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Clinical characteristics and the prognosis of diabetic foot in Tibet: A single center, retrospective study

  • Xiaoyong Yuan EMAIL logo , Difei Lu , Shuyou Meng , Lihui Yang , Geheng Yuan , Xin Qi , Bing Wen , Junqing Zhang and Xiaohui Guo
Published/Copyright: October 17, 2023
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Open Life Sciences
From the journal Open Life Sciences Volume 18 Issue 1

Abstract

The objective of this study was to explore the clinical characteristics and prognosis of diabetic foot in hospitalized patients with diabetes in Tibet. To achieve that, patients hospitalized in People’s Hospital of Tibet Autonomous Region and diagnosed with diabetic foot ulcer (DFU) from January 1, 2016 to December 31, 2020 were enrolled in the study, and DFU cases of Peking University First Hospital were collected as control group. Analysis and comparison of clinical characteristics of DFU in plateau and plain areas were conducted. Normal distribution data or non-normal distribution data between groups were analyzed by t-test analysis or the nonparametric Mann–Whitney U test, and categorical variants were compared by Chi-square of Pearson. A total of 54 DFU cases were enrolled in the study in the People’s Hospital of Tibet Autonomous Region (Tibet group for short). Males accounted for 83.3% (45 cases) in Tibet group, which was higher than that of Peking University First Hospital (Beijing group for short), which accounted for 67.0%. Compared with the DFU patients in the Beijing group, the Tibet group was younger (58.11 ± 12.25 years vs 64.18 ± 11.37 years, P < 0.05), with a shorter disease duration (7.00 years vs 12.00 years, P < 0.05). In contrast, alcohol consumption was higher in the Tibet group (44.4 vs 27.4%, P < 0.05), and the number of patients with smoking habit was higher in the Beijing group (29.6 vs 43.7%, P < 0.05). The Tibet group had higher HbA1c (10.2 vs 8.7%, P < 0.05) and lower DFU proportion (22.2 vs 44.2%, P < 0.05). There was no statistically significant difference in the proportion of moderate to severe infections between the two groups (58.5 vs 59.6%, P = 0.887). Leukocytes (6.75 × 109/L vs 8.72 × 109/L, P < 0.05) and neutrophils (4.07 × 109/L vs 6.26 × 109/L, P < 0.05) in Tibet group were lower. Although the DFU amputation rate in the Tibet group was lower than that in the Beijing group (9.3 vs 29.8%, P < 0.05), there was no statistically significant difference between the two groups in terms of treatment cost, hospital stay, and mortality. In conclusion, patients with DFU in Tibet had a smaller age, shorter duration of diabetes, and more male predominance. The proportions of gangrene and amputation were lower in Tibet, with gangrene accounting for 80% of all amputees.

Keywords: region differences; diabetic foot; infection; amputation; death rate

1 Introduction

Diabetic foot ulcer (DFU) is the leading cause of non-traumatic amputation, which is also one of the most common complications leading to death in patients with diabetes mellitus (DM). According to a community-based study in northwestern United Kingdom [1], the annual incidence of foot ulcer was approximately 2.2%. The lifetime risk of DFU in diabetic patients was estimated to be 19–34%, and the recurrence rate was estimated to be approximately 40% within 1 year of ulcer healing and up to 65% within 5 years [2]. Despite striking data, the clinical implications for the foot ulcers remain limited. Approximately 30.5% of patients with different types of diabetic foot infection underwent different degrees of amputation [3]. A population-based cohort study in the United Kingdom demonstrated a 42% mortality rate associated with DFU. Within 5 years, the risk of death among DFU patients was 2.5 times that of diabetic patients without DFU [4]. Meanwhile, expenditure on direct healthcare for DFU was estimated to be $176 billion in 2012, about one-third of the total cost of diabetic care [5]. Based on the recent data from the UK, it was conservatively estimated that the annual cost of DFU in 2019 was £900 million, which reached approximately 1% of the total budget of the National Health Service [6].

Therefore, effective strategies for foot complications in diabetes patients are urgently needed to improve the poor clinical outcomes. However, few previous studies on DFU rarely involved plateau regions. The unique climate of plateau areas, including low temperature, hypoxia, and dryness, may have certain effects on wound healing, amputation rate, and mortality. According to Wanle Qi’s report, wound healing of elderly DFU patients in plateau area were delayed, accounting for 51.9% of the total chronic refractory wounds [7]. There was a lack of research on the clinical features of DFU in the plateau area. Therefore, this study aims to compare the differences in clinical characteristics and prognosis of DFU in Tibet and Beijing, and then further investigate possible confounders.

2 Materials and methods

2.1 Settings and participants

DM was diagnosed when fasting blood glycemia ≥126 mg/dL or glycosylated hemoglobin (A1c) ≥6.5% according to standards of medical care in diabetes from American Diabetes Association [8]. Patients with previous diagnosis of DM and registered in medical records were also considered as the diagnosis of DM. DFU was considered when the patients were previously diagnosed as diabetic foot infection or ischemic DFU with medical records. Wagner classification [9] was used to evaluate the severity of diabetic foot. Moderate infection and severe infection for DFU was defined according to IDSA criteria [10]. The exclusion criteria were as follows: (1) basic information was incomplete, (2) admitted to hospital for a same ulcer (In other words, if a patient had a hospitalization for a DFU and was subsequently readmitted for the exact same DFU within the specified timeframe, they would be excluded from our analysis.), and (3) ulcer had healed when admission.

Patients with DFU who met the above criteria and were hospitalized in the duration from January 1, 2016 to December 31, 2020 in Tibet Autonomous Region People’s Hospital were enrolled in the study as Tibet group. Patients with DF and hospitalized in Peking University First Hospital between January 1, 2010 and December 31, 2014 were enrolled as control group. We identified all DF subjects through medical records, and data collection was performed using the paper version of case report form.

The study protocol was approved by Ethics Committees of Tibet Autonomous Region People’s Hospital and was in accordance with Helsinki Declaration principles. Our study was approved by the Ethics Committees of Tibet Autonomous Region People’s Hospital (No. ME-TBHP-21-030).

