Association of vitamin D status with all-cause mortality and outcomes among Chinese individuals with diabetic foot ulcers.

AIMS/INTRODUCTION: The aim of this study was to examine the correlation between serum vitamin D concentrations and prognosis among Chinese individuals with diabetic foot ulcers (DFUs). MATERIALS AND METHODS: We retrospectively recruited 488 adults with DFUs in West China Hospital from 1 January 2012 to 31 December 2019. After telephone follow up, 275 patients were finally included. We compared serum vitamin D concentrations among DFUs patients with different prognostic status, and examined the association of vitamin D status with prognostic variables by Kaplan-Meier analysis. Cox proportional hazards models were used to estimate hazard ratios and 95% confidence intervals for all-cause mortality. RESULTS: The median concentration of serum vitamin D of patients with DFUs was 37.78 nmol/L (interquartile range 27.91-50.66 nmol/L), with 31.6% having vitamin D deficiency (<30 nmol/L) and 42.2% having insufficient vitamin D (<50 nmol/L). During a median follow-up period of 52 months, 65 patients died, with an all-cause mortality of 23.64%. Vitamin D deficiency was independently linked to increased all-cause mortality after multivariable adjustments (hazard ratio 0.565, 95% confidence interval 0.338-0.946, P = 0.030). There were no significant differences between vitamin D concentrations and other outcomes of DFUs. Patients who suffered amputations had a tendency of lower vitamin D concentrations (34.00 [interquartile range 26.90-41.81] vs 40.21 [interquartile range 29.60-53.96] nmol/L, P = 0.053). CONCLUSIONS: Vitamin D deficiency was significantly associated with increased all-cause mortality in Chinese individuals with DFUs. Vitamin D supplementation might be a potential therapy for DFUs to prevent premature death and improve outcomes.

Adaptation and Validation of the Diabetic Foot Ulcer Scale-Short Form Scale for Chinese Diabetic Foot Ulcers Individuals.

BACKGROUND: The quality of life (QoL) of diabetic foot ulcer patients is worse than that of diabetic patients. The Diabetic Foot Ulcer Scale-Short Form (DFS-SF) is a readily available instrument used to evaluate the quality of life of diabetic foot ulcer individuals. The aim of this study was to translate the DFS-SF into Chinese, followed by an evaluation of its validity and reliability. METHODS: This study was conducted in two phases. In the first phase, we followed the Brislin's Translation and Back-translation model to translate the DFS-SF into Mandarin Chinese. In the second phase, we examined the reliability and validity of the Chinese version of the DFS-SF, where the reliability was assessed in terms of Cronbach's α coefficient, split-half reliability, and test-retest reliability, and validation of the scale was carried out through content validity, structure validity and criterion validity approaches. RESULTS: A total of 208 participants were recruited for our study. The item-level content validity index (I-CVI) of the Chinese version of the Diabetic Foot Ulcer Scale varied from 0.800 to 1.000, the average scale-level content validity index (S-CVI/Ave) was 0.911, and the Cronbach's α coefficient of the scale was 0.952. Confirmatory factor analysis indicated good structural validity of the scale, with a Comparative Fit Index (CFI) = 0.920 and a root mean square error of approximation (RMSEA) of 0.069 (p < 0.001). The criterion-related validity results indicated that the subscales were significantly related to the subscales of the 36-Item Short-Form Health Survey (SF-36), with coefficients ranging from 0.116 to 0.571 (p < 0.05). DISCUSSION: The translation and the examination of the scale rigidly followed the golden standard model, and the reliability observed in our study was similar to that of other studies. Furthermore, the validity assessment indicated that the scale structure was reliable. Therefore, the proposed scales may serve as a reliable instrument for the quality of life evaluation in the diabetic foot ulcers population. CONCLUSION: The adaptation and validation of the Chinese version of the Diabetic Foot Ulcers Scale-Short Form were reliable, and it will be a reliable instrument to evaluate the QoL of Chinese diabetic foot ulcer patients.

Association between vitamin D status and diabetic foot in patients with type 2 diabetes mellitus.

