Lattice Strain and Composition Effects on the Methanol Oxidation Performance of Platinum-Ruthenium-Nickel Ternary Nanocatalysts.

Ternary Pt-based structures are a positive progress in addressing the disadvantages of monometallic and bimetallic Pt-based alloys for the electrochemical oxidation process of simple alcohols, which is a vital half-reaction in fuel cell technologies. We herein report a facile NaBH4-assisted ethylene glycol reduction process for fabricating a series of nanosized PtRuNi ternary alloys to explore the relationship between physicochemical properties and electrocatalytic behaviors for the acidic methanol oxidation reaction (MOR). Owing to a balance between lattice strain and synergistic effects, the Pt60Ru20Ni20/C electrocatalyst shows the highest MOR efficiency with the mass activity/specific activity of 844.48 mA mgMetal-1/1.93 mA cm-2, being a 1.94 and 2.38 times increase compared to those of the PtRu catalyst, respectively. Also, the Pt60Ru20Ni20/C catalyst possesses superior CO-tolerance and durability in strongly acidic electrolytes. This work suggests that optimizing the surface strain and electronic effects can boost the overall MOR efficiency of multicomponent Pt-based materials, which can help to further develop next-generation catalysts for energy conversion-related technologies.

Porocarcinoma of the Left Foot: A Case Review.

Eccrine porocarcinoma is a rare malignant tumor of the eccrine sweat gland. This malignancy occurs most commonly in the lower extremities. It tends to occur in patients aged 60 to 80 years, affecting men and women equally. We present the case of a 62-year-old man with a lesion on the left foot. The diagnosis of the initial biopsy was squamous cell carcinoma. Six months later, the lesion reoccurred, and a second biopsy confirmed it to be eccrine porocarcinoma.

Charcot neuroarthropathy versus osteomyelitis: a case series.

INTRODUCTION: Patients with diabetes and peripheral neuropathy have a 25% risk of developing a foot ulcer, and these can lead to soft tissue infections that worsen and result in osteomyelitis. While Charcot neuroarthropathy is not as common as osteomyelitis, it is often misdiagnosed as osteomyelitis. CASE REPORTS: Three patients presented with diabetes, neuropathy, and foot ulcers. They underwent prophylactic surgery but later developed swelling at the surgical sites. Radiographs showed fragmentations that caused concern about osteomyelitis. The authors maintained diagnoses of Charcot neuroarthropathy and treated the patients with immobilization and offloading. All patients resolved the fragmentations without antibiotics or surgery. CONCLUSION: While Charcot neuroarthropathy and osteomyelitis have similar signs and symptoms, understanding the similarities and differences between the conditions can aid providers in appropriate wound management.

Integrating Low Pt-Based Ternary NiRuPt Nanoalloy on Hybrid TiO2-Based Oxide-Carbon Composite for Enhanced Ethanol Oxidation.

Ternary NiRuPt nanoscale alloy on hybrid Ti0.9Ir0.1O2-C composite is herein reported to overcome the high cost and tenuous catalytic efficiency of anode catalysts in direct ethanol fuel cells. The small-size NiRuPt alloy is anchored on the Ti0.9Ir0.1O2-C surface via a NaBH4-ethylene glycol-assisted coreduction route. Benefiting from advantages of favorable structure and synergistic effects of compounds, the NiRuPt/Ti0.9Ir0.1O2-C catalyst exhibits high electrocatalytic performance for the ethanol electro-oxidation reaction (EOR) with mass activity of 720.75 mA mgMetal-1 and specific activity of 2.15 mA cm-2, which are 2.25- and 5-fold increases compared to those of the Pt/C (E-TEK) catalyst. The as-synthesized EOR catalyst also shows impressive anti-CO-poisoning ability and great electrocatalytic stability after 5000-cycling ADT. This work can open up an efficient strategy for designing multicomponent catalysts to reduce Pt content and enhance the catalytic performance of electrocatalysts in renewable energy-related technologies.

Mixed-oxide-containing composite-supported MoPt with ultralow Pt content for accelerating hydrogen evolution performance.

