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Determinants of Success After Metatarsal Head Resection for the Treatment of Neuropathic Diabetic Foot Ulcers.

跖骨头切除术治疗神经性糖尿病足溃疡成功的决定因素。

  • 影响因子:1.16
  • DOI:10.1053/j.jfas.2019.06.009
  • 作者列表:"Kalantar Motamedi A","Kalantar Motamedi MA
  • 发表时间:2020-06-09
Abstract

:Metatarsal head resection (MHR) is an effective option for the treatment of nonhealing neuropathic diabetic foot ulcers. The present study aimed to identify factors that predict treatment success for neuropathic diabetic foot ulcers undergoing metatarsal head resection. In this prospective interventional case series, 30 consecutive diabetic patients with documented nonischemic neuropathic plantar diabetic foot ulcers beneath the metatarsal head who underwent MHR were included. The study endpoint was demographic indicators of early and late postoperative outcomes. Patients were followed up for 1 to 66 months (mean 37.6 months). Except for 1 patient, all subjects' wounds (96.6%) healed after metatarsal head resection within an average of 35 days. One of the operated patients (3.4%) suffered short-term complications; long-term complications occurred in 23.3% of the patients. One patient (3.4%) experienced ulcer recurrence, 3 patients (10%) developed wound infection, and transfer lesions occurred in 3 other patients (10%) during the follow-up period. Using 3 estimators including ordinary least squares (OLS), White's heteroscedastic standard errors, and bootstrapping procedure, we could not find any statistically significant demographic feature related to ulcer healing. Using regression modeling, we could not find any evidence for a role of age, sex, weight, height, BMI, duration of ulcer until MHR, and duration of diabetes mellitus (years since diabetes diagnosis) affecting the outcome of MHR. Hence, demographic features, duration of ulcer until MHR, and years with diabetes did not affect the outcome of MHR. In conclusion, the authors believe that MHR will have a high rate of success for neuropathic wound healing in this specific subset of patients regardless of demographic features, as long as there is no ischemia to impair healing by secondary intention.

摘要

: 跖骨头切除术 (MHR) 是治疗不愈合的神经性糖尿病足溃疡的有效选择。本研究旨在确定预测接受跖骨头切除术的神经性糖尿病足溃疡治疗成功的因素。在这个前瞻性介入病例系列中,纳入了 30 例连续糖尿病患者,这些患者在跖骨头下有记录的非缺血性神经性足底糖尿病足溃疡,他们接受了 MHR。研究终点是术后早期和晚期结局的人口统计学指标。随访 1 ~ 66 个月,平均 37.6 个月。除 1 例患者外,所有受试者的伤口 (96.6%) 均在平均 35 天内跖骨头切除后愈合。1 例手术患者 (3.4%) 发生短期并发症; 23.3% 的患者发生长期并发症。1 例 (3.4%) 患者发生溃疡复发,3 例 (10%) 患者发生伤口感染,其他 3 例 (10%) 患者在随访期间发生转移病灶。使用包括普通最小二乘法 (OLS) 、 White 的异方差标准误差和自举程序在内的 3 个估计量,我们找不到任何与溃疡愈合相关的统计学显著的人口统计学特征。使用回归模型,我们找不到年龄、性别、体重、身高、 BMI 、溃疡持续时间的任何证据,直到 MHR,和糖尿病的持续时间 (自糖尿病诊断以来的几年) 影响 MHR 的结果。因此,人口统计学特征、溃疡至 MHR 的持续时间和糖尿病患病年限不影响 MHR 的结局。总之,作者认为,无论人口统计学特征如何,MHR 在这一特定患者子集中的神经性伤口愈合成功率都很高,只要没有缺血损害愈合的次要意图。

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关键词: 暂无
翻译标题与摘要 下载文献
影响因子:19.14
发表时间:2020-01-01
来源期刊:Nature Medicine
DOI:10.1038/s41591-019-0724-8
作者列表:["Artzi, Nitzan Shalom","Shilo, Smadar","Hadar, Eran","Rossman, Hagai","Barbash-Hazan, Shiri","Ben-Haroush, Avi","Balicer, Ran D.","Feldman, Becca","Wiznitzer, Arnon","Segal, Eran"]

METHODS:Leveraging the availability of nationwide electronic health records from over 500,000 pregnancies in Israel, a machine-learning approach offers an alternative means of predicting gestational diabetes at high accuracy in the early stages of pregnancy. Gestational diabetes mellitus (GDM) poses increased risk of short- and long-term complications for mother and offspring^ 1 – 4 . GDM is typically diagnosed at 24–28 weeks of gestation, but earlier detection is desirable as this may prevent or considerably reduce the risk of adverse pregnancy outcomes^ 5 , 6 . Here we used a machine-learning approach to predict GDM on retrospective data of 588,622 pregnancies in Israel for which comprehensive electronic health records were available. Our models predict GDM with high accuracy even at pregnancy initiation (area under the receiver operating curve (auROC) = 0.85), substantially outperforming a baseline risk score (auROC = 0.68). We validated our results on both a future validation set and a geographical validation set from the most populated city in Israel, Jerusalem, thereby emulating real-world performance. Interrogating our model, we uncovered previously unreported risk factors, including results of previous pregnancy glucose challenge tests. Finally, we devised a simpler model based on just nine questions that a patient could answer, with only a modest reduction in accuracy (auROC = 0.80). Overall, our models may allow early-stage intervention in high-risk women, as well as a cost-effective screening approach that could avoid the need for glucose tolerance tests by identifying low-risk women. Future prospective studies and studies on additional populations are needed to assess the real-world clinical utility of the model.

关键词: 暂无
翻译标题与摘要 下载文献
影响因子:4.34
发表时间:2020-01-27
DOI:10.1128/AAC.01777-19
作者列表:["Lowes DJ","Hevener KE","Peters BM"]

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