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Ren Y, Wang H, Song X, Wu Y, Lyu Y, Zeng W. Advancements in diabetic foot insoles: a comprehensive review of design, manufacturing, and performance evaluation. Front Bioeng Biotechnol 2024; 12:1394758. [PMID: 39076210 PMCID: PMC11284111 DOI: 10.3389/fbioe.2024.1394758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 05/24/2024] [Indexed: 07/31/2024] Open
Abstract
The escalating prevalence of diabetes has accentuated the significance of addressing the associated diabetic foot problem as a major public health concern. Effectively offloading plantar pressure stands out as a crucial factor in preventing diabetic foot complications. This review comprehensively examines the design, manufacturing, and evaluation strategies employed in the development of diabetic foot insoles. Furthermore, it offers innovative insights and guidance for enhancing their performance and facilitating clinical applications. Insoles designed with total contact customization, utilizing softer and highly absorbent materials, as well as incorporating elliptical porous structures or triply periodic minimal surface structures, prove to be more adept at preventing diabetic foot complications. Fused Deposition Modeling is commonly employed for manufacturing; however, due to limitations in printing complex structures, Selective Laser Sintering is recommended for intricate insole designs. Preceding clinical implementation, in silico and in vitro testing methodologies play a crucial role in thoroughly evaluating the pressure-offloading efficacy of these insoles. Future research directions include advancing inverse design through machine learning, exploring topology optimization for lightweight solutions, integrating flexible sensor configurations, and innovating new skin-like materials tailored for diabetic foot insoles. These endeavors aim to further propel the development and effectiveness of diabetic foot management strategies. Future research avenues should explore inverse design methodologies based on machine learning, topology optimization for lightweight structures, the integration of flexible sensors, and the development of novel skin-like materials specifically tailored for diabetic foot insoles. Advancements in these areas hold promise for further enhancing the effectiveness and applicability of diabetic foot prevention measures.
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Affiliation(s)
- Yuanfei Ren
- The First Department of Hand and Foot Surgery, Central Hospital of Dalian University of Technology, Dalian, China
| | - Hao Wang
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Xiaoshuang Song
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Yanli Wu
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
| | - Yongtao Lyu
- Department of Engineering Mechanics, School of Mechanics and Aerospace Engineering, Dalian University of Technology, Dalian, China
- DUT-BSU Joint Institute, Dalian University of Technology, Dalian, China
| | - Wei Zeng
- Department of Mechanical Engineering, New York Institute of Technology, New York, NY, United States
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Thakku Sivakumar D, Murray B, Moore Z, Patton D, O'Connor T, Avsar P. Can thermography predict diabetic foot ulcer risk in patients with diabetes mellitus? A systematic review. J Tissue Viability 2024:S0965-206X(24)00093-7. [PMID: 39025743 DOI: 10.1016/j.jtv.2024.06.018] [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: 01/26/2024] [Revised: 05/13/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND There is a growing prevalence of diabetic foot ulcers (DFUs) in patients with diabetes mellitus and the use of thermography has sparked interest in a non-invasive diagnostic method for early DFU risk assessment and management. AIM This systematic review aims to assess the use of thermography in predicting diabetic foot ulcer risk in patients with diabetes mellitus. METHODS A systematic search of publications using MEDLINE, CINAHL, and Cochrane databases was conducted in April 2023, and relevant articles were reviewed. Data was extracted and a narrative synthesis was undertaken. The evidence-based librarianship (EBL) checklist assessed the methodological quality of the studies included. Reviewing these articles to the primary and secondary outcomes of this literature review. The primary outcome focused on the predictive capabilities of thermography for DFU prediction, while the secondary outcome assessed the feasibility, usability, and effectiveness of thermography. RESULTS Eight studies were conducted from 1994 to 2021 with an emphasis on the predictability of thermography in predicting DFU risk. All eight studies focused on temperature variations associated with DFU development. Six of the included studies compared the effectiveness of DFU occurrence in diabetic patients and non-DFU use. The overall results showed that employing thermography in DFU prevention might allow for early detection and intervention, offering a non-invasive and effective means to reduce the risk of DFU development and its associated complications in patients with diabetes mellitus. CONCLUSION The systematic review indicates that thermography holds promise for predicting DFU risk, with studies showcasing predictive capabilities and patient benefits. Despite some challenges and limitations, the evidence suggests thermography's value in assessing DFU risk in diabetes patients, warranting further research on device types and locations.
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Affiliation(s)
- Divyeshz Thakku Sivakumar
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland.
| | - Bridget Murray
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
| | - Zena Moore
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Department of Public Health, Faculty of Medicine and Health Sciences, Ghent University, Belgium; Lida Institute, Shanghai, China; University of Wales, Cardiff, UK; National Health and Medical Research Council Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Queensland, Australia; Honorary Senior Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia.
| | - Declan Patton
- School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia; Honorary Senior Fellow, Faculty of Science, Medicine and Health, University of Wollongong, Australia.
| | - Tom O'Connor
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Fakeeh College of Health Sciences, Jeddah, Saudi Arabia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Lida Institute, Shanghai, China.
| | - Pinar Avsar
- School of Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; School of Nursing and Midwifery, RCSI University of Medicine and Health Sciences, Dublin, Ireland; Skin Wounds and Trauma Research Centre, RCSI University of Medicine and Health Sciences, Dublin, Ireland.
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Rezaei S, Imani R. Highly Absorbent Egg White/Carbomer-940 Hydrofilm as a Potential Diabetic Wound Dressing. Macromol Biosci 2024; 24:e2300353. [PMID: 37939368 DOI: 10.1002/mabi.202300353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 10/20/2023] [Indexed: 11/10/2023]
Abstract
Diabetic foot ulcer (DFU) is the most critical problem in diabetic patients. Managing exudate in this kind of wound presents significant challenges in clinics. Advanced wound dressings serve as the most effective approach to managing DFU. Herein, a highly absorbent hydrofilm is presented through a combination of egg white (EW) and Carbomer-940, benefiting from the bioactivity of the EW component and superabsorption capacity of Carbomer-940. The crystallinity of samples rises due to the presence of Carbomer-940. Regarding the high water absorption capacity of Carbomer-940, the swelling ratio and water-holding capacity of samples are also improved via its incorporation of up to 1005%. In contrast, the transmission of water vapor and in vitro degradation rate decreases as Carbomer-940 powers the crystallinity of hydrofilms. Carbomer-940 incorporation in the EW structure accelerates protein release during the time, while this acceleration is partially compensated by the crystallization effect. The cell viability assay demonstrates no toxicity as well as high human foreskin fibroblast cell proliferation for the hybrid hydrofilm sample, where the cell migration is positively affected in the presence of the bioactive components extracted from the dressing. Taken together, the optimized hybrid hydrofilm could be suggested as a promising wound dressing for managing DFUs.
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Affiliation(s)
- Soheila Rezaei
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, 1591634311, Iran
| | - Rana Imani
- Department of Biomedical Engineering, Amirkabir University of Technology, Tehran, 1591634311, Iran
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Tonna R, Chatzistergos PE, Wyatt O, Chockalingam N. Reliability and Validity of Shore Hardness in Plantar Soft Tissue Biomechanics. SENSORS (BASEL, SWITZERLAND) 2024; 24:539. [PMID: 38257632 PMCID: PMC10818800 DOI: 10.3390/s24020539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024]
Abstract
Shore hardness (SH) is a cost-effective and easy-to-use method to assess soft tissue biomechanics. Its use for the plantar soft tissue could enhance the clinical management of conditions such as diabetic foot complications, but its validity and reliability remain unclear. Twenty healthy adults were recruited for this study. Validity and reliability were assessed across six different plantar sites. The validity was assessed against shear wave (SW) elastography (the gold standard). SH was measured by two examiners to assess inter-rater reliability. Testing was repeated following a test/retest study design to assess intra-rater reliability. SH was significantly correlated with SW speed measured in the skin or in the microchamber layer of the first metatarsal head (MetHead), third MetHead and rearfoot. Intraclass correlation coefficients and Bland-Altman plots of limits of agreement indicated satisfactory levels of reliability for these sites. No significant correlation between SH and SW elastography was found for the hallux, 5th MetHead or midfoot. Reliability for these sites was also compromised. SH is a valid and reliable measurement for plantar soft tissue biomechanics in the first MetHead, the third MetHead and the rearfoot. Our results do not support the use of SH for the hallux, 5th MetHead or midfoot.