AIMS/INTRODUCTION: To assess the association between vitamin D and diabetic foot (DF) in patients with type 2 diabetes mellitus (T2DM), in order to summarize clinical evidence in the prevention and treatment of DF. MATERIALS AND METHODS: Between January 2012 and December 2019, a total of 1,721 hospitalized patients with type 2 diabetes mellitus were continuously enrolled in West China Hospital, Sichuan University, and divided into DF and non-DF groups according to whether they had DF, and divided into four subgroups according to the admission season. The 25-OH-vitamin D levels were compared between groups and subgroups, and independent risk factors discussed for the occurrence of DF. RESULTS: The vitamin D insufficiency and deficiency rate were higher in the DF group (77.51%) than in the non-DF group (59.2%). The 25-OH-vitamin D levels were lower in the DF group (35.80 nmol/L) than in the non-DF group (45.48 nmol/L) (P < 0.001). Patients with poor glycemic control had lower 25-OH-vitamin D levels (P = 0.01). The levels of 25-OH-vitamin D were lower in winter and spring. In the same season, the levels of 25-OH-vitamin D in patients with DF were still lower (P < 0.001). The 25-OH-vitamin D levels of patients with Wagner grades 0 to 5 showed a downward trend (P = 0.114). The 25-OH-vitamin D level was independently associated with diabetic foot (P < 0.001, OR = 0.986). CONCLUSIONS: The low serum vitamin D level was significantly associated with a higher prevalence of DF among Chinese patients with type 2 diabetes mellitus. Although vitamin D levels vary seasonally, patients with DF were always at higher risk of having vitamin D insufficiency and deficiency.

Tenofovir-induced osteopenia and hyperparathyroidism: A case report and literature review.

Tenofovir disoproxil fumarate is the first-line antiviral therapy for chronic viral hepatitis B, but long-term use is associated with renal failure and hypophosphatemic osteomalacia. Tenofovir disoproxil fumarate-induced osteoporosis and secondary hyperparathyroidism are less commonly reported. Herein, we describe the case of a patient with bone and multijoint pain who was initially misdiagnosed as having normocalcemic primary hyperparathyroidism associated with prolonged exposure to tenofovir disoproxil fumarate. The patient's 24-h urinary calcium and phosphorus excretion levels and serum calcium levels were at the lower end of the normal range. After reviewing these findings, the diagnosis was amended to osteoporosis and secondary hyperparathyroidism caused by tenofovir disoproxil fumarate. In this report, we describe the differences in clinical and laboratory manifestations of hyperparathyroidism induced by tenofovir disoproxil fumarate and normocalcemic primary hyperparathyroidism. We also discuss relevant pathophysiological mechanisms and propose a feasible treatment strategy.

[A Case of Pseudohypoaldosteronism Type â ¡ (PHA2) Caused by a Novel Mutation of KLHL3].

The patient, a 41-year-old woman, was admitted because "it was found out she had elevated serum potassium levels for 18 days". Eighteen days prior to admission at our hospital, the patient was found to have elevated serum potassium during hospitalization at another hospital, where the patient received symptomatic treatment and was discharged after her serum potassium returned to a normal level. However, the patient still had elevated serum potassium repeatedly and was referred to our hospital for further examination. The patient had a history of acute nephritis and gestational hypertension. Six months prior to admission at our hospital, it was found out that the patient had slightly elevated blood pressure, but no intervention was done. The patient's father has a history of hypertension and diabetes. After admission, laboratory results showed that the patient had hyperkalemia, hyperchloremia and metabolic acidosis. The level of plasma renin was obviously below the normal range, but the concentration of plasma aldosterone was within the normal range. A new mutation locus (c.1115delG) in KLHL3 (Kelch like family member 3) gene was revealed by genetic testing, leading to the diagnosis of pseudoaldosteronism type Ⅱ (PHA2). The patient was given regular treatment of oral hydrochlorothiazide hydrochloride at set intervals. Subsequently, her blood electrolyte level, blood pH, BE and BEB have returned to normal levels. The patient was followed up for 12 months and did not feel unwell during the follow-up period.

