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Lee CD, Cooper R, Cooper RA. On the Move pad - a portable multipurpose pad: User feedback. J Spinal Cord Med 2024:1-8. [PMID: 38874586 DOI: 10.1080/10790268.2024.2364381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
CONTEXT/OBJECTIVE Hard-shell toilet seats may compromise safety and hinder the participation of individuals at risk for pressure injuries (PIs) when using these facilities away from home in public, hotel, or family/friend restrooms. Moreover, people often add "wash-cloths" for additional padding for comfort, and to reduce the risk of PIs due to pressure or shearing on their wheelchairs surfaces. This study investigated the utilization of portable pads, initially designed for toilet use but adaptable to various places and contexts, while examining pad usability. DESIGN A cross-sectional descriptive survey design. SETTING Inpatient care, outpatient care, and community setting. PARTICIPANTS 45 individuals at risk of PIs. RESULTS Participants extended the use of these pads beyond toilets, employing them as wheelchair armrest and leg rest pads in other settings. Feedback from a customized questionnaire indicated high levels of usefulness (8.5/10) and ease of use (9.1/10) attributed to the pads. Among the features, the top three favored were ease of use, comfort/cushioning, and function. Participants expressed a desire for a variety of sizes and colors to enable versatile usage and suggested incorporating a pocket for storing small items. CONCLUSIONS AND RELEVANCE Individuals at risk of PIs require cushioning not only on hard-shell toilet seats, but also for additional padding, protection and enhancing the use of wheelchairs. Rehabilitation professionals can play a crucial role in educating and training both clients and caregivers to understand PI prevention, enabling them to effectively leverage the pads in appropriate situations, thereby enhancing their comfort in their wheelchairs during social engagement.
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Affiliation(s)
- Chang Dae Lee
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Occupational Therapy, Indiana University Indianapolis, Indianapolis, Indiana, USA
| | - Rosemarie Cooper
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rory A Cooper
- Human Engineering Research Laboratories, US Department of Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Nasirian A, Erel V, Nuthi P, Gu Y, Allman M, Meza F, Sikka S, Wijesundara MBJ. Smart seat cushion feasibility pilot study: automated interface pressure modulation of individuals with spinal cord Injury. Disabil Rehabil Assist Technol 2024:1-10. [PMID: 38712763 DOI: 10.1080/17483107.2024.2349712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 04/22/2024] [Indexed: 05/08/2024]
Abstract
This study investigates the functionality and feasibility of a novel smart seat cushion system designed for wheelchair users with spinal cord injuries. The cushion, equipped with air cells that serve as both sensors and actuators, was tested on 24 participants for its real-time pressure mapping, automated pressure redistribution, and pressure offloading functions. A commercial pressure mat was concurrently used to validate the cushion's pressure modulation functions. Additionally, the perceived comfort of the cushion was evaluated using General Discomfort Assessment (GDA) and Discomfort Intensity (DIS) scores, which provided insights into participants' overall comfort and discomfort levels. Real-time pressure profiles generated by the cushion resembled commercial pressure mat readings. During tests with individuals with spinal cord injury, the cushion was able to dynamically generate and display the real-time pressure profile of a seated individual with strong precision (correlation to commercial pressure mat: r ranging from 0.76 to 0.88), providing effective input into pressure modulation functions. Pressure redistribution algorithms eliminated peak pressure and reduced the overall pressure at the interface. Pressure offloading algorithms automatically identified the regions with the highest interface pressure and subsequently relieved the pressure from those areas. User feedback showed that the cushion was comfortable after redistribution and offloading. This work demonstrated the feasibility of an advanced smart seat cushion system for wheelchair users with spinal cord injuries. The cushion was capable of redistributing pressure evenly across the seating surface, ensuring user's comfort. Additionally, it identifies and eliminates high-pressure points, further improving comfort and reducing the risk of pressure injuries.
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Affiliation(s)
- Aida Nasirian
- The University of TX at Arlington Research Institute, Fort Worth, TX, USA
| | - Veysel Erel
- The University of TX at Arlington Research Institute, Fort Worth, TX, USA
| | - Pavan Nuthi
- The University of TX at Arlington Research Institute, Fort Worth, TX, USA
| | - Yixin Gu
- The University of TX at Arlington Research Institute, Fort Worth, TX, USA
| | - Melissa Allman
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Faith Meza
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
| | - Seema Sikka
- Baylor Scott and White Institute for Rehabilitation, Dallas, TX, USA
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Sargent M, Wark AW, Day S, Buis A. An ex vivo animal model to study the effect of transverse mechanical loading on skeletal muscle. Commun Biol 2024; 7:302. [PMID: 38461200 PMCID: PMC10925026 DOI: 10.1038/s42003-024-05994-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/29/2024] [Indexed: 03/11/2024] Open
Abstract
In many populations like wheelchair and prosthetic users, the soft tissue is subject to excessive or repetitive loading, making it prone to Deep Tissue Injury (DTI). To study the skeletal muscle response to physical stress, numerous in vitro and in vivo models exist. Yet, accuracy, variability, and ethical considerations pose significant trade-offs. Here, we present an ex vivo approach to address these limitations and offer additional quantitative information on cellular damage. In this study, skeletal muscle tissue from Sprague Dawley rats was isolated and transversely loaded. Histological analysis and fluorescence staining demonstrated that the setup was suitable to keep the tissue alive throughout the experimental procedure. Mechanically induced cell damage was readily distinguishable through morphological changes and uptake of a membrane impermeable dye. Our comparably simple experimental setup can be adapted to different loading conditions and tissues to assess the cell response to mechanical loading in future studies.
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Affiliation(s)
- Marisa Sargent
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Alastair W Wark
- Department of Pure and Applied Chemistry, Technology and Innovation Centre, University of Strathclyde, Glasgow, United Kingdom
| | - Sarah Day
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom
| | - Arjan Buis
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, United Kingdom.
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Sundaram SA, Grindle G, Gebrosky B, Brown J, Kelleher A, Cooper R, Chung CS, Cooper RA. Classification of wheelchair pressure relief maneuvers using changes in center of pressure and weight on the seat. Disabil Rehabil Assist Technol 2023; 18:1026-1034. [PMID: 34411503 DOI: 10.1080/17483107.2021.1967472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 08/09/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pressure injuries from prolonged sitting are a significant problem for wheelchair users incurring high costs in healthcare expenditures and reducing quality-of-life. There is a need to improve pressure relief training and adherence in a variety of settings. OBJECTIVE To identify effective common wheelchair pressure relief (PR) manoeuvres based on changes to users' seated centre of pressure (CoP) and seated weight. PARTICIPANTS 20 individuals who use manual wheelchairs as their primary means of mobility. METHODS Participants performed 5 types of PR including seated push-ups, leftward, rightward, forward, and backward leans-while sitting in a wheelchair equipped with a custom instrumented seat pan support. Data were analysed using both clustering and decision tree approaches to identify types of PR. RESULTS Both clustering and decision tree approaches were able to identify and classify PR though neither could accurately distinguish between forward and backward PR. CONCLUSION Changes in the centre of pressure and the total weight on the wheelchair's seat can be used to automatically characterise type, amplitude and duration of pressure relief manoeuvres. Building such a classification and quality assessment scheme into an algorithm could enable a virtual coaching system to track users' pressure relief behaviour and make suggestions to improve adherence with clinical recommendations.IMPLICATIONS FOR REHABILITATIONMultiple bending beam load cells can be used to measure wheelchair users' seated centre of pressure independent of type of cushion used.Both cluster analysis and decision tree algorithms can classify commonly practiced pressure reliefs by measuring changes to the centre of pressure and total weight on the wheelchair's seat.The combination of force sensing for centre of pressure determination and either algorithm could serve as the basis for an application to coach wheelchair users to do effective pressure reliefs.
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Affiliation(s)
- S Andrea Sundaram
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Garrett Grindle
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Benjamin Gebrosky
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
| | - Josh Brown
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
| | - Annmarie Kelleher
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rosemarie Cooper
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Cheng-Shiu Chung
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Rory A Cooper
- Department of Veterans Affairs, Human Engineering Research Laboratories, Pittsburgh, PA, USA
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA, USA
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Sundaram SA, Chung CS, Gebrosky B, Brown J, Grindle GG, Deepak N, Cooper R, Cooper RA. Participatory action design and engineering of a manual wheelchair virtual coach including in-home and community usage. J Spinal Cord Med 2023; 46:546-559. [PMID: 35994022 PMCID: PMC10274533 DOI: 10.1080/10790268.2022.2107352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
BACKGROUND Current clinical practice guidelines (CPG) recommend periodic pressure redistribution (PR) to alter sitting pressure and reduce the risk of developing pressure injuries (PI). Individuals who have strength and trunk stability are asked to perform PR such as wheelies, leaning laterally, and forward-leaning to minimize the duration of pressure acting on the same region of the body. OBJECTIVE Our long-term objective is to build upon previous research and development to create a more effective device for improving PR training and adherence to CPG among manual wheelchair users (MWU). Through this study, we employed a participatory action design and engineering (PADE) approach in developing the hardware and user interface to increase the likelihood of eventually yielding a device effective for both MWU and clinicians. PARTICIPANTS Focus Groups: Ten clinicians - 6 physical therapists, 3 occupational therapists, and one registered nurse, and 10 MWU with spinal cord injuries (SCI) who reported using their wheelchairs 40-80 h per week. Five-Day Assessment: Five male MWU with SCI who had been wheelchair users for 18.5 ± 16.2 years. Four-Week Investigation: The 7 participants with SCI were 5 males and 2 females, who had been wheelchair users for 24.7 ± 17.0 years. METHODS A PADE approach was used to improve upon a manual wheelchair virtual coaching system for people with SCI. The system comprises a seat support instrumented with force sensors, software algorithms to detect PR, and a smart phone app for user interface. The methods included three stages: multiple focus groups, a five-day evaluation phase with participants using their own wheelchairs in their homes and communities, and a 4-week assessment with improvements made based on the 5-day results by users with their own wheelchairs in their homes and communities. RESULTS The focus groups yielded guidance for ergonomics, user interface, charging frequency, and key dimensions and mass. The 5-day study identified mechanical, electrical, and connectivity challenges, which were resolved before the 4-week study. The 4-week trial suggested that participants performed PR less frequently than clinically recommended and provided an indication of the types of maneuvers that they performed. CONCLUSION A prototype manual wheelchair virtual coaching system was developed using a PADE process. The system was able to detect and record PR in home and community environments. Following improvements identified in this study, a future version will be tested with additional users to determine whether it can improve adherence to PR guidance.
