The aim of this study is to determine the predictors for reulceration, reamputation and mortality in patients with diabetes following toe amputation, and the impact of activities of daily living on clinical outcomes. This prospective cohort study included 245 patients who had undergone toe amputation (202 healing and 43 non-healing) and was followed for a 5-year period. Data regarding new foot ulceration, reamputation and mortality were recorded, and the patients' activities of daily living were evaluated. The rate of wound healing was 82·4%. The rate of follow-up in the healed group was 91·6%. In years 1, 3 and 5, the cumulative incidence of patients who developed a new foot ulcer was 27·3%, 57·2% and 76·4%, respectively, leading to reamputation in 12·5%, 22·3% and 47·1%, respectively. The cumulative mortality was 5·8%, 15·1% and 32·7% at 1, 3 and 5 years, respectively. Multivariate analysis showed that GHbA1c > 9% (75 mmol/mol) was identified as an independent predictor of impaired wound healing, reulceration and reamputation. An age of >70 years was identified as an independent predictor of reamputation, mortality and impairment of activities of daily living. Despite a satisfactory initial healing rate after the first toe amputation, with the extension course after the toe amputation, the long-term outcomes are not optimistic. In developing countries like China, taking measures to prevent reulceration and reamputation is very important for patients with diabetic foot minor amputations, especially following toe amputation.

The objective was to determine multidrug-resistant organisms' (MDROs) profile in diabetic foot ulcers (DFU), antibiotic resistance of MDROs, and to find the potential risk factors for infection with MDROs. In 157 patients with DFU admitted to Tianjin Metabolic Disease Hospital, China, from January 2011 to January 2012, microbiological specimens were taken on admission. The patients were divided into 2 groups according to the infection of MDROs. Potential risk factors for MDRO-positive specimens were examined using univariate and multivariate analyses. Seventy-eight MDRO strains were isolated from patients in the MDRO+ group, among which the top 3 were Staphylococcus aureus (16.7%), Enterobacter spp (16.7%), and Pseudomonas aeruginosa (15.4%). Most of the MDROs were resistant to at least 8 kinds of commonly used antibiotics. Gram-negative MDROs showed 23% to 50% resistance to third-generation cephalosporins. The resistant rates of Gram-positive MDROs to fluoroquinolone were more than 70%; penicillin and semisynthetic penicillin were 57% to 100% resistant. Previous hospitalization (odds ratio [OR] = 3.000; 95% confidence interval [CI] = 1.100-8.182; P = .032), previous duration of antibiotic therapy (OR = 1.078; 95% CI = 1.001-1.160; P = .046), ulcer type (OR = 7.185; 95% CI = 2.115-24.408; P = .002), ulcer size (OR = 1.403; 95% CI = 1.042-1.888; P = .026), and osteomyelitis (OR = 3.390; 95% CI = 1.178-9.756; P = .024) were associated with MDRO infection in patients with DFU.

Ageing was found to be the major factor in progressive degeneration of the rotator cuff, and should be considered the single most important contributing factor in the pathogenesis of rotator cuff tears. In addition, degenerative tendonopathy appeared the primary pathology in rotator cuff tear, preceding hypertrophic spur formation. Rotator cuff tears are therefore unlikely to be initiated by impingement; rather, they develop as an intrinsic degenerative tendonopathy.

The objective was to study risk factors and gene type of DF patients infected with MRSA. A total of 429 DF patients were recruited. The patients with S aureus infections were divided into MRSA and MSSA groups. MRSA were genotyped by SCCmec. pvl and lukE-lukD were detected. A total of 559 pathogens were isolated from them, with G+ bacteria firstly(59.0%), followed G- bacilli (37.7%) and true fungi (3.3%). The 3 most frequently isolated pathogens were S aureus (35.2%), S epidermidis (12.3%), and Pseudomonas aeruginosa (11.2%). SCCmec III MRSA and SCCmec IVa MRSA had the same antibacterial spectrum. mecA positive rate was 100%. lukE-lukD and pvl positive rates were 100% and 0%, respectively. 28 strains belonged to SCCmec III and the others belonged to SCCmec IVa. The G+ cocci were the main pathogens, S aureus and S epidermidis were predominant among them. Antibiotic usage in 6 months prior to hospitalization, long course of ulcer, osteomyelitis and hypoproteinemia are risk factors for MRSA. SCCmec IVa is high in proportion to MRSA isolates, suggesting that CA-MRSA has become major pathogen of DF infection. All the MRSA were harboring lukE-lukD, which has been reported to present poor leucotoxin compared to pvl, and may be a response to atypical local inflammatory reaction in DF infection.

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