  1. Informed consent: Informed consent has been obtained from all individuals included in this study.

  2. Ethical approval: The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance with the tenets of the Helsinki Declaration, and has been approved by the Ethics Committees of Tibet Autonomous Region People s Hospital (No. ME-TBHP-21-030).

2.2 Variables

The clinical characteristics of DF patients were collected as follows: the type of diabetes, DM duration, type of anti-diabetic drugs, complications of DM, history of smoking and drinking, body mass index (BMI), body temperature, gangrene, and Wagner classification when admission. Data of clinical outcomes were accumulated including treatment, the rate of amputation, rate of death, length of hospital stay, and cost. Laboratory results including white blood cell count (WBC), neutrophils (Net), red blood cell count (RBC), hemoglobin (Hb), C-reactive protein (CRP), procalcitonin (PCT), serum albumin (Alb), uric acid (UA), fasting blood glucose (Glu), glycosylated hemoglobin (HbA1c), triglyceride (TG), total cholesterol (TCHO), high density lipoprotein cholesterol (HDL-c), and low density lipoprotein cholesterol (LDL-c) were also collected.

2.3 Statistical analysis

Variables in line with normal distribution were described as mean ± standard deviation, and were compared using Student’s t-test between groups. Categorical variables were presented as percentage, and were compared using Chi-square of Pearson between groups. Data were analyzed using Stata version 25.0. P < 0.05 was considered as statistical significance.

3 Results

In this study, there were 54 inpatients with DFU in Tibet Autonomous Region People’s Hospital, and 215 cases in Peking University First Hospital. In the Tibet group, type 2 diabetes patients accounted for 98.1% (53/54), men accounted for 83.3% (45/54), the mean age was 58.11 ± 12.25 years, and the median duration of DM was 7 years. In the Beijing group, males accounted for 67.0% (144/215), the mean age was 64.18 ± 11.37 years, and the median duration of DM was 12 years (Table 1).

Table 1

Characteristics comparison of DFU patients between Tibet Autonomous People’s Hospital (Tibet) and Peking University First Hospital (Beijing)

Tibet (X ± D, M(Q1,Q3), n(%)) Beijing (X ± D, M(Q1,Q3), n(%)) t/Z/χ 2 P
Number of patients 54 215
General characteristics
Age (years) 58.11 ± 12.25 64.18 ± 11.37 −3.454 0.001
Course of DM (years) 7.00(4.00, 11.50) 12.00(8.00, 20.00) −4.039 <0.001
History of smoking 16(29.6%) 94(43.7%) 11.690 0.003
History of drinking 24(44.4%) 59(27.4%) 10.749 0.005
BMI (kg/m2) 24.43 ± 3.55 24.67 ± 3.66 −0.338 0.736
Characteristics of disease
Increased body temperature (>37.3℃) 1(1.9%) 19(8.8%) 3.060 0.080
Thanatosis 12(22.2%) 95(44.2%) 9.764 0.002
Wagner classify
Level 1 6(11.1%) 32(14.9%) 0.506 0.477
Level 2 16(29.6%) 44(20.5%) 2.092 0.148
Level 3 20(37.0%) 32(14.9%) 13.583 0.000
Level 4 12(22.2%) 75(34.9%) 3.162 0.075
Level 5 0(0.0%) 8(3.7%) 2.071 0.150
Infection situation
Moderate infection 24(45.3%) 95(50.5%) 0.456 0.500
Severe infection 7(13.2%) 17(8.1%) 1.038 0.253
Moderate to severe infection 31(58.5%) 112(59.6%) 0.020 0.887
Laboratory characteristics
WBC (109/L) 6.75(5.21, 9.98) 8.72(6.70, 11.37) −2.937 0.003
Net (109/L) 4.07(2.93, 7.25) 6.26(4.47, 8.75) −3.272 0.001
WBC > 10 × 109/L 12(23.1%) 75(35.7%) 3.001 0.083
Net > 70% 20(38.5%) 132(62.9%) 10.184 0.001
CRP (mg/L) 14.53(3.21, 90.03) 47.05(9.49, 104.87) −1.431 0.152
PCT (ng/ml) 0.19(0.05, 0.51) 0.12(0.06, 0.32) −0.361 0.718
RBC (1012/L) 4.57 ± 1.05 3.83 ± 0.73 4.785 <0.001
Hb (g/L) 138.31 ± 34.79 113.69 ± 23.06 4.845 <0.001
Alb (g/L) 31.67 ± 6.76 33.13 ± 5.63 −1.617 0.107
UA (μmol/L) 337(278, 438) 292(234, 374) −3.352 0.001
Glu (mmol/L) 8.55(6.30, 12.03) 7.23(5.54, 10.66) −1.993 0.046
HbA1c (%) 10.2(7.8, 13.0) 8.7(7.3, 10.6) −3.027 0.002
TG (mmol/L) 1.03(0.79, 1.29) 1.16(0.84, 1.56) −1.701 0.089
TCHO (mmol/L) 3.63(3.12, 4.55) 3.77(3.22, 4.48) −0.589 0.556
HDL (mmol/L) 0.96 ± 0.28 0.85 ± 0.25 2.648 0.009
LDL (mmol/L) 2.23(1.65, 2.95) 2.34(1.91, 2.97) −0.959 0.338
Outcome features
The amputation rate 5(9.3%) 64(29.8%) 9.518 0.002
Death rate 1(1.9%) 4(1.9%) 0.000 0.997
Hospitalization expenses (RMB) 20149.61(14834.36, 32739.27) 19029.85(10348.14, 44248.05) −0.990 0.322
Length of hospital stay (days) 13(11, 17) 16(12, 25) −2.446 0.014

In contrast, the incidence of DFU combined with coronary heart disease in Tibet was lower than that in Beijing (0 vs 39.7%, P < 0.001). The incidence of other complications in Tibet was also lower than that in Beijing, including peripheral arterial disease (9.3 vs 86.2%, P < 0.001), peripheral neuropathy (13.0 vs 64.8%, P < 0.001), cerebrovascular disease (5.6 vs 64.0%, P < 0.001), and diabetic retinopathy (24.1 vs 53.3%, P < 0.001). There was no statistically significant difference in the complication rate of diabetic nephropathy between DFU patients in Tibet and Beijing (42.6 vs 50.3%, P = 0.329), as well as those with former diabetic foot (18.5 vs 31.8%, P = 0.055). Fewer patients were diagnosed with peripheral neuropathy in Tibet than in Beijing (11.1 vs 47.4%, P < 0.001). The incidence of peripheral arterial disease was similar in the two groups (92.6 vs 84.2%, P = 0.113).