The hybridization of MoPt with ultralow Pt content (2.81 wt%) on a rutile Ti0.9Ir0.1O2-C composite (MoPt/Ti0.9Ir0.1O2-C) is fabricated by a self-growth-assisted reduction route, serving as an efficient catalyst for the hydrogen evolution reaction (HER). Due to unique structural features, the MoPt/Ti0.9Ir0.1O2-C catalyst requires an extremely low overpotential of 21.35 mV at 10 mA cm-2 and an impressive HER mass activity of 849.36 mA mgMetal-1 at 300 mV overpotential. In addition, the as-made HER electrocatalyst shows superior catalytic stability and chemical after 10 h of testing.

One-pot production of a sea urchin-like alloy electrocatalyst for the oxygen electro-reduction reaction.

Designing a cost-effective catalyst with high performance towards the oxygen electro-oxidation reaction (ORR) is of great interest for the development of green energy storage and conversion technologies. We report herein a facile self-assembly strategy in a mild reducing environment to realize an urchin-like NiPt bimetallic alloy with the domination of the (111) facets as an efficient ORR electrocatalyst. In the rotating-disk electrode test, the as-obtained NiPt nanourchins (NUCs)/C catalyst demonstrates an increase in both onset potential (0.96 VRHE) and half-wave potential (0.92 VRHE) and a direct four-electron ORR pathway with enhanced reaction kinetics. Additionally, the as-made NiPt NUCs/C electrocatalyst also shows impressive ORR catalytic stability compared to a commercial Pt NPs/C catalyst after an accelerated durability test with 15.29% degradation in mass activity, which is 3.04-times lower than 46.48% of the Pt NPs/C catalyst. The great ORR performance of the as-made catalyst is due to its unique urchin-like morphology with the dominant (111) facets and the synergistic and electronic effects of alloying Ni and Pt. This study not only provides a robust ORR electrocatalyst, but also opens a facile but effective route for fabricating 3D Pt-based binary and ternary alloy catalysts.

Highly Porous Hydroxyapatite/Graphene Oxide/Chitosan Beads as an Efficient Adsorbent for Dyes and Heavy Metal Ions Removal.

Dye and heavy metal contaminants are mainly aquatic pollutants. Although many materials and methods have been developed to remove these pollutants from water, effective and cheap materials and methods are still challenging. In this study, highly porous hydroxyapatite/graphene oxide/chitosan beads (HGC) were prepared by a facile one-step method and investigated as efficient adsorbents. The prepared beads showed a high porosity and low bulk density. SEM images indicated that the hydroxyapatite (HA) nanoparticles and graphene oxide (GO) nanosheets were well dispersed on the CTS matrix. FT-IR spectra confirmed good incorporation of the three components. The adsorption behavior of the obtained beads to methylene blue (MB) and copper ions was investigated, including the effect of the contact time, pH medium, dye/metal ion initial concentration, and recycle ability. The HGC beads showed rapid adsorption, high capacity, and easy separation and reused due to the porous characteristics of GO sheets and HA nanoparticles as well as the rich negative charges of the chitosan (CTS) matrix. The maximum sorption capacities of the HGC beads were 99.00 and 256.41 mg g-1 for MB and copper ions removal, respectively.

Wire-like Pt on mesoporous Ti0.7W0.3O2 Nanomaterial with Compelling Electro-Activity for Effective Alcohol Electro-Oxidation.

Finding out robust active and sustainable catalyst towards alcohol electro-oxidation reaction is major challenges for large-scale commercialization of direct alcohol fuel cells. Herein, a robust Pt nanowires (NWs)/Ti0.7W0.3O2 electrocatalyst, as the coherency of using non-carbon catalyst support and controlling the morphology and structure of the Pt nanocatalyst, was fabricated via an effortless chemical reduction reaction approach at room temperature without using surfactant/stabilizers or template to assemble an anodic electrocatalyst towards methanol electro-oxidation reaction (MOR) and ethanol electro-oxidation reaction (EOR). These observational results demonstrated that the Pt NWs/Ti0.7W0.3O2 electrocatalyst is an intriguing anodic electrocatalyst, which can alter the state-of-the-art Pt NPs/C catalyst. Compared with the conventional Pt NPs/C electrocatalyst, the Pt NWs/Ti0.7W0.3O2 electrocatalyst exhibited the lower onset potential (~0.1 V for MOR and ~0.2 for EOR), higher mass activity (~355.29 mA/mgPt for MOR and ~325.01 mA/mgPt for EOR) and much greater durability. The outperformance of the Pt NWs/Ti0.7W0.3O2 electrocatalyst is ascribable to the merits of the anisotropic one-dimensional Pt nanostructure and the mesoporous Ti0.7W0.3O2 support along with the synergistic effects between the Ti0.7W0.3O2 support and the Pt nanocatalyst. Furthermore, this approach may provide a promising catalytic platform for fuel cell technology and a variety of applications.

