Development and Validation of a Risk Prediction Model for Foot Ulcers in Diabetic Patients.

Background: The current study analyzed the status and the factors of foot ulcers in diabetic patients and developed a nomogram and web calculator for the risk prediction model of diabetic foot ulcers. Methods: This was a prospective cohort study that used cluster sampling to enroll diabetic patients in the Department of Endocrinology and Metabolism in a tertiary hospital in Chengdu from July 2015 to February 2020. The risk factors for diabetic foot ulcers were obtained by logistic regression analysis. Nomogram and web calculator for the risk prediction model were constructed by R software. Results: The incidence of foot ulcers was 12.4% (302/2432). Logistic stepwise regression analysis showed that BMI (OR: 1.059; 95% CI 1.021-1.099), abnormal foot skin color (OR: 1.450; 95% CI 1.011-2.080), foot arterial pulse (OR: 1.488; 95% CI: 1.242-1.778), callus (OR: 2.924; 95%: CI 2.133-4.001), and history of ulcer (OR: 3.648; 95% CI: 2.133-5.191) were risk factors for foot ulcers. The nomogram and web calculator model were developed according to risk predictors. The performance of the model was tested, and the testing data were as follows: AUC (area under curve) of the primary cohort was 0.741 (95% CI: 0.7022-0.7799), and AUC of the validation cohort was 0.787 (95% CI: 0.7342-0.8407); the Brier score of the primary cohort was 0.098, and the Brier score of the validation cohort was 0.087. Conclusions: The incidence of diabetic foot ulcers was high, especially in diabetic patients with a history of foot ulcers. This study presented a nomogram and web calculator that incorporates BMI, abnormal foot skin color, foot arterial pulse, callus, and history of foot ulcers, which can be conveniently used to facilitate the individualized prediction of diabetic foot ulcers.

Research on the frailty status and adverse outcomes of elderly patients with multimorbidity.

BACKGROUND: As patients age, the frailty of those with multimorbidity increases, often resulting in adverse health outcomes. The current study investigated the frailty status and the factors which influence it in elderly patients with multimorbidity in Chinese hospitals. The relationship between the frailty of patients with multimorbidity and adverse outcomes was explored. METHODS: The current prospective cohort study investigated inpatients in the internal medicine department of 5 tertiary hospitals in Sichuan Province, China. A total of 3836 elderly patients with multimorbidity were enrolled. Frailty was assessed using the FRAIL scale and adverse outcome events occurring during hospitalization were tracked. Descriptive statistics and logistic regressions were used for data analysis. RESULTS: The prevalence of frailty was 27.2% and of pre-frailty, 58.9%. Logistic regression analysis showed that increasing age, low BMI, low education level, lack of exercise, multiple types of medications and multiple numbers of chronic diseases were the main risk factors for frailty in elderly patients with multimorbidity (OR values: 1.020, 1.469, 2.350, 2.836, 1.156 and 1.308, respectively). The incidence of adverse outcomes was 13.9% among the cohort with the most common being deep vein thrombosis (42.4%), followed by pressure injury (38.8%). Regression analysis showed a significant correlation of frailty with adverse outcome (OR: 1.496; p < 0.01). CONCLUSIONS: The prevalence of frailty and pre-frailty in hospitalized elderly patients with multimorbidity was high. Increasing age, low BMI, low education level, lack of exercise, multiple types of medications and multiple numbers of chronic diseases were factors which influenced frailty and frailty was an important factor in the occurrence of adverse outcomes. The most common adverse outcome of elderly multimorbidity patients during hospitalization was deep vein thrombosis.

Two new monoterpenoid indole alkaloids from Mappianthus iodoides stems.

Two previously unreported monoterpenoid indole alkaloids, 19(20)E-5-carboxymethylvallesiachotamine (1) and 19(20)Z-5-carboxymethylvallesiachotamine (2), along with five known indole alkaloids (3-7) were isolated from Mappianthus iodoides stems. Their structures were characterized by extensive spectroscopic data. Among these isolates, compounds 1 and 2 were the two new Δ19(20) geometric isomers. The anti-inflammatory activities in vitro of all isolated compounds were evaluated using NO assay.[Formula: see text].

Spatial analysis of potential carcinogenic risks associated with ingesting arsenic in aquacultural tilapia (Oreochromis mossambicus) in blackfoot disease hyperendemic areas.