There were fewer patients with gangrene (22.2 vs 44.2%, P = 002) or amputation (9.3 vs 29.8%, P = 0.002) in Tibet than in Beijing. For DFU patients in Tibet and Beijing, there was no statistically significant difference in moderate–severe infection (58.5 vs 59.6%, P = 0.887). Both the WBC elevation rate (38.5 vs 62.9%, P = 0.0001) and Net elevation rate (38.5 vs 62.9%, P = 0.0001) in Tibet were lower than those in Beijing. The death rates of DFU in the two areas were of no significance (1.9 vs 1.9%, P = 0.997, Tables 2 and 3).

Table 2

Characteristics of amputation in DFU patients in the People’s Hospital of Tibet Autonomous Region

Non-amputation patients (X ± D, M(Q, R), n(%)) Amputation patients (X ± D, M(Q, R), n(%)) t/Z/χ 2 P
Age (age) 59.16 ± 12.13 47.80 ± 8.73 2.033 0.047
Course of DM (years) 7.50(4.25, 12.00) 5.00(0.50, 8.00) −1.511 0.131
History of smoking 14(28.6%) 2(40.0%) 0.284 0.594
History of drinking 22(44.9%) 2(40.0%) 0.044 0.834
Thanatosis 8(16.3%) 4(80.0%) 10.643 0.001
Wagner classify
Level 1 6(12.2%) 0(0.0%) 0.689 0.407
Level 2 16(32.7%) 0(0.0%) 2.320 0.128
Level 3 19(38.8%) 1(20.0%) 0.686 0.408
Level 4 8(16.3%) 4(80.0%) 10.643 0.001
Level 5 0(0.0%) 0(0.0%)
Infection situation
Moderate infection 21(57.1%) 3(60.0%) 1.542 0.214
Severe infection 6(12.2%) 1(20.0%) 0.525 0.469
Moderate to severe infection 27(55.1%) 4(80.0%) 3.070 0.080
Laboratory characteristics
WBC (109/L) 6.75(5.21, 9.98) 7.00(5.38, 19.70) −0.446 0.655
Net (109/L) 4.07(2.84, 7.25) 4.56(3.23, 16.38) −0.601 0.548
RBC (1012/L) 4.56 ± 1.07 4.68 ± 0.90 −0.216 0.830
Hb (g/L) 138.27 ± 35.50 138.75 ± 28.65 −0.026 0.979
Alb (g/L) 31.34 ± 6.94 34.86 ± 3.83 −1.111 0.272
UA (μmol/L) 334(272, 438) 413(325, 479) −1.133 0.257
Glu (mmol/L) 9.04(6.45, 12.78) 6.30(5.76, 7.17) −2.134 0.033
HbA1c (%) 10.40(7.58, 10.25) 10.1(9.15, 10.25) −0.506 0.613
TG (mmol/L) 0.98(0.77, 1.25) 0.118(1.00, 1.43) −1.106 0.269
TCHO (mmol/L) 3.57(3.07, 4.55) 3.71(3.43, 4.48) −0.468 0.640
HDL (mmol/L) 0.980 ± 0.29 0.750 ± 0.13 1.592 0.119
LDL (mmol/L) 2.21(1.62, 2.95) 2.59(2.30, 2.95) −1.144 0.253
Table 3

Characteristics comparison of amputations in DFU patients between the People’s Hospital of Tibet Autonomous Region (Tibet) and Peking University First Hospital (Beijing)

Tibet (X ± D, M(Q, R), n(%)) Beijing (X ± D, M(Q, R), n(%)) t/Z/χ 2 P
Age (age) 47.80 ± 8.73 64.70 ± 9.73 −3.763 <0.001
Course of DM (years) 5.00(0.50, 8.00) 16.50(9.50, 20.00) −2.834 0.005
History of smoking 2(40.0%) 21(32.8%) 0.385 0.825
History of drinking 2(40.0%) 13(20.3%) 1.310 0.520
Thanatosis 4(80.0%) 9(14.1%) 13.187 <0.001
Wagner classify
Level 1 0(0.0%) 1(1.6%) 0.079 0.778
Level 2 0(0.0%) 4(6.3%) 0.332 0.565
Level 3 1(20.0%) 10(15.6%) 0.066 0.797
Level 4 4(80.0%) 39(60.9%) 0.718 0.397
Level 5 0(0.0%) 6(9.4%) 0.513 0.474
Infection situation
Moderate infection 3(60.0%) 48(75.0%) 0.098 0.754
Severe infection 1(20.0%) 6(9.4%) 0.963 0.326
Moderate to severe infection 4(80.0%) 54(84.4%) 0.368 0.544
Laboratory characteristics
WBC (109/L) 7.00(5.38, 19.70) 9.20(7.12, 11.60) −0.887 0.375
Net (109/L) 4.56(3.23, 16.38) 7.11(5.31, 9.24) −1.085 0.278
RBC (1012/L) 4.68 ± 0.90 3.67 ± 0.70 2.745 0.008
Hb (g/L) 138.75 ± 28.65 107.03 ± 22.30 2.718 0.008
Alb (g/L) 34.86 ± 3.83 31.76 ± 5.06 1.334 0.187
UA (μmol/L) 413(325, 479) 257(203, 363) −2.411 0.016
Glu (mmol/L) 6.30(5.76, 7.17) 7.84(5.79, 11.78) −1.059 0.290
HbA1c (%) 10.1(9.15, 10.25) 8.8(7.6, 10.4) −0.920 0.358
TG (mmol/L) 1.18(1.00, 1.43) 1.11(0.79, 1.41) −0.516 0.606
TCHO (mmol/L) 3.71(3.43, 4.48) 3.54(2.97, 4.19) −0.670 0.503
HDL (mmol/L) 0.750 ± 0.13 0.760 ± 0.22 −0.082 0.935
LDL (mmol/L) 2.59(2.30, 2.95) 2.34(1.89,3.02) −0.888 0.374