High Conductivity and Surface Area of Mesoporous Ti0.7W0.3O2 Materials as Promising Catalyst Support for Pt in Proton-Exchange Membrane Fuel Cells.

In this work, mesoporous Ti0.7W0.3O2 materials with high conductivity and surface area as promising catalyst support for Pt in Proton-Exchange Membrane Fuel Cells (PEMFCs) were synthesized via a single-step solvothermal process at low-temperature without using any surfactants or stabilizers. The characterizations of material are measured via XRD, TEM, SEM-EDS, and BET as well as electronic conductivity measurement. As a result, Ti0.7W0.3O2 formed a homogenous solid solution with mesoporous anatase-TiO2 structure and uniformly spherical nanoparticles morphology of about ~10 nm diameter, together with a high electrical conductivity of 0.022 S/cm compared to that of undoped-TiO2 (1.37×10-7 S/cm), which implied that tungsten (VI) ions was successfully doped into anatase-TiO2 lattices. The N2 adsorption/desorption isotherms indicated that Ti0.7W0.3O2 is being mesoporous structure with high surface area up to ~202 m²/g, which is nearly similar to that of the commercial Vulcan XC72 (~232 m²/g). The Pt nanoparticles was easily anchored onto Ti0.7W0.3O2 surface by the chemical reduction process using NaBH4 as a reducing agent. The spherical Pt nanoparticles of ~9 nm in diameter were deposited uniformly on the mesoporous support. These results suggested that mesoporous Ti0.7W0.3O2 materials synthesized are promising catalyst supports to replace carbon-based supports for Proton-exchange membrane fuel cells.

Meteorological factors associated with hand, foot and mouth disease in a Central Highlands province in Viet Nam: an ecological study.

BACKGROUND: Hand, foot and mouth disease (HFMD) is a public health problem in Viet Nam, and studies have reported seasonal fluctuation in the occurrence of HFMD. This study sought to describe the occurrence of HFMD and its associated meteorological factors in Dak Lak province, Viet Nam. METHODS: Monthly data on HFMD cases were collected from all commune health stations in Dak Lak province from 2012 through 2013. An HFMD case was defined as a brief febrile illness accompanied by a typical skin rash with or without mouth ulcers. Average temperature, maximum temperature, minimum temperature, humidity, rainfall, evaporation, sunshine duration and wind speed were recorded monthly at five local meteorological stations throughout Dak Lak.Data were aggregated at the district level, and the association between these meteorological factors and HFMD cases were examined by Poisson regression. RESULTS: In 2012 through 2013, there were 7128 HFMD patients in Dak Lak. The number of HFMD cases increased during the rainy season. An increased risk of HFMD was associated with higher average temperature (risk ratio and 95% confidence interval: 1.06; 1.03-1.08 per 1 °C increase), higher rainfall (1.19; 1.14-1.24 per 200 mm increase) and longer sunshine duration (1.14; 1.07-1.22 per 60 hours increase). The risk of HFMD was inversely associated with wind speed (0.77; 0.73-0.81 per 1 m/s increase). CONCLUSION: This study suggests that there is a significant association between HFMD occurrence and climate. Temperature, rainfall, wind speed and sunshine duration could be used as meteorological predictors of HFMD occurrence in Viet Nam's Central Highlands region. Intensified surveillance for HFMD during the rainy season is recommended.

One-Step Hydrothermal Synthesis of a New Nanostructure Ti07Ir03O2 for Enhanced Electrical Conductivity: The Effect of pH on the Formation of Nanostructure.

