Identification, influencing factors and outcomes of time delays in the management pathway of diabetic foot: A systematic review.

OBJECTIVE: A systematic review was conducted to evaluate the time delays in the management of diabetic foot and explore influencing factors of these delays and potential outcomes. METHODS: The researchers searched several electronic databases (Pubmed, Web of Science, Cochrane Library, EMbase, CNKI, WanFang, CBM and VIP) for English and Chinese studies that examined time delays in the management pathway of diabetic foot. Two authors independently screened and extracted data, and assessed the quality of the included studies using the Newcastle-Ottawa Scale and the Agency for Health Research and Quality checklist. Due to heterogeneity among the studies, descriptive analysis was performed. RESULTS: The review included 28 articles, comprising 20 cohort studies and 8 cross-sectional studies, that met the inclusion criteria. Among these, 14 were deemed of high quality. The median times from symptom onset to primary health care or specialist care varied from 3 to 46.69 days. The median delay in referral by primary care specialists ranged from 7 to 31 days, and subsequent median times to definitive treatment ranged from 6.2 to 56 days. Multiple complex factors were found to contribute to these delays, including patient demographics (older age, lower education level and income level) and poor patient health-seeking behaviors (inaccurate self-treatment, incorrect recognition and interpretation of symptoms), inaccurate assessment or initial treatment by health primary professionals, complex referral pathways and clinical characteristics of diabetic foot (number of foot ulcers, Wagner grade scale, and hemoglobin A1c index). Negative outcomes associated with these delays included increased risk of major amputation and mortality, decreased wound healing rate, prolonged hospital stay, and increased hospital costs. CONCLUSIONS: Time delays in the diabetic foot management pathway were both common and serious, contributing to negative health outcomes for patients with diabetic foot. Many complex factors related to patient's poor patient health-seeking behaviors, health system, and clinical characteristics of diabetic foot are responsible for these delays. Therefore, it is necessary to develop new strategies for standard referral practices and strengthen patient awareness of seeking care.

Acellular Dermal Matrix for Treatment of Diabetic Foot Ulcer: An Overview of Systematic Reviews.

Aims: To evaluate the reliability of the methodological quality and outcome measures of systematic reviews (SRs)/metaanalyses (MAs) of the acellular dermal matrix (ADM) for diabetic foot ulcer (DFU). Methods: We searched and retrieved SRs and MAs on the application of ADM for DFU from PubMed, Web of Science, The Cochrane Library, EMBASE, CNKI, CBM, WanFang, and VIP databases. We employed AMSTAR 2 to assess methodological quality, Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system to grade, and the strength of evidence of included SRs/MAs. We excluded the overlapping randomized controlled trials (RCTs) and conducted a re-MA of the primary RCTs. Results: A total of 7 SRs/MAs were included. Results from the AMSTAR 2 evaluation revealed a low overall quality; the GRADE system showed that the evidence was of moderate to very low quality. Our re-MA showed that ADM was superior to standard of care (SOC), with regards to complete wound healing rate at 12 weeks (RR = 1.74, 95% CI:1.34-2.25, P < .0001), complete wound healing rate at 16 weeks (RR = 1.50, 95% CI: 1.26-1.77, P ＜ .00001); healing time (MD = -2.06, 95% CI: -2.57 to -1.54, P < .00001) and adverse events (RR = 0.62, 95% CI: 0.49-0.80, P = .0002). However, a consensus has not yet been reached between ADM and SOC groups with regard to outcome indicators of the reduction of ulcer area and quality of life; and subgroup analyses showed no statistically significant differences between the xenograft ADM and SOC groups (RR = 1.36, 95% CI: 0.95-1.93, P = .09) at 12 weeks. Conclusion: Current evidence suggests that ADM is more effective than the standard of care in the treatment of DFU, particularly for full-thickness, noninfected, and nonischemic foot ulcers, but with low evidence quality. Therefore, the results of this overview should be interpreted dialectically and prudently, and the role of ADM in DFU needs further exploration.

New skin tissue engineering scaffold with sulfated silk fibroin/chitosan/hydroxyapatite and its application.

Repairing skin wounds has always been challenging in clinical practice. The new skin tissue engineering scaffold provides innovative ways to address these challenges with a good chance of success because of its stable mechanical properties, biodegradability, and antibacterial properties. This paper presents the fabrication and evaluation of a three-dimensional composite scaffold made with sulfated silk fibroin, chitosan, and hydroxyapatite (SSF/CS/HAP). An electron microscope shows that the scaffold has an aperture of 15-20 µm, while an absorption performance test shows that its expansion index reaches 779%. The co-culture of L929 cells and the CCK-8 experiments demonstrated good cell compatibility and low scaffold cytotoxicity, respectively. Meanwhile, in vivo experiments demonstrate that rats with SSF/CS/HAP scaffold-treated neck wounds heal faster. In the wound skin tissue of the SSF/CS/HAP scaffold group, immunohistochemistry indicates a more rapid and mature development of hair follicles. This study successfully developed a novel skin tissue engineering scaffold material with high moisture retention, high tissue compatibility, and low cytotoxicity, demonstrating its ability to improve wound repair with promising potential for tissue engineering applications.