4 Discussion

Tibet is a special area characterized by several local diseases or special features of common diseases due to hypoxia and severe cold in high altitude areas, for instance less infection from resistant bacteria [11], higher prevalence of parasites [12], higher prevalence of hypertension [13], and endemic high altitude polycythemia [14]. In our study, the clinical features of diabetic foot in Tibet were different from that in plain areas such as Beijing. Compared with diabetic patients in Beijing, patients in Tibet were more likely to develop DFU in a relatively smaller age (58.11 years vs 64.18 years, P = 0.001), and the youngest DFU patient in Tibet was only 34 years old. Meanwhile, patients in Tibet presented with 5 years earlier in diabetes duration at the onset of DFU compared with patients in Beijing (7.00 years vs 12.00 years, P < 0.001).

Diabetic patients often suffer from the stenosis of lower extremity artery due to long-term hyperglycemia, which would lead to extremity ischemia. Harsh climate in plateau combining severe cold and hypoxia could aggravate lower extremity ischemia [15] furthermore leading to lower extremity ulcers or gangrene. The severe cold climate could lead to diminished sensitivity of peripheral sensory nerve in diabetic patients [16], which could further bring about frostbite or scald. Therefore, DFU patients in Tibet are younger and with shorter duration of diabetes. In addition, poor glycemic control may also contribute to the earlier onset of DFU in Tibet, which was demonstrated by the phenomenon that the HbA1c of DFU patients in Tibet increased by 1.5% (10.2 vs 8.7%, P = 0.002) compared with patients in Beijing.

In terms of the severity of diabetic foot, DFU in Tibet was mild presented compared with Beijing. The proportion of moderate-to-severe infection of DFU in these two areas was similar (80.0 vs 84.4%, P = 0.544), while the inflammatory indicators reflecting the severity of infection including WBC, Net, and rate of elevated WBC and elevated Net, in Tibet, were lower than Beijing. It was speculated that the milder infection might be related to the special environment in Tibet. Although people in Tibet live in poor sanitary conditions with limited frequency of self-examination, and hypoxia and severe cold abated the immune response of them, which could increase the possibility of skin and soft tissue infection. However, the harsh environment in plateau area also restricted the survival and growth of pathogens [17], especially for those infecting skin and soft tissues. Therefore, the infection rate of DFU in Tibet was similar to that in Beijing, but the inflammatory indicators were lower. On the other hand, DFU in Tibet showed a reduced risk of gangrene (22.2 vs 44.2%, P < 0.001). Gangrene is caused by vascular occlusion of lower extremities, while altered glucose and lipid metabolism are risk factors for vascular disease. The HbA1c and lipid profile were revealed to be in poor control in DFU patients in Tibet, which was inconsistent with the situation of the small proportion of gangrene. Taking the population characteristics of DFU in Tibet into account, the smaller age, shorter course of disease, and low smoking rate could be main contributors to the low risk of gangrene in Tibet.

With regard to the clinical outcomes, the mortality rate of DFU in the two areas was insignificant (1.9 vs 1.9%, P = 0.997), while the amputation rate in Tibet was significantly lower than that in Beijing (9.3 vs 29.8%, P = 0.002). In terms of mortality, it has commonly been assumed that the main cause of death in DFU was cardiovascular and cerebrovascular diseases or serious infections [9]. The harsh environment of the plateau might not be a significant influencing factor of cardiovascular lesions for DM patients, thus the mortality rate was comparable of the two areas. A possible explanation for the reduced amputation rate in Tibet might be the smaller age of DFU patients in Tibet the shorter duration of DM. Also, gangrene accounted for 80% of DFU with amputation in Tibet, which was higher than Beijing. Therefore, the lower rate of amputation in Tibet could be the result of fewer gangrene and milder infection. Thus, the younger age, the shorter duration of DM, lower smoking rate, the lower proportion of gangrene, and the milder infection may contribute to the decrease of the overall amputation rate in Tibet.

There were several limitations in this study. First, this was a retrospective study, and was insufficient for causal inferences. Therefore, we could only provide the possible influencing factors for characteristics of DFU in Tibet. Second, the number of DFU patients in Tibet was small, which may lead to bias in subgroup analysis.

Furthermore, for practical considerations, we chose Beijing as the control group. The First Hospital of Beijing is a well-established institution with a larger patient population, making it easier to collect an adequate number of DFU cases for comparison. Additionally, the hospital possesses specialized knowledge in treating DFUs, ensuring standardized care protocols. We understand the concerns regarding the differences between Beijing and Tibet potentially introducing confounders and limiting the generalizability of our findings. The variations in demographics, culture, environment, and economic development between these two regions are indeed important factors to consider. However, it is worth noting that there is a scarcity of studies investigating diabetic foot in Tibet. Our study fills this gap in the literature by providing valuable insights into the clinical characteristics and prognosis of diabetic foot in this specific region. Despite the limitations associated with the choice of the comparison group, we believe that our research still contributes to the understanding of diabetic foot in Tibet.

5 Conclusions

Our study compared the clinical characteristics and outcomes of DFU patients in Tibet and Beijing. The results showed that DFU patients in Tibet were younger, had a shorter duration of diabetes, and had a lower incidence of complications such as coronary heart disease, peripheral arterial disease, peripheral neuropathy, cerebrovascular disease, and diabetic retinopathy compared to those in Beijing. Additionally, DFU patients in Tibet had a lower rate of gangrene and amputation, milder infection, and comparable mortality rates. These differences could be attributed to the unique environment and population characteristics of Tibet. However, the study has limitations, including its retrospective nature and a small sample size in Tibet, highlighting the need for further research to validate these findings.

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Acknowledgements

Not applicable.

