Graded Mxene-Doped Liquid Metal as Adhesion Interface Aiming for Conductivity Enhancement of Hybrid Rigid-Soft Interconnection.

Hybrid rigid-soft electronic system combines the biocompatibility of stretchable electronics and the computing capacity of silicon-based chips, which has a chance to realize a comprehensive stretchable electronic system with perception, control, and algorithm in near future. However, a reliable rigid-soft interconnection interface is urgently required to ensure both the conductivity and stretchability under a large strain. To settle this demand, this paper proposes a graded Mxene-doped liquid metal (LM) method to achieve a stable solid-liquid composite interconnect (SLCI) between the rigid chip and stretchable interconnect lines. To overcome the surface tension of LM, a high-conductive Mxene is doped for the balance between adhesion and liquidity of LM. And the high-concentration doping could prevent the contact failure with chip pins, while the low-concentration doping tends to maintain the stretchability. Based on this dosage-graded interface structure, the solid light-emitting diode (LED) and other devices integrated into the stretchable hybrid electronic system could achieve an excellent conductivity insensitive to the exerted tensile strain. In addition, the hybrid electronic system is demonstrated for skin-mounted and tire-mounted temperature-test applications under the tensile strain up to 100%. This Mxene-doped LM method aims to obtain a robust interface between rigid components and flexible interconnects by attenuating the inherent Young's modulus mismatch between rigid and flexible systems and makes it a promising candidate for effective interconnection between solid electronics and soft electronics.

Computational Design and Theoretical Properties of WC3N6, an H-Free Melaminate and Potential Multifunctional Material.

By means of first-principles theory, existence, synthetic conditions, and structural as well as physicochemical properties have been predicted for the first hydrogen-free melaminate salt of the composition WC3N6. We find at least two energetically favorable polymorphs adopting space groups P1 and P3, both of which are layer-like porous materials. In addition to sizable Madelung fields stabilizing saltlike WC3N6, the complex C3N66- anions are connected via perfectly optimized W-N bonds, forming WN5 in the P1 and WN6 coordination polyhedra in the P3 polymorphs. The band gaps of the P1 and P3 phases are HSE-predicted as 2.25 and 1.21 eV, respectively, significantly smaller than those of g-C3N4 and WO3. Moreover, both phases have suitable band-edge potentials that may provide sufficient driving force for photocatalytic water splitting; at least for the P1 phase, there is also a reasonable chance for reduced electron-hole recombination. In addition, the polymorphs's large optical absorption coefficients should greatly enhance the photocatalytic performance. WC3N6 defines a new class of compounds and has unique structural characteristics, mirrored from its electrical and optical properties, and it should provide another chemical path for preparing efficient photocatalysts and optoelectronic devices.

A systematic analysis of the global and regional burden of colon and rectum cancer and the difference between early- and late-onset CRC from 1990 to 2019.

The burden of colorectal cancer (CRC) varies substantially across different geographical locations. However, there was no further quantitative analysis of regional social development and the disease burden of CRC. In addition, the incidence of early- and late-onset CRC has increased rapidly in developed and developing regions. The main purpose of this study was to investigate the trends in CRC burden across different regions, in addition to the epidemiological differences between early and late-onset CRC and their risk factors. In this study, estimated annual percentage change (EAPC) was employed to quantify trends in age-standardized incidence rate (ASIR), mortality rate, and disability-adjusted life-years. Restricted cubic spline models were fitted to quantitatively analyze the relationship between trends in ASIR and Human Development Index (HDI). In addition, the epidemiological characteristics of early- and late-onset CRC were investigated using analyses stratified by age groups and regions. Specifically, meat consumption and antibiotic use were included to explore the differences in the risk factors for early- and late-onset CRC. The quantitative analysis showed that the ASIR of CRC was exponentially and positively correlated with the 2019 HDI in different regions. In addition, the growing trend of ASIR in recent years varied substantially across HDI regions. Specifically, the ASIR of CRC showed a significant increase in developing countries, while it remained stable or decreased in developed countries. Moreover, a linear correlation was found between the ASIR of CRC and meat consumption in different regions, especially in developing countries. Furthermore, a similar correlation was found between the ASIR and antibiotic use in all age groups, with different correlation coefficients for early-onset and late-onset CRC. It is worth mentioning that the early onset of CRC could be attributable to the unrestrained use of antibiotics among young people in developed countries. In summary, for better prevention and control of CRC, governments should pay attention to advocate self-testing and hospital visits among all age groups, especially among young people at high risk of CRC, and strictly control meat consumption and the usage of antibiotics.