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Affiliation(s)
- Redent Tonna
- Department of Engineering, School of Digital, Technologies and Arts, Staffordshire University, Stoke-on-Trent ST4 2DE, UK;
| | - Panagiotis E. Chatzistergos
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (O.W.); (N.C.)
| | - Otis Wyatt
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (O.W.); (N.C.)
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent ST4 2DE, UK; (O.W.); (N.C.)
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Raghav SS, Kumar B, Sethiya NK, Lal DK. Diabetic Foot Ulcer Management and Treatment: An Overview of Published Patents. Curr Diabetes Rev 2024; 20:e120623217906. [PMID: 37309771 DOI: 10.2174/1573399820666230612161846] [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: 12/12/2022] [Revised: 03/24/2023] [Accepted: 05/15/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND One of the most challenging effects of diabetes is diabetic foot ulceration (DFU). DFU may occur in up to one-third of individuals with diabetes mellitus (D.M.) at some point in their lives. The major cause of morbidity in D.M. patients is DFU. The length of treatment is difficult, and DFU recurrence is common. OBJECTIVE The most crucial element for the treatment and prevention of DFUs require a multidisciplinary approach. Patients who are at risk should be identified, depending on the type of risk, prophylactic actions etc. It is imperative to identify at-risk patients and take preventative measures accordingly. METHOD The at-risk diabetes-related foot ulcer was identified based on the risk category classification, while the foot ulcers were evaluated using Wagner's classification system. RESULTS Literature reported that patients with lower limb vascular insufficiency, loss of vibratory sensation, or protective sensation loss have an increased risk of developing foot ulcers. Proper categorization and therapeutic measures will be implemented after the DFU has been formed. The appropriate assessment and management of general health status should include glycemic control, the diagnosis and treatment of vascular disease, standard care for wounds, diagnosis, and infection treatments. CONCLUSION The review reflects the updated awareness of the treatment and management of DFU based on the current and past literature and patent analysis.
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Affiliation(s)
| | - Bhavna Kumar
- Faculty of Pharmacy, DIT University, Dehradun 248009, Uttarakhand, India
| | | | - Diwya Kumar Lal
- Faculty of Pharmacy, DIT University, Dehradun 248009, Uttarakhand, India
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Liang Y, Li M, Tang Y, Yang J, Wang J, Zhu Y, Liang H, Lin Q, Cheng Y, Yang X, Zhu H. Temperature-sensitive hydrogel dressing loaded with nicotinamide mononucleotide accelerating wound healing in diabetic mice. Biomed Pharmacother 2023; 167:115431. [PMID: 37688988 DOI: 10.1016/j.biopha.2023.115431] [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: 07/07/2023] [Revised: 08/27/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023] Open
Abstract
Diabetic foot ulcers, a common complication of diabetes mellitus, significantly impact patients' quality of life and impose a substantial economic burden on healthcare systems. However, the currently used treatments are associated with various challenges and the traditionally used dressings lack functional efficacy. Oxidative stress is believed to play a vital role in diabetic wound healing. Therefore, nicotinamide mononucleotide (NMN), which is known for its antioxidant properties, offers the potential to accelerate the wound-healing process. Here, a thermosensitive composite hydrogel was synthesized by mixing Pluronic F127 and Pluronic F68 with an antibacterial component chitosan. The hydrogel exhibited favorable properties including a stable structure, appropriate solid-liquid phase change, loose porosity, slow-release, antibacterial properties, and biocompatibility. In vitro experiments demonstrated that the NMN-loaded temperature-sensitive hydrogel effectively promoted cell proliferation, migration, and angiogenesis and exhibited antioxidant activity. In diabetic thickness skin defect models, NMN-loaded temperature-sensitive hydrogel treatment significantly accelerated wound healing by promoting collagen synthesis, angiogenesis, and increased expression of vascular endothelial growth factor and transforming growth factor- β1. In summary, NMN-loaded temperature-sensitive hydrogel can promote diabetic wound healing in a simple, economical, effective, and safe manner, with potential application in treating diabetic wounds.
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Affiliation(s)
- Yue Liang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Min Li
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Yuan Tang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Jinlong Yang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Jing Wang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Yuqi Zhu
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Huitong Liang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Qinru Lin
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Yipen Cheng
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Xinyi Yang
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China
| | - Huanzhang Zhu
- State Key Laboratory of Genetic Engineering and Engineering Research Center of Gene Technology, Ministry of Education, Institute of Genetics, School of Life Sciences, Fudan University, Shanghai, China.
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Huang H, Xin R, Li X, Zhang X, Chen Z, Zhu Q, Tai Z, Bao L. Physical therapy in diabetic foot ulcer: Research progress and clinical application. Int Wound J 2023; 20:3417-3434. [PMID: 37095726 PMCID: PMC10502280 DOI: 10.1111/iwj.14196] [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: 01/30/2023] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
Diabetes foot ulcer (DFU) is one of the most intractable complications of diabetes and is related to a number of risk factors. DFU therapy is difficult and involves long-term interdisciplinary collaboration, causing patients physical and emotional pain and increasing medical costs. With a rising number of diabetes patients, it is vital to figure out the causes and treatment techniques of DFU in a precise and complete manner, which will assist alleviate patients' suffering and decrease excessive medical expenditure. Here, we summarised the characteristics and progress of the physical therapy methods for the DFU, emphasised the important role of appropriate exercise and nutritional supplementation in the treatment of DFU, and discussed the application prospects of non-traditional physical therapy such as electrical stimulation (ES), and photobiomodulation therapy (PBMT) in the treatment of DFU based on clinical experimental records in ClinicalTrials.gov.
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Affiliation(s)
- Hao Huang
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Rujuan Xin
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xiaolong Li
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Xinyue Zhang
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
| | - Zhongjian Chen
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Quangang Zhu
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Zongguang Tai
- Shanghai Skin Disease Hospital, School of MedicineTongji UniversityShanghaiChina
| | - Leilei Bao
- School of PharmacyBengbu Medical CollegeBengbuAnhuiChina
- Department of PharmacyThird Affiliated Hospital of Naval Medical UniversityShanghaiChina
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Monteiro RL, Drechsel TJ, Ferreira JSSP, Zippenfennig C, Sacco ICN. Potential predictive effect of mechanical properties of the plantar skin and superficial soft tissue, and vibration perception on plantar loading during gait in individuals with diabetes. BMC Musculoskelet Disord 2023; 24:712. [PMID: 37674163 PMCID: PMC10483699 DOI: 10.1186/s12891-023-06851-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/02/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND This exploratory study aimed to investigate the extent to which mechanical properties of the plantar skin and superficial soft tissue (hardness, stiffness, and thickness) and vibration perception thresholds (VPTs) predict plantar pressure loading during gait in people with diabetes compared to healthy controls. METHODS Mechanical properties, VPTs, and plantar loadings during gait at the heel and first metatarsal head (MTH) of 20 subjects with diabetes, 13 with DPN, and 33 healthy controls were acquired. Multiple regression analyses were used to predict plantar pressure peaks and pressure-time integrals at both locations based on the mechanical properties of the skin and superficial soft tissues and VPTs. RESULTS In the diabetes group at the MTH, skin hardness associated with 30-Hz (R2 = 0.343) and 200-Hz (R2 = 0.314) VPTs predicted peak pressure at the forefoot. In the controls at the heel, peak pressure was predicted by the skin thickness, hardness, and stiffness associated with 30-Hz (R2 = 0.269, 0.268, and 0.267, respectively) and 200-Hz (R2 = 0.214, 0.247, and 0.265, respectively) VPTs. CONCLUSION The forefoot loading of people with diabetes can be predicted by the hardness of the skin when combined with loss of vibration perception at low (30-Hz) and high (200-Hz) frequencies. Further data from larger sample sizes are needed to confirm the current findings.