  1. Funding information: Authors state no funding involved.

  2. Author contributions: X.Y.Y. and D.F.L. designed the experiments; S.L.F., S.Y.M., and L.H.Y. performed the experiments; J.Q.Z. and X.H.G. collected and analyzed the data; X.Y.Y. and X.H.G. drafted manuscript. All authors read and approved the final manuscript.

  3. Conflict of interest: Authors state no conflict of interest.

  4. Data availability statement: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Received: 2023-05-29
Revised: 2023-08-17
Accepted: 2023-09-04
Published Online: 2023-10-17

© 2023 the author(s), published by De Gruyter

This work is licensed under the Creative Commons Attribution 4.0 International License.

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  266. Erratum
  267. Erratum to “Protein Z modulates the metastasis of lung adenocarcinoma cells”
  268. Erratum to “BRCA1 subcellular localization regulated by PI3K signaling pathway in triple-negative breast cancer MDA-MB-231 cells and hormone-sensitive T47D cells”
  269. Retraction
  270. Retraction to “Protocatechuic acid attenuates cerebral aneurysm formation and progression by inhibiting TNF-alpha/Nrf-2/NF-kB-mediated inflammatory mechanisms in experimental rats”
https://doi.org/10.1515/biol-2022-0740
Keywords for this article
region differences; diabetic foot; infection; amputation; death rate
Creative Commons
BY 4.0

