Wound healing is an extremely complex process involving multiple levels of cells and tissues. It is mainly completed through four stages: haemostasis, inflammation, proliferation, and remodelling. When any one of these stages is impaired, it may lead to delayed healing or even transformation into chronic refractory wounds. Diabetes is a kind of common metabolic disease that affects approximately 500 million people worldwide, 25% of whom develop skin ulcers that break down repeatedly and are difficult to heal, making it a growing public health problem. Neutrophils extracellular traps and ferroptosis are new types of programmed cell death identified in recent years and have been found to interact with diabetic wounds. In this paper, the normal wound healing and interfering factors of the diabetic refractory wound were outlined. The mechanism of two kinds of programmed cell death was also described, and the interaction mechanism between different types of programmed cell death and diabetic refractory wounds was discussed.
A45some point during the course of the disease. Within the latter group, stenosis was found to be the diagnosis associated with the highest total costs. ConClusions: The treatment pathway for low back pain has not been modelled in such a comprehensive manner before. However, the model demands detailed data not currently available in most countries. There is a need of further data collection to be able to provide more reliable estimates for the burden of spinal disease.
Gout is the most common and progressive arthritic condition. Its severity is assumed to have implications for the humanistic and economic burden of the illness. The objective of this study is to examine the burden of gout between patients with and without tophi using electronic health records (EHR). METHODS: The Humedica EHR database was searched starting on January 1, 2008 through February 28, 2013 for patients having an initial gout diagnosis (ICD-9 274.xx) and a confirmatory gout diagnosis at least 30 days later. Deidentified patients with enrollment from 6-months pre/12-months post initial gout diagnosis and at least one serum uric acid (SUA) level were included in the study. Patients (n= 933) with a diagnosis of tophaceous gout (274.03, 274.81, and 274.82) during the 12-months postindex period were compared to all other gout (non-tophaceous) patients (n= 45,512). Demographic characteristics and comorbidities, SUA levels, and use of colchicine for acute flares during the 12-months post-index period were compared using chisquare tests. RESULTS: Gout patients with tophi were more likely to be female (p< 0.01) and have uncontrolled (SUA= 6-8) or severely uncontrolled (SUA = > 10) SUA (p< 0.0001) than patients without tophi. Colchicine use was higher in patients with tophi (p< .0001). There were significantly higher levels of cardiovascular comorbidities in the gout patients with tophi vs those without: hypertension (p< 0.05), myocardial infarction (p< 0.01), atherosclerosis (p< 0.0001), dyslipidemia (p< 0.0001), peripheral arterial disease (p< 0.0001), congestive heart failure (p< 0.0001), chronic heart disease (p< 0.0001), cardiomyopathy(p< 0.0001), ischemic and valvular heart disease (p< 0.0001) and left ventricular hypertrophy (p< 0.001). Gout patients with tophi had higher levels of chronic kidney disease, Stages 3-5, (p< 0.0001), osteoarthritis (p< 0.0001), rheumatoid arthritis (p< 0.0001). CONCLUSIONS: Gout patients with tophi had significantly greater burden of disease and greater frequency of comorbidities than those without. Preventing the development of tophi may reduce comorbidities and frequency of colchicine use and warrants further investigation.
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