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Affiliation(s)
- Renan L Monteiro
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
- Department of Health and Biological Science, Federal University of Amapá, Macapá, Brazil
| | - Tina J Drechsel
- Department of Human Locomotion, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Jane Suelen S P Ferreira
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Claudio Zippenfennig
- Department of Human Locomotion, Institute of Human Movement Science and Health, Chemnitz University of Technology, Chemnitz, Germany
| | - Isabel C N Sacco
- Department of Physical Therapy, Speech, and Occupational Therapy, School of Medicine, University of São Paulo, São Paulo, Brazil.
- Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional da Faculdade de Medicina da Universidade de São Paulo, Rua Cipotânea, 51 - Cidade Universitária, São Paulo, 05360-160, Brazil.
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Ge Q, Zhou Y, Liu Z. Analysis of pre-hospital delay in Chinese patients with diabetic foot ulcers: Based on 46 cases. Int Wound J 2023; 20:2657-2663. [PMID: 36916307 PMCID: PMC10410325 DOI: 10.1111/iwj.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
To study the causes of pre-hospital delay in Chinese patients with diabetic foot ulcers (DFUs). A retrospective study, investigating a case series of 46 DFUs treated at a single hospital, was conducted to evaluate wound condition, wound treatment, costs, and patients' complete medical records, and analyse the reasons causing the pre-hospital delay. We assessed 46 DFUs aged between 53 and 92 years old. The average pre-hospital delay was 5 months, with nearly 20% being delayed for more than 1 year. The average length of hospital stay in China was 21 days, with an average cost of $8672. Recurrence rate of DFUs was 21%, and three patients were recommended to transfer to upper-level hospital. Besides, the intervention was limited and homogenous and medical records were incomplete. Medical service users' limited understanding of diseases, high costs that patients need to afford, and unsatisfactory treatment by medical service providers are the main reasons for patients' delay in seeking treatment. Recommendations are offered to reduce the pre-hospital delay of Chinese patients with DFUs.
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Affiliation(s)
- Qiaoyue Ge
- West China School of Public HealthSichuan University/West China Fourth Hospital, Sichuan UniversityChengduChina
| | - Yue Zhou
- Health and Social Policy DivisionChengdu Preventive Medicine AssociationChengduChina
| | - Zhenmi Liu
- West China School of Public HealthSichuan University/West China Fourth Hospital, Sichuan UniversityChengduChina
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B. G. S, V. U, Shivaram JM, Belehalli P, M. A. S, H. C. C, Sikkandar MY, Brioschi ML. Diabetic Foot Assessment and Care: Barriers and Facilitators in a Cross-Sectional Study in Bangalore, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:5929. [PMID: 37297533 PMCID: PMC10252617 DOI: 10.3390/ijerph20115929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/25/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023]
Abstract
(1) Background: This cross-sectional study aims to highlight the assessment and foot care practices in an advanced clinical setting, the clinical characteristics of the patients, and to understand the barriers and facilitators for effective foot care from the perspectives of healthcare practices, resources, and patients' socioeconomic and cultural practices, and other aspects in terms of new technologies for effective foot care such as infrared thermography. (2) Methods: Clinical test data from 158 diabetic patients and a questionnaire to assess the foot care education retention rate were collected at the Karnataka Institute of Endocrinology and Research (KIER) facility. (3) Results: Diabetic foot ulcers (DFUs) were found in 6% of the examined individuals. Male patients were more likely to have diabetes complications, with an odds ratio (OR) of 1.18 (CI = 0.49-2.84). Other diabetes problems raised the likelihood of DFUs by OR 5 (CI = 1.40-17.77). The constraints include socioeconomic position, employment conditions, religious customs, time and cost, and medication non-adherence. The attitude of podiatrists and nurses, diabetic foot education, and awareness protocols and amenities at the facility were all facilitators. (4) Conclusions: Most diabetic foot complications might be avoided with foot care education, regular foot assessments as the standard of treatment, and self-care as a preventive/therapeutic strategy.
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Affiliation(s)
- Sudha B. G.
- Department of Computer Science and Engineering, B.M.S. College of Engineering, Bangalore 560019, India
| | - Umadevi V.
- Department of Computer Science and Engineering, B.M.S. College of Engineering, Bangalore 560019, India
| | - Joshi Manisha Shivaram
- Department of Medical Electronics, B.M.S. College of Engineering, Bangalore 560019, India
| | - Pavan Belehalli
- Department of Podiatry, Karnataka Institute of Endocrinology and Research, Bangalore 560019, India
| | - Shekar M. A.
- Department of Podiatry, Karnataka Institute of Endocrinology and Research, Bangalore 560019, India
| | - Chaluvanarayana H. C.
- Department of Podiatry, Karnataka Institute of Endocrinology and Research, Bangalore 560019, India
| | - Mohamed Yacin Sikkandar
- Medical Equipment Technology, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia
| | - Marcos Leal Brioschi
- Medical Thermography Service, Neurology Department, Hospital das Clínicas, Sao Paulo University, Sao Paulo 01246-903, Brazil
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Yan Y, Ou J, Shi H, Sun C, Shen L, Song Z, Shu L, Chen Z. Plantar pressure and falling risk in older individuals: a cross-sectional study. J Foot Ankle Res 2023; 16:14. [PMID: 36941642 PMCID: PMC10029259 DOI: 10.1186/s13047-023-00612-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 03/02/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Falls are commonplace among elderly people. It is urgent to prevent falls. Previous studies have confirmed that there is a difference in plantar pressure between falls and non-falls in elderly people, but the relationship between fall risk and foot pressure has not been studied. In this study, the differences in dynamic plantar pressure between elderly people with high and low fall risk were preliminarily discussed, and the characteristic parameters of plantar pressure were determined. METHODS Twenty four high-fall-risk elderly individuals (HR) and 24 low-fall-risk elderly individuals (LR) were selected using the Berg Balance Scale 40 score. They wore wearable foot pressure devices to walk along a 20-m-long corridor. The peak pressure (PP), pressure time integral (PTI), pressure gradient (maximum pressure gradient (MaxPG), minimum pressure gradient (MinPG), full width at half maximum (FWHM)) and average pressure (AP) of their feet were measured for inter-group and intra-group analysis. RESULTS The foot pressure difference comparing the high fall risk with low fall risk groups was manifested in PP and MaxPG, concentrated in the midfoot and heel (p < 0.05), while the only time parameter, FWHM, was manifested in the whole foot (p < 0.05). The differences between the left and right foot were reflected in all parameters. The differences between the left and right foot in LR were mainly reflected in the heel (p < 0.05), while it in the HR was mainly reflected in the forefoot (p < 0.05). CONCLUSIONS The differences comparing the high fall risk with low fall risk groups were mostly reflected in the midfoot and heel. The HR may have been more cautious when landing. In the intra-group comparison, the difference between the right and left foot of the LR was mainly reflected during heel striking, while it was mainly reflected during pedalling in the HR. The sensitivity of PP, PTI and AP was lower and the newly introduced pressure gradient could better reflect the difference in foot pressure between the two groups. The pressure gradient can be used as a new foot pressure parameter in scientific research.
