A meta-analysis of the relationship between foot local characteristics and major lower extremity amputation in diabetic foot patients.

OBJECTIVE: To clarify and quantify risk factors among local characteristics of the foot for major amputation in diabetic foot patients. METHODS: Articles published before January 2018 on PubMed and Embase were conducted observational studies about risk factors for major amputation in patients with diabetic foot were retrieved and systematically reviewed by using Stata 12.0 statistical software. RESULTS: A total of 4668 major amputees and 65 831 controls were reported in 18 observational studies. Across the studies, the overall odds ratios (ORs) and 95% confidence intervals (CIs) of significant risk factors are ulcer reaching bone (OR, 11.796; 95% CI, 6.905-20.152), gangrene (OR, 6.487; 95% CI, 4.088-10.293), hindfoot position (OR, 3.913; 95% CI, 2.254-6.795), decreased ankle-brachial index (ABI) (OR, 2.522; 95% CI, 1.805-3.523), infection (OR, 2.516; 95% CI, 1.708-3.706), peripheral arterial disease (PAD) (OR, 2.114; 95% CI, 1.326-3.372). While there is no significant difference in the size of the ulcer, neuropathy, Charcot foot, osteomyelitis and intermittent claudication (OR, 1.15; 95% CI, 0.85-1.54). CONCLUSION: Factors among local characteristics of the foot associated with major amputation in patients with diabetic foot are the ulcer reaching bone, gangrene, hindfoot position, decreased ABI, infection, and PAD, a negative risk factor for the risk of amputation. Further studies are required to provide more details of foot local characteristics.

The Effect of Alternative vs. Focal Identity Accessibility on the Intent to Purchase Products: An Exploratory Study Based on Chinese Culture.

Much of early western research has focused on identity. A primed identity can inhibit the priming of other alternative identities, and also negatively affect the intention to purchase products related to those alternative identities. In western culture, individuals operate within a cultural framework that makes them more likely to prioritize their own goals and less likely to rely on environmental factors when evaluating others. Individuals are more likely to choose products that fit their primed identity. In this study, we suggest that in collectivist Chinese culture, individuals may give priority to group-level goals and attach more importance to situational factors when evaluating others. Therefore, a primed identity may not necessarily inhibit the priming of alternative identities. In this research, we examine the association between a focal identity and alternative identities, with particular emphasis on the accessibility, discrepancies, and effects on purchase intention of alternative identities. We also examine the intent to purchase products related to the alternative identity vs. the focal identity, developing a model with which to explore this construct. We test four hypotheses through experiments using an online questionnaire and analyzing the resulting data using statistical product service solutions (SPSS) 22.0 and the PROCESS macro modeling tool. The results are as follows: First, the association between a focal identity and alternative identity has a positive impact on the accessibility of the alternative identity. The clearer the alternative identity is, the greater the impact of the association between the focal identity and alternative identity on the latter's accessibility. Second, the accessibility of the alternative identity has a positive impact on the intent to purchase alternative identity vs. focal identity-related products. The greater the discrepancy between the focal identity and the alternative identity, the greater the impact on the intent to purchase alternative identity vs. focal identity-related products. The results of this study confirmed the interaction between identity association and the clarity of the alternative identity, as well as the influence of the accessibility of the alternative identity on the intent to purchase alternative identity vs. focal identity-related products. We contribute to the development of a theory on intention to purchase identity-related products.

Association Between the Lower Extremity Deep Venous Thrombosis, the Warfarin Maintenance Dose, and CYP2C9*3, CYP2D6*10, and CYP3A5*3 Genetic Polymorphisms: A Case-Control Study.

OBJECTIVE: This study explored the association between the CYP2C9*3/CYP2D6*10/CYP3A5*3 genetic polymorphisms with lower extremity deep venous thrombosis (LEDVT) and the warfarin maintenance dose. METHODS: Five hundred thirty-six patients who were pathologically diagnosed with LEDVT after surgery were included in the LEDVT group. At the same time, 540 patients without LEDVT who underwent surgery were recruited as the control group. Patients were given warfarin at an initial dose of 2.5-3.0 mg. Blood samples were collected to detect the initial and stable international normalized ratio (INR) values. The warfarin maintenance dose was obtained if the INR remained within a range of 2.0-3.0 for 3 consecutive days. The genotype distribution and haplotype analysis of the CYP2C9*3/CYP2D6*10/CYP3A5*3 alleles were analyzed using polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) testing and SHEsis software, respectively. Logistic regression analysis was used to analyze the risk and protective factors for LEDVT. RESULTS: The A/G genotypes, G/G genotypes, and G allele of CYP3A5*3 in the LEDVT group were observed with increased frequency compared with the control group. The LEDVT group displayed a higher ACG haplotype frequency, and lower ACA and ATA haplotype frequencies than the control group. Age, diabetes, low-density lipoprotein, CYP3A5*3 and the ACG haplotype were independent risk factors for LEDVT. High-density lipoprotein and the ACA haplotype were independent protective factors for LEDVT. The genotype distributions of the CYP2C9*3, CYP2D6*10, and CYP3A5*3 genetic polymorphisms were associated with the warfarin maintenance dose. CONCLUSION: The CYP3A5*3 genetic polymorphism may be an important risk factor for LEDVT. Moreover, CYP2C9*3, CYP2D6*10, and CYP3A5*3 are associated with the warfarin maintenance dose.