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.

Objectives Soluble urokinase plasminogen activated receptor (suPAR) is a biomarker that may predict the occurrence of focal segmental glomerulosclerosis (FSGS); however, there is still controversy about whether suPAR can predict FSGS. In this study, we performed a systematic evaluation and meta-analysis to prove whether suPAR can predict FSGS, and to detect a threshold concentration of suPAR that can be used to diagnose FSGS. In addition, a threshold concentration of suPAR for the diagnosis of FSGS was proposed. Design Systematic review and meta-analysis. Data sources We systematically searched PubMed, Embase, Cochrane Library, Web of Science and China Biology Medicine databases for studies published from the inception dates to 1 December 2018. Eligibility criteria (1) Data involving the suPAR level were from blood samples; (2) FSGS was diagnosed by biopsy; and (3) randomised controlled trials, cohort studies, case-control studies and cross-sectional studies. Data extraction and synthesis Initially, a total of 364 studies were searched, among which 29 studies were finally included. In addition, seven studies described the cut-off value of suPAR, which ranged from 2992.6 to 5500 pg/mL. Results The results showed that the suPAR levels in the primary FSGS group were significantly higher when compared with that in the normal control group (p<0.001; standard mean difference (SMD): 2.56; 95% CI 1.85 to 3.28), and significant differences were observed in the secondary FSGS and in the normal control group (p<0.001; SMD: 1.68; 95% CI 1.37 to 1.98). A suPAR concentration of 3000 pg/mL may be the best threshold for the diagnosis of primary FSGS (sensitivity=0.72; specificity=0.88; area under the curve=0.85). Conclusion Our results suggested that suPAR might be a potential biomarker for predicting primary and secondary FSGS. In addition, our data showed that a suPAR concentration of 3000 pg/mL might be used as a threshold for the diagnosis of FSGS.