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Affiliation(s)
- Yifeng Yan
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jianlin Ou
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hanxue Shi
- School of Future Technology, South China University of Technology, Guangzhou, China
| | - Chenming Sun
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Longbin Shen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhen Song
- School of Future Technology, South China University of Technology, Guangzhou, China
- School of Microelectronics, South China University of Technology, Guangzhou, China
| | - Lin Shu
- School of Future Technology, South China University of Technology, Guangzhou, China.
- Institute of Modern Industrial Technology of SCUT in Zhongshan, Zhongshan, China.
- Pazhou Lab, Guangzhou, China.
| | - Zhuoming Chen
- Department of Rehabilitation Medicine, The First Affiliated Hospital of Jinan University, Guangzhou, China.
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12
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Wang X, Yuan CX, Xu B, Yu Z. Diabetic foot ulcers: Classification, risk factors and management. World J Diabetes 2022; 13:1049-1065. [PMID: 36578871 PMCID: PMC9791567 DOI: 10.4239/wjd.v13.i12.1049] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 10/18/2022] [Accepted: 11/18/2022] [Indexed: 12/15/2022] Open
Abstract
Diabetic foot ulceration is a devastating complication of diabetes that is associated with infection, amputation, and death, and is affecting increasing numbers of patients with diabetes mellitus. The pathogenesis of foot ulcers is complex, and different factors play major roles in different stages. The refractory nature of foot ulcer is reflected in that even after healing there is still a high recurrence rate and amputation rate, which means that management and nursing plans need to be considered carefully. The importance of establishment of measures for prevention and management of DFU has been emphasized. Therefore, a validated and appropriate DFU classification matching the progression is necessary for clinical diagnosis and management. In the first part of this review, we list several commonly used classification systems and describe their application conditions, scope, strengths, and limitations; in the second part, we briefly introduce the common risk factors for DFU, such as neuropathy, peripheral artery disease, foot deformities, diabetes complications, and obesity. Focusing on the relationship between the risk factors and DFU progression may facilitate prevention and timely management; in the last part, we emphasize the importance of preventive education, characterize several of the most frequently used management approaches, including glycemic control, exercise, offloading, and infection control, and call for taking into account and weighing the quality of life during the formulation of treatment plans. Multidisciplinary intervention and management of diabetic foot ulcers (DFUs) based on the effective and systematic combination of these three components will contribute to the prevention and treatment of DFUs, and improve their prognosis.
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Affiliation(s)
- Xuan Wang
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Chong-Xi Yuan
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Bin Xu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Zhi Yu
- Key Laboratory of Acupuncture and Medicine Research of Ministry of Education, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
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13
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Zorkaltsev MA, Zavadovskaya VD, Saprina TV, Zamyshevskaya MA, Udodov VD, Shestakov AV, Mikhailova AA, Loyko YN, Musina NN. Pathogen-specific molecular imaging and molecular testing methods in the prognosis of the complicated course of diabetic foot syndrome, the risk of amputation, and patient survival. BULLETIN OF SIBERIAN MEDICINE 2022. [DOI: 10.20538/1682-0363-2022-3-166-180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The aim of this review was to provide extended information on current trends in the diagnosis of complicated diabetic foot syndrome (DFS), the most frequent and severe complication of diabetes mellitus, including hightech medical imaging methods and instrumental and laboratory predictors of the complicated course and risk of amputation in DFS.The article provides an analytical review of modern publications over the past 5 years on diagnosis and therapy. Pilot data on the use of high-tech medical imaging methods, assessment of skin microbiota and ulcers in DFS, molecular testing methods in terms of predicting the amputation risk and survival of patients with DFS, as well as the effectiveness of biosensing systems have been systematized, summarized, and subjected to analytical evaluation.The review provides an expert assessment of the capabilities of pathogen-specific molecular imaging using modern positron emission tomography (PET), single-photon emission computed tomography (SPECT), and highenergy radionuclides in bacterial infection to understand its pathogenesis, minimize diagnostic problems, improve antimicrobial treatment, and address fundamental and applied aspects of DFS. Literature data on the assessment of foot perfusion in diabetic patients with varying degrees of limb ischemia by hybrid technologies (SPECT / CT and PET / CT) and new modalities of magnetic resonance imaging (MRI) are also systematized, which contributes to new understanding of the response to revascularization, surgical shunting, and stimulation of angiogenesis within ischemic tissue, as well as potentially to healing of foot ulcers.The review is aimed at substantiating a multidisciplinary approach in DFS, selection, development, and implementation of innovative strategies for diagnostic modalities to identify diabetic foot pathologies, and choice of an adequate method for treating and monitoring the results of therapy in the context of personalized medicine.
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14
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Akhtar S, Latif M, Ahmed OS, Sarwar A, Alina A, Khan MI. Prevalence of foot ulcers in diabetic patients in Punjab, Pakistan. Front Public Health 2022; 10:967733. [PMID: 36016895 PMCID: PMC9397578 DOI: 10.3389/fpubh.2022.967733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 07/20/2022] [Indexed: 01/25/2023] Open
Abstract
Diabetes-related foot ulceration is prevalent and disabling, usually resulting in the amputation of the limb. The mortality rate is significant, and healed ulcers frequently reoccur. The main purpose of this study was to explore the prevalence of foot ulcers and their associated factors among diabetic patients in Punjab, Pakistan. Multistage cluster random sampling procedure was applied to perform a cross-sectional analysis in the state of Punjab, Pakistan. A sample of 1,503 people with diabetes, including 504 men and 999 women, were selected from different clusters. Data were collected from December 18, 2018, to June 30, 2019. Individuals of 18 years or above were selected. A binary multiple logistic regression analysis was utilized to find the factors associated with a diabetic foot ulcer. The overall prevalence of diabetic foot ulcers was 16.83% (95% CI: 14.9-18.7%). The prevalence among the female was 17.52% (95% CI: 15.2-19.9%), and the male was 15.48% (95% CI: 12.3-18.6%). In rural areas, prevalence was 13.91% (95% CI: 10.6-17.2%) compared to the prevalence of 17.96% (95% CI: 15.7-20.2%) in the urban area. Individuals 75 years and above had the highest prevalence of 66.67% (95% CI: 51.9-81.5%). According to the income status, subjects with monthly income above Rs. 61,000 had a prevalence of 24.24% (95% CI: 15.8-32.7%), and among overweight subjects was 25.49% (95% CI: 21.3-29.7%). This study found a relatively high prevalence of foot ulcers in Punjab, Pakistan. The results indicate that diabetic foot ulcers have become a major health problem in diabetic patients, and better strategies and preventive measures should be opted to deal with the epidemic.