Protein-Based Fat Replacers: A Focus on Fabrication Methods and Fat-Mimic Mechanisms.

The increasing occurrence of obesity and other non-communicable diseases has shifted the human diet towards reduced calorie intake. This drives the market to develop low-fat/non-fat food products with limited deterioration of textural properties. Thus, developing high-quality fat replacers which can replicate the role of fat in the food matrix is essential. Among all the established types of fat replacers, protein-based ones have shown a higher compatibility with a wide range of foods with limited contribution to the total calories, including protein isolate/concentrate, microparticles, and microgels. The approach to fabricating fat replacers varies with their types, such as thermal-mechanical treatment, anti-solvent precipitation, enzymatic hydrolysis, complexation, and emulsification. Their detailed process is summarized in the present review with a focus on the latest findings. The fat-mimic mechanisms of fat replacers have received little attention compared to the fabricating methods; attempts are also made to explain the underlying principles of fat replacers from the physicochemical prospect. Finally, a future direction on the development of desirable fat replacers in a more sustainable way was also pointed out.

Exposure to legacy and alternative flame retardants in two harbor seal populations and the association with blubber fatty acid profiles.

Flame retardants (FRs) are ubiquitously present in various environmental compartments due to widespread application. However, there have been few reports on the alternative FRs in harbor seals, and their relationship with fatty acid (FA) profiles have largely been overlooked. Here, we investigated the levels of legacy and alternative FRs and FA profiles in the blubber of harbor seals from the coasts of South Sweden (2009-2016) and Northeastern US (NE US) (1999-2010). We observed different proportions of mono- and poly-unsaturated FAs (MUFAs and PUFAs) between the two populations, which may reflect variations in the diet. Significantly higher concentrations of ΣPBDE were also observed in harbor seals from US compared to those from Sweden, both dominated by BDE 47. By comparison, the levels of alternative FRs, noticeably HBBZ and PBEB were much lower compared to those of PBDEs. Moreover, we found a positive correlation between BDE 99 and Σn-6/Σn-3 PUFA in harbor seals from Sweden. In addition, BDE 153 and BDE 154 were positively correlated with ΣUFA/ΣSFA in seals from Sweden and US, respectively. Our results imply the influence of diet in FA profiles and FR concentrations in top predators, as well as the importance of blubber FA characteristics in indicating FR exposure. Further investigations are required to assess the risk of exposure in these harbor seals, as well as to elucidate the underlying mechanisms associating FA profiles with FR exposure.

Synthesis, crystal structures and semiconducting properties of new hexacyanidometallates.

We describe the synthesis, crystal structure and semiconducting properties of a number of hexacyanidometallates with the formula A2[MFe(CN)6]·xH2O (A = Na, K; M = Mg, Ca, Sr and Ba). All crystal structures were studied via single-crystal or powder X-ray diffraction. The unexpectedly low-symmetric structures in these ferrocyanides are described and contrasted with analogous transition-metal compounds which have been reported to be strictly or nearly cubic. The amount of crystal water in the structure for powder samples was determined by the thermogravimetric analysis (TGA), supported by IR and Raman spectroscopy. Electronic-structure calculations of K2[MgFe(CN)6] and K2[CaFe(CN)6] are compared with experimental UV-Vis measurements. The large band gaps by advanced theory indicate that the smaller experimental band gaps are due to surface effects of impurity states. Mott-Schottky curves of K2[MgFe(CN)6], K2[CaFe(CN)6] and K2[BaFe(CN)6]·3H2O exhibit positive slopes, which characterizes these compounds as n-type semiconductors.

Activated cascade effect for dual-mode ratiometric and smartphone-assisted visual detection of curcumin and F- based on nitrogen-doped carbon dots.