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Affiliation(s)
- S. Andrea Sundaram
- Human Engineering Research Laboratories, US Department of Veterans Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Cheng-Shiu Chung
- Human Engineering Research Laboratories, US Department of Veterans Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Benjamin Gebrosky
- Human Engineering Research Laboratories, US Department of Veterans Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joshua Brown
- Human Engineering Research Laboratories, US Department of Veterans Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Garrett G. Grindle
- Human Engineering Research Laboratories, US Department of Veterans Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nikitha Deepak
- Human Engineering Research Laboratories, US Department of Veterans Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rosemarie Cooper
- Human Engineering Research Laboratories, US Department of Veterans Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rory A. Cooper
- Human Engineering Research Laboratories, US Department of Veterans Affairs, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Mamom J, Rungroungdouyboon B, Daovisan H, Sri-Ngernyuang C. Electronic Alert Signal for Early Detection of Tissue Injuries in Patients: An Innovative Pressure Sensor Mattress. Diagnostics (Basel) 2023; 13:diagnostics13010145. [PMID: 36611437 PMCID: PMC9818190 DOI: 10.3390/diagnostics13010145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/03/2023] Open
Abstract
Monitoring the early stage of developing tissue injuries requires intact skin for surface detection of cell damage. However, electronic alert signal for early detection is limited due to the lack of accurate pressure sensors for lightly pigmented skin injuries in patients. We developed an innovative pressure sensor mattress that produces an electronic alert signal for the early detection of tissue injuries. The electronic alert signal is developed using a web and mobile application for pressure sensor mattress reporting. The mattress is based on body distributions with reference points, temperature, and a humidity sensor to detect lightly pigmented skin injuries. Early detection of the pressure sensor is linked to an electronic alert signal at 32 mm Hg, a temperature of 37 °C, a relative humidity of 33.5%, a response time of 10 s, a loading time of 30 g, a density area of 1 mA, and a resistance of 7.05 MPa (54 N) at 0.87 m3/min. The development of the innovative pressure sensor mattress using an electronic alert signal is in line with its enhanced pressure detection, temperature, and humidity sensors.
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Affiliation(s)
- Jinpitcha Mamom
- Center of Excellence in Creative Engineering Design and Development, Faculty of Engineering, Thammasat University, Pathum Thani 12121, Thailand
- Department of Adult Nursing and the Aged, Faculty of Nursing, Thammasat University, Pathum Thani 12121, Thailand
- Correspondence: (J.M.); (H.D.)
| | - Bunyong Rungroungdouyboon
- Center of Excellence in Creative Engineering Design and Development, Faculty of Engineering, Thammasat University, Pathum Thani 12121, Thailand
| | - Hanvedes Daovisan
- Human Security and Equity Centre of Excellence, Social Research Institute, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence: (J.M.); (H.D.)
| | - Chawakorn Sri-Ngernyuang
- Institute of Field Robotics, King Mongkut’s University of Technology Thonburi, Bangkok 10140, Thailand
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7
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Mukhina E, Trebbi A, Rohan PY, Connesson N, Payan Y. In vivo quantification of 3D displacement in sacral soft tissues under compression: Relevance of 2D US-based measurements for pressure ulcer risk assessment. J Tissue Viability 2022; 31:593-600. [DOI: 10.1016/j.jtv.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
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8
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Fougeron N, Connesson N, Chagnon G, Alonso T, Pasquinet L, Bahuon M, Guillin E, Perrier A, Payan Y. New pressure ulcers dressings to alleviate human soft tissues: A finite element study. J Tissue Viability 2022; 31:506-513. [DOI: 10.1016/j.jtv.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 05/11/2022] [Accepted: 05/20/2022] [Indexed: 10/18/2022]
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Lavigne T, Sciumè G, Laporte S, Pillet H, Urcun S, Wheatley B, Rohan PY. Société de Biomécanique Young Investigator Award 2021: Numerical investigation of the time-dependent stress-strain mechanical behaviour of skeletal muscle tissue in the context of pressure ulcer prevention. Clin Biomech (Bristol, Avon) 2022; 93:105592. [PMID: 35151107 DOI: 10.1016/j.clinbiomech.2022.105592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pressure-induced tissue strain is one major pathway for Pressure Ulcer development and, especially, Deep Tissue Injury. Biomechanical investigation of the time-dependent stress-strain mechanical behaviour of skeletal muscle tissue is therefore essential. In the literature, a viscoelastic formulation is generally assumed for the experimental characterization of skeletal muscles, with the limitation that the underlying physical mechanisms that give rise to the time dependent stress-strain behaviour are not known. The objective of this study is to explore the capability of poroelasticity to reproduce the apparent viscoelastic behaviour of passive muscle tissue under confined compression. METHODS Experimental stress-relaxation response of 31 cylindrical porcine samples tested under fast and slow confined compression by Vaidya and collaborators were used. An axisymmetric Finite Element model was developed in ABAQUS and, for each sample a one-to-one inverse analysis was performed to calibrate the specimen-specific constitutive parameters, namely, the drained Young's modulus, the void ratio, hydraulic permeability, the Poisson's ratio, the solid grain's and fluid's bulk moduli. FINDINGS The peak stress and consolidation were recovered for most of the samples (N=25) by the poroelastic model (normalised root-mean-square error ≤0.03 for fast and slow confined compression conditions). INTERPRETATION The strength of the proposed model is its fewer number of variables (N=6 for the proposed poroelastic model versus N=18 for the viscohyperelastic model proposed by Vaidya and collaborators). The incorporation of poroelasticity to clinical models of Pessure Ulcer formation could lead to more precise and mechanistic explorations of soft tissue injury risk factors.
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Affiliation(s)
- T Lavigne
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France; Arts et Metiers Institute of Technology, Univ. of Bordeaux, CNRS, Bordeaux INP, INRAE, I2M Bordeaux, Avenue d'Aquitaine, Pessac, 33607, France.
| | - G Sciumè
- Arts et Metiers Institute of Technology, Univ. of Bordeaux, CNRS, Bordeaux INP, INRAE, I2M Bordeaux, Avenue d'Aquitaine, Pessac, 33607, France
| | - S Laporte
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France
| | - H Pillet
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France
| | - S Urcun
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France; Arts et Metiers Institute of Technology, Univ. of Bordeaux, CNRS, Bordeaux INP, INRAE, I2M Bordeaux, Avenue d'Aquitaine, Pessac, 33607, France; Institute for Computational Engineering Sciences, Department of Engineering Sciences, Faculte des Sciences, de la Technologie et de Medecine, Universite du Luxembourg, Campus Kirchberg, 6, rue Coudenhove-Kalergi, Luxembourg, L-1359, Luxembourg
| | - B Wheatley
- Department of Mechanical Engineering, Bucknell University, 1 Dent Drive, Lewisburg 17837, PA, USA
| | - P-Y Rohan
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France
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10
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Chaturvedi P, Worsley PR, Zanelli G, Kroon W, Bader DL. Quantifying skin sensitivity caused by mechanical insults: A review. Skin Res Technol 2021; 28:187-199. [PMID: 34708455 PMCID: PMC9298205 DOI: 10.1111/srt.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Skin sensitivity (SS) is a commonly occurring response to a range of stimuli, including environmental conditions (e.g., sun exposure), chemical irritants (e.g., soaps and cosmetics), and mechanical forces (e.g., while shaving). From both industry and academia, many efforts have been taken to quantify the characteristics of SS in a standardised manner, but the study is hindered by the lack of an objective definition. METHODS A review of the scientific literature regarding different parameters attributed to the loss of skin integrity and linked with exhibition of SS was conducted. Articles included were screened for mechanical stimulation of the skin, with objective quantification of tissue responses using biophysical or imaging techniques. Additionally, studies where cohorts of SS and non-SS individuals were reported have been critiqued. RESULTS The findings identified that the structure and function of the stratum corneum and its effective barrier properties are closely associated with SS. Thus, an array of skin tissue responses has been selected for characterization of SS due to mechanical stimuli, including: transepidermal water loss, hydration, redness, temperature, and sebum index. Additionally, certain imaging tools allow quantification of the superficial skin layers, providing structural characteristics underlying SS. CONCLUSION This review proposes a multimodal approach for identification of SS, providing a means to characterise skin tissue responses objectively. Optical coherence tomography (OCT) has been suggested as a suitable tool for dermatological research with clinical applications. Such an approach would enhance the knowledge underlying the multifactorial nature of SS and aid the development of personalised solutions in medical and consumer devices.
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Affiliation(s)
- Pakhi Chaturvedi
- Philips Consumer Lifestyle B.V., Drachten, The Netherlands.,School of Health Sciences, University of Southampton, Southampton, UK
| | - Peter R Worsley
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Giulia Zanelli
- Philips Consumer Lifestyle B.V., Drachten, The Netherlands
| | - Wilco Kroon
- Philips Consumer Lifestyle B.V., Drachten, The Netherlands
| | - Dan L Bader
- School of Health Sciences, University of Southampton, Southampton, UK
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11
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Changes in Tissue Composition and Load Response After Transtibial Amputation Indicate Biomechanical Adaptation. Ann Biomed Eng 2021; 49:3176-3188. [PMID: 34580782 PMCID: PMC8671271 DOI: 10.1007/s10439-021-02858-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/20/2021] [Indexed: 12/03/2022]
Abstract
Despite the potential for biomechanical conditioning with prosthetic use, the soft tissues of residual limbs following lower-limb amputation are vulnerable to damage. Imaging studies revealing morphological changes in these soft tissues have not distinguished between superficial and intramuscular adipose distribution, despite the recognition that intramuscular fat levels indicate reduced tolerance to mechanical loading. Furthermore, it is unclear how these changes may alter tissue tone and stiffness, which are key features in prosthetic socket design. This study was designed to compare the morphology and biomechanical response of limb tissues to mechanical loading in individuals with and without transtibial amputation, using magnetic resonance imaging in combination with tissue structural stiffness. The results revealed higher adipose infiltrating muscle in residual limbs than in intact limbs (residual: median 2.5% (range 0.2–8.9%); contralateral: 1.7% (0.1–5.1%); control: 0.9% (0.4–1.3%)), indicating muscle atrophy and adaptation post-amputation. The intramuscular adipose content correlated negatively with daily socket use, although there was no association with time post-amputation. Residual limbs were significantly stiffer than intact limbs at the patellar tendon site, which plays a key role in load transfer across the limb-prosthesis interface. The tissue changes following amputation have relevance in the clinical understanding of prosthetic socket design variables and soft tissue damage risk in this vulnerable group.