Articles in the same Issue

  1. Biomedical Sciences
  2. Systemic investigation of inetetamab in combination with small molecules to treat HER2-overexpressing breast and gastric cancers
  3. Immunosuppressive treatment for idiopathic membranous nephropathy: An updated network meta-analysis
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  26. Experimental study on the optimization of ANM33 release in foam cells
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  48. Association of interleukin-10 rs1800896, rs1800872, and interleukin-6 rs1800795 polymorphisms with squamous cell carcinoma risk: A meta-analysis
  49. Exosomal HBV-DNA for diagnosis and treatment monitoring of chronic hepatitis B
  50. Shear stress leads to the dysfunction of endothelial cells through the Cav-1-mediated KLF2/eNOS/ERK signaling pathway under physiological conditions
  51. Interaction between the PI3K/AKT pathway and mitochondrial autophagy in macrophages and the leukocyte count in rats with LPS-induced pulmonary infection
  52. Meta-analysis of the rs231775 locus polymorphism in the CTLA-4 gene and the susceptibility to Graves’ disease in children
  53. Cloning, subcellular localization and expression of phosphate transporter gene HvPT6 of hulless barley
  54. Coptisine mitigates diabetic nephropathy via repressing the NRLP3 inflammasome
  55. Significant elevated CXCL14 and decreased IL-39 levels in patients with tuberculosis
  56. Whole-exome sequencing applications in prenatal diagnosis of fetal bowel dilatation
  57. Gemella morbillorum infective endocarditis: A case report and literature review
  58. An unusual ectopic thymoma clonal evolution analysis: A case report
  59. Severe cumulative skin toxicity during toripalimab combined with vemurafenib following toripalimab alone
  60. Detection of V. vulnificus septic shock with ARDS using mNGS
  61. Novel rare genetic variants of familial and sporadic pulmonary atresia identified by whole-exome sequencing
  62. The influence and mechanistic action of sperm DNA fragmentation index on the outcomes of assisted reproduction technology
  63. Novel compound heterozygous mutations in TELO2 in an infant with You-Hoover-Fong syndrome: A case report and literature review
  64. ctDNA as a prognostic biomarker in resectable CLM: Systematic review and meta-analysis
  65. Diagnosis of primary amoebic meningoencephalitis by metagenomic next-generation sequencing: A case report
  66. Phylogenetic analysis of promoter regions of human Dolichol kinase (DOLK) and orthologous genes using bioinformatics tools
  67. Collagen changes in rabbit conjunctiva after conjunctival crosslinking
  68. Effects of NM23 transfection of human gastric carcinoma cells in mice
  69. Oral nifedipine and phytosterol, intravenous nicardipine, and oral nifedipine only: Three-arm, retrospective, cohort study for management of severe preeclampsia
  70. Case report of hepatic retiform hemangioendothelioma: A rare tumor treated with ultrasound-guided microwave ablation
  71. Curcumin induces apoptosis in human hepatocellular carcinoma cells by decreasing the expression of STAT3/VEGF/HIF-1α signaling
  72. Rare presentation of double-clonal Waldenström macroglobulinemia with pulmonary embolism: A case report
  73. Giant duplication of the transverse colon in an adult: A case report and literature review
  74. Ectopic thyroid tissue in the breast: A case report
  75. SDR16C5 promotes proliferation and migration and inhibits apoptosis in pancreatic cancer
  76. Vaginal metastasis from breast cancer: A case report
  77. Screening of the best time window for MSC transplantation to treat acute myocardial infarction with SDF-1α antibody-loaded targeted ultrasonic microbubbles: An in vivo study in miniswine
  78. Inhibition of TAZ impairs the migration ability of melanoma cells
  79. Molecular complexity analysis of the diagnosis of Gitelman syndrome in China
  80. Effects of maternal calcium and protein intake on the development and bone metabolism of offspring mice
  81. Identification of winter wheat pests and diseases based on improved convolutional neural network
  82. Ultra-multiplex PCR technique to guide treatment of Aspergillus-infected aortic valve prostheses
  83. Virtual high-throughput screening: Potential inhibitors targeting aminopeptidase N (CD13) and PIKfyve for SARS-CoV-2
  84. Immune checkpoint inhibitors in cancer patients with COVID-19
  85. Utility of methylene blue mixed with autologous blood in preoperative localization of pulmonary nodules and masses
  86. Integrated analysis of the microbiome and transcriptome in stomach adenocarcinoma
  87. Berberine suppressed sarcopenia insulin resistance through SIRT1-mediated mitophagy
  88. DUSP2 inhibits the progression of lupus nephritis in mice by regulating the STAT3 pathway
  89. Lung abscess by Fusobacterium nucleatum and Streptococcus spp. co-infection by mNGS: A case series
  90. Genetic alterations of KRAS and TP53 in intrahepatic cholangiocarcinoma associated with poor prognosis
  91. Granulomatous polyangiitis involving the fourth ventricle: Report of a rare case and a literature review
  92. Studying infant mortality: A demographic analysis based on data mining models
  93. Metaplastic breast carcinoma with osseous differentiation: A report of a rare case and literature review
  94. Protein Z modulates the metastasis of lung adenocarcinoma cells
  95. Inhibition of pyroptosis and apoptosis by capsaicin protects against LPS-induced acute kidney injury through TRPV1/UCP2 axis in vitro
  96. TAK-242, a toll-like receptor 4 antagonist, against brain injury by alleviates autophagy and inflammation in rats
  97. Primary mediastinum Ewing’s sarcoma with pleural effusion: A case report and literature review
  98. Association of ADRB2 gene polymorphisms and intestinal microbiota in Chinese Han adolescents
  99. Tanshinone IIA alleviates chondrocyte apoptosis and extracellular matrix degeneration by inhibiting ferroptosis
  100. Study on the cytokines related to SARS-Cov-2 in testicular cells and the interaction network between cells based on scRNA-seq data
  101. Effect of periostin on bone metabolic and autophagy factors during tooth eruption in mice
  102. HP1 induces ferroptosis of renal tubular epithelial cells through NRF2 pathway in diabetic nephropathy
  103. Intravaginal estrogen management in postmenopausal patients with vaginal squamous intraepithelial lesions along with CO2 laser ablation: A retrospective study
  104. Hepatocellular carcinoma cell differentiation trajectory predicts immunotherapy, potential therapeutic drugs, and prognosis of patients
  105. Effects of physical exercise on biomarkers of oxidative stress in healthy subjects: A meta-analysis of randomized controlled trials
  106. Identification of lysosome-related genes in connection with prognosis and immune cell infiltration for drug candidates in head and neck cancer
  107. Development of an instrument-free and low-cost ELISA dot-blot test to detect antibodies against SARS-CoV-2
  108. Research progress on gas signal molecular therapy for Parkinson’s disease
  109. Adiponectin inhibits TGF-β1-induced skin fibroblast proliferation and phenotype transformation via the p38 MAPK signaling pathway
  110. The G protein-coupled receptor-related gene signatures for predicting prognosis and immunotherapy response in bladder urothelial carcinoma
  111. α-Fetoprotein contributes to the malignant biological properties of AFP-producing gastric cancer
  112. CXCL12/CXCR4/CXCR7 axis in placenta tissues of patients with placenta previa
  113. Association between thyroid stimulating hormone levels and papillary thyroid cancer risk: A meta-analysis
  114. Significance of sTREM-1 and sST2 combined diagnosis for sepsis detection and prognosis prediction
  115. Diagnostic value of serum neuroactive substances in the acute exacerbation of chronic obstructive pulmonary disease complicated with depression
  116. Research progress of AMP-activated protein kinase and cardiac aging
  117. TRIM29 knockdown prevented the colon cancer progression through decreasing the ubiquitination levels of KRT5
  118. Cross-talk between gut microbiota and liver steatosis: Complications and therapeutic target
  119. Metastasis from small cell lung cancer to ovary: A case report
