repair”,and“activation,repair,differentiation”appeared more frequently.The study of macrophage polarization in DFU healing focused on the regulatory mechanism,gene expression,and other aspects.CONCLUSION This study through the bibliometric method reveals the research trends and development trends in this field of macrophage polarization in DFU healing from 2013 to 2023 in the Web of Science Core Collection database.The key hotspots in this field mainly include the regulation of macrophage activation,gene expression,wound tissue repair,and new wound materials.This study provides references for future research directions.
基金Supported by the Fundamental Research Funds for the Central Universities,No.2022CDJYGRH-004.
文摘Foot reflexology is a non-invasive and safe complementary therapy that works by massaging the reflex zones of the feet and exerts systemic or whole-body regulation through meridian nerve conduction.This therapy is commonly used in the treatment of various conditions such as autism and Parkinson's disease.However,there is limited reporting on the use of foot reflexology therapy for infants with sensorineural hearing loss(SNHL).Currently,there is no definitive conclusion on how foot reflexology therapy can influence hearing.This editorial holds some guiding significance regarding this clinical issue.The aim is to present physiological evidence of how foot reflexology therapy can impact infants with SNHL,thereby enhancing clinician’s awareness of foot reflexology in treating infants with SNHL.
基金Supported by the Zhejiang Medical Technology Project,No.2022RC009 and No.2024KY645.
文摘Diabetic foot ulcers(DFUs)represents a significant public health issue,with a rising global prevalence and severe potential complications including amputation.Traditional treatments often fall short due to various limitations such as high recurrence rates and extensive resource utilization.This editorial explores the innovative use of acellular fish skin grafts as a transformative approach in DFU management.Recent studies and a detailed case report highlight the efficacy of acellular fish skin grafts in accelerating wound closure,reducing dressing changes,and enhancing patient outcomes with a lower socio-economic burden.Despite their promise,challenges such as limited availability,patient acceptance,and the need for further research persist.Addressing these through more extensive randomized controlled trials and fostering a multidisciplinary treatment approach may optimize DFU care and reduce the global health burden associated with these complex wounds.
文摘Diabetic foot attack(DFA)is the most severe presentation of diabetic foot disease,with the patient commonly displaying severe sepsis,which can be limb or life threatening.DFA can be classified into two main categories:Typical and atypical.A typical DFA is secondary to a severe infection in the foot,often initiated by minor breaches in skin integrity that allow pathogens to enter and proliferate.This form often progresses rapidly due to the underlying diabetic pathophysiology of neuropathy,microvascular disease,and hyperglycemia,which facilitate infection spread and tissue necrosis.This form of DFA can present as one of a number of severe infective pathologies including pyomyositis,necrotizing fasciitis,and myonecrosis,all of which can lead to systemic sepsis and multiorgan failure.An atypical DFA,however,is not primarily infection-driven.It can occur secondary to either ischemia or Charcot arthropathy.Management of the typical DFA involves prompt diagnosis,aggressive infection control,and a multidisciplinary approach.Treatment can be guided by the current International Working Group on the Diabetic Foot/Infectious Diseases Society of America guidelines on diabetic foot infections,and the combined British Orthopaedic Foot and Ankle Society-Vascular Society guidelines.This article highlights the importance of early recognition,comprehensive management strategies,and the need for further research to establish standardized protocols and improve clinical outcomes for patients with DFA.
文摘The prosthesis is an artificial device that can replace an organ of a human body member to restore a compromised function. It is necessary following the removal of a human organ, which can occur as a result of an illness, trauma or congenital malformation. The trans-tibia prosthesis, in particular, allows the amputee patient to recover the impaired function and regain autonomy, while facilitating their daily social integration. The trans-tibia prosthesis consists of a socket, a sleeve, connecting elements and a prosthetic foot. Each of these components plays a very important role. Among these components, the prosthetic foot usually called “SACH foot” is very often replaced due to cracking and therefore has a fairly short lifespan. At the Center for Equipment and Rehabilitation of Kabalaye (CERK), the SACH foot made using polyurethane and wood is imported and is given to patients with reduced mobility. The aim of this article is twofold, on the one hand, to make a social and pathological study of trans-tibia amputees in relation to the use of the SACH foot prosthesis, on the other hand, to compare this foot with a new prosthetic foot proposed and which is manufactured using extruded polystyrene. The result of prosthetic tests carried out on twenty-four amputees showed that the foot manufactured using extruded polystyrene is better in terms of resistance, bulk and adaptability to active amputees.