This work analyzed spatially potential carcinogenic risks associated with ingesting arsenic (As) contents in aquacultural tilapia (Oreochromis mossambicus) in coastal regions of southwestern Taiwan, where the blackfoot disease prevails. Sequential indicator simulation (SIS) was used to reproduce As exposure distributions in groundwater based on their three-dimensional variability. A target cancer risk (TR) associated with ingesting As in aquacultural tilapia was calculated to evaluate the potential risk to human health. Owing to sparse measured data, Monte Carlo simulation and SIS properly accounted for the uncertainty of assessed parameters. The probabilistic risk assessment formulated suitable strategies under various remedial stages. Aquacultural regions with high risks were mapped to elucidate the safety of groundwater use at different depths. Many TRs determined from the risks at the 75th and 95th percentiles exceed one millionth in the regions, indicating that ingesting tilapia farmed in the highly As-polluted regions poses potential cancer threats to human health. The 75th percentile of TR is considered in formulating a remedial strategy for the aquacultural use of groundwater in the preliminary stage. Additionally, this study suggests reducing the use of groundwater in aquaculture or changing the depths from which groundwater is withdrawn in the areas with high risks of cancer.

Assessing the human health risks from exposure of inorganic arsenic through oyster (Crassostrea gigas) consumption in Taiwan.

This study estimated the human health risk associated with ingesting inorganic arsenic through consumption of farmed oysters in Taiwan. Two hundred fifty-four samples of oyster (Crassostrea gigas) were collected from four townships in southwest coastal areas, where 90% of Taiwan's oysters are produced. The concentrations of total arsenic and arsenic species including As(V), As(III), monomethylarsonic acid (MMA) and dimethylarsinic acid (DMA) were analyzed. The analytical results reveal that the ratio of mean concentration among the four townships of inorganic As to total concentration of As in oysters is approximately 1.64%. The mean concentrations of As(III) and As(V) in oysters from the four townships range from 0.071 to 0.145 microg/g, and 0.032 to 0.062 microg/g respectively. The estimated target cancer risks (TR), based on a 95% occurrence probability from ingesting inorganic As by consuming oysters at a rate of 18.6-56 g/day, range from 1.26 x 10(-5) to 3.82 x 10(-5). The probabilities of TR fell within the range 10(-6)-10(-4), suggesting that inorganic As uptake from farmed oysters is associated with a potential cancer risk. Moreover, a target hazard quotient (THQ) was used to evaluate the non-carcinogenic risk associated with ingesting inorganic As through oyster consumption at a rate of 18.6-56 g/day. The THQ values based on a 95% probability of exposure range from 0.071 to 0.214. All THQ values are below unity, indicating that farmed oyster consumption contributes only a little to the non-carcinogenic risk. Based on the estimation of the TR model, an ingestion rate of 1.6 g/day is recommended to meet the 95th percentile of carcinogenic risk, 10(-6), for exposure to inorganic As through the consumption of oysters in Taiwan.

Association of the mitochondrial DNA 16189 T to C variant with lacunar cerebral infarction: evidence from a hospital-based case-control study.

A transition of T to C at nucleotide position 16189 in the hypervariable D-loop region of mitochondrial DNA (mtDNA) has attracted research interest for its probable correlation with increasing insulin resistance and development of diabetes mellitus (DM) in adult life. In this article, we present our observations of the positive relationship between this variant and cerebral infarction. Six hundred and one subjects in two groups-one with cerebral infarction (307 cases), the other with no cerebral infarction (294 cases)-were recruited. Their clinical features, fasting blood sugar and insulin levels, and insulin resistance index, were recorded. Patients with cerebral infarction were further categorized into four different subgroups according to the TOAST criteria for stroke classification. The results showed the occurrence of the mtDNA 16189 variant in 34.2% of patients with cerebral infarction and in 26.5% of normal controls. The difference in the occurrence rates between the two groups was statistically significant (P = 0.041). Further studies of the occurrence rate in each stroke subgroup revealed that the variant occurred at the highest frequency in the small vessel subgroup (41.5%). The difference in occurrence rate between this subgroup and the normal controls is highly significant (P = 0.006). These results correlated well with the findings of significantly increased levels of average fasting blood insulin and a higher index of average insulin resistance in the small vessel subgroup of patients harboring this mtDNA variant. Taken together, we suggest that the mtDNA 16189 variant is a predisposing genetic factor for the development of insulin resistance and may be related to various phenotypic expressions in adult life such as development of DM and vascular pathologies involved in stroke and cardiovascular diseases.