The growing persistence of harmful ion or drug molecular residues has always been considered as a matter of concern due to its importance in biological and environmental processes, which requires taking measures to maintain environmental health sustainably and effectively. Inspired by the multi-system and visual quantitative detection of nitrogen-doped carbon dots (N-CDs), we develop a novel cascade nano-system based on dual emission carbon dots for on-site visual quantitative detection of curcumin and fluoride ion (F-). Herein, tris (hydroxymethyl) aminomethane (Tris) and m-dihydroxybenzene (m-DHB) are elected as reaction precursors to synthesize dual-emission N-CDs by a one-step hydrothermal method. The obtained N-CDs exhibit dual emission peaks at 426 nm (blue) and 528 nm (green) with quantum yields of 53 % and 71 %, respectively. Then, trace curcumin and F- intelligent off-on-off sensing probe is formed by taking advantage of the activated cascade effect. As for the occurrence of inner filter effect (IFE) and fluorescence resonance energy transfer (FRET), the green fluorescence of N-CDs quenches remarkably, called as OFF initial state. Then the curcumin-F- complex leads to the hypochromatic shift of the absorption band from 532 to 430 nm, which activates the green fluorescence of N-CDs, named as ON state. Meanwhile, the blue fluorescence of N-CDs is quenched due to the FRET, called as OFF terminal state. This system shows good linear relationships from 0 to 35 µM and 0 to 40 µM with low detection limits of 29 nM and 42 nM for curcumin and F- ratiometric detection, respectively. Moreover, a smartphone-assisted analyzer is developed for on-site quantitative detection. Furthermore, we design a logic gate for logistics information storage, which proves the possibility of a logic gate based on N-CDs in practical application. Thus, our work will provide an effective strategy for environmental quantitative monitoring and information storage encryption.

Mechanism and intervention of murine transfusion-related acute lung injury caused by anti-CD36 antibodies.

Anti-CD36 antibodies have been suggested to induce transfusion-related acute lung injury (TRALI) upon blood transfusion, particularly in Asian populations. However, little is known about the pathological mechanism of anti-CD36-mediated TRALI, and potential therapies haven't yet been identified. Here, we developed a murine model of anti-CD36-mediated TRALI to address these questions. We found that administration of mouse monoclonal antibody against CD36 (mAb GZ1) or human anti-CD36 IgG, but not GZ1 F(ab')2 fragments, induced severe TRALI in Cd36+/+ male mice. Pre-depletion of recipient monocytes or complement, but not neutrophils or platelets, prevented the development of murine TRALI. Moreover, plasma C5a levels after TRALI induction by anti-CD36 were increased more than 3-fold, implying a critical role of complement C5 activation in the mechanism of Fc-dependent anti-CD36-mediated TRALI. Administration of GZ1 F(ab')2, antioxidant (NAC) or C5-blocker (mAb BB5.1) before TRALI induction completely protected mice from anti-CD36-mediated TRALI. Although no significant amelioration in TRALI was observed when mice were injected with GZ1 F(ab')2 after TRALI induction, significant improvement was achieved when mice were treated post-induction with NAC or anti-C5. Importantly, anti-C5 treatment completely rescued mice from TRALI, suggesting the potential role of existing anti-C5 drugs in the treatment of patients with TRALI caused by anti-CD36.

Clinical profiles differ in IgG4-related disease with and without allergy: a large case-control study in China.