文摘Objective:To explore the correlation between fetal foot length measured by ultrasound and gestational age.Methods:This study employed ultrasound to measure the fetal foot length,femoral length,and foot length/femoral length ratio in 214 pregnant women from 12 to 40 weeks of gestation,all of whom had no pregnancy complications or obstetric complications,and whose fetuses were normal.Results:A significant positive correlation was found between fetal foot length and gestational age(r=0.967,p<0.001);a similarly significant positive correlation was observed between fetal femoral length and gestational age(r=0.972,p<0.001);and a non-significant positive correlation was noted between the foot length/femoral length ratio and gestational age(r=0.943,p<0.001).Conclusion:Ultrasound can accurately measure fetal foot length and femoral length,both of which exhibit a significant positive correlation with gestational age,making them important reference indicators for assessing fetal growth and development.
文摘BACKGROUND Sepsis is a severe complication in hospitalized patients with diabetic foot(DF),often associated with high morbidity and mortality.Despite its clinical significance,limited tools exist for early risk prediction.AIM To identify key risk factors and evaluate the predictive value of a nomogram model for sepsis in this population.METHODS This retrospective study included 216 patients with DF admitted from January 2022 to June 2024.Patients were classified into sepsis(n=31)and non-sepsis(n=185)groups.Baseline characteristics,clinical parameters,and laboratory data were analyzed.Independent risk factors were identified through multivariable logistic regression,and a nomogram model was developed and validated.The model's performance was assessed by its discrimination(AUC),calibration(Hosmer-Lemeshow test,calibration plots),and clinical utility[decision curve analysis(DCA)].RESULTS The multivariable analysis identified six independent predictors of sepsis:Diabetes duration,DF Texas grade,white blood cell count,glycated hemoglobin,Creactive protein,and albumin.A nomogram integrating these factors achieved excellent diagnostic performance,with an AUC of 0.908(95%CI:0.865-0.956)and robust internal validation(AUC:0.906).Calibration results showed strong agreement between predicted and observed probabilities(Hosmer-Lemeshow P=0.926).DCA demonstrated superior net benefit compared to extreme intervention scenarios,highlighting its clinical utility.CONCLUSION The nomogram prediction model,based on six key risk factors,demonstrates strong predictive value,calibration,and clinical utility for sepsis in patients with DF.This tool offers a practical approach for early risk stratification,enabling timely interventions and improved clinical management in this high-risk population.
文摘BACKGROUND Pain often predisposes patients with diabetic foot ulcers(DFUs)to negative emotional states,such as anxiety and depression,which can significantly impair treatment outcomes and recovery.However,very few studies have explored the relationship between anxiety,depression,and pain in DFUs,as well as the associated risk factors.AIM To analyze the correlation between anxiety,depression,and pain in patients with DFUs and to identify the associated risk factors.METHODS This study included 106 patients diagnosed with DFUs who were admitted to Tiantai County People’s Hospital between March 2022 and March 2024.The patients’anxiety levels were evaluated using Zung’s self-rating anxiety scale(SAS),depression status was assessed using Zung’s self-rating depression scale(SDS),and pain intensity was assessed using the visual analog scale(VAS).Subsequently,correlations between SAS,SDS,and VAS scores were analyzed.Univariate and multivariate analyses were conducted to explore the risk factors that contributed to anxiety and depression in patients with DFUs.RESULTS Among the 106 patients,39.62%exhibited anxiety and 43.40%presented with depression.Most patients experiencing anxiety or depression exhibited mild symptoms,with no severe cases observed.Compared with asymptomatic patients,those with anxiety or depression had significantly higher VAS scores.Correlation analysis indicated a significant positive relationship between both SAS and SDS scores and the VAS score.Univariate analysis identified sex,age,Wagner’s grade,presence of other complications,and smoking history as factors significantly associated with anxiety and depression.Multivariate analysis further confirmed that younger age,higher Wagner’s grade,and higher VAS scores were independent predictors of anxiety and depression.CONCLUSION This study reveals a significant positive correlation between anxiety,depression,and pain in patients with DFUs.This finding suggests that timely and effective pain intervention may be beneficial in alleviating negative emotions such as anxiety and depression.In addition,younger age(<50 years),higher Wagner’s grade,and higher VAS scores increase the risk of developing anxiety and depression in this patient population.