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12
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Gefen A, Brienza DM, Cuddigan J, Haesler E, Kottner J. Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries. Int Wound J 2021; 19:692-704. [PMID: 34382331 PMCID: PMC8874092 DOI: 10.1111/iwj.13667] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/25/2021] [Indexed: 12/25/2022] Open
Abstract
In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up‐to‐date evidence‐based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.
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Affiliation(s)
- Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - David M Brienza
- Departments of Rehabilitation Science and Technology & Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janet Cuddigan
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Haesler
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.,Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, LaTrobe University, Melbourne, Victoria, Australia.,Australian National University Medical School, Academic Unit of General Practice, Australian National University, Canberra, ACT, Australia
| | - Jan Kottner
- Charité Center 1 for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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13
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Jobanputra RD, Hayes J, Royyuru S, Masen MA. A numerical analysis of skin-PPE interaction to prevent facial tissue injury. Sci Rep 2021; 11:16248. [PMID: 34376802 PMCID: PMC8355255 DOI: 10.1038/s41598-021-95861-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 07/29/2021] [Indexed: 12/02/2022] Open
Abstract
The use of close-fitting PPE is essential to prevent exposure to dispersed airborne matter, including the COVID-19 virus. The current pandemic has increased pressure on healthcare systems around the world, leading to medical professionals using high-grade PPE for prolonged durations, resulting in device-induced skin injuries. This study focuses on computationally improving the interaction between skin and PPE to reduce the likelihood of discomfort and tissue damage. A finite element model is developed to simulate the movement of PPE against the face during day-to-day tasks. Due to limited available data on skin characteristics and how these vary interpersonally between sexes, races and ages, the main objective of this study was to establish the effects and trends that mask modifications have on the resulting subsurface strain energy density distribution in the skin. These modifications include the material, geometric and interfacial properties. Overall, the results show that skin injury can be reduced by using softer mask materials, whilst friction against the skin should be minimised, e.g. through use of micro-textures, humidity control and topical creams. Furthermore, the contact area between the mask and skin should be maximised, whilst the use of soft materials with incompressible behaviour (e.g. many elastomers) should be avoided.
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Affiliation(s)
- Rikeen D Jobanputra
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK.
| | - Jack Hayes
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Sravani Royyuru
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Marc A Masen
- Tribology Group, Department of Mechanical Engineering, Imperial College London, London, UK
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14
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Borzdynski C, Miller C, Vicendese D, McGuiness W. Brief intermittent pressure off-loading on skin microclimate in healthy adults - A descriptive-correlational pilot study. J Tissue Viability 2021; 30:379-394. [PMID: 33893013 DOI: 10.1016/j.jtv.2021.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/21/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
AIM This study examined microclimate changes to the skin as a result of pressure over a 1 h period. The results were compared to skin parameter results following brief consecutive off-loading of pressure-prone areas. DESIGN A descriptive-correlational pilot study was undertaken. METHOD A convenience sample of 41 healthy adults aged 18-60 years was recruited. Participants engaged in four 1 h data collection sessions. The sessions were conducted in both semi-recumbent and supine positions. Measures of erythema, melanin, stratum corneum hydration, and skin temperature were taken at pressure-prone areas at baseline and after 1 h in an uninterrupted method (continuous pressure-loading) and every 10 min in an interrupted method (brief off-loading). The Corneometer and Mexameter (Courage + Khazaka Electronics GMbH, 2013) and Exergen DermaTemp DT-1001 RS Infrared Thermographic Scanner (Exergen Corporation, 2008) provided a digital appraisal of skin parameters. Intraclass correlation coefficients (ICC) were calculated to indicate test-retest reliability and absolute agreement of results between the two methods. RESULTS Strong agreement between the interrupted and uninterrupted method was observed with ICCs ranging from 0.72 to 0.99 (supine) and 0.62-0.99 (semi-recumbent). Endpoint measures tended to be higher compared to baseline measures for all skin parameters. Differences in skin parameters results by anatomical location were evident particularly for erythema and stratum corneum hydration; the elbows and heels yielded lower scores compared to the sacrum. Erythema had the most variation across methods. The supine and semi-recumbent positions had negligible effect on measured skin parameters. CONCLUSIONS Minimal variation between skin parameter results indicates that brief off-loading in the interrupted method did not significantly change the outcomes; minor shifts in positioning do not alter changes to the skin from pressure. Skin parameters varied by anatomical location and changed over a 1 h period of pressure-loading. RELEVANCE TO CLINICAL PRACTICE Biophysical techniques may be able to assist accurate assessment of skin microclimate and skin colour. As brief off-loading (interruptions) to enable skin parameter measurement does not alter skin readings, researchers can proceed with some confidence regarding the use of this protocol in future studies assessing skin parameters. This study data provides a library of cutaneous changes at pressure-prone areas of healthy adults and is expected to inform innovative approaches to pressure injury risk assessment.
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Affiliation(s)
- Caroline Borzdynski
- School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.
| | - Charne Miller
- School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Don Vicendese
- Department of Mathematics and Statistics La Trobe University, Melbourne, Victoria, Australia; Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia
| | - William McGuiness
- School of Nursing & Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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15
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Bai DL, Liu TW, Chou HL, Hsu YL. Relationship between a pressure redistributing foam mattress and pressure injuries: An observational prospective cohort study. PLoS One 2020; 15:e0241276. [PMID: 33166300 PMCID: PMC7652312 DOI: 10.1371/journal.pone.0241276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 10/12/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND PURPOSE Pressure injuries remain a significant health care issue in various settings. The purpose of this study was to examine the relationship between a pressure redistributing foam mattress (PRFM) and the development of pressure injuries. METHODS This study employed an observational prospective cohort study design. We enrolled 254 participants from the intensive care unit who were at risk of developing pressure injuries. Participants were exposed to either a nonpressure redistributing foam mattress (NPRFM), which was the standard mattress used at the study site, or a PRFM made of viscoelastic, temperature-sensitive, polyurethane memory foam. The patients' assignment to either a PRFM or NPRFM was performed upon their admission, before the study eligibility screening. The relationship between the PRFM and the development of pressure injuries was studied using a logistic regression model. RESULTS The overall incidence of pressure injuries was 5.9% (15/254) in our study, with 1.6% (2/127) for participants who used a PRFM and 10.2% (13/127) for those using a NPRFM. After adjusting for potential confounding variables, use of a PRFM was associated with an 88% reduced risk of pressure injury development (OR = 0.12, 95% CI: 0.03, 0.56, P = 0.007). The use of a PRFM also contributed to a postponed occurrence of pressure injuries by 4.2 days on average in comparison with that of a NPRFM (P = 0.041). CONCLUSIONS A PRFM is associated with a significantly reduced incidence and postponed occurrence of pressure injuries. It is recommended to use a PRFM for patients at risk of developing pressure injuries.
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Affiliation(s)
- Dorothy Li Bai
- Gerontechnology Research Center, Yuan Ze University, Taoyuan, Taiwan
| | - Tsai-Wen Liu
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Hsiu-Ling Chou
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Yeh-Liang Hsu
- Gerontechnology Research Center, Yuan Ze University, Taoyuan, Taiwan
- Mechanical Engineering Department, Yuan Ze University, Taoyuan, Taiwan
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16
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Graser M, Day S, Buis A. Exploring the role of transtibial prosthetic use in deep tissue injury development: a scoping review. BMC Biomed Eng 2020; 2:2. [PMID: 32903320 PMCID: PMC7422482 DOI: 10.1186/s42490-020-0036-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 01/07/2020] [Indexed: 12/25/2022] Open
Abstract
Background The soft tissue of the residual limb in transtibial prosthetic users encounters unique biomechanical challenges. Although not intended to tolerate high loads and deformation, it becomes a weight-bearing structure within the residuum-prosthesis-complex. Consequently, deep soft tissue layers may be damaged, resulting in Deep Tissue Injury (DTI). Whilst considerable effort has gone into DTI research on immobilised individuals, only little is known about the aetiology and population-specific risk factors in amputees. This scoping review maps out and critically appraises existing research on DTI in lower-limb prosthetic users according to (1) the population-specific aetiology, (2) risk factors, and (3) methodologies to investigate both. Results A systematic search within the databases Pubmed, Ovid Excerpta Medica, and Scopus identified 16 English-language studies. The results indicate that prosthetic users may be at risk for DTI during various loading scenarios. This is influenced by individual surgical, morphological, and physiological determinants, as well as the choice of prosthetic componentry. However, methodological limitations, high inter-patient variability, and small sample sizes complicate the interpretation of outcome measures. Additionally, fundamental research on cell and tissue reactions to dynamic loading and on prosthesis-induced alterations of the vascular and lymphatic supply is missing. Conclusion We therefore recommend increased interdisciplinary research endeavours with a focus on prosthesis-related experimental design to widen our understanding of DTI. The results have the potential to initiate much-needed clinical advances in surgical and prosthetic practice and inform future pressure ulcer classifications and guidelines.