OBJECTIVES: This study aimed to elucidate different clinical profiles in IgG4-related disease (IgG4-RD) with and without allergy. METHODS: Four hundred and thirty-four patients diagnosed with IgG4-RD at Peking University People's Hospital were included. Clinical and treatment options-based relapse data were collected and compared between IgG4-RD patients with and without allergy. RESULTS: Among these patients, 214 (49.3%) had allergic diseases. Most of the IgG4-RD patients with allergy had initial involved organs directly exposed to ambient air and their allergic symptoms occurred mostly before or at IgG4-RD disease onset. Compared with IgG4-RD patients without allergy, allergic patients had almost equal sex ratio, more organ involvement, earlier ages of disease onset and diagnosis, longer disease duration, higher incidence of dacryoadenitis, sialadenitis, lymphadenopathy, paranasal sinus and lung lesions. Higher serum IgG4, IgE and IgG4/IgG ratio, lower serum C3 complement 3 (C3) and C4, and higher incidence of eosinophilia were also found in IgG4-RD patients with allergy. Furthermore, allergy may increase relapse rate and shorten relapse-free survival time in IgG4-RD patients treated with glucocorticoids only, whereas combination therapy of glucocorticoids and immunosuppressants could improve treatment outcome. CONCLUSIONS: Allergy leads to disparities in clinical profiles in IgG4-RD patients. Allergy could result in higher relapse rate and shorten relapse-free survival time in patients receiving glucocorticoids only.

Reduction of Reactive Oxygen Species Accumulation Using Gadolinium-Doped Ceria for the Alleviation of Atherosclerosis.

Atherosclerosis is a common cardiovascular disease with increasing morbidity and mortality. The pathogenesis of atherosclerosis is strongly related to endothelial dysfunction, which is induced by severe oxidative stress damage derived from reactive oxygen species (ROS). Thus, ROS plays a critical role in the pathogenesis and progression of atherosclerosis. In this work, we demonstrated that the gadolinium doping of CeO2 (Gd/CeO2) nanozymes as effective ROS scavengers delivered high performance for antiatherosclerosis. It was found that the chemical doping of Gd promoted the surface proportion of Ce3+ in the nanozymes and thereby enhanced the overall ROS scavenging ability. In vitro and in vivo experiments unambiguously showed that the Gd/CeO2 nanozymes efficiently scavenged harmful ROS at the cellular and histological levels. Further, Gd/CeO2 nanozymes were demonstrated to significantly reduce vascular lesions by reducing lipid accumulation in macrophage and decreasing inflammatory factor levels, thereby inhibiting the exacerbation of atherosclerosis. Moreover, Gd/CeO2 can serve as T1-weighted magnetic resonance imaging contrast agents, which can generate sufficient contrast to distinguish the location of plaque during living imaging. Through those efforts, Gd/CeO2 may serve as a potential diagnostic and treatment nanomedicine for the ROS-induced atherosclerosis.

Nonphthalate Plasticizers in House Dust from Multiple Countries: An Increasing Threat to Humans.

Along with the restrictions of phthalate esters (PAEs), a variety of nonphthalate plasticizers (NPPs) have been increasingly used for industrial needs. Knowledge remains limited on the environmental occurrences, fate, and human exposure risks of many emerging NPPs. In this study, we investigated a suite of 45 NPPs along with the major PAEs in house dust from five regions in the Asia-Pacific region and the United States. The findings clearly demonstrated ubiquitous occurrences of many NPPs in the home environment, particularly acetyl tributyl citrate (ATBC), tricapryl trimellitate (TCTM), trioctyl trimellitate (TOTM), glycerol monooleate (GMO), methyl oleate (MO), and diisobutyl adipate (DiBA). The median total concentrations of NPPs ranged from 17.8 to 252 µg/g in the study regions, while the mean ratios of ΣNPPs to ΣPAEs ranged from 0.19 (Hanoi) to 0.72 (Adelaide). Spatial differences were observed not only for the chemical abundances but also for the composition profiles and the hazard quotient (HQ) prioritization of individual chemicals. Although the current exposure may unlikely cause significant health risks according to the HQ estimation, potential exposure risks cannot be overlooked, due to the lack of appropriate toxic threshold data, the existence of additional exposure pathways, and possible cocktail effects from coexisting NPPs and PAEs.

Construction of graphene quantum dots ratiometric fluorescent probe by intermolecular electron transfer effect for intelligent and real-time visual detection of ofloxacin and its L-isomer in daily drink.