Hemodynamic Analysis of Redissection after Endovascular Repair for One Stanford Type B Aortic Dissection Case / 医用生物力学

Objective Based on hemodynamic analysis, to investigate the cause of distal re-entry tear in Stanford type B aortic dissection after thoracic endovascular aortic repair (TEVAR).Methods A patient with type B aortic dissection was reexamined regularly with computed tomography angiography (CTA) at 1st month, 6th month, 12th month and 24th month after TEVAR. Based on the CTA images in each period, three-dimensional (3D) aorta models were reconstructed to perform morphological analysis and hemodynamic simulation.Results Compared with the diameter at 1st month after TEVAR, the diameter of true lumen at 12 months after TEVAR increased by 1.8 times and the global distortion of aorta increased by 16.67%. At postoperative 1st, 6th and 12th month, the maximum blood velocities at the new entry tear in systole were 69.6%, 33.7% and 92.1% higher than the average ones at distal landing zone, and the maximum wall shear stresses (WSSs) were 2.52, 2.32 and 3.52 times of the average WSSs respectively. In addition, the maximum time-averaged WSS (TAWSS) at 1st, 6th and 12th month after TEVAR were 1.88, 2.53 and 3.62 times of the mean TAWSS respectively.ConclusionsThe morphology of the aorta remodeled after TEVAR, and a sudden change in the diameter of true lumen occurred at distal anchoring zone and continued to increase. As a result, the blood flow velocity in this area accelerated, and the intima was continuously exposed to high WSS, leading to the redissection.

Case Study of Compound Traditional Chinese Medicine Globalization / 世界科学技术-中医药现代化

Compound Traditional Chinese Medicine (CTCM) applying for FDA approval as botanical drug is a systemic and innovative work.Compound Danshen Dripping Pill (T89) is the first CTCM completed FDA global multi-center Phase Ⅲ clinical trial,which has become a benchmark for TCM globalization.Extensive experiences have been accumulated through the 20 years' research and development.Tasly fully considered the characteristics of CTCM while complying with FDA regulations during the entire application process.In which,product indication was clearly defined and agreed,clinical trial protocol was scientifically and innovatively designed with gold standard,phase Ⅱ study was well completed,SPA for phase Ⅲ study was obtained,and eventually the global multi-center phase Ⅲ study was successfully completed.In order to better support T89's application,Tasly conducted series of additional studies and introduced many innovations,such as drug-drug interaction study for TCM,finger printing study for CTCM,quality consistency study,biological assay study and etc.Globalization of T89 is not only a product creating history,but also a process for Tasly and the US FDA working together to continuously innovate and create history in innovating modern TCM standards,improving industrial chain GMP system for botanical drugs,making technical breakthroughs,exploring regulatory pathways and increasing product value.It represents the national power and historical progress in medicine.

Experimental and Clinical Research Progress in Acupoint Catgut Embedding Therapy on Obesity / 中国中医药信息杂志

Acupoint catgut embedding therapy shows significant efficacy in treating obesity with simple operation and definite safety. This article reviewed research progress in acupoint catgut embedding therapy on obesity from the aspects of experiment and clinical research in recent years and made evaluation and proposed expectation, with a purpose to further guide clinical application and research of acupoint catgut embedding.

Orthogonal design method to optimize rehabilitation prescription of pulsed electric field at Jiaji (EX-B 2) points for spinal cord injury / 中国针灸

<p><b>OBJECTIVE</b>By using orthogonal design method to optimnize prescription of pulsed electric field at Jiaji (EX- B 2) points for spinal cord injury (SCI).</p><p><b>METHODS</b>Fifty six patients of SCI were selected, in which 36 cases were divided into orthogonal design trial and 20 cases were into clinical verification. With 36 patients who received orthogonal design trial, Frankel grading scale was used as observation index to screen optimal prescription of pulsed electric field. Pulse frequency (factor A) included low frequency (factor A(I), 10(2) Hz). moderate frequency (factor A(II), 10(4) Hz) and high frequency (factor A(III), 10(3) Hz); pulse amplitude (factor B) included 0-30 V (factor B ), 0-60 V (factor B(II)) and 0-90 V (factor B(III)); pulse width (factor C) included 0.1 ms (factor C(I)). 0.6 ms (factor C(II)) and 0.9 ms (factor C(III)); acupuncture time (factor D) included one month (DI), three months (D(II)) and five months (D(III)). Twenty patients were used for clinical efficacy observation and the effects of screened optimal pre scription of pulsed electric field at Jiaji (EX-B 2) points combined with regular rehabilitation training on spasm se- verity, score of sensory and motor functions, Barthel index and Frankel score were observed.</p><p><b>RESULTS</b>(1) As results of orthogonal design trial, the optimal prescription was A(III) B(III), C(I), D(III), which were high frequency (10(3) Hz), 0-90 V of pulse amplitude, 0.4 ms of pulse width and 5 months of treatment time. (2) As results of 20 patient clinical verification, Ashworth score, tendon reflex and clonus were all significantly improved (P<0.001, P<0.01), the scores of sensory and motor functions were evidently improvedtl (P<0.001, P<0.05), and Barthel in dex and Frankel score were also enhanced (P<0.001, P<0.05).</p><p><b>CONCLUSION</b>The optimal prescription of pulsed electric field at Jiaji (EX-B 2) points for spinal cord injury is high frequency (10& Hz), 0-90 V of pulse amplitude, 0.4 ms of pulse width and 5 months of treatment time. The optimal prescription of pulsed electric field at Jiaji (EX-B 2) points combined with regular rehabilitation could obviously improve spasm severity, enhance senso- ry and motor functions, and ameliorate activity of daily life and Frankel score.</p>