Oxygen-doped hollow, porous NiCoP nanocages derived from Ni-Co prussian blue analogs for oxygen evolution.

An oxygen-doped, hollow, porous NiCoP nanocage (O-NiCoP Cages) electrocatalyst was synthesized derived from Ni-Co Prussian blue analogs. O-NiCoP Cages exhibited an overpotential of 310 mV at 10 mA cm-2 and a Tafel slope of 84 mV dec-1, significantly higher than that of undoped NiCoP nanocages, and also better than that of RuO2 and several reported phosphide electrocatalysts. This work provides a new strategy for the design of highly efficient oxygen evolution reaction (OER) electrocatalysts based on hollow, nanostructured and heteroatom-doped metal phosphides.

Diagnostic Accuracy of Oxygen Desaturation Index for Sleep-Disordered Breathing in Patients With Diabetes.

Background: Polysomnography (PSG) is the gold standard for diagnosis of sleep-disordered breathing (SDB). But it is impractical to perform PSG in all patients with diabetes. The objective was to develop a clinically easy-to-use prediction model to diagnosis SDB in patients with diabetes. Methods: A total of 440 patients with diabetes were recruited and underwent overnight PSG at West China Hospital. Prediction algorithms were based on oxygen desaturation index (ODI) and other variables, including sex, age, body mass index, Epworth score, mean oxygen saturation, and total sleep time. Two phase approach was employed to derivate and validate the models. Results: ODI was strongly correlated with apnea-hypopnea index (AHI) (rs = 0.941). In the derivation phase, the single cutoff model with ODI was selected, with area under the receiver operating characteristic curve (AUC) of 0.956 (95%CI 0.917-0.994), 0.962 (95%CI 0.943-0.981), and 0.976 (95%CI 0.956-0.996) for predicting AHI ≥5/h, ≥15/h, and ≥30/h, respectively. We identified the cutoff of ODI 5/h, 15/h, and 25/h, as having important predictive value for AHI ≥5/h, ≥15/h, and ≥30/h, respectively. In the validation phase, the AUC of ODI was 0.941 (95%CI 0.904-0.978), 0.969 (95%CI 0.969-0.991), and 0.949 (95%CI 0.915-0.983) for predicting AHI ≥5/h, ≥15/h, and ≥30/h, respectively. The sensitivity of ODI ≥5/h, ≥15/h, and ≥25/h was 92%, 90%, and 93%, respectively, while the specificity was 73%, 89%, and 85%, respectively. Conclusions: ODI is a sensitive and specific tool to predict SDB in patients with diabetes.

Association of sleep-disordered breathing and wound healing in patients with diabetic foot ulcers.

STUDY OBJECTIVES: Sleep-disordered breathing (SDB) is prevalent and associated with an increased risk of morbidity and mortality. However, whether SDB has an adverse impact on wound healing in patients with diabetic foot ulcers (DFUs) is uncertain. The purpose of this study was to investigate the association of SDB with wound healing in patients with DFUs. METHODS: A total of 167 patients with DFUs were enrolled between July 2013 and June 2019 at West China Hospital (Chengdu, China) to assess the association of SDB with wound healing, ulcer recurrence, and all-cause mortality. RESULTS: Whereas there was no significant association between apnea-hypopnea index (AHI) and wound healing, total sleep time (per hour: hazard ratio [HR], 1.15; 95% confidence interval [CI], 1.01-1.30; P = .029), sleep efficiency (per 10%: HR, 1.20; 95% CI, 1.04-1.37; P = .012), and wakefulness after sleep onset (per 30 minutes: HR, 0.89; 95% CI, 0.82-0.97; P = .008) were associated with wound healing. Total sleep time (per hour: odds ratio, 0.71; 95% CI, 0.51-0.97; P = .035) and sleep efficiency (per 10%: odds ratio, 0.68; 95% CI, 0.47-0.97; P = .033) were also associated with ulcer recurrence. Mean oxygen saturation (per 3%: HR, 0.68; 95% CI, 0.49-0.94; P = .021) and percentage of sleep time with oxygen saturation < 90% (per 10%: HR, 1.25; 95% CI, 1.03-1.53; P = .026) were significantly associated with mortality. CONCLUSIONS: SDB is highly prevalent in patients with DFUs but its severity, as conventionally measured by AHI, is not associated with wound healing. Sleep fragmentation and hypoxemia are stronger predictors of poor wound healing, high ulcer recurrence, and increased risk of death in patients with DFUs.