  120. The early diagnosis and pathogenic mechanisms of sepsis-related acute kidney injury
  121. The effect of NK cell therapy on sepsis secondary to lung cancer: A case report
  122. Erianin alleviates collagen-induced arthritis in mice by inhibiting Th17 cell differentiation
  123. Loss of ACOX1 in clear cell renal cell carcinoma and its correlation with clinical features
  124. Signalling pathways in the osteogenic differentiation of periodontal ligament stem cells
  125. Crosstalk between lactic acid and immune regulation and its value in the diagnosis and treatment of liver failure
  126. Clinicopathological features and differential diagnosis of gastric pleomorphic giant cell carcinoma
  127. Traumatic brain injury and rTMS-ERPs: Case report and literature review
  128. Extracellular fibrin promotes non-small cell lung cancer progression through integrin β1/PTEN/AKT signaling
  129. Knockdown of DLK4 inhibits non-small cell lung cancer tumor growth by downregulating CKS2
  130. The co-expression pattern of VEGFR-2 with indicators related to proliferation, apoptosis, and differentiation of anagen hair follicles
  131. Inflammation-related signaling pathways in tendinopathy
  132. CD4+ T cell count in HIV/TB co-infection and co-occurrence with HL: Case report and literature review
  133. Clinical analysis of severe Chlamydia psittaci pneumonia: Case series study
  134. Bioinformatics analysis to identify potential biomarkers for the pulmonary artery hypertension associated with the basement membrane
  135. Influence of MTHFR polymorphism, alone or in combination with smoking and alcohol consumption, on cancer susceptibility
  136. Catharanthus roseus (L.) G. Don counteracts the ampicillin resistance in multiple antibiotic-resistant Staphylococcus aureus by downregulation of PBP2a synthesis
  137. Combination of a bronchogenic cyst in the thoracic spinal canal with chronic myelocytic leukemia
  138. Bacterial lipoprotein plays an important role in the macrophage autophagy and apoptosis induced by Salmonella typhimurium and Staphylococcus aureus
  139. TCL1A+ B cells predict prognosis in triple-negative breast cancer through integrative analysis of single-cell and bulk transcriptomic data
  140. Ezrin promotes esophageal squamous cell carcinoma progression via the Hippo signaling pathway
  141. Ferroptosis: A potential target of macrophages in plaque vulnerability
  142. Predicting pediatric Crohn's disease based on six mRNA-constructed risk signature using comprehensive bioinformatic approaches
  143. Applications of genetic code expansion and photosensitive UAAs in studying membrane proteins
  144. HK2 contributes to the proliferation, migration, and invasion of diffuse large B-cell lymphoma cells by enhancing the ERK1/2 signaling pathway
  145. IL-17 in osteoarthritis: A narrative review
  146. Circadian cycle and neuroinflammation
  147. Probiotic management and inflammatory factors as a novel treatment in cirrhosis: A systematic review and meta-analysis
  148. Hemorrhagic meningioma with pulmonary metastasis: Case report and literature review
  149. SPOP regulates the expression profiles and alternative splicing events in human hepatocytes
  150. Knockdown of SETD5 inhibited glycolysis and tumor growth in gastric cancer cells by down-regulating Akt signaling pathway
  151. PTX3 promotes IVIG resistance-induced endothelial injury in Kawasaki disease by regulating the NF-κB pathway
  152. Pancreatic ectopic thyroid tissue: A case report and analysis of literature
  153. The prognostic impact of body mass index on female breast cancer patients in underdeveloped regions of northern China differs by menopause status and tumor molecular subtype
  154. Report on a case of liver-originating malignant melanoma of unknown primary
  155. Case report: Herbal treatment of neutropenic enterocolitis after chemotherapy for breast cancer
  156. The fibroblast growth factor–Klotho axis at molecular level
  157. Characterization of amiodarone action on currents in hERG-T618 gain-of-function mutations
  158. A case report of diagnosis and dynamic monitoring of Listeria monocytogenes meningitis with NGS
  159. Effect of autologous platelet-rich plasma on new bone formation and viability of a Marburg bone graft
  160. Small breast epithelial mucin as a useful prognostic marker for breast cancer patients
  161. Continuous non-adherent culture promotes transdifferentiation of human adipose-derived stem cells into retinal lineage
  162. Nrf3 alleviates oxidative stress and promotes the survival of colon cancer cells by activating AKT/BCL-2 signal pathway
  163. Favorable response to surufatinib in a patient with necrolytic migratory erythema: A case report
  164. Case report of atypical undernutrition of hypoproteinemia type
  165. Down-regulation of COL1A1 inhibits tumor-associated fibroblast activation and mediates matrix remodeling in the tumor microenvironment of breast cancer
  166. Sarcoma protein kinase inhibition alleviates liver fibrosis by promoting hepatic stellate cells ferroptosis
  167. Research progress of serum eosinophil in chronic obstructive pulmonary disease and asthma
  168. Clinicopathological characteristics of co-existing or mixed colorectal cancer and neuroendocrine tumor: Report of five cases
  169. Role of menopausal hormone therapy in the prevention of postmenopausal osteoporosis
  170. Precisional detection of lymph node metastasis using tFCM in colorectal cancer
  171. Advances in diagnosis and treatment of perimenopausal syndrome
  172. A study of forensic genetics: ITO index distribution and kinship judgment between two individuals
  173. Acute lupus pneumonitis resembling miliary tuberculosis: A case-based review
  174. Plasma levels of CD36 and glutathione as biomarkers for ruptured intracranial aneurysm
  175. Fractalkine modulates pulmonary angiogenesis and tube formation by modulating CX3CR1 and growth factors in PVECs
  176. Novel risk prediction models for deep vein thrombosis after thoracotomy and thoracoscopic lung cancer resections, involving coagulation and immune function
  177. Exploring the diagnostic markers of essential tremor: A study based on machine learning algorithms
  178. Evaluation of effects of small-incision approach treatment on proximal tibia fracture by deep learning algorithm-based magnetic resonance imaging
  179. An online diagnosis method for cancer lesions based on intelligent imaging analysis
  180. Medical imaging in rheumatoid arthritis: A review on deep learning approach
  181. Predictive analytics in smart healthcare for child mortality prediction using a machine learning approach
  182. Utility of neutrophil–lymphocyte ratio and platelet–lymphocyte ratio in predicting acute-on-chronic liver failure survival
  183. A biomedical decision support system for meta-analysis of bilateral upper-limb training in stroke patients with hemiplegia
  184. TNF-α and IL-8 levels are positively correlated with hypobaric hypoxic pulmonary hypertension and pulmonary vascular remodeling in rats
  185. Stochastic gradient descent optimisation for convolutional neural network for medical image segmentation
  186. Comparison of the prognostic value of four different critical illness scores in patients with sepsis-induced coagulopathy
  187. Application and teaching of computer molecular simulation embedded technology and artificial intelligence in drug research and development
  188. Hepatobiliary surgery based on intelligent image segmentation technology
  189. Value of brain injury-related indicators based on neural network in the diagnosis of neonatal hypoxic-ischemic encephalopathy
  190. Analysis of early diagnosis methods for asymmetric dementia in brain MR images based on genetic medical technology
  191. Early diagnosis for the onset of peri-implantitis based on artificial neural network
  192. Clinical significance of the detection of serum IgG4 and IgG4/IgG ratio in patients with thyroid-associated ophthalmopathy
  193. Forecast of pain degree of lumbar disc herniation based on back propagation neural network
  194. SPA-UNet: A liver tumor segmentation network based on fused multi-scale features
  195. Systematic evaluation of clinical efficacy of CYP1B1 gene polymorphism in EGFR mutant non-small cell lung cancer observed by medical image