基金Supported by General Program of Hainan Natural Science Foundation,No.824MS143.
文摘BACKGROUND Diabetic foot ulcers(DFUs)are a major complication of diabetes mellitus,and anemia is commonly observed in diabetic patients.However,the relationship between anemia and the risk of developing DFUs remains unclear.AIM To investigate the relationship between anemia and the risk of DFUs in diabetic patients through a meta-analysis.METHODS A systematic search was conducted across PubMed,Embase,and Web of Science databases to identify studies that reported the co-occurrence of anemia and DFUs in diabetic patients.The primary outcome was an association between anemia and DFU risk,expressed as odds ratios(ORs).Secondary outcomes included the risk of DFU per 1-g/dL decrease in hemoglobin and the difference in hemoglobin le-vels between patients with and without DFU.Statistical analyses were performed using random-effects models to account for heterogeneity.RESULTS Sixteen studies involving 170,949 diabetic patients were included in the analysis.The results indicated a significant association between anemia and an increased risk of DFUs(eight studies,n=166173,OR:2.72,95%CI:1.73–4.25,P<0.001;I2=93%).Subgroup analyses sup-ported consistent findings across various patient characteristics,analytic models,and study quality scores(P for subgroup differences,all>0.05).Additionally,each 1-g/dL decrease in hemoglobin was associated with an excess risk of DFUs(four studies,n=2543,OR:1.65,95%CI:1.21–2.27,P=0.002;I2=68%).Furthermore,diabetic patients with DFUs exhibited significantly lower hemoglobin levels compared to those without DFUs(nine studies,n=3986,mean difference:-2.13 g/dL,95%CI:-2.58 to-1.68,P<0.001;I2=90%).CONCLUSION Anemia can be associated with an increased risk of DFUs in diabetic patients.Monitoring and managing anemia in diabetic population may help mitigate the risk of DFUs,emphasizing the need for early interventions.Further research is required to investigate the underlying mechanisms and potential therapeutic strategies.
基金Supported by General Project of Xuzhou Science and Technology Bureau,No.KC22070.
文摘BACKGROUND Diabetic foot ulcers(DFU)are estimated to affect about 18.6 million people worldwide annually.The pathogenesis of DFU is complex,and the available drugs are not effective.Dl-3-n-butylphthalide(NBP)is a synthetic mixture of racemates used in China for the treatment of ischemic stroke.It was initially isolated from the seeds of Apium graveolens Linn,with studies showing its potential role in treating diabetes and its complications.AIM To predict and validate the mechanism by which NBP treats DFU.METHODS Network pharmacological analysis was performed to identify pharmacological targets and signaling pathways mediating the treatment effect of NBP on DFU.In vivo and in vitro experiments were conducted to validate the therapeutic effects and mechanisms of NBP on DFU.RESULTS Network pharmacology analysis identified 26 pharmacological targets of NBP and predicted that NBP could treat DFU partially by modulating apoptosis and vascular signaling pathways.Results from animal experiments showed that NBP significantly improved DFU by increasing neovascularization and fibroblast proliferation.In vitro tests demonstrated that NBP treatment promoted the migration and proliferation of human umbilical vein endothelial cells and human dermal fibroblasts,while inhibiting the apoptosis of human umbilical vein endothelial cells,human dermal fibroblasts,and human keratinocytes cells.CONCLUSION This study found that NBP could treat DFU by decreasing the rate of apoptosis and increasing angiogenesis via the advanced glycation end products-receptor of advanced glycation end products signaling pathway and binding to the heme oxygenase 1,caspase 3,B cell leukemia/lymphoma 2,brain derived neurotrophic factor,and nuclear factor erythroid 2 L2 genes.