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Affiliation(s)
- Marisa Graser
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE Scotland, UK
| | - Sarah Day
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE Scotland, UK
| | - Arjan Buis
- Department of Biomedical Engineering, University of Strathclyde, Graham Hills Building, 40 George Street, Glasgow, G1 1QE Scotland, UK
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17
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Macron A, Pillet H, Doridam J, Rivals I, Sadeghinia MJ, Verney A, Rohan PY. Is a simplified Finite Element model of the gluteus region able to capture the mechanical response of the internal soft tissues under compression? Clin Biomech (Bristol, Avon) 2020; 71:92-100. [PMID: 31707190 DOI: 10.1016/j.clinbiomech.2019.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 09/11/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Internal soft tissue strains have been shown to be one of the main factors responsible for the onset of Pressure Ulcers and to be representative of its risk of development. However, the estimation of this parameter using Finite Element (FE) analysis in clinical setups is currently hindered by costly acquisition, reconstruction and computation times. Ultrasound (US) imaging is a promising candidate for the clinical assessment of both morphological and material parameters. METHOD The aim of this study was to investigate the ability of a local FE model of the region beneath the ischium with a limited number of parameters to capture the internal response of the gluteus region predicted by a complete 3D FE model. 26 local FE models were developed, and their predictions were compared to those of the patient-specific reference FE models in sitting position. FINDINGS A high correlation was observed (R = 0.90, p-value < 0.01). A sensitivity analysis showed that the most influent parameters were the mechanical behaviour of the muscle tissues, the ischium morphology and the external mechanical loading. INTERPRETATION Given the progress of US for capturing both morphological and material parameters, these results are promising because they open up the possibility to use personalised simplified FE models for risk estimation in daily clinical routine.
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Affiliation(s)
- Aurélien Macron
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France; Univ. Grenoble Alpes, CEA, LETI, CLINATEC, MINATEC Campus, 38000 Grenoble, France
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France
| | - Jennifer Doridam
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France
| | - Isabelle Rivals
- Sorbonne Université, INSERM, UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, Paris, France; Equipe de Statistique Appliquée, ESPCI Paris, PSL Research University, Paris, France
| | - Mohammad Javad Sadeghinia
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France; School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Alexandre Verney
- CEA, LIST, Interactive Robotics Laboratory, F-91191 Gif-sur-Yvette, France
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France.
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18
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Soetens J, Worsley P, Herniman J, Langley G, Bader D, Oomens C. The expression of anaerobic metabolites in sweat and sebum from human skin subjected to intermittent and continuous mechanical loading. J Tissue Viability 2019; 28:186-193. [DOI: 10.1016/j.jtv.2019.10.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 08/19/2019] [Accepted: 10/06/2019] [Indexed: 11/16/2022]
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19
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Coyer F, Clark M, Slattery P, Thomas P, McNamara G, Edwards C, Ingleman J, Stephenson J, Ousey K. Exploring pressures, tissue reperfusion and body positioning: a pilot evaluation. J Wound Care 2019; 26:583-592. [PMID: 28976827 DOI: 10.12968/jowc.2017.26.10.583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To assess the relationship in healthy adults and critically ill patients between: patient position, body mass index (BMI), patient body temperature, interface pressure (IP) and tissue reperfusion (TR). Also to determine the relationship in critically ill patients between: Sequential Organ Failure Assessment (SOFA) score, Braden Scale score for predicting pressure injury risk, Acute Physiology and Chronic Health Evaluation II (APACHE II) severity of disease classification score, IP and TR. METHODS This study took place in a 27-bed intensive care unit (ICU) of an Australian tertiary hospital. IP and TR outcomes were measured at the sacrum and greater trochanter. Repeated measures analyses of variance (ANOVAs) and doubly multivariate repeated measures ANOVAs were conducted using peak pressure index (PPI), peak time (PT), settled time constant (STC) and normalised hyperaemic area (NHA) measures of TR as outcomes. Participant type, body mass index (BMI), Braden and APACHE II scores and patient body temperature were considered as between-groups factors and covariates. RESULTS We recruited 23 low- and high-acuity ICU patients and nine healthy adult volunteers. Not all IP readings could be obtained from ICU patients. TR readings were collected from all recruited patients, but not all TR measurements were mutually uncorrelated. Controlling for age, PPI readings differed between participant types (p=0.093), with the highest values associated with high-acuity patients and the lowest with healthy adults; the association was not substantive when controlling for age and BMI. Age was a significant variable (p=0.008), with older participants having higher scores than younger ones. No statistically significant associations between any measured parameter and TR variables were observed. However, temperature was revealed to be related to TR (p=0.091). CONCLUSIONS Although not powered to detect significant effects, this pilot analysis has determined several associations of importance, with differences in outcomes observed between low- and high-acuity ICU patients; and between ICU patients and healthy volunteers.
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Affiliation(s)
- F Coyer
- Professor of Nursing, Joint appointment, Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia; School of Nursing, Faculty of Health, Queensland University of Technology, Herston, Queensland, Australia; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
| | - M Clark
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - P Slattery
- Director, Department of Rehabilitation Engineering, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - P Thomas
- Consultant Physiotherapist, Department of Physiotherapy, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - G McNamara
- Clinical Nurse, Intensive Care Services, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - C Edwards
- Senior Lecturer and Course Coordinator (Graduate Diploma) Medical Ultrasound, School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - J Ingleman
- MAdvPracticeCritCare, Research Assistant, School of Nursing, Faculty of Health, Queensland University of Technology, Herston, Queensland, Australia
| | - J Stephenson
- Senior Lecturer Biomedical Statistics, School of Human and Health Sciences, University of Huddersfield, UK
| | - K Ousey
- Professor and Director/Adjunct Associate Professor, School of Nursing, Faculty of Health, Queensland University of Technology, Institute of Skin Integrity and Infection Prevention, University of Huddersfield, UK
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20
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Design and operation verification of an automated pressure mapping and modulating seat cushion for pressure ulcer prevention. Med Eng Phys 2019; 69:17-27. [DOI: 10.1016/j.medengphy.2019.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/22/2019] [Accepted: 06/06/2019] [Indexed: 01/28/2023]
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21
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Linking microvascular collapse to tissue hypoxia in a multiscale model of pressure ulcer initiation. Biomech Model Mechanobiol 2019; 18:1947-1964. [PMID: 31203488 DOI: 10.1007/s10237-019-01187-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/05/2019] [Indexed: 12/27/2022]
Abstract
Pressure ulcers are devastating injuries that disproportionately affect the older adult population. The initiating factor of pressure ulcers is local ischemia, or lack of perfusion at the microvascular level, following tissue compression against bony prominences. In turn, lack of blood flow leads to a drop in oxygen concentration, i.e, hypoxia, that ultimately leads to cell death, tissue necrosis, and disruption of tissue continuity. Despite our qualitative understanding of the initiating mechanisms of pressure ulcers, we are lacking quantitative knowledge of the relationship between applied pressure, skin mechanical properties as well as structure, and tissue hypoxia. This gap in our understanding is, at least in part, due to the limitations of current imaging technologies that cannot simultaneously image the microvascular architecture, while quantifying tissue deformation. We overcome this limitation in our work by combining realistic microvascular geometries with appropriate mechanical constitutive models into a microscale finite element model of the skin. By solving boundary value problems on a representative volume element via the finite element method, we can predict blood volume fractions in response to physiological skin loading conditions (i.e., shear and compression). We then use blood volume fraction as a homogenized variable to couple tissue-level skin mechanics to an oxygen diffusion model. With our model, we find that moderate levels of pressure applied to the outer skin surface lead to oxygen concentration contours indicative of tissue hypoxia. For instance, we show that applying a pressure of 60 kPa at the skin surface leads to a decrease in oxygen partial pressure from a physiological value of 65 mmHg to a hypoxic level of 31 mmHg. Additionally, we explore the sensitivity of local oxygen concentration to skin thickness and tissue stiffness, two age-related skin parameters. We find that, for a given pressure, oxygen concentration decreases with decreasing skin thickness and skin stiffness. Future work will include rigorous calibration and validation of this model, which may render our work an important tool toward developing better prevention and treatment tools for pressure ulcers specifically targeted toward the older adult patient population.
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22
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Nelissen JL, Sinkus R, Nicolay K, Nederveen AJ, Oomens CW, Strijkers GJ. Magnetic resonance elastography of skeletal muscle deep tissue injury. NMR IN BIOMEDICINE 2019; 32:e4087. [PMID: 30897280 PMCID: PMC6593838 DOI: 10.1002/nbm.4087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 05/31/2023]
Abstract
The current state-of-the-art diagnosis method for deep tissue injury in muscle, a subcategory of pressure ulcers, is palpation. It is recognized that deep tissue injury is frequently preceded by altered biomechanical properties. A quantitative understanding of the changes in biomechanical properties preceding and during deep tissue injury development is therefore highly desired. In this paper we quantified the spatial-temporal changes in mechanical properties upon damage development and recovery in a rat model of deep tissue injury. Deep tissue injury was induced in nine rats by two hours of sustained deformation of the tibialis anterior muscle. Magnetic resonance elastography (MRE), T2 -weighted, and T2 -mapping measurements were performed before, directly after indentation, and at several timepoints during a 14-day follow-up. The results revealed a local hotspot of elevated shear modulus (from 3.30 ± 0.14 kPa before to 4.22 ± 0.90 kPa after) near the center of deformation at Day 0, whereas the T2 was elevated in a larger area. During recovery there was a clear difference in the time course of the shear modulus and T2 . Whereas T2 showed a gradual normalization towards baseline, the shear modulus dropped below baseline from Day 3 up to Day 10 (from 3.29 ± 0.07 kPa before to 2.68 ± 0.23 kPa at Day 10, P < 0.001), followed by a normalization at Day 14. In conclusion, we found an initial increase in shear modulus directly after two hours of damage-inducing deformation, which was followed by decreased shear modulus from Day 3 up to Day 10, and subsequent normalization. The lower shear modulus originates from the moderate to severe degeneration of the muscle. MRE stiffness values were affected in a smaller area as compared with T2 . Since T2 elevation is related to edema, distributing along the muscle fibers proximally and distally from the injury, we suggest that MRE is more specific than T2 for localization of the actual damaged area.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Biomedical Engineering and Physics, Academic Medical CenterAmsterdamThe Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical CenterAmsterdamThe Netherlands
| | - Ralph Sinkus
- Image Sciences & Biomedical Engineering, King's College LondonLondonUK
| | - Klaas Nicolay
- Biomedical NMR, Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical CenterAmsterdamThe Netherlands
| | - Cees W.J. Oomens
- Soft Tissue Engineering and Mechanobiology, Biomedical EngineeringEindhoven University of TechnologyThe Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical CenterAmsterdamThe Netherlands
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23
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Myoglobin and troponin concentrations are increased in early stage deep tissue injury. J Mech Behav Biomed Mater 2019; 92:50-57. [DOI: 10.1016/j.jmbbm.2018.12.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 12/27/2022]
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24
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Song J, Wang Y, Yuan X, Ji Q, Fan C, Zhao H, Hao W, Ren D. Stretching magnitude-dependent inactivation of AKT by ROS led to enhanced p53 mitochondrial translocation and myoblast apoptosis. Mol Biol Cell 2019; 30:1182-1197. [PMID: 30865562 PMCID: PMC6724521 DOI: 10.1091/mbc.e18-12-0770] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Previously, we had shown that high magnitude stretch (HMS), rather than low magnitude stretch (LMS), induced significant apoptosis of skeletal muscle C2C12 myoblasts. However, the molecular mechanism remains obscure. In this study, we found that p53 protein accumulated in the nucleus of LMS-loaded cells, whereas it translocated into mitochondria of HMS-loaded cells. Knocking down endogenous p53 by shRNA abrogated HMS-induced apoptosis. Furthermore, we demonstrated that overaccumulation of reactive oxygen species (ROS) during HMS-inactivated AKT that was activated in LMS-treated cells, which accounted for the distinct p53 subcellular localizations under HMS and LMS. Blocking ROS generation by N-acetylcysteine (NAC) or overexpressing constitutively active AKT vector (CA-AKT) inhibited HMS-incurred p53 mitochondrial translocation and promoted its nuclear targeting. Moreover, both NAC and CA-AKT significantly attenuated HMS-induced C2C12 apoptosis. Finally, we found that Ser389 phosphorylation of p53 was a downstream event of ROS-inactivated AKT pathway, which was critical to p53 mitochondrial trafficking during HMS stimuli. Transfecting p53-shRNA C2C12s with the mutant p53 (S389A) that was unable to target p53 to mitochondria underwent significantly lower apoptosis than transfection with wild-type p53. Altogether, our study uncovered that mitochondrial localization of p53, resulting from p53 Ser389 phosphorylation through ROS-inactivated AKT pathway, prompted C2C12 myoblast apoptosis during HMS stimulation.
