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Kobara K, Nagata Y, Takahashi H, Osaka H, Suehiro T, Fujita D. Effect of shape of back support adjustment on shear force applied to buttocks when tilt-in-space and reclining functions are combined in wheelchairs. Disabil Rehabil Assist Technol 2024; 19:1916-1922. [PMID: 37815148 DOI: 10.1080/17483107.2023.2267581] [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: 01/27/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE This study aimed to investigate the effect of the shape of the back support adjustment on the shear force applied to the buttocks when tilt-in-space and reclining functions are combined in wheelchairs. MATERIALS AND METHODS Fourteen healthy adult men were included in the study. The force plate was used to measure the parallel force as shear force. The measurement posture, leaning against the back support of an experimental chair, was a comfortable sitting posture. The tilt-in-space angle was set to 15°. The back support was inclined at increasing angles, starting from the upright position (IUP), proceeding to a fully reclined position (FRP), and returning to the upright position (RUP). The experimental conditions were as follows: adjusting the back-support shape (aBS) and non-adjusting the back support shape (non-aBS). RESULTS Positive values indicate a parallel force applied to the buttocks posteriorly. The average values in the aBS condition were 3.4 ± 2.3, 13.6 ± 2.2, and -7.1 ± 2.4% body weight in the IUP, FRP, and RUP, respectively. The average values in the non-aBS condition were 3.8 ± 2.5, 11.4 ± 2.1, and -6.2 ± 3.1% body weight in the IUP, FRP, and RUP, respectively. There were significant differences between the two conditions in FRP (p < 0.01). CONCLUSION These findings suggest that the shape of the back support adjustment function increased the shear force applied to the buttocks posteriorly when the back support was inclined backwards using both the tilt-in-space and reclining functions.
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Affiliation(s)
- Kenichi Kobara
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki City, Japan
| | - Yasuyuki Nagata
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki City, Japan
| | - Hisashi Takahashi
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki City, Japan
| | - Hiroshi Osaka
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki City, Japan
| | - Tadanobu Suehiro
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki City, Japan
| | - Daisuke Fujita
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare, Kurashiki City, Japan
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2
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Wang C, Stovitz SD, Kaufman JS, Steele RJ, Shrier I. Principles of musculoskeletal sport injuries for epidemiologists: a review. Inj Epidemiol 2024; 11:21. [PMID: 38802864 PMCID: PMC11131288 DOI: 10.1186/s40621-024-00507-3] [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: 02/01/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Musculoskeletal injuries are a common occurrence in sport. The goal of sport injury epidemiology is to study these injuries at a population level to inform their prevention and treatment. MAIN BODY This review provides an overview of musculoskeletal sport injuries and the musculoskeletal system from a biological and epidemiologic perspective, including injury mechanism, categorizations and types of sport injuries, healing, and subsequent injuries. It is meant to provide a concise introductory substantive background of musculoskeletal sport injuries for epidemiologists who may not have formal training in the underlying anatomy and pathophysiology. CONCLUSION An understanding of sport injuries is important for researchers in sport injury epidemiology when determining how to best define and assess their research questions and measures.
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Affiliation(s)
- Chinchin Wang
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada
| | - Steven D Stovitz
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, USA
| | - Jay S Kaufman
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Russell J Steele
- Department of Mathematics and Statistics, McGill University, Montreal, Canada
| | - Ian Shrier
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, 3755 Côte Ste-Catherine Road, Montreal, QC, H3T 1E2, Canada.
- Department of Family Medicine, McGill University, Montreal, Canada.