Non-carbon materials are considered as the promising candidates for carbon-based catalyst support to increase the durability of proton exchange membrane fuel cells (PEMFCs). Due to the high stability and good electrical conductivity of TiO2, M-doped TiO2 (M is transition metals: Mo, Ru, V, W) is an emerging candidate for Pt nanoparticles support on the cathode side of PEMFCs. In this research, the synthesis mechanism of Ti0.7Ir0.3O2 nanostructure by the one-step hydrothermal method at low temperature was studied. We found that by only controlling the pH of the precursor solution, Ti0.7Ir0.3O2 can be synthesized with different morphology and phase selection without any formation of mixed oxides. In particular, Ti0.7Ir0.3O2 nanostructure synthesized at pH = 0 exhibited concomitant anatase, brookite, and rutile phases. The spherical particles of diameter 20-40 nm, cubic particles of 30-50 nm in side-length and rod-like particles with 70 nm in length and 20 nm in diameter represented the anatase, brookite, and rutile phases respectively. At a pH value of 1 or 2, the majority of spherical nanoparticles were homogeneous at 15-20 nm in diameter. It was observed that the electronic conductivity of novel Ti0.7Ir0.3O2 nanostructure was significantly higher than that of the undoped TiO2. Thus the promising properties of this new nanostructure open a new path to the much-needed fuel cell applications.

Advanced Ti0.7W0.3O2 Nanoparticles Prepared via Solvothermal Process Using Titanium Tetrachloride and Tungsten Hexachloride as Precursors.

The degradation of Pt-based catalysts is considered as the main barrier to the commercialization of fuel cells. M-doped TiO2 (M is a transition metal) has been investigated to improve the stability of electrocatalysts. Recently, W-doped TiO2 materials have been found as a good catalyst support for the photocatalyst applications but their application in Proton-exchange membrane fuel cell application has rarely been reported. In addition, the agglomeration of nanoparticles, which are synthesized from the organic precursor, has been reported. Here, we report Ti0.7W0.3O2 nanoparticles prepared via a one-step solvothermal method with inorganic precursors without using surfactants or stabilizers for restricting nanoparticle agglomeration. The properties of the material were measured by XRD, TEM, BET, and electronic conductivity. The mean particle size of ∼5 nm, the high specific surface area of 126.471 m2/g and a moderate electronic conductivity of 0.014 S/cm were obtained for the sample prepared at 220 °C for 4 h. It was observed that using inorganic precursors to prevent particle agglomeration is more advantageous compared to organic precursors as mentioned in previous reports.

A randomized clinical trial of a human acellular dermal matrix demonstrated superior healing rates for chronic diabetic foot ulcers over conventional care and an active acellular dermal matrix comparator.

This study compared the efficacy and safety of a human acellular dermal matrix (ADM), D-ADM, with a conventional care arm and an active comparator human ADM arm, GJ-ADM, for the treatment of chronic diabetic foot ulcers. The study design was a prospective, randomized controlled trial that enrolled 168 diabetic foot ulcer subjects in 13 centers across 9 states. Subjects in the ADM arms received one application but could receive one additional application of ADM if deemed necessary. Screen failures and early withdrawals left 53 subjects in the D-ADM arm, 56 in the conventional care arm, and 23 in the GJ-ADM arm (2:2:1 ratio). Subjects were followed through 24 weeks with major endpoints at Weeks 12, 16, and 24. Single application D-ADM subjects showed significantly greater wound closure rates than conventional care at all three endpoints while all applications D-ADM displayed a significantly higher healing rate than conventional care at Week 16 and Week 24. GJ-ADM did not show a significantly greater healing rate over conventional care at any of these time points. A blinded, third party adjudicator analyzed healing at Week 12 and expressed "strong" agreement (κ = 0.837). Closed ulcers in the single application D-ADM arm remained healed at a significantly greater rate than the conventional care arm at 4 weeks posttermination (100% vs. 86.7%; p = 0.0435). There was no significant difference between GJ-ADM and conventional care for healed wounds remaining closed. Single application D-ADM demonstrated significantly greater average percent wound area reduction than conventional care for Weeks 2-24 while single application GJ-ADM showed significantly greater wound area reduction over conventional care for Weeks 4-6, 9, and 11-12. D-ADM demonstrated significantly greater wound healing, larger wound area reduction, and a better capability of keeping healed wounds closed than conventional care in the treatment of chronic DFUs.