The design of intelligent and real-time sensing devices is significant in the medical drug monitoring field, but it is still highly challenging. Here, ratiometric fluorescent detections of ofloxacin (OFL) and its L-isomer levofloxacin (LEV) constructed from tri-doped graphene quantum dots (T-GQDs) are reported, and the detection limits reach as low as 46/67 nM toward OFL/LEV due to the intermolecular electron transfer (intermolecular ET) effect. After adding OFL/LEV, the generation of electrostatic bond provides a channel for the intermolecular ET from the edge of T-GQDs to OFL/LEV, resulting in the fluorescence quenching at 414 nm and the fluorescence promoting at 498 nm. Furthermore, a smartphone can be used for the visual and quantitative detection of OFL and LEV by identifying the RGB values of test paper and drink samples. This work not only reveals the physics mechanism of ratiometric detection, but also develops a convenient smartphone diagnostic for OFL and LEV.

Lightning-Rod Effect on Nanowire Tips Reinforces Electroporation and Electrochemical Oxidation: An Efficient Strategy for Eliminating Intracellular Antibiotic Resistance Genes.

Conventional oxidative disinfection methods are usually inefficient to eliminate intracellular antibiotic resistance genes (i-ARGs) due to competitive oxidation of cellular components of antibiotic-resistant bacteria (ARB), resulting in the ubiquitous occurrence of ARGs in drinking water systems. Herein, we developed the strategy of coupling electroporation and electrochemical oxidation on a Co3O4-nanowires-modified electrode to destroy the multiresistant Escherichia coli cells and promote subsequent i-ARG (blaTEM-1 and aac(3)-II) degradation. The lightning-rod effect over nanowire tips can form finite regions with a locally enhanced electric field and highly concentrated charge density, in turn facilitating the electroporation for ARB cell damage and electrochemical reactivity for reactive chlorine/oxygen species generation. Characterization of the ARB membrane integrity and morphology revealed that electroporation-induced cell pores were further enlarged by the oxidation of reactive species, resulting in i-ARG removal at lower applied voltages and with 6-9 times lower energy consumption than the conventional electrochemical oxidation approach with a Co3O4-film-modified electrode. The satisfactory application and effective inhibition of horizontal gene transfer in tap water further demonstrated the great potential of our strategy in the control of the ARG dissemination risk in drinking water systems.

Ellagic acid induces apoptosis and autophagy in colon cancer through the AMPK/mTOR pathway.

Ellagic acid (EA), found in fruits and foods, has been shown to be effective in the treatment of breast, colon and bladder cancer. However, due to the complexity of colon cancer, the therapeutic mechanism of EA for colon cancer is still unclear. Cell Counting Kit-8 (CCK-8) assay were employed to investigate the cell proliferation. Western blotting and flow cytometry assays were utilized to investigate apoptosis and autophagy in CRC cells (HCT116), respectively. Moreover, western blotting and luciferase reporter assays were evaluated the effect of EA on AMPK/mTOR pathway. Through flow cytometry analysis, EA could promote the apoptosis of HCT116 cells. In addition, EA can reduce the phosphorylation of mTOR, promoted phosphorylation of AMPK, and induced autophagy in HCT116 cells. Also, Dorsomorphin pretreatment can reduce the expression of autophagy protein, which indicates that EA induces autophagy through AMPK/mTOR pathway. These results suggest that EA inhibits the growth of colon cancer through AMPK/mTOR pathway and induces apoptosis and protective autophagy.

Spike and nsp6 are key determinants of SARS-CoV-2 Omicron BA.1 attenuation.

The SARS-CoV-2 Omicron variant is more immune evasive and less virulent than other major viral variants that have so far been recognized1-12. The Omicron spike (S) protein, which has an unusually large number of mutations, is considered to be the main driver of these phenotypes. Here we generated chimeric recombinant SARS-CoV-2 encoding the S gene of Omicron (BA.1 lineage) in the backbone of an ancestral SARS-CoV-2 isolate, and compared this virus with the naturally circulating Omicron variant. The Omicron S-bearing virus robustly escaped vaccine-induced humoral immunity, mainly owing to mutations in the receptor-binding motif; however, unlike naturally occurring Omicron, it efficiently replicated in cell lines and primary-like distal lung cells. Similarly, in K18-hACE2 mice, although virus bearing Omicron S caused less severe disease than the ancestral virus, its virulence was not attenuated to the level of Omicron. Further investigation showed that mutating non-structural protein 6 (nsp6) in addition to the S protein was sufficient to recapitulate the attenuated phenotype of Omicron. This indicates that although the vaccine escape of Omicron is driven by mutations in S, the pathogenicity of Omicron is determined by mutations both in and outside of the S protein.

