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Glaucoma is the second leading cause of global blindness. The etiology of glaucoma is complicated. In addition to elevated intraocular pressure (IOP), several other mechanisms have been implicated in pathogenesis, such as oxidative stress and systemic inflammation. Serum albumin (ALB) and bilirubin (BIL) have been reported to have potent antioxidant properties and contribute to maintain redox homeostasis in various diseases. However, associations between these parameters and glaucoma remain mostly unknown. Here, we conducted a retrospective case-control study, revealing that serum ALB, total BIL (TBIL), and indirect BIL (IBIL) levels were markedly lower in glaucoma patients than those in healthy controls. Furthermore, the neutrophil-to-ALB (NAR), neutrophil-to-TBIL (NTBR), and neutrophil-to-IBIL (NIBR) ratios were greatly higher in glaucoma. Additionally, interestingly, lower ALB and BIL levels and higher NAR, NTBR, and NIBR were associated with severer glaucomatous visual impairment, and NAR, NTBR, and NIBR showed good accuracy as diagnostic tests for glaucoma severity, suggesting these indices might be useful as discriminative biomarkers for disease severity. Our current findings demonstrate associations between ALB, BIL, NAR, NTBR, NIBL, and glaucoma. It might be useful to use NAR, NTBR, and NIBR as predictive markers for disease severity and employ ALB/BIL as alternative therapy or adjuvant medicines in glaucoma patients.

The study aims to develop and assess and validate a brief diabetic foot ulceration risk checklist among diabetic patients through a longitudinal study. Patients who had diabetes mellitus and had no foot ulceration and severe systematic disorders were recruited from eleven tertiary hospitals in nine provinces or municipalities of China. Internal consistency reliability, construct validity, concurrent validity, item property, and measurement invariance of the tool were assessed. The predictive capability of the tool was validated by the follow-up data using the receiver operating characteristic curve. At baseline, 477 valid cases were collected. Twelve items were remained after initial selection. Cronbach’s alpha was 0.56. Confirmatory factor analysis showed that the model had acceptable goodness-of-fit yet local dependency between two items. Item response theory showed that most items had acceptable discrimination and difficulty parameters. Differential item functioning showed that tool had measurement invariance. 278 were followed up one year after the baseline. Follow-up showed that one-year incidence of ulceration among the patients was 3.6%, and the area under the receiver operating characteristic curve was 0.77 (95% confidence interval: 0.61–0.93). The cut-off point of the tool was 4, when sensitivity and specificity were 0.62 and 0.75 respectively. The checklist has good psychometric properties according to mixed evidences from classical and modern test theory, and has good predictive capability.