Prevalence of Obstructive Sleep Apnea in Patients With Diabetic Foot Ulcers.

Objectives: Diabetic foot ulcers (DFUs) are a considerable burden on patients and the healthcare service system. Patients with DFUs have many risk factors that might contribute to obstructive sleep apnea (OSA). The purposes of this study were to assess the prevalence of OSA and associated features in patients with DFUs. Methods: Between July 2017 and June 2019, we recruited 245 consecutive patients who sought for treatment at West China Hospital because of DFUs. Polysomnography data from 127 Patients were included in the final analysis. Results: Of the 127 patients, with a median age of 64 years (interquartile range, 55-73 years; range, 36-86 years) and a mean body mass index (BMI) 24.09 ± 0.37 kg/m2, 91 (72%) were men. The prevalence of OSA [apnea-hypopnea index (AHI) ≧5/h] was 92% in men and 97% in women (P = 0.304). Moderate to severe OSA (AHI ≧15/h) was noted in 44 men (48%) and 26 women (72%) (P = 0.015). The risk factors associated with the severity of OSA were sex, age, smoking, alcohol use, and duration of diabetes. After multivariable adjustment, duration of diabetes and age were independent predictive factors of the severity of OSA. No significant association was observed between BMI, waist circumference, Epworth score, and the severity of OSA. There were no significant associations between OSA and ischemic heart disease, cerebral infarction, hypertension, diabetic retinopathy, diabetic kidney disease, and peripheral artery disease. Conclusions: The prevalence of OSA was high in patients with DFUs, with moderate to severe OSA accounting for more than half of the patients. Age and duration of diabetes were independent predictive factors of the severity of OSA.

[The Management of Blood Glucose Should be Emphasized in the Treatment of COVID-19].

Based on the higher mortality and the higher proportion of critically ill adults in coronavirus disease 2019 (COVID-19) patients with diabetes, good inpatient glycemic control is particularly important in the comprehensive treatment of COVID-19. Individualized blood glucose target goals and treatment strategies should be made according to specific circumstances of COVID-19 inpatients with diabetes. For mild patients, a strict glycemic control target (fasting plasma glucose (FPG) 4.4-6.1 mmol/L, 2-hour postprandial plasma glucose (2 h PG) 6.1-7.8 mmol/L) are recommended; a target for the glycemic control of common type patients (FPG 6.1-7.8 mmol/L, 2 h PG 7.8-10.0 mmol/L) and subcutaneous insulin deliver therapy are recommended; a target nonfasting blood glucose range of 10.0 mmol or less per liter for severe-type COVID-19 patients, a relatively Less stringent blood glucose control target (FPG 7.8-10.0 mmol/L, 2 h PG 7.8-13.9 mmol/L) for critically ill patients and intravenous insulin infusion therapy are recommended. Due to the rapid changes in the condition of some patients, the risk of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar status (HHS) maybe occur during the treatment. Blood glucose monitoring, dynamic evaluation and timely adjustment of strategies should be strengthened to ensure patient safety and promote early recovery of patients.

Coupling Co2P and CoP nanoparticles with copper ions incorporated Co9S8 nanowire arrays for synergistically boosting hydrogen evolution reaction electrocatalysis.

