Objective: To investigate independent risk factors for lower extremity amputation (LEA) in hospitalized patients with diabetic foot ulcers ( DFUs) . Methods: A multicenter retrospective analysis was conducted on the clinical data of 329 DFUs hospitalized patients with diabetic foot ulcers from four general hospitals across the na⁃tion. A multivariate Logistic regression model was constructed , and prediction analysis was performed using R 4. 2. 1 . The discriminative ability of the model was assessed using receiver operating characteristic curves , while calibration accuracy and clinical applicability were evaluated via calibration curves and decision curve analysis. Results : The study revealed that patients with higher education backgrounds showed lower disease severity (Wagnergrade) (Z = - 4. 331 , P < 0. 05) . A history of amputation , pre⁃existing lower extremity vascular disease , abnormal dorsalis pedis artery pulsation , and a history of coronary heart disease were significantly associated with the severity of DFUs , resulting in higher Wagner scores (P < 0. 05) . In the amputation prognosis analysis , prolonged duration of diabetes and elevated white blood cell count were positively correlated with amputation risk ( both P < 0. 01) .Multivariable regression identified non⁃higher education , low hemoglobin levels , decreased total cholesterol , and abnormally elevated platelet counts as independent risk factors for high Wagner grades ( ≥ grade 3 ) ( all P <0. 05) . The integrated predictive model incorporating these factors demonstrated strong discriminative performance ,with an area under curve of 0. 880 (95% CI: 0. 801 - 0. 960) . The calibration curve slope approached the ideal value , and decision curve analysis confirmed the model ′s clinical net benefit within a threshold probability range of 10% - 65% . Conclusion Lower education level , poor baseline nutritional status , infection , hypercoagulability ,and underlying vascular diseases collectively constitute key factors contributing to elevated amputation risk in DFUs patients. The developed predictive model exhibits high accuracy and may assist clinicians in formulating individual⁃ized intervention strategies.

Objective:To observe the effectiveness and safety of pars plana vitrectomy (PPV) combined with inner limiting membrane (ILM) removal and 41G microneedle subretinal injection of balanced salt solution (BSS) in the treatment of refractory macular hole.Methods:A prospective clinical study. From January to June 2023, 20 cases (20 eyes) of refractory macular hole patients diagnosed through examination at The Affiliated Eye Hospital of Nanchang University were included in the study. The basal diameter of the affected eye's basal diameter (BD) was >1 000 μm. Macular hole index (MHI) was <0.5. The affected eye received treatment with 23G PPV combined with ILM removal and 41G microneedle subretinal injection of BSS. Best corrected visual acuity (BCVA), microperimetry, and optical coherence tomography angiography (OCTA) were performed before and 1, 2, 3, and 6 months after surgery for the affected eye. BCVA examination was performed using standard logarithmic visual acuity chart, and convert it to logarithmic minimum resolution angle (logMAR) visual acuity for statistical purposes. MP-3 microperimetry was used for micro view examination, record the mean sensitivity (MS) of the retinal within a 12° range of the fovea. OCTA was used to measure the area of the avascular zone of the macula (FAZ), perimeter of the FAZ (PERIM), retinal vascular length density (VLD), and vascular perfusion density (VPD). The changes in BCVA, MS, FAZ area, PERIM, VLD, VPD before and after surgery were compared and analyzed. After the same time, the closure of macular hole and the occurrence of complications after surgery were observed. Single factor analysis of variance was used to compare the observation indicators at different times before and after surgery. The correlation between various observation indicators and preoperative minimum diameter (MD), BD, and hiatus height at 6 months after surgery were analyzed using Pearson correlation analysis.Results:Among the 20 cases with 20 eyes, there were 2 males with 2 eyes and 18 females with 18 eyes. Age was (61.45±8.56) years old. The logMAR BCVA, MS, FAZ area, PERIM, VLD, and VPD of the affected eye were 1.46±0.21, (16.20±5.81) dB、(0.40±0.17) mm 2, (2.89±0.99) mm, (6.23±3.59) mm -1, (0.17±0.10)%, respectively. Six months after surgery, out of 20 eyes, macular hole closure and incomplete closure were 18 (90.0%, 18/20) and 2 (10.0%, 2/20) eyes, respectively. The logMAR BCVA, MS, FAZ area, PERIM, VLD, and VPD were 0.80±0.20, (22.20±4.60) dB, (0.18±0.10) mm 2, (1.83±0.80) mm, (9.54±2.88) mm -1, (0.31±0.14)%. Compared with before surgery, the differences were statistically significant ( P<0.05). The correlation analysis results showed a positive correlation ( P<0.05) between preoperative BD and postoperative 6-month PERIM and VPD. There was a negative correlation between preoperative MD and postoperative VLD at 6 months ( P<0.05). There was a negative correlation between preoperative MHI and logMAR BCVA and VPD at 6 months after surgery ( P<0.05). No complications such as elevated or decreased intraocular pressure, damage to retinal pigment epithelium, retinal hemorrhage, endophthalmitis, or retinal detachment occurred after surgery in all affected eyes. Conclusion:Minimally invasive PPV combined with ILM removal and 41G microneedle subretinal injection of BSS can effectively improve the closure rate of refractory macular hole patients in the short term, improve vision, and have good safety.