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Affiliation(s)
- Sohail Akhtar
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Pakistan,*Correspondence: Sohail Akhtar
| | | | | | - Aqsa Sarwar
- Department Statistics, Government College University Lahore, Lahore, Pakistan
| | - Ayisham Alina
- Department Statistics, Government College University Lahore, Lahore, Pakistan
| | - Muhammad Imran Khan
- Department of Mathematics and Statistics, The University of Haripur, Haripur, Pakistan,Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, China
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15
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Arruda LM, Moreira IP, Sanivada UK, Carvalho H, Fangueiro R. Development of Piezoresistive Sensors Based on Graphene Nanoplatelets Screen-Printed on Woven and Knitted Fabrics: Optimisation of Active Layer Formulation and Transversal/Longitudinal Textile Direction. MATERIALS 2022; 15:ma15155185. [PMID: 35897616 PMCID: PMC9369725 DOI: 10.3390/ma15155185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/20/2022] [Accepted: 07/21/2022] [Indexed: 12/05/2022]
Abstract
Although the force/pressure applied onto a textile substrate through a uniaxial compression is constant and independent of the yarn direction, it should be noted that such mechanical action causes a geometric change in the substrate, which can be identified by the reduction in its lateral thickness. Therefore, the objective of this study was to investigate the influence of the fabric orientation on both knitted and woven pressure sensors, in order to generate knowledge for a better design process during textile piezoresistive sensor development. For this purpose, these distinct textile structures were doped with different concentrations of graphene nanoplatelets (GNPs), using the screen-printing technique. The chemical and physical properties of these screen-printed fabrics were analysed using Field Emission Scanning Electron Microscopy, Ground State Diffuse Reflectance and Raman Spectroscopy. Samples were subjected to tests determining linear electrical surface resistance and piezoresistive behaviour. In the results, a higher presence of conductive material was found in woven structures. For the doped samples, the electrical resistance varied between 105 Ω and 101 Ω, for the GNPs’ percentage increase. The lowest resistance value was observed for the woven fabric with 15% GNPs (3.67 ± 8.17 × 101 Ω). The samples showed different electrical behaviour according to the fabric orientation. Overall, greater sensitivity in the longitudinal direction and a lower coefficient of variation CV% of the measurement was identified in the transversal direction, coursewise for knitted and weftwise for woven fabrics. The woven fabric doped with 5% GNPs assembled in the weftwise direction was shown to be the most indicated for a piezoresistive sensor, due to its most uniform response and most accurate measure of mechanical stress.
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Affiliation(s)
- Luisa M. Arruda
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (I.P.M.); (U.K.S.); (H.C.); (R.F.)
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal
- Correspondence:
| | - Inês P. Moreira
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (I.P.M.); (U.K.S.); (H.C.); (R.F.)
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal
| | - Usha Kiran Sanivada
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (I.P.M.); (U.K.S.); (H.C.); (R.F.)
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal
| | - Helder Carvalho
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (I.P.M.); (U.K.S.); (H.C.); (R.F.)
| | - Raul Fangueiro
- Centre for Textile Science and Technology (2C2T), University of Minho, 4800-058 Guimaraes, Portugal; (I.P.M.); (U.K.S.); (H.C.); (R.F.)
- Fibrenamics, Institute of Innovation on Fibre-Based Materials and Composites, University of Minho, 4800-058 Guimaraes, Portugal
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16
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Wang Y. Prevention of Physical Risk and Rehabilitation of Muscle Injury in Sanda Competition. Occup Ther Int 2022; 2022:9486697. [PMID: 35912306 PMCID: PMC9282994 DOI: 10.1155/2022/9486697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022] Open
Abstract
The Target. The purpose of this study is to explore the reduction of sports injury risk and verify the effective methods and means of athlete's muscle injury rehabilitation. Methods. In this study, 80 sanda athletes from a university were randomly selected as subjects, and the main parts of injury of all subjects were counted. After 12 weeks of muscle injury rehabilitation intervention, the pain, acute injury, and technical and tactical evaluation levels of subjects in the intervention group and the control group were compared. Results/Discussion. The overall performance of the 80 subjects' basic exercise ability was at a moderate level, and there was no significant difference between male and female subjects (P >0.05). After 12 weeks of rehabilitation intervention, there was no significant difference in the scores of shoulder joint flexibility, supine straight leg raising, and trunk stable support between male and female subjects in the intervention group in more than 7 sports (P >0.05). In the control group, there were significant differences in the scores of shoulder flexibility and trunk stability of male and female subjects (P < 0.05). Future research should further explore the effect of muscle injury rehabilitation on effectively reducing potential sports injuries and introduce advanced and effective medical rehabilitation methods.
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Affiliation(s)
- Yong Wang
- School of Physical Education and Health, Hangzhou Normal University, Hangzhou, Zhejiang, China 311121
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17
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Guan Y, Bai M, Li Q, Li W, Liu G, Liu C, Chen Y, Lin Y, Hui Y, Wei R. A plantar wearable pressure sensor based on hybrid lead zirconate-titanate/microfibrillated cellulose piezoelectric composite films for human health monitoring. LAB ON A CHIP 2022; 22:2376-2391. [PMID: 35635092 DOI: 10.1039/d2lc00051b] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Flexible and wearable electronic sensors hold great promise for improving the quality of life, especially in the field of healthcare monitoring, owing to their low cost, flexibility, high electromechanical coupling performance, high sensitivity, and biocompatibility. To achieve high piezoelectric performance similar to that of rigid materials while satisfying the flexible requirements for wearable sensors, we propose novel hybrid films based on lead zirconate titanate powder and microfibrillated cellulose (PZT/MFC) for plantar pressure measurements. The flexible films made using the polarization process are tested. It was found that the maximum piezoelectric coefficient was 31 pC N-1 and the maximum tensile force of the flexible films was 26 N. A wide range of bending angles between 15° and 180° proves the flexibility capability of the films. In addition, the charge density shows a proportional relation with the applied mechanical force, and it could sense stress of 1 kPa. Finally, plantar pressure sensors are arranged and packaged with a film array followed by connection with the detection module. Then, the pressure curves of each point on the plantar are obtained. Through analysis of the curve, several parameters of human body motions that are important in the rehabilitation of diabetic patients and the detection of sports injury can be performed, including stride frequency, length and speed. Overall, the proposed PZT/MFC wearable plantar pressure sensor has broad application prospects in the field of sports injury detection and medical rehabilitation training.
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Affiliation(s)
- Yanfang Guan
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
- National Engineering Laboratory/Key Laboratory of Henan Province, Henan University of Technology, Zhengzhou 450001, China
| | - Mingyang Bai
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Qiuliang Li
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Wujie Li
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Guangyu Liu
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Chunbo Liu
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Yu Chen
- School of Mechanical Engineering, Chengdu University, Chengdu, 610106, China
| | - Yang Lin
- Department of Mechanical, Industrial & Systems Engineering, University of Rhode Island, Kingston 02881, USA
| | - Yanbo Hui
- School of Electromechanical Engineering, Henan University of Technology, Zhengzhou 450001, China.
| | - Ronghan Wei
- Advanced Intelligent Manufacturing, Nano Opto-mechatronics & Biomedical Engineering Lab, Zhengzhou University, Zhengzhou 450001, China
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18
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Zhang L, Yick KL, Li PL, Yip J, Ng SP. Foot deformation analysis with different load-bearing conditions to enhance diabetic footwear designs. PLoS One 2022; 17:e0264233. [PMID: 35320281 PMCID: PMC8942268 DOI: 10.1371/journal.pone.0264233] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 02/06/2022] [Indexed: 01/22/2023] Open
Abstract
In-depth analyses of foot surface measurements upon weight bearing are crucial to understand how the dorsal and plantar surfaces of the foot deform during motion to enhance the fit of footwear, which is particularly important for diabetic patients with stringent fit requirements to redistribute the plantar weight forces. This study analyzes diabetic foot deformations under 3 different weight bearing conditions (no weight bearing, half weight bearing, and 80% weight bearing) by using a novel foot scanning method that enables efficient scanning of the dorsal and plantar surfaces of the foot simultaneously. The feet of 48 patients with diabetes mellitus (DM) are scanned. With increased load on the feet, the width of the forefoot increases by 9.7%-10.4%, height of the midfoot decreases by 15.1%-18.2%, forefoot and midfoot rotate to the medial side by 16.9%-23.9% while the rearfoot rotates to the lateral side by 15.2% simultaneously, and the plantar of the foot increases contact with the floor by 11.4%-23.0%. Gender differences in foot shape are also found between males and females, males have a broader foot than females for the same foot length. Precise anthropometric information of foot changes and deformation therefore enables adequate foot protection, fit and comfort when designing footwear. This research contributes to shoe design considerations that focus on the deformation of the foot under different loads.