Clinical characteristics of hand, foot and mouth disease in Daklak Province, Vietnam and associated factors of severe cases.

The Hand, Foot and Mouth Disease (HFMD) outbreaks occurred throughout Daklak province, Vietnam in 2011. This study reviewed all 744 medical records of HFMD patients admitted to Daklak Hospital in 2011 to describe the clinical characteristics of HFMD patients and determined factors associated with severe illness. Among 744 patients, 63 (8.5%) cases were severe. Most (695, 93.4%) of the cases were 3 years old or younger, and 464 (62.4%) were boys. The number of cases peaked between August and November. Most (726, 97.6%) recovered, 17 severe cases (2.3%) were transferred to higher level hospitals, and one death. Symptoms at admission included fever (93.5% had a fever ≥ 38.5 °C), blisters (99.1%), myoclonus (58.5%), and leukocytosis (> 11,300/mm3: 38.8%). Viral cultures were performed for 61 of 63 severe cases, of which 26.2% were positive for Enteroviruses. Multivariable analysis found that oral ulcers (Odds Ratio (OR) 3.74; 95% Confidence Interval (CI) 2.13-6.58), myoclonus (OR 44.75; 95% CI 6.04-331.66) and high white blood cell count (OR 1.08; 95% CI 1.01-1.16 per 1000/mm3 increase) were significantly associated with severe illness. HFMD mainly occurs in children younger than 3 years old and rainy season. Oral ulcers, myoclonus, and leukocytosis should be closely monitored to promptly detect severe cases of HFMD.

Healing Rates in a Multicenter Assessment of a Sterile, Room Temperature, Acellular Dermal Matrix Versus Conventional Care Wound Management and an Active Comparator in the Treatment of Full-Thickness Diabetic Foot Ulcers.

OBJECTIVE: The purpose of this 16-week, multicenter, randomized, controlled trial was to assess the healed ulcer rate of a human acellular dermal matrix, DermACELL, compared with conventional care and a second acellular dermal matrix, Graftjacket, in the treatment of full-thickness diabetic foot ulcers. METHODS: One hundred sixty-eight patients were randomized into DermACELL, conventional care, and Graftjacket treatment arms in a 2:2:1 ratio. Patients in the acellular dermal matrix groups received either 1 or 2 applications of the graft at the discretion of the investigator. Weekly follow-up visits were conducted until the ulcer healed or the endpoint was reached. RESULTS: At 16 weeks, the DermACELL arm had a significantly higher proportion of completely healed ulcers than the conventional care arm (67.9% vs 48.1%; P = .0385) and a nonsignificantly higher proportion than the Graftjacket arm (67.9% vs 47.8%; P = .1149). The DermACELL arm also exhibited a greater average percent reduction in wound area than the conventional care arm (91.4% vs 80.3%; P = .0791) and the Graftjacket arm (91.4% vs 73.5%; P = .0762). The proportion of severe adverse events and the proportion of overall early withdrawals were similar among the 3 groups based on relative population size (P ≥ .05). CONCLUSIONS: The results presented here indicate that DermACELL is an appropriate clinical option in the treatment of diabetic foot ulcers, with significant increases in healing rates and rate of percentage wound closure as compared with conventional care options.

Epidemiological and clinical characteristics of children who died from hand, foot and mouth disease in Vietnam, 2011.