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Affiliation(s)
- Jing Song
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Central Laboratory of Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Department of Orthodontics, School of Stomatology, Qingdao University, Qingdao, China
| | - Yaqi Wang
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Central Laboratory of Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Department of Orthodontics, School of Stomatology, Qingdao University, Qingdao, China
| | - Xiao Yuan
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Department of Orthodontics, School of Stomatology, Qingdao University, Qingdao, China
| | - Qiuxia Ji
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Central Laboratory of Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Cunhui Fan
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Central Laboratory of Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Hongmei Zhao
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Central Laboratory of Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Wenjing Hao
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Central Laboratory of Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Dapeng Ren
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Department of Orthodontics, School of Stomatology, Qingdao University, Qingdao, China
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25
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Traa WA, van Turnhout MC, Nelissen JL, Strijkers GJ, Bader DL, Oomens CWJ. There is an individual tolerance to mechanical loading in compression induced deep tissue injury. Clin Biomech (Bristol, Avon) 2019; 63:153-160. [PMID: 30897463 DOI: 10.1016/j.clinbiomech.2019.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deep tissue injury is a type of pressure ulcer which originates subcutaneously due to sustained mechanical loading. The relationship between mechanical compression and damage development has been extensively studied in 2D. However, recent studies have suggested that damage develops beyond the site of indentation. The objective of this study was to compare mechanical loading conditions to the associated damage in 3D. METHODS An indentation test was performed on the tibialis anterior muscle of rats (n = 39). Changes in the form of oedema and structural damage were monitored with MRI in an extensive region. The internal deformations were evaluated using MRI based 3D finite element models. FINDINGS Damage propagates away from the loaded region. The 3D analysis indicates that there is a subject specific tolerance to compression induced deep tissue injury. INTERPRETATION Individual tolerance is an important factor when considering the mechanical loading conditions which induce damage.
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Affiliation(s)
- Willeke A Traa
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Mark C van Turnhout
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jules L Nelissen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dan L Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Cees W J Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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26
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Soetens J, Worsley P, Bader D, Oomens C. Investigating the influence of intermittent and continuous mechanical loading on skin through non-invasive sampling of IL-1α. J Tissue Viability 2019; 28:1-6. [DOI: 10.1016/j.jtv.2018.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 11/15/2018] [Accepted: 12/31/2018] [Indexed: 12/14/2022]
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Traa WA, van Turnhout MC, Moerman KM, Nelissen JL, Nederveen AJ, Strijkers GJ, Bader DL, Oomens CWJ. MRI based 3D finite element modelling to investigate deep tissue injury. Comput Methods Biomech Biomed Engin 2018; 21:760-769. [DOI: 10.1080/10255842.2018.1517868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Willeke A. Traa
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Mark C. van Turnhout
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Kevin M. Moerman
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Jules L. Nelissen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Gustav J. Strijkers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Dan L. Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Cees W. J. Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Macron A, Pillet H, Doridam J, Verney A, Rohan PY. Development and evaluation of a new methodology for the fast generation of patient-specific Finite Element models of the buttock for sitting-acquired deep tissue injury prevention. J Biomech 2018; 79:173-180. [PMID: 30201252 DOI: 10.1016/j.jbiomech.2018.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 06/17/2018] [Accepted: 08/10/2018] [Indexed: 01/11/2023]
Abstract
The occurrence and management of Pressure Ulcers remain a major issue for patients with reduced mobility and neurosensory loss despite significant improvement in the prevention methods. These injuries are caused by biological cascades leading from a given mechanical loading state in tissues to irreversible tissue damage. Estimating the internal mechanical conditions within loaded soft tissues has the potential of improving the management and prevention of PU. Several Finite Element models of the buttock have therefore been proposed based on either MRI or CT-Scan data. However, because of the limited availability of MRI or CT-Scan systems and of the long segmentation time, all studies in the literature include the data of only one individual. Yet the inter-individual variability can't be overlooked when dealing with patient specific estimation of internal tissue loading. As an alternative, this contribution focuses on the combined use of low-dose biplanar X-ray images, B-mode ultrasound images and optical scanner acquisitions in a non-weight-bearing sitting posture for the fast generation of patient-specific FE models of the buttock. Model calibration was performed based on Ischial Tuberosity sagging. Model evaluation was performed by comparing the simulated contact pressure with experimental observations on a population of 6 healthy subjects. Analysis of the models confirmed the high inter-individual variability of soft tissue response (maximum Green Lagrange shear strains of 213 ± 101% in the muscle). This methodology opens the way for investigating inter-individual factors influencing the soft tissue response during sitting and for providing tools to assess PU risk.
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Affiliation(s)
- Aurélien Macron
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France; Univ. Grenoble Alpes, CEA, LETI, CLINATEC, MINATEC Campus, 38000 Grenoble, France.
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France
| | - Jennifer Doridam
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France
| | - Alexandre Verney
- CEA, LIST, Interactive Robotics Laboratory, F-91191 Gif-sur-Yvette, France
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, 151 bd de l'Hôpital, 75013 Paris, France
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Doridam J, Macron A, Vergari C, Verney A, Rohan PY, Pillet H. Feasibility of sub-dermal soft tissue deformation assessment using B-mode ultrasound for pressure ulcer prevention. J Tissue Viability 2018; 27:238-243. [PMID: 30195464 DOI: 10.1016/j.jtv.2018.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 07/15/2018] [Accepted: 08/10/2018] [Indexed: 10/28/2022]
Abstract
Pressure Ulcer (PU) prevention remains a main public health issue. The physio-pathology of this injury is not fully understood, and a satisfactory therapy is currently not available. Recently, several works suggested that mechanical strains are responsible of deformation-induced damage involved in the initiation of Deep Tissue Injury (DTI). A better assessment of the internal behavior could allow to enhance the modeling of the transmission of loads into the different structures composing the buttock. A few studies focused on the experimental in vivo buttock deformation quantification using Magnetic Resonance Imaging (MRI), but its use has important drawbacks. In clinical practice, ultrasound imaging is an accessible, low cost, and real-time technic to study the soft tissue. The objective of the present work was to show the feasibility of using B-mode ultrasound imaging for the quantification of localised soft-tissue strains of buttock tissues during sitting. An original protocol was designed, and the intra-operator reliability of the method was assessed. Digital Image Correlation was used to compute the displacement field of the soft tissue of the buttock during a full realistic loading while sitting. Reference data of the strains in the frontal and sagittal planes under the ischium were reported for a population of 7 healthy subjects. The average of shear strains over the region of interest in the fat layer reached levels up to 117% higher than the damage thresholds previously quantified for the muscular tissue in rats. In addition, the observation of the muscles displacements seems to confirm previous results which already reported the absence of muscular tissue under the ischium in the seated position, questioning the assumption commonly made in Finite Element modeling that deep tissue injury initiates in the muscle underlying the bone.