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Affiliation(s)
- Liying Zhang
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, China
| | - Kit-lun Yick
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
- Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, China
- * E-mail:
| | - Pui-ling Li
- Laboratory for Artificial Intelligence in Design, Hong Kong Science Park, New Territories, Hong Kong, China
| | - Joanne Yip
- The Institute of Textiles and Clothing, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
| | - Sun-pui Ng
- Hong Kong Community College, The Hong Kong Polytechnic University, Kowloon, Hong Kong, China
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19
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Doğruel H, Aydemir M, Balci MK. Management of diabetic foot ulcers and the challenging points: An endocrine view. World J Diabetes 2022; 13:27-36. [PMID: 35070057 PMCID: PMC8771264 DOI: 10.4239/wjd.v13.i1.27] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/18/2021] [Accepted: 12/11/2021] [Indexed: 02/06/2023] Open
Abstract
Diabetic foot ulcers (DFU) are one of the most challenging complications of diabetes. Up to one-third of patients with diabetes mellitus (DM) may suffer from DFUs during their life. DFU is one of the leading causes of morbidity in patients with DM. The treatment period is challenging, and the recurrence rate of DFUs is high. Hence, establishing prevention strategies is the most important point to be emphasized. A multidisciplinary approach is necessary in the prevention and treatment of DFUs. Patients at risk should be identified, and prevention measures should be taken based on the risk category. Once a DFU is formed, the appropriate classification and evidence-based treatment interventions should be executed. Glycemic control, diagnosis and treatment of vascular disease, local wound care, diagnosis, and treatment of infection should be addressed along with the proper evaluation and management of general health status.
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Affiliation(s)
- Hakan Doğruel
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University Hospital, Konyaaltı 07059, Antalya, Turkey
| | - Mustafa Aydemir
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University Hospital, Konyaaltı 07059, Antalya, Turkey
| | - Mustafa Kemal Balci
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Akdeniz University Faculty of Medicine, Konyaaltı 07059, Antalya, Turkey
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20
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Balasubramanian GV, Chockalingam N, Naemi R. The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes. Front Bioeng Biotechnol 2021; 9:732753. [PMID: 34595160 PMCID: PMC8476833 DOI: 10.3389/fbioe.2021.732753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/26/2021] [Indexed: 12/23/2022] Open
Abstract
Diabetic foot syndrome is one of the most costly complications of diabetes. Damage to the soft tissue structure is one of the primary causes of diabetic foot ulcers and most of the current literature focuses on factors such as neuropathy and excessive load. Although the role of blood supply has been reported in the context of macro-circulation, soft tissue damage and its healing in the context of skin microcirculation have not been adequately investigated. Previous research suggested that certain microcirculatory responses protect the skin and their impairment may contribute to increased risk for occlusive and ischemic injuries to the foot. The purpose of this narrative review was to explore and establish the possible link between impairment in skin perfusion and the chain of events that leads to ulceration, considering the interaction with other more established ulceration factors. This review highlights some of the key skin microcirculatory functions in response to various stimuli. The microcirculatory responses observed in the form of altered skin blood flow are divided into three categories based on the type of stimuli including occlusion, pressure and temperature. Studies on the three categories were reviewed including: the microcirculatory response to occlusive ischemia or Post-Occlusive Reactive Hyperaemia (PORH); the microcirculatory response to locally applied pressure such as Pressure-Induced Vasodilation (PIV); and the interplay between microcirculation and skin temperature and the microcirculatory responses to thermal stimuli such as reduced/increased blood flow due to cooling/heating. This review highlights how microcirculatory responses protect the skin and the plantar soft tissues and their plausible dysfunction in people with diabetes. Whilst discussing the link between impairment in skin perfusion as a result of altered microcirculatory response, the review describes the chain of events that leads to ulceration. A thorough understanding of the microcirculatory function and its impaired reactive mechanisms is provided, which allows an understanding of the interaction between functional disturbances of microcirculation and other more established factors for foot ulceration.
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Affiliation(s)
| | - Nachiappan Chockalingam
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
| | - Roozbeh Naemi
- Centre for Biomechanics and Rehabilitation Technologies, Staffordshire University, Stoke-on-Trent, United Kingdom
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21
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Zhu X, Zhang K, He L, Liao F, Ren Y, Jan YK. Spectral analysis of blood flow oscillations to assess the plantar skin blood flow regulation in response to preconditioning local vibrations. Biorheology 2021; 58:39-49. [PMID: 33896803 DOI: 10.3233/bir-201011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Local vibration has shown promise in improving skin blood flow and wound healing. However, the underlying mechanism of local vibration as a preconditioning intervention to alter plantar skin blood flow after walking is unclear. OBJECTIVE The objective was to use wavelet analysis of skin blood flow oscillations to investigate the effect of preconditioning local vibration on plantar tissues after walking. METHODS A double-blind, repeated measures design was tested in 10 healthy participants. The protocol included 10-min baseline, 10-min local vibrations (100 Hz or sham), 10-min walking, and 10-min recovery periods. Skin blood flow was measured over the first metatarsal head of the right foot during the baseline and recovery periods. Wavelet amplitudes after walking were expressed as the ratio of the wavelet amplitude before walking. RESULTS The results showed the significant difference in the metabolic (vibration 10.06 ± 1.97, sham 5.78 ± 1.53, p < 0.01) and neurogenic (vibration 7.45 ± 1.54, sham 4.78 ± 1.22, p < 0.01) controls. There were no significant differences in the myogenic, respiratory and cardiac controls between the preconditioning local vibration and sham conditions. CONCLUSIONS Our results showed that preconditioning local vibration altered the normalization rates of plantar skin blood flow after walking by stimulating the metabolic and neurogenic controls.
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Affiliation(s)
- Xiaotong Zhu
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Keying Zhang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Li He
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Fuyuan Liao
- Department of Biomedical Engineering, Xi'an Technological University, Xi'an, China
| | - Yuanchun Ren
- College of Physical Education and Sports, Beijing Normal University, Beijing, China
| | - Yih-Kuen Jan
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.,Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing, China
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22
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Knowledge, Practice and Attitude towards Foot Ulcers and Foot Care among Adults Living with Diabetes in Tobago: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158021. [PMID: 34360314 PMCID: PMC8345419 DOI: 10.3390/ijerph18158021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
Globally, the prevalence of diabetes has risen significantly by 62% over the last ten years. A complication of unmanaged diabetes is diabetic foot ulcer (DFU), which adversely affects the quality of life of individuals with diabetes and inflicts a huge economic burden on the family, government, and health care services. However, this complication is preventable with adequate patient knowledge and practice regarding DFU and foot care. The present study was aimed at assessing the knowledge, attitude, and practice of adults with diabetes on foot ulcers and foot care in Tobago using a qualitative exploratory design. Purposeful sampling technique was used to recruit 20 participants from the lifestyle and diabetes foot clinics of Scarborough Health Centre, Tobago. Telephone interviews were conducted with the use of a semi-structured interview guide. The data obtained from participants were analyzed using thematic content analysis. Four major themes, namely foot ulcer problems, participants’ knowledge on DFU, knowledge on foot care, and practice and attitude of foot care, emerged from the study. The findings from the study revealed that the majority of participants had poor knowledge regarding DFU but exhibited awareness about foot care, especially on foot cleaning and inspection, preventing irritation after washing, appropriate footwear, and not walking barefooted. The participants had good attitudes and practices of foot care despite their poor knowledge of DFU. However, participants reported inadequate health education on DFU and foot care from healthcare personnel. There should be improved health education, information, and communication on DFU and foot care centred and tailored to the understanding of people living with diabetes. This will prevent DFU and reduce the mortality arising from this complication, which is a major target of the sustainable development goals (SDG) in mitigating the burden of non-communicable diseases (NCD) such as diabetes.