BACKGROUND: In 2011, a large outbreak of hand, foot and mouth disease (HFMD) in Vietnam resulted in 113,121 children seeking medical attention, of whom170 died. Understanding the epidemiology of fatal HFMD may improve treatment and help targeting prevention activities for vulnerable populations. We describe epidemiological and clinical characteristics of children who died from HFMD in Vietnam in 2011. METHODS: Clinical data were obtained through reviewing medical records of the deaths occurring from January through December 2011 in all hospitals in Vietnam. Hospitals reported any deaths among patients with laboratory-confirmed enterovirus (EV) infection to the Ministry of Health. Data were extracted from the national database. RESULTS: Of the 169 deaths reviewed for whom records were available, 87% were 3-year-old or younger, 69% were male, 18% attended daycare, 89% lived in Southern Vietnam, and 85% of the deaths occurred between May-October 2011. One hundred thirty (77%) cases sought treatment in a hospital within three days of onset of illness. Symptoms at admission included fever (98%), myoclonus (66%), vomiting (53%), oral ulcers (50%) and vesicular erythema (50%). One hundred six (75%) cases had leukocytosis and 91 (54%) had hyperglycemia. One hundred three (61%) tested positive for EV, of which 84 (82%) were positive for EV71. CONCLUSIONS: Deaths associated with HFMD occurred throughout 2011 among males three years or younger who were cared for at home. The HFMD control program should focus on interventions at the household level. Clinicians should be alerted to symptoms suggestive of severe HFMD including fever, myoclonus, vomiting, oral ulcers and vesicles with high white blood cell count especially in young children.

Ecological factors associated with dengue fever in a Central Highlands province, Vietnam.

BACKGROUND: Dengue is a leading cause of severe illness and hospitalization in Vietnam. This study sought to elucidate the linkage between climate factors, mosquito indices and dengue incidence. METHODS: Monthly data on dengue cases and mosquito larval indices were ascertained between 2004 and 2008 in the Dak Lak province (Vietnam). Temperature, sunshine, rainfall and humidity were also recorded as monthly averages. The association between these ecological factors and dengue was assessed by the Poisson regression model with adjustment for seasonality. RESULTS: During the study period, 3,502 cases of dengue fever were reported. Approximately 72% of cases were reported from July to October. After adjusting for seasonality, the incidence of dengue fever was significantly associated with the following factors: higher household index (risk ratio [RR]: 1.66; 95% confidence interval [CI]: 1.62-1.70 per 5% increase), higher container index (RR: 1.78; 95% CI: 1.73-1.83 per 5% increase), and higher Breteau index (RR: 1.57; 95% CI: 1.53-1.60 per 5 unit increase). The risk of dengue was also associated with elevated temperature (RR: 1.39; 95% CI: 1.25-1.55 per 2 °C increase), higher humidity (RR: 1.59; 95% CI: 1.51-1.67 per 5% increase), and higher rainfall (RR: 1.13; 95% CI: 1.21-1.74 per 50 mm increase). The risk of dengue was inversely associated with duration of sunshine, the number of dengue cases being lower as the sunshine increases (RR: 0.76; 95% CI: 0.73-0.79 per 50 hours increase). CONCLUSIONS: These data suggest that indices of mosquito and climate factors are main determinants of dengue fever in Vietnam. This finding suggests that the global climate change will likely increase the burden of dengue fever infection in Vietnam, and that intensified surveillance and control of mosquito during high temperature and rainfall seasons may be an important strategy for containing the burden of dengue fever.

Correlates of environmental factors and human plague: an ecological study in Vietnam.

BACKGROUND: Human plague caused by Yersinia pestis remains a public health threat in endemic countries, because the disease is associated with increased risk of mortality and severe economic and social consequences. During the past 10 years, outbreaks of plague have occasionally occurred in Vietnam's Central Highlands region. The present study sought to describe and analyse the occurrence of plague and its association with ecological factors. METHODS: The study included all 510 communes of the Central Highlands region (with a total population of approximately 4 million) where 95% of incidence of plague cases in Vietnam had been reported from 1997 through 2002. Plague was clinically ascertained by using a standard protocol by WHO. Data on domestic fleas and rodents were obtained by using traps and periodic surveillance in accordance with the WHO guidelines. Temperature, duration of sunshine, rainfall and humidity were recorded as monthly averages by local meteorological stations. The association between these ecological factors and plague was assessed by using the Poisson regression model. RESULTS: From 1997 through 2002, 472 cases of plague were reported, of whom 24 (5.1%) died. The incidence of plague peaked during the dry season, with approximately 63% of cases occurring from February through April. The risk of plague occurrence was associated with an increased monthly flea index (RR and 95% CI: 1.93; 1.61-2.33 for months with the flea index >1) and increased rodent density (RR 1.23; 1.15-1.32 per each 3% increase in density). Moreover, the risk of plague increased during the dry season (RR 2.07; 1.64-2.62), when rainfall fell <10 mm (RR 1.44; 1.17-1.77). CONCLUSIONS: These data suggest that the flea index, rodent density and rainfall could be used as ecological indicators of plague risk in Vietnam. The data also suggest that the occurrence of plague in Vietnam's Central Highlands is likely resulted from multiple causes that remain to be delineated.