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Affiliation(s)
- J Doridam
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France; Department of Anatomy, University Paris XIII, UFR Santé Médecine Biologie Humaine, Bobigny, France.
| | - A Macron
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France; CEA, LIST, Interactive Robotics Laboratory, F-91191, Gif-sur-Yvette, France
| | - C Vergari
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - A Verney
- CEA, LIST, Interactive Robotics Laboratory, F-91191, Gif-sur-Yvette, France
| | - P-Y Rohan
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
| | - H Pillet
- Arts et Métiers ParisTech, LBM/Institut de Biomécanique Humaine Georges Charpak, 151 bd de l'Hôpital, 75013, Paris, France
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30
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Song J, Zhang Q, Wang S, Yang F, Chen Z, Dong Q, Ji Q, Yuan X, Ren D. Cleavage of caspase-12 at Asp94, mediated by endoplasmic reticulum stress (ERS), contributes to stretch-induced apoptosis of myoblasts. J Cell Physiol 2018; 233:9473-9487. [PMID: 29943814 DOI: 10.1002/jcp.26840] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 05/03/2018] [Indexed: 12/25/2022]
Abstract
Mechanical overloading can lead to skeletal muscle damage instead of remodeling. This is attributed to the excessive apoptosis of myoblasts, mechanism of which remains to be elucidated. The present study aimed to investigate the involvement of endoplasmic reticulum stress (ERS) and caspase-12 in mediating the stretch-induced apoptosis of myoblasts. Myoblast apoptosis was evaluated by Hoechst staining, DNA fragmentation assay, Annexin V binding, and propidium iodide staining, as well as caspase-3 and poly-ADP-ribose polymerase 1 cleavage. First, our results showed that apoptosis was elevated in a time-dependent manner when myoblasts were subjected to cyclic mechanical stretch (CMS) for 12, 24, and 36 hr. Concomitantly, CMS triggered the ERS and caspase-12 cleavage; ERS inhibitor GSK 2606414 suppressed the CMS-induced cleavage of caspase-12 and myoblast apoptosis. Silencing caspase-12 attenuated the apoptosis of myoblasts under CMS. Furthermore, CMS-induced myoblast apoptosis was partially recovered by overexpressing wild-type caspase-12 in caspase-12-silenced myoblasts. In contrast, overexpressing mutant caspase-12 (D94N), which cannot be cleaved into the active caspase-12 fragments, failed to accomplish the same effect. Finally, C2C12 overexpressing truncated caspase-12 segment (TC-casp12-D94), which starts from Asp94 and ends at Asn419, underwent apoptosis under both static and stretched conditions. Interestingly, C2C12 myoblasts seemed to be resistant to stretch-induced apoptosis upon low-serum-induced differentiation. In conclusion, our study provided evidence that caspase-12 cleavage at Asp94, induced by ERS under mechanical stimuli, is the key molecule in initiating the stretch-triggered apoptosis of myoblasts.
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Affiliation(s)
- Jing Song
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Department of Central Laboratory, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Qiang Zhang
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Department of Central Laboratory, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Shuai Wang
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Department of Central Laboratory, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Fang Yang
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Zhenggang Chen
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Quanjiang Dong
- Department of Central Laboratory, Qingdao Municipal Hospital, Qingdao University, Qingdao, China
| | - Qiuxia Ji
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Xiao Yuan
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China
| | - Dapeng Ren
- Department of Stomatology Medical Center, Affiliated Hospital of Qingdao University, Qingdao University, Qingdao, China.,Department of Orthodontics, School of Stomatology, Qingdao University, Qingdao, China
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31
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Nelissen JL, Traa WA, de Boer HH, de Graaf L, Mazzoli V, Savci-Heijink CD, Nicolay K, Froeling M, Bader DL, Nederveen AJ, Oomens CWJ, Strijkers GJ. An advanced magnetic resonance imaging perspective on the etiology of deep tissue injury. J Appl Physiol (1985) 2018; 124:1580-1596. [DOI: 10.1152/japplphysiol.00891.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Early diagnosis of deep tissue injury remains problematic due to the complicated and multifactorial nature of damage induction and the many processes involved in damage development and recovery. In this paper, we present a comprehensive assessment of deep tissue injury development and remodeling in a rat model by multiparametric magnetic resonance imaging (MRI) and histopathology. The tibialis anterior muscle of rats was subjected to mechanical deformation for 2 h. Multiparametric in vivo MRI, consisting of T2, T2*, mean diffusivity (MD), and angiography measurements, was applied before, during, and directly after indentation as well as at several time points during a 14-day follow-up. MRI readouts were linked to histological analyses of the damaged tissue. The results showed dynamic change in various MRI parameters, reflecting the histopathological status of the tissue during damage induction and repair. Increased T2 corresponded with edema, muscle cell damage, and inflammation. T2* was related to tissue perfusion, hemorrhage, and inflammation. MD increase and decrease was reported on the tissue’s microstructural integrity and reflected muscle degeneration and edema as well as fibrosis. Angiography provided information on blockage of blood flow during deformation. Our results indicate that the effects of a single damage-causing event of only 2 h of deformation were present up to 14 days. The initial tissue response to deformation, as observed by MRI, starts at the edge of the indentation. The quantitative MRI readouts provided distinct and complementary information on the extent, temporal evolution, and microstructural basis of deep tissue injury-related muscle damage. NEW & NOTEWORTHY We have applied a multiparametric MRI approach linked to histopathology to characterize damage development and remodeling in a rat model of deep tissue injury. Our approach provided several relevant insights in deep tissue injury. Response to damage, as observed by MRI, started at some distance from the deformation. Damage after a single indentation period persisted up to 14 days. The MRI parameters provided distinct and complementary information on the microstructural basis of the damage.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Willeke A. Traa
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hans H. de Boer
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Larry de Graaf
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Valentina Mazzoli
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Orthopedic Research Laboratory, Radboud UMC, Nijmegen, The Netherlands
| | | | - Klaas Nicolay
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dan L. Bader
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Cees W. J. Oomens
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
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32
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Bader DL, Worsley PR. Technologies to monitor the health of loaded skin tissues. Biomed Eng Online 2018; 17:40. [PMID: 29650012 PMCID: PMC5897925 DOI: 10.1186/s12938-018-0470-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/24/2018] [Indexed: 01/18/2023] Open
Abstract
There are many situations where the skin and underlying soft tissues are compromised by mechanical loading in the form or pressure, or pressure in combination with shear. If sustained, this can lead to damage in the tissues particularly adjacent to bony prominences, resulting in chronic wounds. An array of bioengineering technologies have been adopted to assess the integrity of loaded soft tissues. This paper aims to review these approaches for the quantification, simulation and early detection of mechanically-induced skin damage. The review considers different measurements at the interface between the skin and support surface/medical device, involving pressure, shear, friction and the local microclimate. The potential of the techniques to monitor the physiological response of the skin to these external stimuli including biophysical measurement devices and sampling of biofluids are critically analysed. In addition, it includes an analysis of medical imaging technologies and computational modelling to provide a means by which tissue deformation can be quantified and thresholds for tissue damage defined. Bioengineering measurement and imaging technologies have provided an insight into the temporal status of loaded skin. Despite the advances in technology, to date, the translation to clinical tools which are robust and cost effective has been limited. There is a need to adapt existing technologies and simulation platforms to enable patients, carers and clinicians to employ appropriate intervention strategies to minimise soft tissue damage.
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Affiliation(s)
- Dan L Bader
- Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Peter R Worsley
- Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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Padhye NS, Bergstrom N, Rapp MP, Etcher L, Redeker NS. Pressure ulcer risk detection from complexity of activity. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2017; 2017:2304-2307. [PMID: 29060358 DOI: 10.1109/embc.2017.8037316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Activity levels in nursing home residents were measured with accelerometers over one week as part of a multicenter randomized controlled trial, and complexity of the resulting activity patterns were characterized. Among 813 study participants on whom activity data had been collected, 16 participants developed pressure ulcers by the end of the study. The fractal dimension D0 of the activity series was lower (p=0.039) in residents who developed pressure ulcers than in controls matched on the basis of race, randomization group, score on the Braden scale, and diagnoses of cardiovascular disease and dementia. Hurst exponents indicated that the scaling of the power spectrum was close to 1/f in pressure ulcer cases. At timescales exceeding 30 minutes, approximate entropy tended to be higher in the controls than in the pressure ulcer cases. The fractal structure of the activity time series and its information content offer the ability to predict higher risk of development of pressure ulcers in nursing home residents.
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Behforootan S, Chatzistergos PE, Chockalingam N, Naemi R. A Simulation of the Viscoelastic Behaviour of Heel Pad During Weight-Bearing Activities of Daily Living. Ann Biomed Eng 2017; 45:2750-2761. [DOI: 10.1007/s10439-017-1918-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/06/2017] [Indexed: 11/24/2022]
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Oliveira AL, Moore Z, O Connor T, Patton D. Accuracy of ultrasound, thermography and subepidermal moisture in predicting pressure ulcers: a systematic review. J Wound Care 2017; 26:199-215. [PMID: 28475447 DOI: 10.12968/jowc.2017.26.5.199] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Our aims were to: establish the clinical significance of ultrasound, thermography, photography and subepidermal moisture (SEM) measurement; determine the accuracy of ultrasound, thermography, photography and SEM measurement in detecting skin/tissue damage; determine the relative accuracy of one of these assessment methods over another; make recommendations for practice pertaining to assessment of early skin/tissue damage. METHOD The following databases, Cochrane Wounds Group Specialised Register, The Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid EMBASE, Elsevier version, EBSCO CINAHL, ClinicalTrials.gov , WHO International Clinical Trials Registry (ICTR) and The EU Clinical Trials Register were searched for terms including; thermography, ultrasound, subepidermal moisture, photograph and pressure ulcer. RESULTS We identified four SEM, one thermography and five ultrasound studies for inclusion in this review. Data analysis indicated that photography was not a method which allowed for the early prediction of PU presence. SEM values increased with increasing tissue damage, with the sacrum and the heels being the most common anatomical locations for the development of erythema and stage I PUs. Thermography identified temperature changes in tissues and skin that may give an indication of early PU development; however the data were not sufficiently robust. Ultrasound detected pockets of fluid/oedema at different levels of the skin that were comparable with tissue damage. Thus, SEM and ultrasound were the best methods for allowing a more accurate assessment of early skin/tissue damage. Using the EBL Critical Appraisal Tool the overall validities of the studies varied between 33.3-55.6%, meaning that there is potential for bias within all the included studies. All of the studies were situated at level IV, V and VII of the evidence pyramid. Although the methodological quality of the studies warrants consideration, these studies showed the potential that SEM and ultrasound have in early PU detection. CONCLUSION SEM and ultrasound are promising in the detection and prediction of early tissue damage and PU presence. However, these methods should be further studied to clarify their potential for use more widely in PU prevention strategies.