文摘Dear Editor,We read with a great interest the recently published systematic review by Shamsikhani and Hosseini titled,“Foot reflexology on nausea and vomiting:A systematic review.”[1]While the authors provided a comprehensive qualitative synthesis of six studies meeting their inclusion criteria,we believe that additional quantitative analysis would strengthen the evidence base for foot reflexology in managing nausea and vomiting.We conducted a complementary meta-analysis to provide quantitative evidence supporting the qualitative findings presented in the systematic review.
基金The funding of this study was of the 2021 Shandong Province Higher Education“Young Innovative Talent Introduction and Training Program”(Public Health Safety Risk Assessment and Response Innovation Team)the annual education and teaching reform and research project at the school level of Shandong Second Medical University(No.2023YBD006)+1 种基金the Public Health Standards Research and Development Project of the National Disease Control and Prevention Bureau(No.233007)the Public Health Standards Revision and Supervision Support Project of the National Disease Control and Prevention Bureau (No.242401).
文摘Objective To assess health equity in the Yangtze River region to improve understanding of the correlation between hand, foot, and mouth disease(HFMD) and socioeconomic factors.Methods From 2014–2016, data on HFMD incidence, population statistics, economic indicators, and meteorology from 26 cities along the Yangtze River were analyzed. A multi-city random-effects metaanalysis was performed to study the relationship between temperature and HFMD transmission, and health equity was assessed with respect to socio-economic impact.Results Over the study period, 919,458 HFMD cases were reported, with Shanghai(162,303) having the highest incidence and Tongling(5,513) having the lowest. Males were more commonly affected(male-to-female ratio, 1.49:1). The exposure-response relationship had an M-shaped curve, with two HFMD peaks occurring at 4 ℃ and 26 ℃. The relative risk had two peaks at 1.30 ℃(1.834, 95% CI:1.204–2.794) and 31.4 ℃(1.143, 95% CI: 0.901–1.451), forming an M shape, with the first peak higher than the second. The most significant impact of temperature on HFMD was observed between –2 ℃ and18.1 ℃. The concentration index(0.2463) indicated moderate concentration differences, whereas the Theil index(0.0418) showed low inequality in distribution.Conclusion The incidence of HFMD varied across cities, particularly with changes in temperature.Economically prosperous areas showed higher risks, indicating disparities. Targeted interventions in these areas are crucial for mitigating the risk of HFMD.
文摘Introduction: Foot amputation in a diabetic patient is a real public health problem due to its functional and psychological repercussions. The objective was to study the factors associated with amputation in patients monitored for a diabetic foot in the internal medicine hospitalization of the Abass Ndao University Hospital Center (CHU) in Dakar. Methods: This was a retrospective, descriptive and analytical study conducted from the records of hospitalized patients over a 24-month period. The analysis included a descriptive phase, followed by a bivariate phase completed by logistic modeling following a descending procedure. Results: Of 1499 hospitalized patients, 224 cases had diabetic foot (14.9%). Among the cases of diabetic foot, 198 patients met the inclusion criteria. Their mean age was 61.7 ± 11.3 years, the sex ratio (M/F) was 1.2. Other associated cardiovascular risk factors were high blood pressure (54.0% 107 cases), and smoking (10.9% 21 cases). A history of lower limb amputation was found in 21.2% (42 cases). It was type 2 diabetes in 184 cases (92.9%) and the mean blood sugar was 2.7 ± 1.3 g/l. Chronic complications included neuropathy in 112 cases (78.3%), arteriopathy in 172 cases (86.9%), and chronic kidney disease in 167 cases (84.4%). The mean consultation time was 47.6 days. The main lesions were gangrene (64.6%), ulcer (24.7%), phlegmon (5.6%), and necrotizing fasciitis (5.1%). According to the University of Texas classification, patients presented with a stage D lesion (86.4%), grade 3 (51.0%). The hospital prevalence of amputation was 57.6% (114 cases), including major amputation in 55.1% (109 cases). The mortality rate was 36.4% (72 cases). Risk factors for amputation were peripheral arterial disease (ORa = 4.96 [1.33 - 18.43] p = 0.017), foot gangrene (Ora = 3.16 [1.24 - 8.04] p = 0.016) and Texas classification grade 3 (ORa = 17.49 [1.67 - 190] p = 0.019). Conclusion: The prevalence of foot and amputations remains a health problem. Reducing amputations will necessarily require strengthening prevention through education and early monitoring of diabetic patients.