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3
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Wilson HJE, Patton D, Budri AMV, Boland F, O'Connor T, McDonnell CO, Rai H, Moore ZEH. The correlation between sub-epidermal moisture measurement and other early indicators of pressure ulcer development-A prospective cohort observational study. Part 1. The correlation between sub-epidermal moisture measurement and ultrasound. Int Wound J 2024; 21:e14732. [PMID: 38385834 PMCID: PMC10883243 DOI: 10.1111/iwj.14732] [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: 11/10/2023] [Revised: 01/16/2024] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
The correlation between sub-epidermal moisture (SEM) and other early indicators of pressure ulcer (PU) development is yet to be determined. This three-part series aims to bridge this knowledge gap, through investigating SEM and its correlation with evidence-based technologies and assessments. This article focuses on the correlation between SEM and ultrasound. A prospective cohort observational study was undertaken between February and November 2021. Patients undergoing three surgery types were consecutively enrolled to the study following informed consent. Assessments were performed prior to and following surgery for 3 days at the sacrum, both heels and a control site, using a SEM scanner and high-frequency ultrasound scanner (5-15 MHz). Spearman's rank (rs ) explored the correlation between SEM and ultrasound. A total of 60 participants were included; 50% were male with a mean age of 58 years (±13.46). A statistically significant low to moderately positive correlation was observed between SEM and ultrasound across all anatomical sites (rs range = 0.39-0.54, p < 0.05). The only exception was a correlation between SEM and ultrasound on day 0 at the right heel (rs = 0.23, p = 0.09). These results indicate that SEM and ultrasound agreed in the presence of injury; however, SEM was able to identify abnormalities before ultrasound.
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Affiliation(s)
- Hannah Jane Elizabeth Wilson
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Declan Patton
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Department of NursingFakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Honorary Senior Fellow, Faculty of Science, Medicine and HealthUniversity of WollongongWollongongNew South WalesAustralia
| | - Aglecia Moda Vitoriano Budri
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
| | - Fiona Boland
- Data Science Centre, School of Population HealthRCSI University of Medicine and Health SciencesDublinIreland
| | - Tom O'Connor
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Department of NursingFakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Department of NursingLida InstituteShanghaiChina
| | | | - Himanshu Rai
- Cardiovascular Research Institute Dublin (CVRI Dublin)Mater Private NetworkDublinIreland
- School of Pharmacy and Biomolecular SciencesRCSI University of Medicine and Health SciencesDublinIreland
| | - Zena Elizabeth Helen Moore
- Skin Wounds and Trauma Research CentreRCSI University of Medicine and Health SciencesDublinIreland
- School of Nursing and MidwiferyRCSI University of Medicine and Health SciencesDublinIreland
- Department of NursingFakeeh College of Health SciencesJeddahSaudi Arabia
- School of Nursing and MidwiferyGriffith UniversityBrisbaneQueenslandAustralia
- Department of NursingLida InstituteShanghaiChina
- Faculty of Medicine, Nursing and Health SciencesMonash UniversityMelbourneVictoriaAustralia
- Department of Public Health, Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium
- School of Healthcare SciencesUniversity of WalesCardiffUK
- National Health and Medical Research Council Centre of Research Excellence in Wiser Wound CareMenzies Health Institute QueenslandGold CoastQueenslandAustralia
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4
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Shu J, Deng H, Zhang Y, Wu F, He J. Cancer cell response to extrinsic and intrinsic mechanical cue: opportunities for tumor apoptosis strategies. Regen Biomater 2024; 11:rbae016. [PMID: 38476678 PMCID: PMC10932484 DOI: 10.1093/rb/rbae016] [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: 12/17/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/14/2024] Open
Abstract
Increasing studies have revealed the importance of mechanical cues in tumor progression, invasiveness and drug resistance. During malignant transformation, changes manifest in either the mechanical properties of the tissue or the cellular ability to sense and respond to mechanical signals. The major focus of the review is the subtle correlation between mechanical cues and apoptosis in tumor cells from a mechanobiology perspective. To begin, we focus on the intracellular force, examining the mechanical properties of the cell interior, and outlining the role that the cytoskeleton and intracellular organelle-mediated intracellular forces play in tumor cell apoptosis. This article also elucidates the mechanisms by which extracellular forces guide tumor cell mechanosensing, ultimately triggering the activation of the mechanotransduction pathway and impacting tumor cell apoptosis. Finally, a comprehensive examination of the present status of the design and development of anti-cancer materials targeting mechanotransduction is presented, emphasizing the underlying design principles. Furthermore, the article underscores the need to address several unresolved inquiries to enhance our comprehension of cancer therapeutics that target mechanotransduction.