Proteomic analysis identifies Stomatin as a biological marker for psychological stress.

Psychological stress emerges to be a common health burden in the current society for its highly related risk of mental and physical disease outcomes. However, how the quickly-adaptive stress response process connects to the long-observed organismal alterations still remains unclear. Here, we investigated the profile of circulatory extracellular vesicles (EVs) after acute stress (AS) of restraint mice by phenotypic and proteomic analyses. We surprisingly discovered that AS-EVs demonstrated significant changes in size distribution and plasma concentration compared to control group (CN) EVs. AS-EVs were further characterized by various differentially expressed proteins (DEPs) closely associated with biological, metabolic and immune regulations and were functionally important in potentially underlying multiple diseases. Notably, we first identified the lipid raft protein Stomatin as an essential biomarker expressed on the surface of AS-EVs. These findings collectively reveal that EVs are a significant function-related liquid biopsy indicator that mediate circulation alterations impinged by psychological stress, while also supporting the idea that psychological stress-associated EV-stomatin can be used as a biomarker for potentially predicting acute stress responses and monitoring psychological status. Our study will pave an avenue for implementing routine plasma EV-based theranostics in the clinic.

Energy transfer mediated rapid and visual discrimination of tetracyclines and quercetin in food by using N, Cu Co-doped carbon dots.

The appearance of multi-drug resistant Escherichia coli makes the combination of tetracyclines (TCs) and quercetin (QCT) more common to fight stubborn bacterial infections so that the effective detections of TCs and QCT are essential and necessary. Here, a novel fluorescence probe for differentiating TCs and QCT is developed based on the nitrogen and copper co-doped carbon dots (N, Cu-CDs). The N, Cu-CDs are prepared from ethylene diamine tetraacetic acid (EDTA) and anhydrous copper chloride as precursors through hydrothermal process and exhibit bright blue fluorescence with excellent optical stability. With the presence of four tetracyclines (DOX, TC, CTC and OTC), the fluorescence intensity of N, Cu-CDs is quenched directly due to the internal filtration effect (IFE), and the detection limit obtained through single-signal fluorescence sensing is as low as 23.8 nM for DOX, 37.2 nM for TC, 43.8 nM for OTC and 28.8 nM for CTC. More remarkably, three dimensional ratiometric fluorescence probe for detecting QCT is proposed based on the appearance of another emission at (410 nm, 490 nm) due to electron transform (ET) process. This new method shows a good linear relationship in the range of 10-100 µM with a low detection limit of 59.3 nM. Furthermore, a dual-channel fluorescence sensing platform based on microfluidics paper-based analytical devices (µPADs) is developed for simultaneously visual discrimination of TCs (DOX is chosen as the typical detecting model for TCs) and QCT. This investigation provides a new way for the development of CDs as multifunction fluorescence probes.

[Clinical Characteristics and Prognosis of Diabetic Foot Ulcers Patients of Different Renal Function Statuses].