文摘Diabetic neuropathy (DN) and impaired wound healing in diabetic foot ulcers(DFUs) are major complications of diabetes mellitus, driven by complex molecularmechanisms, including epigenetic modifications. Recent research highlights therole of epigenetic markers including DNA methylation, histone modifications,and non-coding RNAs in regulating inflammatory responses, neuronal degeneration,and tissue repair. This review explores the epigenetics of DN and DFUs,emphasizing key regulatory pathways that influence disease progression andwound healing outcomes. Genome-wide DNA methylation studies reveal acceleratedepigenetic aging and metabolic memory effects in DN, contributing tosensory neuron dysfunction and neuropathic pain. Epigenetic dysregulation ofinflammatory mediators such as Toll-like receptors and the Nod-like receptorfamily, pyrin domain-containing 3 inflammasome further exacerbates neuronaldamage and delays wound healing. Additionally, histone deacetylases play apivotal role in oxidative stress regulation via the Nrf2 pathway, which is critical for both neuronal protection and angiogenesis in DFUs. Non-coding RNAs, particularly microRNAs (miRNAs),long non-coding RNAs (lncRNAs), and circular RNAs, are emerging as central regulators of the epigeneticcrosstalk between DN and DFUs. Several miRNAs, including miR-146a-5p and miR-518d-3p, are implicated inneuropathy severity, while lncRNAs such as nuclear enriched abundant transcript 1 modulate angiogenesis andwound repair. Cellular reprogramming of DFU fibroblasts has also been shown to induce pro-healing miRNAsignatures, offering potential therapeutic avenues. Furthermore, recent whole-genome and transcriptomic analysesof DFU-derived monocytes and Charcot foot lesions reveal unique epigenetic signatures that may serve as biomarkersfor early detection and personalized interventions. This epigenetic interplay between DN and DFUpathogenesis not only enhances our knowledge of disease mechanisms but also opens avenues for targetedepigenetic therapies to improve clinical outcomes.
基金Supported by National Natural Science Foundation of China,No.81972947Academic Promotion Programme of Shandong First Medical University,No.2019LJ005.
文摘BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.METHODS We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021.A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors.Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions.The Cox model was further employed to evaluate the impact of risk factors on DF.The area under the curve(AUC)was measured to evaluate the accuracy of the prediction model.RESULTS Seventy-five diabetic inpatients experienced DF.The incidence density of DF was 4.5/1000 person-years.A long duration of diabetes,lower extremity arterial disease,lower serum albumin,fasting plasma glucose(FPG),and diabetic nephropathy were independently associated with DF.Among these risk factors,the serum albumin concentration was inversely associated with DF,with a hazard ratio(HR)and 95%confidence interval(CI)of 0.91(0.88-0.95)(P<0.001).Additionally,a U-shaped nonlinear relationship was observed between the FPG level and DF.After adjusting for other variables,the HRs and 95%CI for FPG<4.4 mmol/L and≥7.0 mmol/L were 3.99(1.55-10.25)(P=0.004)and 3.12(1.66-5.87)(P<0.001),respectively,which was greater than the mid-range level(4.4-6.9 mmol/L).The AUC for predicting DF over 3 years was 0.797.CONCLUSION FPG demonstrated a U-shaped relationship with DF.Serum albumin levels were negatively associated with DF.The prediction nomogram model of DF showed good discrimination ability using diabetes duration,lower extremity arterial disease,serum albumin,FPG,and diabetic nephropathy(Clinicaltrial.gov NCT05519163).