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Affiliation(s)
- Jun Shu
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, PR China
| | - Huan Deng
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, PR China
| | - Yu Zhang
- College of Food and Biological Engineering, Chengdu University, Chengdu 610106, PR China
| | - Fang Wu
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, PR China
| | - Jing He
- National Engineering Research Center for Biomaterials, College of Biomedical Engineering, Sichuan University, Chengdu 610064, PR China
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5
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Peng Q, Vermolen FJ, Weihs D. Physical confinement and cell proximity increase cell migration rates and invasiveness: A mathematical model of cancer cell invasion through flexible channels. J Mech Behav Biomed Mater 2023; 142:105843. [PMID: 37104897 DOI: 10.1016/j.jmbbm.2023.105843] [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: 08/23/2022] [Revised: 03/28/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023]
Abstract
Cancer cell migration between different body parts is the driving force behind cancer metastasis, which is the main cause of mortality of patients. Migration of cancer cells often proceeds by penetration through narrow cavities in locally stiff, yet flexible tissues. In our previous work, we developed a model for cell geometry evolution during invasion, which we extend here to investigate whether leader and follower (cancer) cells that only interact mechanically can benefit from sequential transmigration through narrow micro-channels and cavities. We consider two cases of cells sequentially migrating through a flexible channel: leader and follower cells being closely adjacent or distant. Using Wilcoxon's signed-rank test on the data collected from Monte Carlo simulations, we conclude that the modelled transmigration speed for the follower cell is significantly larger than for the leader cell when cells are distant, i.e. follower cells transmigrate after the leader has completed the crossing. Furthermore, it appears that there exists an optimum with respect to the width of the channel such that cell moves fastest. On the other hand, in the case of closely adjacent cells, effectively performing collective migration, the leader cell moves 12% faster since the follower cell pushes it. This work shows that mechanical interactions between cells can increase the net transmigration speed of cancer cells, resulting in increased invasiveness. In other words, interaction between cancer cells can accelerate metastatic invasion.
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Affiliation(s)
- Qiyao Peng
- Mathematical Institute, Faculty of Science, Leiden University, Neils Bohrweg 1, 2333 CA, Leiden, The Netherlands.
| | - Fred J Vermolen
- Computational Mathematics Group, Department of Mathematics and Statistics, Faculty of Science, University of Hasselt, 3590 Diepenbeek, Belgium
| | - Daphne Weihs
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, 3200003 Haifa, Israel
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6
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Carver CH, Mullis S, Fitzgerald KH. Seating and Wheeled Mobility Clinicians Contribute to the Wound Care Team. Phys Med Rehabil Clin N Am 2022; 33:789-803. [PMID: 36243470 DOI: 10.1016/j.pmr.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Many know that the wound care team consists of physicians and nurses with specialized training. Many may not know of physical therapists (PT) or occupational therapists (OT) with training in seating and wheeled mobility who address skin injuries in people who are full-time wheelchair users. PTs/OTs address the fit and use of their wheelchair to their body and look at their daily function while looking for causes of skin injury otherwise not seen and can help prevent them in the future. Therefore, this makes PTs and OTs with this expertise a valuable part of the wound care team.