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Raghav A, Tripathi P, Mishra BK, Jeong GB, Banday S, Gautam KA, Mateen QN, Singh P, Singh M, Singla A, Ahmad J. Mesenchymal Stromal Cell-Derived Tailored Exosomes Treat Bacteria-Associated Diabetes Foot Ulcers: A Customized Approach From Bench to Bed. Front Microbiol 2021; 12:712588. [PMID: 34385994 PMCID: PMC8354005 DOI: 10.3389/fmicb.2021.712588] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/16/2021] [Indexed: 12/18/2022] Open
Abstract
Exosomes are nano-vesicles of endosomal origin inherited with characteristics of drug delivery and cargo loading. Exosomes offer a diverse range of opportunities that can be exploited in the treatment of various diseases post-functionalization. This membrane engineering is recently being used in the management of bacteria-associated diabetic foot ulcers (DFUs). Diabetes mellitus (DM) is among the most crippling disease of society with a large share of its imposing economic burden. DM in a chronic state is associated with the development of micro- and macrovascular complications. DFU is among the diabetic microvascular complications with the consequent occurrence of diabetic peripheral neuropathy. Mesenchymal stromal cell (MSC)-derived exosomes post-tailoring hold promise to accelerate the diabetic wound repair in DFU associated with bacterial inhabitant. These exosomes promote the antibacterial properties with regenerative activity by loading bioactive molecules like growth factors, nucleic acids, and proteins, and non-bioactive substances like antibiotics. Functionalization of MSC-derived exosomes is mediated by various physical, chemical, and biological processes that effectively load the desired cargo into the exosomes for targeted delivery at specific bacterial DFUs and wound. The present study focused on the application of the cargo-loaded exosomes in the treatment of DFU and also emphasizes the different approaches for loading the desired cargo/drug inside exosomes. However, more studies and clinical trials are needed in the domain to explore this membrane engineering.
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Affiliation(s)
- Alok Raghav
- Multidisciplinary Research Unit, Department of Health Research, MoHFW, GSVM Medical College, Kanpur, India
| | | | | | - Goo-Bo Jeong
- Department of Anatomy and Cell Biology, College of Medicine, Gachon University, Incheon, South Korea
| | - Shahid Banday
- Department of Molecular, Cell and Cancer Biology, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kirti Amresh Gautam
- Multidisciplinary Research Unit, Department of Health Research, MoHFW, GSVM Medical College, Kanpur, India
| | - Qazi Noorul Mateen
- Department of Biochemical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | - Prem Singh
- Department of Medicine, GSVM Medical College, Kanpur, India
| | - Manish Singh
- Department of Neurosurgery, GSVM Medical College, Kanpur, India
| | - Akhil Singla
- Department of Medicine, Maharishi Markandeshwar College and Hospital, Maharishi Markandeshwar University, Solan, India
| | - Jamal Ahmad
- Faculty of Medicine, Rajiv Gandhi Centre for Diabetes and Endocrinology, JN Medical College, Aligarh Muslim University, Aligarh, India
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Using Bidimensional Multiscale Entropy Analysis of Ultrasound Images to Assess the Effect of Various Walking Intensities on Plantar Soft Tissues. ENTROPY 2021; 23:e23030264. [PMID: 33668190 PMCID: PMC7995977 DOI: 10.3390/e23030264] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 02/07/2023]
Abstract
Walking performance is usually assessed by linear analysis of walking outcome measures. However, human movements consist of both linear and nonlinear complexity components. The purpose of this study was to use bidimensional multiscale entropy analysis of ultrasound images to evaluate the effects of various walking intensities on plantar soft tissues. Twelve participants were recruited to perform six walking protocols, consisting of three speeds (slow at 1.8 mph, moderate at 3.6 mph, and fast at 5.4 mph) for two durations (10 and 20 min). A B-mode ultrasound was used to assess plantar soft tissues before and after six walking protocols. Bidimensional multiscale entropy (MSE2D) and the Complexity Index (CI) were used to quantify the changes in irregularity of the ultrasound images of the plantar soft tissues. The results showed that the CI of ultrasound images after 20 min walking increased when compared to before walking (CI4: 0.39 vs. 0.35; CI5: 0.48 vs. 0.43, p < 0.05). When comparing 20 and 10 min walking protocols at 3.6 mph, the CI was higher after 20 min walking than after 10 min walking (CI4: 0.39 vs. 0.36, p < 0.05; and CI5: 0.48 vs. 0.44, p < 0.05). This is the first study to use bidimensional multiscale entropy analysis of ultrasound images to assess plantar soft tissues after various walking intensities.
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Faizah R, Efendi F, Suprajitno S. The effects of foot exercise with audiovisual and group support foot exercises to diabetes mellitus patients. J Diabetes Metab Disord 2021; 20:377-382. [PMID: 34178845 DOI: 10.1007/s40200-021-00756-9] [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] [Received: 09/24/2020] [Accepted: 01/26/2021] [Indexed: 11/21/2022]
Abstract
Objectives This study aimed to analyze the effect of audiovisual and group support foot exercises on the Ankle Brachial Pressure Index and foot sensation. Methods This study used a quasi-experimental design. The sample number of this study was 156 using a purposive sampling technique. The research group was divided into three groups. The variables measured in this study were ABPI, foot sensation, and foot exercise experience. The statistical analysis was conducted by a paired-sample t-test, an independent-sample t-test, and a two-way Manova. Results The results showed that each group had a difference in how ABPI and foot sensation were influenced (p = 0.000). Additionally, audiovisual and group support foot exercises have been shown to influence ABPI (p = 0.000) and foot sensation (p) = 0.000). Conclusions Audiovisual and group support foot exercises significantly influenced the Ankle Brachial Pressure Index value and foot sensation in diabetic mellitus patients. This intervention is encouraged for diabetic mellitus patients who would like to see the benefits of exercise and group support.
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Affiliation(s)
- Rohmatul Faizah
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
| | - Ferry Efendi
- Faculty of Nursing, Universitas Airlangga, Surabaya, Indonesia
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Ding Y, Zhong J, Wang Y, Xie W. Proteomic and microRNA-omic profiles and potential mechanisms of dysfunction in pancreatic islet cells primed by inflammation. Exp Ther Med 2020; 21:122. [PMID: 33335585 PMCID: PMC7739849 DOI: 10.3892/etm.2020.9554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 10/26/2020] [Indexed: 12/16/2022] Open
Abstract
Diabetes is an inflammatory disease that induces pancreatic islet dysfunction. However, to the best of our knowledge, the potential underlying molecular mechanisms of this inflammatory process remains unknown. The present study investigated microRNA (miRNA/miR) and protein expression profiles through proteomics and miRNA-omics. Lipopolysaccharide-induced macrophage cell medium (LRM) was used to stimulate inflammation in mouse Beta-TC-6 islet cells. Protein analysis revealed that 87 proteins were upregulated and 42 proteins were downregulated in LRM-treated Beta-TC-6 cells compared with control cells. Additionally, miRNA analysis revealed that 11 miRNAs were upregulated, while 28 miRNAs were downregulated in LRM-treated Beta-TC-6 cells compared with control cells. Islet cells exposed to inflammation exhibited markedly downregulated protein levels of transcription factor MafA, pancreatic and duodenal homeobox 1, paired box 6, homeobox protein Nkx-2.2, synaptosomal-associated protein 25, glucagon and insulin-2, while the expression of miR-146a-5p and miR-21a-5p were upregulated. It was also determined that upregulated miR-146a-5p and miR-21a-5p levels may be mediated by NF-κB activation. The downregulation of islet functional factor mRNA was partially reversed by treating islet cells with an inhibitor of miR-21a-5p. However, treatment with an miR-146a-5p inhibitor did not exert the same effect. Overall, the present study determined the molecular profiles of islet cell inflammation based on proteomics and miRNA-omics, and indicated that the proteins and miRNAs with altered expressions may form a large network that serves a role in islet dysfunction. Particularly, miR-21a-5p upregulation in response to inflammation may contribute to islet cell dysfunction. However, how these miRNAs regulated the expression of certain mRNAs and proteins in islet cell inflammation requires further investigation.
