Total contact casts versus removable offloading interventions for the treatment of diabetic foot ulcers: a systematic review and meta-analysis.

Objective: This study aimed to evaluate the effectiveness of total contact casts (TCCs) versus removable offloading interventions among patients with diabetic foot ulcers (DFUs). Methods: A comprehensive search was done in databases Embase, Cochrane Library, and, PubMed. The references of retrieved articles were reviewed, up until February 2023. Controlled trials comparing the effects of TCCs with removable offloading interventions (removable walking casts and footwear) in patients with DFUs were eligible for review. Results: Twelve studies were included in the meta-analysis, involving 591 patients with DFUs. Among them, 269 patients were in the intervention group (TCC), and 322 in the control group (removable walking casts/footwear). The analysis revealed that the TCC group had higher healing rates (Risk Ratio(RR)=1.22; 95% confidence interval(CI):1.11 to 1.34, p<0.001), shorter healing time (Standard Mean Difference(SMD)=-0.57; 95%CI: -1.01 to -0.13, P=0.010), and elevated occurrence of device-related complications (RR=1.70; 95%CI:1.01 to 2.88, P=0.047), compared with the control group. Subgroup analysis illustrated patients using TCCs had higher healing rates than those using removable walking casts (RR=1.20; 95%CI:1.08 to 1.34, p=0.001) and footwear (RR=1.25; 95%CI:1.04 to 1.51, p=0.019), but they required comparable time for ulcer healing compared with those using removable walking casts (SMD=-0.60; 95%CI: -1.22 to 0.02, P=0.058) or footwear group (SMD=-0.52; 95%CI: -1.17 to 0.12, P=0.110). Although patients using TCCs had significantly higher incidence of device-related complications than those using footwear (RR=4.81; 95%CI:1.30 to 17.74, p=0.018), they had similar one compared with those using the removable walking casts (RR=1.27; 95%CI:0.70 to 2.29, p=0.438). Conclusion: The use of TCCs in patients with DFUs resulted in improved rates of ulcer healing and shorter healing time compared to removable walking casts and footwear. However, it is important to note that TCCs were found to be associated with increased prevalence of complications.

Decreased soil multifunctionality is associated with altered microbial network properties under precipitation reduction in a semiarid grassland.

Our results reveal different responses of soil multifunctionality to increased and decreased precipitation. By linking microbial network properties to soil functions, we also show that network complexity and potentially competitive interactions are key drivers of soil multifunctionality.

Braces versus casts for post-operational immobilization of ankle fractures: A meta-analysis.

Background and aims: Both casts and braces can be used for post-operational immobilization of ankle fractures. This meta-analysis aimed to assess the complications and functional effects of the two types of immobilization. Material and methods: PubMed, Embase, Cochrane, and CNKI was searched for randomized controlled trials (published between Jan 1, 1950, and March 2022). Relative risk (RR) or standard mean difference (SMD) with a 95% confidence interval (CI) was used to present the outcomes. The pooled data were assessed by using the fixed-effects model or random-effects model. Results: A total of 5 randomized controlled studies involving 930 subjects were included according to our inclusion criteria. On the ankle score at 6w,12w and 52w, there was no statistically significant difference between the two groups. In terms of 6w, the brace group showed better ankle dorsiflexion (MD = 6.78, 95% CI 0.56-13.00, p = 0.03) and plantar flexion (MD = 6.58, 95% CI 1.60-11.55, p = 0.01) than the cast group. The wound complications (RR = 3.49, 95% CI 1.32 to 9.24, p = 0.01) and total complications (RR = 3.54, 95% CI 1.92 to 6.50, p < 0.0001) in the brace group were three times more than that in the cast group. There was no statistically significant difference between the two groups in the non-wound complications. There was no statistically significant difference between the two groups in the time of going back to work, swelling of the ankle, and atrophy of the calf muscle. Conclusion: The short-term and long-term functional outcomes after postoperative treatment of adult ankle fractures with braces are similar to those with casts. The usage of braces may cause three times more wound complications than that of casts.

Preparation and properties of a novel biodegradable polyester elastomer with functional groups.

A novel biodegradable poly(sebacate-glycerol-citrate) (PGSC) elastomer with functional groups was prepared in this study. First, moldable mixtures were obtained by mixing citric acid with the poly(glycerol-sebacate) (PGS) pre-polymers synthesized in our lab. The PGSC elastomers were obtained from moldable mixtures that were thermally cured in the moulds. Then, the structures, compositions and properties of the elastomers were studied by Fourier transformation infrared spectroscopy (FT-IR), swelling test, differential scanning calorimeter (DSC), tensile test, water contact angle measurement, water absorption experiments and a in vitro degradation test. It showed that the hydroxyl groups remained in the elastomers which would endow the polymer chains with functionality such as good surface modification. By controlling the thermal curing time, the compositions of the PGSC elastomers were adjusted for different mechanical and biodegradable properties. Therefore, PGSC elastomers might be used as anti-conglutination films in surgery, guided tissue regeneration membranes and drug-delivery matrices.

Study on the control of the compositions and properties of a biodegradable polyester elastomer.

Biodegradable polyester elastomers are widely reported to be applied in varied biomedical fields. In this paper, we attempt to investigate how both the thermal-curing time and molar ratio of the monomers affect the final compositions and properties of the novel poly(glycerol-sebacate-citrate) (PGSC) elastomers. First, PGSC elastomers are obtained after the thermal curing of the moldable mixtures consisting of citric acid and poly(glycerol-sebacate) (PGS) prepolymers synthesized in the lab. Then further studies show that, on the one hand, the control of longer thermal-curing time results in elastomers with less sol, lower swelling degree, slower degradation, greater mechanical strength and higher glass transition temperature and, on the other hand, the crosslink with more citric acid is advantageous to greatly improving their mechanical strength and glass transition temperatures, simultaneously decreasing their sol contents, swelling degrees and degradation rates. The PGSC elastomers show thermosetting properties, certain strength, mass losses lower than 20% after 4-week degradation and durative water absorption during degradation. Thus they might be potentially used as degradable bio-coatings, varied soft biomedical membranes and drug delivery matrices.

Recent advances in synthetic bioelastomers.

This article reviews the degradability of chemically synthesized bioelastomers, mainly designed for soft tissue repair. These bioelastomers involve biodegradable polyurethanes, polyphosphazenes, linear and crosslinked poly(ether/ester)s, poly(epsilon-caprolactone) copolymers, poly(1,3-trimethylene carbonate) and their copolymers, poly(polyol sebacate)s, poly(diol-citrates) and poly(ester amide)s. The in vitro and in vivo degradation mechanisms and impact factors influencing degradation behaviors are discussed. In addition, the molecular designs, synthesis methods, structure properties, mechanical properties, biocompatibility and potential applications of these bioelastomers were also presented.

[Bio-active substances derived from marine microorganisms].

Marine microorganisms, which are taxonomically diverse and genetically special, have powerful potential in producing novel bio-active substances. This article summarized research progress in this respect. The results showed that marine bacteria which are main marine microorganism flora can produce rich kinds of bio-active substances and that even though marine actinomycetes and marine fungi are not as many as marine bacteria in species and quantity, they should be paid no less attention about their bio-active substances. Besides, present research are limited to those marine microorganisms which are easily cultured. One of the future research trends will be focused on bio-active substances derived from non-culturable marine microorganisms.