A randomized, controlled trial of Promogran (a collagen/oxidized regenerated cellulose dressing) vs standard treatment in the management of diabetic foot ulcers.

HYPOTHESIS: Promogran, a wound dressing consisting of collagen and oxidized regenerated cellulose, is more effective that standard care in treating chronic diabetic plantar ulcers. DESIGN: Randomized, prospective, controlled multicenter trial. SETTING: University teaching hospitals and primary care centers. PATIENTS: A total of 276 patients from 11 centers were enrolled in the study. The mean age of the patients was 58.3 years (range, 23-85 years). All patients had at least 1 diabetic foot ulcer. INTERVENTIONS: Patients were randomized to receive Promogran (n = 138) or moistened gauze (control group; n = 138) and a secondary dressing. Dressings were changed when clinically required. The maximum follow-up for each patient was 12 weeks. MAIN OUTCOME MEASURE: Complete healing of the study ulcer (wound). RESULTS: After 12 weeks of treatment, 51 (37.0%) Promogran-treated patients had complete wound closure compared with 39 (28.3%) control patientss, but this difference was not statistically significant (P =.12). The difference in healing between treatment groups achieved borderline significance in the subgroup of patients with wounds of less than 6 months' duration. In patients with ulcers of less than 6 months' duration, 43 (45%) of 95 Promogran-treated patients healed compared with 29 (33%) of 89 controls (P =.056). In the group with wounds of at least 6 months' duration, similar numbers of patients healed in the control (10/49 [20%]) and the Promogran (8/43 [19%]; P =.83) groups. No differences were seen in the safety measurements between groups. Patients and investigators expressed a strong preference for Promogran compared with moistened gauze. CONCLUSIONS: Promogran was comparable to moistened gauze in promoting wound healing in diabetic foot ulcers. It showed an additional efficacy for ulcers of less than 6 months' duration that was of marginal statistical significance. Furthermore, Promogran had a safety profile that was similar to that of moistened gauze, with greater user satisfaction. Therefore, Promogran may be a useful adjunct in the management of diabetic foot ulceration, especially in ulcers of less than 6 months' duration.

A prospective, randomized, controlled double-blind study of a moisturizer for xerosis of the feet in patients with diabetes.

Xerosis is frequently noted in the feet of people with diabetes. The presence of xerosis increases the risk of complications, including infection and ulceration, making it imperative to counteract its effects. A prospective, randomized, controlled double-blind study was conducted to compare the efficacy of a test moisturizer containing 10% urea and 4% lactic acid versus its emulsion base vehicle in the treatment of xerosis of the feet in patients with diabetes. Forty patients (mean age 62 +/- 11 years) with diabetes and moderate-to-severe xerosis of both feet were enrolled. Xerosis severity was assessed using a nine-point Xerosis Assessment Scale. The tested moisturizer was applied to one foot and the vehicle to the other, twice a day, for 4 weeks. The regression of xerosis also was evaluated 2 weeks following discontinuation of the treatments. Progress was noted weekly with photographs and examination. Feet treated with the vehicle cream (control) had an initial mean xerosis grading of 6.17 (+/- 0.79) and a final xerosis grading of 4.38 (+/- 2.20). In the treatment group, mean xerosis grading diminished from 6.13 (+/- 0.73) to 3.19 (+/- 2.23) after 4 weeks (P < 0.01). The difference between control and treatment remained statistically significant following discontinuation of cream application. In this study, regular use of a moisturizer was found to be beneficial in the treatment of moderate-to-severe xerosis of the feet in patients with diabetes. The cream containing 10% urea and 4% lactic acid provided faster and better improvement with significantly less xerosis regression.