Rational design of high-performance and low-cost electrocatalyst for the hydrogen evolution reaction (HER) is highly desirable but remains a long-standing challenge. Herein, an integration of interfacial engineering and ions incorporation was achieved to develop high-performance hybrid electrocatalyst through a facile phosphidation treatment of Cu2+-doped Co9S8 nanowires arrays (Co9S8-Cu NAs) growth on nickel foam. Through this treatment, cobalt phosphide (CoxP, i.e., Co2P and CoP) nanoparticles are decorated on the surface of Co9S8-Cu NAs, forming a novel ternary CoxP/Co9S8-Cu NAs electrocatalyst. The incorporation of Cu2+ enables the modulation of electronic structures of Co9S8 and contributes to the optimization of reaction immediate energetics. The formed abundant interfaces between CoxP and Co9S8-Cu facilitate the charge transfer and create more exposed active sites, further boosting the HER performance. As a result, the CoPx/Co9S8-Cu NAs exhibited high HER activity and stability with a low overpotential of 118 mV to reach a current density of 10 mA cm-2 in alkaline solution, which can surpass many previously reported Co-based HER catalysts. This work highlights the synergy of the interfacial engineering and ions incorporation in the construction of high-performance and stable electrocatalysts for the water splitting application.

Construction of novel Sr0.4H1.2Nb2O6·H2O/g-C3N4 heterojunction with enhanced visible light photocatalytic activity for hydrogen evolution.

Construction of heterojunction is an effective strategy to conquer the severe charge carrier recombination limitation of single component g-C3N4 photocatalyst. In the present work, novel heterojunctions composed of g-C3N4 nanosheets and Sr0.4H1.2Nb2O6·H2O nanooctahedrons were constructed via a simple hydrothermal method. The as-prepared Sr0.4H1.2Nb2O6·H2O/g-C3N4 (HSN/CN) heterojunction showed high photocatalytic activity in the water splitting reactions. Specially, it is found that the developed 20 wt%-HSN/CN heterojunction shows high water splitting activity with H2 evolution rate up to 469.4 µmol g-1, which was much higher than that of bare CN. This enhanced photocatalytic activity for H2 evolution can be mainly attributed to the matched energy level and heterojunction structure which could improve the photo-generated charge carriers separation and transfer. This work implies that construction of heterojunctions with a wide band gap semiconductor is a feasible strategy for enhancement of photocatalytic activity of CN materials.

Enhanced photocatalytic activity of graphitic carbon nitride/carbon nanotube/Bi2WO6 ternary Z-scheme heterojunction with carbon nanotube as efficient electron mediator.

All-solid-state Z-scheme heterojunction has attracted much attention in photocatalytic field because of its strong ability in charge separation and transfer. In the present study, all-solid-state ternary Z-scheme heterojunction constructed by graphitic carbon nitride (CN) nanosheet, carbon nanotube (CNT), and Bi2WO6 (BWO) nanosheet, in which CNT was employed as the electron mediator. The CN/CNT/BWO ternary Z-scheme heterojunction shows the enhanced photocatalytic activity towards the degradation of tetracycline hydrochloride (TC) as compared to the pristine g-C3N4, Bi2WO6, CNT/BWO, CNT/CN, and CN/BWO. The significantly improved photocatalytic activity can be mainly ascribed to the formed CNT-mediated Z-scheme heterojunction, which facilitates the separation and transfer of photogenerated electron-hole pairs. Our work provides a rational design of all-solid-state Z-scheme heterojunction with CNT as the electron mediator for highly efficient photocatalysis.

Construction of novel WO3/SnNb2O6 hybrid nanosheet heterojunctions as efficient Z-scheme photocatalysts for pollutant degradation.

The artificially Z-scheme heterojunctions between WO3 nanosheet and SnNb2O6 nanosheet with strongly coupled heterointerfaces were successfully constructed via a simple hydrothermal coassembly method. Transmission electron microscopy (TEM) and high-resolution TEM proved that an intimate contact interface was formed. The synthesized heterojunctions exhibites enhanced photodegradation efficiency for Rhodamine B under irradiation of visible light, and the highest reaction rate over 30%-WO3/SnNb2O6 nanosheet heterojunctions is about 4.7-fold and 2-fold higher than that of pristine WO3 and SnNb2O6, respectively. Such a considerable improvement could be mainly attributed to the rapid migration of the photo-induced e-/h+ pairs through the nanosheets-coupled heterojunction interfaces. A possible directly Z-scheme charge transfer mechanism was proposed for the elimination of organic contaminants under irradiation of visible light. This work may furnish new insights into development of novel 2D/2D nanosheet heterojunctions with the enhanced photocatalytic activity.