Extracorporeal shock wave therapy (ESWT) as a new adjuvant therapy has shown a potential capability to promote diabetic foot ulcer (DFU) healing. The purpose of this study was to assess the efficacy and safety of ESWT on the healing of DFUs. The Cochrane Library, PubMed, Embase, Web of Science, China Biology Medicine and reference lists were searched for studies published up to December 2018. Randomized controlled trials of any design, including ESWT for patients with DFU, were included. Two reviewers extracted data, including the wound surface area (WSA), percentage of re-epithelialization, population of complete cure and unchanged and other related outcomes. Eight randomized controlled trials (N=339) were included. ESWT was found to be associated with a greater reduction of WSA by 1.54 cm2, and increase of re-epithelialization by 26.31%. A greater population with complete cure was found at the end of treatment (risk ratio [RR] = 2.22; 95% confidence interval [CI], 1.46 to 3.40); however, there was no statistically significant difference at the end of follow up (p=0.052). It can also reduce treatment inefficiency by 4.8-fold (95% CI, 0.12 to 0.37). In addition, ESWT also showed a higher superiority than hyperbaric oxygen therapy in the population for complete cure and unchanged ulcer (RR=1.83; 95% CI, 1.14 to 2.94 and RR=0.25; 95% CI, 0.13 to 0.48, respectively). ESWT is a feasible adjuvant treatment for DFUs. It can effectively improve the complete cure rate, shorten the healing period of DFUs and significantly reduce treatment ineffectiveness. This can provide new therapeutic ideas for clinical practice of intractable and recurrent DFUs.

Background: Chronic renal failure (CRF) is a serious disease that has become a burden on global and local economics and public health. In addition, non-thyroidal illness syndrome (NTIS) has become increasingly more prevalent in CRF patients. Materials and methods: A data search was conducted on the PubMed/Medline, Cochrane Library, Web of Science, Embase, and CBM databases to identify studies up to November 1st, 2018, that compared low T3 and normal T3 levels in patients with CRF. Data analysis was done by calculating the relative risks (RR) and 95% confidence intervals (95% CI) and continuous variables were described by weighted mean difference (WMD) and 95% CI. The efficacy outcomes included renal function and mortality. The Newcastle-Ottawa Scale and Agency for Healthcare Research and Quality scale were used to assess the quality of the cohort and cross-sectional studies, respectively. A funnel plot was used to identify publication bias. Results: Seventeen studies with a total of 4593 patients were finally included in the analysis. Among the 17 studies, 11 reported the mortality of CRF patients with low T3 and normal T3 levels. Subgroups were assigned according to different follow-up times and different methods of treatment. The mortality rate in the low T3 group was much higher than in the normal T3 group. 11 studies reported creatinine (Cr) results in patients with low T3 and normal T3 levels and our analysis found no significant differences between the two groups (95%CI: 0.46-0.25; P-heterogeneity = 0.000; P = 0.559). Five studies reported uric acid results and we found no significant differences between the two groups (95%CI: 0.08-0.22; P-heterogeneity = 0.438; P = 0.377). Five studies reported the urea levels in the two groups and our analysis found no significant differences (95%CI: 1.60-1.23; I2 = 0.0%; P-heterogeneity = 0.498;P = 0.798). Conclusion: Low T3 had a greater impact on the short-term prognosis of patients with CRF than on the long-term prognosis. NTIS did not cause substantial kidney damage.