Objective: To explore the clinical characteristics and the prognosis of diabetic foot ulcers (DFU) inpatients of different renal function statuses. Methods: A retrospective analysis of 962 inpatients with DFU was conducted. The patients were divided into three groups according to their renal function statuses, and the clinical characteristics of the three groups were compared to identify differences. In addition, the patients were followed up in outpatient clinics or by telephone and their prognostic status and risk factors for death were analyzed. Results: Analysis of the clinical characteristics showed that, compared with diabetic patients with normal renal function or mild renal function impairment, diabetic patients with moderate and severe renal function impairment had a longer course of disease ( P<0.001). Patients with foot ulcers of Wagner grade 4 predominates the moderate and severe renal function impairment groups ( P<0.05). Patients in the moderate and severe renal function impairment groups had a relatively higher proportion of comorbidities, including hypertension, coronary heart disease, and peripheral arterial disease ( P<0.05). These patients had relatively lower levels of glycosylated hemoglobin and hemoglobin (all P<0.05) and relatively higher levels of neutrophil ratio and procalcitonin (all P<0.05). Of the two groups, patients in the moderate renal function impairment group were older ( P<0.001) and had lower ankle-brachial index ( P<0.001). The severe renal function impairment group had a higher proportion of patients with foot ulcers of Wagner grades 3 and 5 (all P<0.05). For the purpose of conducting prognostic analysis, 748 patients were followed up in outpatient clinics or by telephone for a median length of 41 months. Among them, 239 died. The all-cause mortality was 31.9%, and the mortality in the three groups was 25.8%, 46.2% ( P<0.001), and 59.4% ( P<0.001), respectively. The survival rate of patients in the moderate and severe renal function impairment groups was significantly lower than those in the normal renal function and mild renal function impairment groups ( P<0.001). Univariate Cox regression analysis showed that age, concomitant coronary heart disease and peripheral arterial disease, degree of renal function impairment, and foot ulcers of Wagner grade 4 and 5 were associated with all-cause deaths. Furthermore, multivariate Cox regression analysis showed that moderate and severe renal function impairment was an independent risk factor for all-cause deaths in DFU patients ( P<0.001). Conclusions: As renal function impairment worsens, patients with DFU present clinical characteristics of greater complexity, higher risks of cardiovascular events, and higher mortality. It is essential to prevent kidney damage and foot ulcers, to pay attention to the cardiovascular risks of DFU patients with moderate and severe renal function impairment, and to reduce mortality.

[Preliminary Application of Contrast-Enhanced Ultrasound in the Treatment of Diabetic Ulcers].

Objective: To investigate the role of contrast-enhanced ultrasound (CEUS) in the treatment of diabetic ulcers. Methods: The clinical data of 27 diabetic patients, who underwent CEUS examination of their ulcers in our hospital between April 2021 and July 2022 were collected. Among them, 26 patients suffered from diabetic foot ulcers, 5 of whom underwent amputation during hospitalization, and one patient suffered from hip ulcer. The 27 patients' mean age was (64.08±12.57) years. Fasting blood glucose levels of the patients were 3.36-34.61 mmol/L, with a mean of (10.62±8.77) mmol/L. Their glycosylated hemoglobin levels were 5.80%-10.70%, with an average of 7.96%±1.50%. Philips EPIQ7 ultrasound system with L9-3 linear probe of 3-9 MHz was used. First, the patients' ulcers were examined with conventional ultrasound to observe for abnormal echo. Then, 2.4 mL SonoVue (Bracco, Italy), a contrast agent, was injected intravenously through the elbow to look for effusion/pus, sinus tract, or dead space in the lesion area, and images were acquired. Results: Among the 27 patients, except for 5 with amputation stumps, 22 patients had wound areas ranging from 0.16 cm 2 to 215 cm 2, all being accompanied by sinus tract formation. Ten patients underwent ultrasound examination during their treatment. The positive rate of the results of conventional ultrasound was 50% (5/10) for identifying effusion/pus and pseudoaneurysm in the deep area of ulcers, while the positive rate of CEUS results was 100% (10/10). In addition to the lesions found by conventional ultrasound, CEUS also found large sinus tracts or dead spaces in the deep surface of ulcers in 5 additional patients. Of the 27 patients, 17 underwent ultrasound examination of the healing status of sinus tracts and dead spaces in the deep areas of ulcers before discharge. No sinus tracts in the deep areas of the ulcers were found by conventional ultrasound. However, relatively small dead spaces or sinus tracts in the deep areas of the ulcers were found in 10 patients by CEUS. Conventional ultrasound and CEUS found that 1 patient had a small amount of fluid in the amputation stump. In the remaining 6 patients, no deep sinus tracts in the ulcers were found by either conventional ultrasound or CUES, and the ulcers healed completely. Conclusion: By examining microvascular perfusion in diabetic wounds with CEUS, we can observe the extent of sinus tracts during treatment and whether the sinus tracts have healed or whether there are still dead spaces before patient discharge, which provides support for clinical decision-making concerning the treatment of diabetic ulcers.