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Affiliation(s)
- A L Oliveira
- Royal College of Surgeons in Ireland Dublin, Dublin Ireland
| | - Z Moore
- Royal College of Surgeons in Ireland Dublin, Dublin Ireland
| | - T O Connor
- Royal College of Surgeons in Ireland Dublin, Dublin Ireland
| | - D Patton
- Royal College of Surgeons in Ireland Dublin, Dublin Ireland
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36
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Dickinson A, Steer J, Worsley P. Finite element analysis of the amputated lower limb: A systematic review and recommendations. Med Eng Phys 2017; 43:1-18. [DOI: 10.1016/j.medengphy.2017.02.008] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 01/18/2023]
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Kane A, Warwaruk-Rogers R, Ho C, Chan M, Stein R, Mushahwar VK, Dukelow SP. A Feasibility Study of Intermittent Electrical Stimulation to Prevent Deep Tissue Injury in the Intensive Care Unit. Adv Wound Care (New Rochelle) 2017; 6:115-124. [PMID: 28451468 DOI: 10.1089/wound.2016.0686] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 04/25/2016] [Indexed: 12/29/2022] Open
Abstract
Objective: The primary goal of this study was to investigate the feasibility of utilizing intermittent electrical stimulation (IES) in an intensive care environment as a potential method for preventing pressure ulcers. Furthermore, we wished to evaluate the practicality of the innovation and end-user acceptability. Approach: Twenty immobile subjects, age ranging from 19 to 86 years old with a Braden Scale score ranging from 9 to 16 (very high to moderate risk of developing pressure ulcers), were enrolled. Intermittent 35 Hz electrical stimulation was administered through surface electrodes to the gluteal muscles causing them to contract for 10 s every 10 min. Subjects utilized IES on a program that increased from 4 to 24 h per day over 8 days and lasted up to a maximum of 4 weeks. Results: Bedside nurses reported that IES was simple to use, took an average of 6 min to apply, and 2 min to remove. Furthermore, IES could be easily incorporated into routine patient care. No pressure ulcers occurred in any subject during the study. No untoward reactions or adverse events had occurred directly as a result of IES. Innovation: IES represents a potential method of preventing bedsores. This study represents a necessary pilot study, investigating safety and feasibility before proceeding with a larger randomized controlled trial to determine efficacy. Conclusion: Our results suggest that IES is both safe and feasible to implement in intensive care units.
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Affiliation(s)
- Angela Kane
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Robyn Warwaruk-Rogers
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Ming Chan
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Alberta, Canada
| | - Richard Stein
- Department of Physiology, University of Alberta, Alberta, Canada
| | - Vivian K. Mushahwar
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Alberta, Canada
| | - Sean P. Dukelow
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
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38
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Nelissen JL, de Graaf L, Traa WA, Schreurs TJL, Moerman KM, Nederveen AJ, Sinkus R, Oomens CWJ, Nicolay K, Strijkers GJ. A MRI-Compatible Combined Mechanical Loading and MR Elastography Setup to Study Deformation-Induced Skeletal Muscle Damage in Rats. PLoS One 2017; 12:e0169864. [PMID: 28076414 PMCID: PMC5226723 DOI: 10.1371/journal.pone.0169864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 12/23/2016] [Indexed: 02/01/2023] Open
Abstract
Deformation of skeletal muscle in the proximity of bony structures may lead to deep tissue injury category of pressure ulcers. Changes in mechanical properties have been proposed as a risk factor in the development of deep tissue injury and may be useful as a diagnostic tool for early detection. MRE allows for the estimation of mechanical properties of soft tissue through analysis of shear wave data. The shear waves originate from vibrations induced by an external actuator placed on the tissue surface. In this study a combined Magnetic Resonance (MR) compatible indentation and MR Elastography (MRE) setup is presented to study mechanical properties associated with deep tissue injury in rats. The proposed setup allows for MRE investigations combined with damage-inducing large strain indentation of the Tibialis Anterior muscle in the rat hind leg inside a small animal MR scanner. An alginate cast allowed proper fixation of the animal leg with anatomical perfect fit, provided boundary condition information for FEA and provided good susceptibility matching. MR Elastography data could be recorded for the Tibialis Anterior muscle prior to, during, and after indentation. A decaying shear wave with an average amplitude of approximately 2 μm propagated in the whole muscle. MRE elastograms representing local tissue shear storage modulus Gd showed significant increased mean values due to damage-inducing indentation (from 4.2 ± 0.1 kPa before to 5.1 ± 0.6 kPa after, p<0.05). The proposed setup enables controlled deformation under MRI-guidance, monitoring of the wound development by MRI, and quantification of tissue mechanical properties by MRE. We expect that improved knowledge of changes in soft tissue mechanical properties due to deep tissue injury, will provide new insights in the etiology of deep tissue injuries, skeletal muscle damage and other related muscle pathologies.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Larry de Graaf
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Willeke A. Traa
- Soft Tissue Biomechanics and Engineering, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Tom J. L. Schreurs
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Kevin M. Moerman
- Center for Extreme Bionics, Media lab, MIT, Cambridge, MA, United States of America
| | - Aart J. Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ralph Sinkus
- Image Sciences & Biomedical Engineering, King’s College London, London, United Kingdom
| | - Cees W. J. Oomens
- Soft Tissue Biomechanics and Engineering, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
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Moore Z, Patton D, Rhodes SL, O'Connor T. Subepidermal moisture (SEM) and bioimpedance: a literature review of a novel method for early detection of pressure-induced tissue damage (pressure ulcers). Int Wound J 2016; 14:331-337. [PMID: 27126794 PMCID: PMC7949650 DOI: 10.1111/iwj.12604] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 03/21/2016] [Accepted: 03/29/2016] [Indexed: 02/03/2023] Open
Abstract
Current detection of pressure ulcers relies on visual and tactile changes at the skin surface, but physiological changes below the skin precede surface changes and have a significant impact on tissue health. Inflammatory and apoptotic/necrotic changes in the epidermal and dermal layers of the skin, such as changes in interstitial fluid (also known as subepidermal moisture (SEM)), may precede surface changes by 3–10 days. Those same epidermal and subepidermal changes result in changes in the electrical properties (bioimpedance) of the tissue, thereby presenting an objective, non‐invasive method for assessing tissue damage. Clinical studies of bioimpedance for the detection of pressure ulcers have demonstrated that changes in bioimpedance correlate with increasing severity of pressure ulcer stages. Studies have also demonstrated that at anatomical locations with pressure ulcers, bioimpedance varies with distance from the centre of the pressure ulcers. The SEM Scanner, a handheld medical device, offers an objective and reliable method for the assessment of local bioimpedance, and therefore, assessment of tissue damage before signs become visible to the unaided eye. This literature review summarises pressure ulcer pathophysiology, principles of bioimpedance and clinical research using bioimpedance technology to assess pressure ulcers.
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Affiliation(s)
- Zena Moore
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Declan Patton
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Tom O'Connor
- Royal College of Surgeons in Ireland, Dublin, Ireland
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Norman G, Dumville JC, Moore ZEH, Tanner J, Christie J, Goto S. Antibiotics and antiseptics for pressure ulcers. Cochrane Database Syst Rev 2016; 4:CD011586. [PMID: 27040598 PMCID: PMC6486293 DOI: 10.1002/14651858.cd011586.pub2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pressure ulcers, also known as bedsores, decubitus ulcers and pressure injuries, are localised areas of injury to the skin or the underlying tissue, or both. A range of treatments with antimicrobial properties, including impregnated dressings, are widely used in the treatment of pressure ulcers. A clear and current overview is required to facilitate decision making regarding use of antiseptic or antibiotic therapies in the treatment of pressure ulcers. This review is one of a suite of Cochrane reviews investigating the use of antiseptics and antibiotics in different types of wounds. It also forms part of a suite of reviews investigating the use of different types of dressings and topical treatments in the treatment of pressure ulcers. OBJECTIVES To assess the effects of systemic and topical antibiotics, and topical antiseptics on the healing of infected and uninfected pressure ulcers being treated in any clinical setting. SEARCH METHODS In October 2015 we searched: the Cochrane Wounds Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), Ovid MEDLINE, Ovid MEDLINE (In-Process & Other Non-Indexed Citations), Ovid EMBASE, and EBSCO CINAHL Plus. We also searched three clinical trials registries and the references of included studies and relevant systematic reviews. There were no restrictions based on language or date of publication or study setting. SELECTION CRITERIA Randomised controlled trials which enrolled adults with pressure ulcers of stage II or above were included in the review. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS We included 12 trials (576 participants); 11 had two arms and one had three arms. All assessed topical agents, none looked at systemic antibiotics. The included trials assessed the following antimicrobial agents: povidone iodine, cadexomer iodine, gentian violet, lysozyme, silver dressings, honey, pine resin, polyhexanide, silver sulfadiazine, and nitrofurazone with ethoxy-diaminoacridine. Comparators included a range of other dressings and ointments without antimicrobial properties and alternative antimicrobials. Each comparison had only one trial, participant numbers were low and follow-up times short. The evidence varied from moderate to very low quality.Six trials reported the primary outcome of wound healing. All except one compared an antiseptic with a non-antimicrobial comparator. There was some moderate and low quality evidence that fewer ulcers may heal in the short term when treated with povidone iodine compared with non-antimicrobial alternatives (protease-modulating dressings (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.62 to 0.98) and hydrogel (RR 0.64, 95% CI 0.43 to 0.97)); and no clear difference between povidone iodine and a third non-antimicrobial treatment (hydrocolloid) (low quality evidence). Pine resin salve may heal more pressure ulcers than hydrocolloid (RR 2.83, 95% CI 1.14 to 7.05) (low quality evidence). There is no clear difference between cadexomer iodine and standard care, and between honey a combined antiseptic and antibiotic treatment (very low quality evidence).Six trials reported adverse events (primary safety outcome). Four reported no adverse events; there was very low quality evidence from one showing no clear evidence of a difference between cadexomer iodine and standard care; in one trial it was not clear whether data were appropriately reported.There was limited reporting of secondary outcomes. The five trials that reported change in wound size as a continuous outcome did not report any clear evidence favouring any particular antiseptic/anti-microbial treatments. For bacterial resistance, one trial found some evidence of more MRSA eradication in participants with ulcer treated with a polyhexanide dressing compared with a polyhexanide swab (RR 1.48, 95% CI 1.02 to 2.13); patients in the dressing group also reported less pain (MD -2.03, 95% CI -2.66 to -1.40). There was no clear evidence of a difference between interventions in infection resolution in three other comparisons. Evidence for secondary outcomes varied from moderate to very low quality; where no GRADE assessment was possible we identified substantial limitations which an assessment would have taken into account. AUTHORS' CONCLUSIONS The relative effects of systemic and topical antimicrobial treatments on pressure ulcers are not clear. Where differences in wound healing were found, these sometimes favoured the comparator treatment without antimicrobial properties. The trials are small, clinically heterogenous, generally of short duration, and at high or unclear risk of bias. The quality of the evidence ranges from moderate to very low; evidence on all comparisons was subject to some limitations.