Dietary survey in a unit of armed police forces:a comparison between food weighing and chemical analysis / 军事医学

Objective To assess the differences in nutrient composition by chemical analysis method and weighing method,A corps of armed police forces daily dietary nutrient intakes were investigated in Tianjin,to understand the status of the actual intakes of dietary nutrient.Methods A dietary survey was performed using the weighing method and with ref-erence to China food composition database in 2002.The intake of each nutrient was calculated through chemical analysis;Nutritional analysis was used in the collection of duplicate food portions during the dietary survey.Results For most of the main dietary nutrients(protein,fat and carbohydrates),minerals (Na,K,Mg,Ca,Zn,Cu and Se)and vitamins (β-car-otene,vitamin E,thiamine,riboflavin,vitamin C,niacin,and vitamin A),the calculated values of intakes were found to exceed those obtained via chemical analysis.Conclusion Differences of the two methods of dietary survey were ultimately due to the analysed values were below the calculated ones.So it is necessary to improve methods of food storage and trans-portation in order to obtain adequate nutrition and to improve the health of troops.

Psychometric features of the body image after breast cancer questionnaire-Chinese version in women with breast cancer / 中南大学学报(医学版)

OBJECTIVE@#To examine the psychometric features of the body image after breast cancer questionnaire-Chinese version (BIBCQ-C) in Chinese women with breast cancer.@*METHODS@#A total of 545 women with breast cancer received a demographics investigation: BIBCQ-C and hospital anxiety and depression scale (HAD). Four weeks later, 31 patients were selected randomly to finish BIBCQ-C again.@*RESULTS@#The Cronbach's alpha coefficient for the total scale was 0.90, and that for the 6 factors ranged from 0.62 to 0.87. The mean inter-item correlation coefficient of the total scale was 0.16, and the mean inter-item correlation coefficient of the subscales ranged from 0.21 to 0.57, and the test-retest reliability of the total scale and 6 factors was over 0.60. The confirmatory factor analyses supported the 6-factor model, and BIBCQ-C were significantly correlated with the symptom scales of anxiety and depression (r=0.20, 0.21, P<0.01).@*CONCLUSION@#BIBCQ-C is reliable and valid, which can effectively assess body image of Chinese women with breast cancer.

Teaching Reform of Rehabilitation Assessment in Higher Vocational Education Rehabilitation Treatment Technology / 中国康复理论与实践

@#Based on talented person admittance standard and train objective, considering student's cognition characteristic and the professional rank test and so on in higher vocational education rehabilitation treatment technology, this paper explored reform and construction of rehabilitation assessment.

Isolation and classification of the bacteriophages of Pseudomonas aeruginosa and their application on biofilm control / 中华微生物学和免疫学杂志

Objective To isolate and classigy the bacteriophages specific to Pseudomonas aetuginosa and to investigate biofilm control efficaey of the isolated virulent phages.Methods With P. aeruginosa clinical strains as indicators.bacteriophages were isolated by screening difierent environmental samples.Classification of the isolated phages was done with the methods of restriction fragment analysis of phage genome and host range analysis.Transmission electron microscopy(TEM)was used in phage morphology study.In biogilm control tests,TJC729 was used as the jndicator strain to study the biofilm control efficacy of the isolated phages.Results Total 13 lytic phages specific to P.aeruginosa strains were isolated and named as C1-C13.According to the result of restriction fragment analysis.all 13 phages were double-stranded DNA viruses and could be divided into eight groups.Host range experiments were conducted with 5 laboratory strains and 12 clinical strains of P. aeruginosa.The same infection profiles were observed among phage C1 and C13,C6 and C7,and C9 and C11,respectively.While the remaining 7 phages each had different unique infection profile.Phage C1 was selected randomly to study its morphology.The obtained images showed that phage C1 had an icosahedral head with a non-contractile tail,belonging to the Siphoviridae family.Compared with the single phage,phage cocktail had the best effect on biofilm control.Further experiment results showed that phage C1.C10 and C12 can destroy biofilm after treatment of the biofilm for 24 h.The biofilm amounts were deceased to 32.7%,57.6%and 32.8%of the initial values,respectively.Conclusion Thirteen virulent phages specific to P. aeruginosa had been isolated.The phages could significantly inhibit the biofilm formation and had a certain degree of damage on the biofilm.The results suggested an alternative method for the treatments of P.aeruginosa infections.