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Affiliation(s)
- Yipei Ding
- Shenzhen Key Lab of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China.,State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China.,Department of Chemistry, Tsinghua University, Beijing 100084, P.R. China
| | - Jin Zhong
- Shenzhen Key Lab of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China.,State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China.,Open FIESTA Center, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China
| | - Yangyang Wang
- Shenzhen Key Lab of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China.,State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China.,Open FIESTA Center, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China
| | - Weidong Xie
- Shenzhen Key Lab of Health Science and Technology, Institute of Biopharmaceutical and Health Engineering, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China.,State Key Laboratory of Chemical Oncogenomics, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China.,Open FIESTA Center, Shenzhen International Graduate School, Tsinghua University, Shenzhen, Guangdong 518055, P.R. China
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Liao F, Zhang K, Zhou L, Chen Y, Elliott J, Jan YK. Effect of Different Local Vibration Frequencies on the Multiscale Regularity of Plantar Skin Blood Flow. ENTROPY 2020; 22:e22111288. [PMID: 33287056 PMCID: PMC7712514 DOI: 10.3390/e22111288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/02/2020] [Accepted: 11/11/2020] [Indexed: 12/14/2022]
Abstract
Local vibration has shown promise in improving skin blood flow (SBF). However, there is no consensus on the selection of the best vibration frequency. An important reason may be that previous studies utilized time- and frequency-domain parameters to characterize vibration-induced SBF responses. These parameters are unable to characterize the structural features of the SBF response to local vibrations, thus contributing to the inconsistent findings seen in vibration research. The objective of this study was to provide evidence that nonlinear dynamics of SBF responses would be an important aspect for assessing the effect of local vibration on SBF. Local vibrations at 100 Hz, 35 Hz, and 0 Hz (sham vibration) with an amplitude of 1 mm were randomly applied to the right first metatarsal head of 12 healthy participants for 10 min. SBF at the same site was measured for 10 min before and after local vibration. The degree of regularity of SBF was quantified using a multiscale sample entropy algorithm. The results showed that 100 Hz vibration significantly increased multiscale regularity of SBF but 35 Hz and 0 Hz (sham vibration) did not. The significant increase of regularity of SBF after 100 Hz vibration was mainly attributed to increased regularity of SBF oscillations within the frequency interval at 0.0095–0.15 Hz. These findings support the use of multiscale regularity to assess effectiveness of local vibration on improving skin blood flow.
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Affiliation(s)
- Fuyuan Liao
- Department of Biomedical Engineering, Xi’an Technological University, Xi’an 710021, China;
| | - Keying Zhang
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA; (K.Z.); (L.Z.)
| | - Lingling Zhou
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA; (K.Z.); (L.Z.)
| | - Yanni Chen
- Department of Pediatrics, Xi’an Jiaotong University Health Science Center, Xi’an 710021, China;
| | - Jeannette Elliott
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA;
| | - Yih-Kuen Jan
- Rehabilitation Engineering Laboratory, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA; (K.Z.); (L.Z.)
- Correspondence: ; Tel.: +1-217-300-7253
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Using Elastographic Ultrasound to Assess Plantar Tissue Stiffness after Walking at Different Speeds and Durations. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10217498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Exercise has been demonstrated to improve health in people with diabetes. However, exercise may increase risk for foot ulcers because of increased plantar pressure during most weight-bearing physical activities. To date, there is no study investigating the effect of various walking speeds and durations (i.e., the most common form of exercise in daily living) on the plantar foot. The objective of this study was to investigate the effect of various walking intensities on plantar tissue stiffness. A 3 × 2 factorial design, including three walking speeds (1.8, 3.6 and 5.4 mph) and two durations (10 and 20 min), was tested in 12 healthy participants. B-mode and elastographic ultrasound images were measured from the first metatarsal head to quantify plantar tissue stiffness after walking. Two-way ANOVA was used to examine the results. Our results showed that the walking speed factor caused a significant main effect of planar stiffness of the superficial layers (p = 0.007 and 0.003, respectively). However, the walking duration factor did not significantly affect the plantar stiffness. There was no interaction between the speed and duration factors on plantar tissue stiffness. Regarding the walking speed effect, there was a significant difference in the plantar stiffness between 1.8 and 3.6 mph (56.8 ± 0.8% vs. 53.6 ± 0.9%, p = 0.017) under 20 min walking duration. This finding is significant because moderate-to-fast walking speed (3.6 mph) can decrease plantar stiffness compared to slow walking speed (1.8 mph). This study suggests people at risk for foot ulcers walk at a preferred or fast speed (3.6 mph) rather than walk slowly (1.8 mph).
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Wu FL, Zheng Z, Ma Y, Weng K, Liao F, Jan YK. Effects of cycle periods and pressure amplitudes of alternating pressure on sacral skin blood flow responses. J Tissue Viability 2020; 29:264-268. [PMID: 32978042 DOI: 10.1016/j.jtv.2020.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/02/2020] [Accepted: 09/16/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are no guidelines on selecting alternating pressure (AP) configurations on increasing sacral skin blood flow (SBF). AIM The specific aims were to compare different cycle periods and pressure amplitudes of AP on sacral SBF responses in healthy people to establish the efficacy and safety of the protocols. METHODS Two studies were tested, including the cycle period study (8 2.5-min vs 4 5-min protocols) and the pressure amplitude study (75/5 vs 65/15 mmHg protocols). Sacral SBF was measured using laser Doppler flowmetry (LDF) in 20 participants. AP loads were randomly applied using an indenter through the rigid LDF probe. Each protocol included a 10-min baseline, 20-min AP and 10-min recovery periods. A 30-min washout period was provided. The SBF response was normalized to the baseline SBF of each condition of each participant. RESULTS For the cycle period study, the 4 5-min cycle protocol partially restored more SBF than the 8 2.5-min cycle protocol at the low-pressure phase (0.87 ± 0.04 vs 0.71 ± 0.03, p < 0.05) and at the high-pressure phase (0.25 ± 0.03 vs 0.19 ± 0.03, p < 0.05). For the pressure amplitude study, the 75/5 mmHg protocol partially restored more sacral SBF than the 65/15 mmHg protocol at the low-pressure phase (0.87 ± 0.1 vs 0.25 ± 0.03, p < 0.05) but not at the high-pressure phase (0.23 ± 0.02 vs 0.21 ± 0.02, non-significant). CONCLUSION This study demonstrated that 1) a cycle period of 5 min was better than 2.5 min and 2) a pressure amplitude of 75/5 mmHg was better than 65/15 mmHg. The finding provides insights for selecting the AP configurations for increasing SBF.
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Affiliation(s)
- Fu-Lien Wu
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Zhi Zheng
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Yinyin Ma
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Kaixiang Weng
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Fuyuan Liao
- Department of Biomedical Engineering, Xi'an Technological University, Xi'an, China
| | - Yih-Kuen Jan
- Rehabilitation Engineering Lab, Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL, USA.
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