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Affiliation(s)
- Gill Norman
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Jo C Dumville
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Zena EH Moore
- Royal College of Surgeons in IrelandSchool of Nursing & Midwifery123 St. Stephen's GreenDublinIrelandD2
| | - Judith Tanner
- University of NottinghamSchool of Health SciencesQueens Medical CentreNottinghamUKNG7 2HA
| | - Janice Christie
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthJean McFarlane BuildingOxford RoadManchesterUKM13 9PL
| | - Saori Goto
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
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O'Connor T, Moore ZEH, Dumville JC, Patton D. Patient and lay carer education for preventing pressure ulceration in at-risk populations. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd012006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Tom O'Connor
- Royal College of Surgeons in Ireland; School of Nursing & Midwifery; 123 St Stephen’s Green Dublin Ireland
| | - Zena EH Moore
- Royal College of Surgeons in Ireland; School of Nursing & Midwifery; 123 St Stephen’s Green Dublin Ireland
| | - Jo C Dumville
- University of Manchester; School of Nursing, Midwifery and Social Work; Manchester UK M13 9PL
| | - Declan Patton
- Royal College of Surgeons in Ireland; School of Nursing & Midwifery; 123 St Stephen’s Green Dublin Ireland
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Schäfer G, Dobos G, Lünnemann L, Blume-Peytavi U, Fischer T, Kottner J. Using ultrasound elastography to monitor human soft tissue behaviour during prolonged loading: A clinical explorative study. J Tissue Viability 2015; 24:165-72. [DOI: 10.1016/j.jtv.2015.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 06/14/2015] [Accepted: 06/18/2015] [Indexed: 01/25/2023]
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Nemunaitis G, Roach MJ, Boulet M, Nagy JA, Kaufman B, Mejia M, Hefzy MS. The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization. Assist Technol 2015; 27:9-17. [PMID: 26132220 DOI: 10.1080/10400435.2014.940473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Sacral pressure ulcers are a significant problem following spinal cord injury and are felt to be in part due to the high interface-pressures generated while strapped to the spine board. The objective of this study was to determine sacral interface-pressure and sensing area in healthy volunteers on a spine board and the effects of a gel pressure dispersion liner. Thirty-seven volunteers were placed on a pressure-sensing mat between the subject and the spine board. Measurements were carried out with and without a gel liner. Pressures and sensing area were recorded every minute for 40 minutes. The highest pressure was generated at the sacral prominence of each subject. Mean interface-pressures were higher on the spine board alone than with the gel liner (p < .0001). Overall, mean sensing area was lower on the spine board than with the gel liner (p < .0001). Standard spinal immobilization causes high sacral interface-pressures. The addition of a gel liner on the spine board decreased overall mean sacral pressures and increased mean sensing area. Generation of sacral pressure ulcers may be related to the initial interface-pressures generated while the patient is strapped to the spine board. The addition of a gel liner may reduce the incidence of sacral pressure ulcers.
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Affiliation(s)
- Greg Nemunaitis
- a MetroHealth Rehabilitation Institute of Ohio , Cleveland , Ohio , USA
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Al-Dirini RMA, Reed MP, Thewlis D. Deformation of the gluteal soft tissues during sitting. Clin Biomech (Bristol, Avon) 2015; 30:662-8. [PMID: 26032324 DOI: 10.1016/j.clinbiomech.2015.05.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 04/23/2015] [Accepted: 05/14/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Excessive deformation of soft tissues is considered to be one of the major contributing factors to discomfort and injury for individuals who sit for long periods of time. Soft tissue deformation in research has been measured under the assumption that tissues deform uniaxially below the ischium, with very small or negligible deformations taking place in other directions. Therefore, this study describes the deformation of the gluteus maximus muscle and surrounding fat tissues in the buttock region for seated subjects. METHODS In vivo measurements of the deformation for the gluteal soft tissues were obtained from MRI scans of six seated subjects. Each subject was scanned in weight-bearing and non-weight-bearing sitting postures using a Positional MRI scanner (Fonar 0.6 Tesla Indomitable™). Deformations were measured below the ischium and the proximal femur. Deformation of the gluteus maximus was also measured in the distal direction along the thigh for each subject. FINDINGS Our data suggest that soft tissues undergo three-dimensional deformation with considerable components below the ischium (mean of 21.4mm) and in the distal direction along the thigh (mean of 20.3mm). Differences in muscle deformation below the ischium were also observed between obese (mean of 27.4mm) and non-obese subjects (mean of 16.5mm). INTERPRETATION Findings of this study demonstrate that tissue deformations in sitting include complex three-dimensional motions that are not well approximated by two-dimensional models.
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Affiliation(s)
- Rami M A Al-Dirini
- School of Computer Science, Engineering and Mathematics, Flinders University, Adelaide, SA 5001, Australia; School of Engineering, University of South Australia, Adelaide, SA 5001, Australia.
| | - Matthew P Reed
- University of Michigan Transportation Research Institute, University of Michigan, Ann Arbor, MI 48109, USA
| | - Dominic Thewlis
- Sansom Institute for Health Research, Division of Health Sciences, University of South Australia, Adelaide, SA 5001, Australia
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3D anatomy and deformation of the seated buttocks. J Tissue Viability 2015; 24:51-61. [DOI: 10.1016/j.jtv.2015.03.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/12/2015] [Accepted: 03/23/2015] [Indexed: 11/23/2022]
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Norman G, Dumville JC, Moore ZEH, Tanner J, Christie J. Antibiotics and antiseptics for pressure ulcers. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [DOI: 10.1002/14651858.cd011586] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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A Review of the Role of the Partial Pressure of Carbon Dioxide in Mechanically Loaded Tissues: The Canary in the Cage Singing in Tune with the Pressure Ulcer Mantra. Ann Biomed Eng 2014; 43:336-47. [DOI: 10.1007/s10439-014-1233-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 12/17/2014] [Indexed: 10/24/2022]
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Coleman S, Nixon J, Keen J, Wilson L, McGinnis E, Dealey C, Stubbs N, Farrin A, Dowding D, Schols JMGA, Cuddigan J, Berlowitz D, Jude E, Vowden P, Schoonhoven L, Bader DL, Gefen A, Oomens CWJ, Nelson EA. A new pressure ulcer conceptual framework. J Adv Nurs 2014; 70:2222-34. [PMID: 24684197 PMCID: PMC4263098 DOI: 10.1111/jan.12405] [Citation(s) in RCA: 232] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2014] [Indexed: 11/26/2022]
Abstract
AIM This paper discusses the critical determinants of pressure ulcer development and proposes a new pressure ulcer conceptual framework. BACKGROUND Recent work to develop and validate a new evidence-based pressure ulcer risk assessment framework was undertaken. This formed part of a Pressure UlceR Programme Of reSEarch (RP-PG-0407-10056), funded by the National Institute for Health Research. The foundation for the risk assessment component incorporated a systematic review and a consensus study that highlighted the need to propose a new conceptual framework. DESIGN Discussion Paper. DATA SOURCES The new conceptual framework links evidence from biomechanical, physiological and epidemiological evidence, through use of data from a systematic review (search conducted March 2010), a consensus study (conducted December 2010-2011) and an international expert group meeting (conducted December 2011). IMPLICATIONS FOR NURSING A new pressure ulcer conceptual framework incorporating key physiological and biomechanical components and their impact on internal strains, stresses and damage thresholds is proposed. Direct and key indirect causal factors suggested in a theoretical causal pathway are mapped to the physiological and biomechanical components of the framework. The new proposed conceptual framework provides the basis for understanding the critical determinants of pressure ulcer development and has the potential to influence risk assessment guidance and practice. It could also be used to underpin future research to explore the role of individual risk factors conceptually and operationally. CONCLUSION By integrating existing knowledge from epidemiological, physiological and biomechanical evidence, a theoretical causal pathway and new conceptual framework are proposed with potential implications for practice and research.
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Affiliation(s)
- Susanne Coleman
- Leeds Institute of Clinical Trials Research, University of Leeds, UK
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Kasuya A, Sakabe JI, Tokura Y. Potential application of in vivo imaging of impaired lymphatic duct to evaluate the severity of pressure ulcer in mouse model. Sci Rep 2014; 4:4173. [PMID: 24566895 PMCID: PMC3933905 DOI: 10.1038/srep04173] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Accepted: 02/05/2014] [Indexed: 11/23/2022] Open
Abstract
Ischemia-reperfusion (IR) injury is a cause of pressure ulcer. However, a mechanism underlying the IR injury-induced lymphatic vessel damage remains unclear. We investigated the alterations of structure and function of lymphatic ducts in a mouse cutaneous IR model. And we suggested a new method for evaluating the severity of pressure ulcer. Immunohistochemistry showed that lymphatic ducts were totally vanished by IR injury, while blood vessels were relatively preserved. The production of harmful reactive oxygen species (ROS) was increased in injured tissue. In vitro study showed a high vulnerability of lymphatic endothelial cells to ROS. Then we evaluated the impaired lymphatic drainage using an in vivo imaging system for intradermally injected indocyanine green (ICG). The dysfunction of ICG drainage positively correlated with the severity of subsequent cutaneous changes. Quantification of the lymphatic duct dysfunction by this imaging system could be a useful strategy to estimate the severity of pressure ulcer.
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Affiliation(s)
- Akira Kasuya
- Department of Dermatology, Hamamatsu University School of Medicine, Japan
| | - Jun-ichi Sakabe
- Department of Dermatology, Hamamatsu University School of Medicine, Japan
| | - Yoshiki Tokura
- Department of Dermatology, Hamamatsu University School of Medicine, Japan
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