  196. Rehabilitation effect of intelligent rehabilitation training system on hemiplegic limb spasms after stroke
  197. A novel approach for minimising anti-aliasing effects in EEG data acquisition
  198. ErbB4 promotes M2 activation of macrophages in idiopathic pulmonary fibrosis
  199. Clinical role of CYP1B1 gene polymorphism in prediction of postoperative chemotherapy efficacy in NSCLC based on individualized health model
  200. Lung nodule segmentation via semi-residual multi-resolution neural networks
  201. Evaluation of brain nerve function in ICU patients with Delirium by deep learning algorithm-based resting state MRI
  202. A data mining technique for detecting malignant mesothelioma cancer using multiple regression analysis
  203. Markov model combined with MR diffusion tensor imaging for predicting the onset of Alzheimer’s disease
  204. Effectiveness of the treatment of depression associated with cancer and neuroimaging changes in depression-related brain regions in patients treated with the mediator-deuterium acupuncture method
  205. Molecular mechanism of colorectal cancer and screening of molecular markers based on bioinformatics analysis
  206. Monitoring and evaluation of anesthesia depth status data based on neuroscience
  207. Exploring the conformational dynamics and thermodynamics of EGFR S768I and G719X + S768I mutations in non-small cell lung cancer: An in silico approaches
  208. Optimised feature selection-driven convolutional neural network using gray level co-occurrence matrix for detection of cervical cancer
  209. Incidence of different pressure patterns of spinal cerebellar ataxia and analysis of imaging and genetic diagnosis
  210. Pathogenic bacteria and treatment resistance in older cardiovascular disease patients with lung infection and risk prediction model
  211. Adoption value of support vector machine algorithm-based computed tomography imaging in the diagnosis of secondary pulmonary fungal infections in patients with malignant hematological disorders
  212. From slides to insights: Harnessing deep learning for prognostic survival prediction in human colorectal cancer histology
  213. Ecology and Environmental Science
  214. Monitoring of hourly carbon dioxide concentration under different land use types in arid ecosystem
  215. Comparing the differences of prokaryotic microbial community between pit walls and bottom from Chinese liquor revealed by 16S rRNA gene sequencing
  216. Effects of cadmium stress on fruits germination and growth of two herbage species
  217. Bamboo charcoal affects soil properties and bacterial community in tea plantations
  218. Optimization of biogas potential using kinetic models, response surface methodology, and instrumental evidence for biodegradation of tannery fleshings during anaerobic digestion
  219. Understory vegetation diversity patterns of Platycladus orientalis and Pinus elliottii communities in Central and Southern China
  220. Studies on macrofungi diversity and discovery of new species of Abortiporus from Baotianman World Biosphere Reserve
  221. Food Science
  222. Effect of berrycactus fruit (Myrtillocactus geometrizans) on glutamate, glutamine, and GABA levels in the frontal cortex of rats fed with a high-fat diet
  223. Guesstimate of thymoquinone diversity in Nigella sativa L. genotypes and elite varieties collected from Indian states using HPTLC technique
  224. Analysis of bacterial community structure of Fuzhuan tea with different processing techniques
  225. Untargeted metabolomics reveals sour jujube kernel benefiting the nutritional value and flavor of Morchella esculenta
  226. Mycobiota in Slovak wine grapes: A case study from the small Carpathians wine region
  227. Elemental analysis of Fadogia ancylantha leaves used as a nutraceutical in Mashonaland West Province, Zimbabwe
  228. Microbiological transglutaminase: Biotechnological application in the food industry
  229. Influence of solvent-free extraction of fish oil from catfish (Clarias magur) heads using a Taguchi orthogonal array design: A qualitative and quantitative approach
  230. Chromatographic analysis of the chemical composition and anticancer activities of Curcuma longa extract cultivated in Palestine
  231. The potential for the use of leghemoglobin and plant ferritin as sources of iron
  232. Investigating the association between dietary patterns and glycemic control among children and adolescents with T1DM
  233. Bioengineering and Biotechnology
  234. Biocompatibility and osteointegration capability of β-TCP manufactured by stereolithography 3D printing: In vitro study
  235. Clinical characteristics and the prognosis of diabetic foot in Tibet: A single center, retrospective study
  236. Agriculture
  237. Biofertilizer and NPSB fertilizer application effects on nodulation and productivity of common bean (Phaseolus vulgaris L.) at Sodo Zuria, Southern Ethiopia
  238. On correlation between canopy vegetation and growth indexes of maize varieties with different nitrogen efficiencies
  239. Exopolysaccharides from Pseudomonas tolaasii inhibit the growth of Pleurotus ostreatus mycelia
  240. A transcriptomic evaluation of the mechanism of programmed cell death of the replaceable bud in Chinese chestnut
  241. Melatonin enhances salt tolerance in sorghum by modulating photosynthetic performance, osmoregulation, antioxidant defense, and ion homeostasis
  242. Effects of plant density on alfalfa (Medicago sativa L.) seed yield in western Heilongjiang areas
  243. Identification of rice leaf diseases and deficiency disorders using a novel DeepBatch technique
  244. Artificial intelligence and internet of things oriented sustainable precision farming: Towards modern agriculture
  245. Animal Sciences
  246. Effect of ketogenic diet on exercise tolerance and transcriptome of gastrocnemius in mice
  247. Combined analysis of mRNA–miRNA from testis tissue in Tibetan sheep with different FecB genotypes
  248. Isolation, identification, and drug resistance of a partially isolated bacterium from the gill of Siniperca chuatsi
  249. Tracking behavioral changes of confined sows from the first mating to the third parity
  250. The sequencing of the key genes and end products in the TLR4 signaling pathway from the kidney of Rana dybowskii exposed to Aeromonas hydrophila
  251. Development of a new candidate vaccine against piglet diarrhea caused by Escherichia coli
  252. Plant Sciences
  253. Crown and diameter structure of pure Pinus massoniana Lamb. forest in Hunan province, China
  254. Genetic evaluation and germplasm identification analysis on ITS2, trnL-F, and psbA-trnH of alfalfa varieties germplasm resources
  255. Tissue culture and rapid propagation technology for Gentiana rhodantha
  256. Effects of cadmium on the synthesis of active ingredients in Salvia miltiorrhiza
  257. Cloning and expression analysis of VrNAC13 gene in mung bean
  258. Chlorate-induced molecular floral transition revealed by transcriptomes
  259. Effects of warming and drought on growth and development of soybean in Hailun region
  260. Effects of different light conditions on transient expression and biomass in Nicotiana benthamiana leaves
  261. Comparative analysis of the rhizosphere microbiome and medicinally active ingredients of Atractylodes lancea from different geographical origins
  262. Distinguish Dianthus species or varieties based on chloroplast genomes
  263. Comparative transcriptomes reveal molecular mechanisms of apple blossoms of different tolerance genotypes to chilling injury
  264. Study on fresh processing key technology and quality influence of Cut Ophiopogonis Radix based on multi-index evaluation
  265. An advanced approach for fig leaf disease detection and classification: Leveraging image processing and enhanced support vector machine methodology
  266. Erratum
  267. Erratum to “Protein Z modulates the metastasis of lung adenocarcinoma cells”
  268. Erratum to “BRCA1 subcellular localization regulated by PI3K signaling pathway in triple-negative breast cancer MDA-MB-231 cells and hormone-sensitive T47D cells”
  269. Retraction
  270. Retraction to “Protocatechuic acid attenuates cerebral aneurysm formation and progression by inhibiting TNF-alpha/Nrf-2/NF-kB-mediated inflammatory mechanisms in experimental rats”
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