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7
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Scorpion Peptide Smp24 Exhibits a Potent Antitumor Effect on Human Lung Cancer Cells by Damaging the Membrane and Cytoskeleton In Vivo and In Vitro. Toxins (Basel) 2022; 14:toxins14070438. [PMID: 35878176 PMCID: PMC9318729 DOI: 10.3390/toxins14070438] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 12/25/2022] Open
Abstract
Smp24, a cationic antimicrobial peptide identified from the venom gland of the Egyptian scorpion Scorpio maurus palmatus, shows variable cytotoxicity on various tumor (KG1a, CCRF-CEM and HepG2) and non-tumor (CD34+, HRECs, HACAT) cell lines. However, the effects of Smp24 and its mode of action on lung cancer cell lines remain unknown. Herein, the effect of Smp24 on the viability, membrane disruption, cytoskeleton, migration and invasion, and MMP-2/-9 and TIMP-1/-2 expression of human lung cancer cells have been evaluated. In addition, its in vivo antitumor role and acute toxicity were also assessed. In our study, Smp24 was found to suppress the growth of A549, H3122, PC-9, and H460 with IC50 values from about 4.06 to 7.07 µM and show low toxicity to normal cells (MRC-5) with 14.68 µM of IC50. Furthermore, Smp24 could induce necrosis of A549 cells via destroying the integrity of the cell membrane and mitochondrial and nuclear membranes. Additionally, Smp24 suppressed cell motility by damaging the cytoskeleton and altering MMP-2/-9 and TIMP-1/-2 expression. Finally, Smp24 showed effective anticancer protection in a A549 xenograft mice model and low acute toxicity. Overall, these findings indicate that Smp24 significantly exerts an antitumor effect due to its induction of membrane defects and cytoskeleton disruption. Accordingly, our findings will open an avenue for developing scorpion venom peptides into chemotherapeutic agents targeting lung cancer cells.
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8
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Martins de Oliveira AL, O'Connor T, Patton D, Strapp H, Moore Z. Sub-epidermal moisture versus traditional and visual skin assessments to assess pressure ulcer risk in surgery patients. J Wound Care 2022; 31:254-264. [PMID: 35199594 DOI: 10.12968/jowc.2022.31.3.254] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare the predictive ability of subepidermal moisture (SEM) measurement versus traditional risk assessment and visual skin assessment (VSA) as means of detecting early pressure ulcer (PU) damage development among adults undergoing surgery. METHOD A non-experimental, comparative, descriptive cohort study design was used. Following ethical approval, participants who had given their informed written consent had their skin assessed over the areas that were weight-bearing during surgery, using VSA and the SEM measurement. Visual PUs were graded according to the European Pressure Ulcer Advisory Panel and National Pressure Ulcer Advisory Panel ulcer grading system. Assessments took place preoperatively, then daily on the ward, beginning on day one postoperatively and continuing for three days or until discharge. RESULTS Of the 231 participants, who had a mean age of 57.50 years, 55.8% (n=129) were male. The most common comorbidity was cardiology/vascular (n=42; 18.2%). Just over half (52.4%; n=121) underwent orthopaedic surgery and 47.6% (n=110) underwent non-orthopaedic surgery; 70% (n=163) received a general anaesthetic and 43% (n=100) were in the supine decubitus position during surgery. PU incidence was 51% (n=116), according to SEM measurement, and 3% (n=7) according to VSA. Among the seven participants who developed a visual PU, 10 PUs at stage 1 developed (31%); some patients developed more than one PU. Of the participants who had assessments for three days postoperatively, 94% (n=61) had a persistently high SEM delta on day three. The variables that emerged as statistically significantly related to abnormal SEM measurement deltas among these participants were: surgery duration (p=0.038); having orthopaedic surgery (p=0.020); supine surgical position (p=0.003); spinal anaesthetic type (p=0.0001); and Waterlow and Braden mobility subscale day one postoperatively (p=0.0001). None of the variables had a statistically significant influence on abnormal VSA. CONCLUSION Surgical patients, because of immobility, are vulnerable to the action of compression and shear forces. These forces cause changes at a cellular level that trigger inflammation, which is a precursor to early tissue damage. SEM measurement can detect this tissue damage from the increase in the underlying tissue water content that results from inflammation. From the findings of this study, SEM measurement is very promising in the detection of early tissue damage in those at risk of PU development among the surgical population.
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Affiliation(s)
| | - Tom O'Connor
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,Lida Institute, Shanghai.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia
| | - Declan Patton
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia.,Faculty of Science, Medicine and Health, University of Wollongong, Australia
| | - Helen Strapp
- Tallaght University Hospital, Ireland.,SWaT Research Network, RCSI University of Medicine and Health Sciences, Ireland
| | - Zena Moore
- RCSI University of Medicine and Health Sciences, School of Nursing and Midwifery, Ireland.,Skin Wounds and Trauma (SWaT) Research Centre, RCSI University of Medicine and Health Sciences, Ireland.,Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.,Faculty of Medicine and Health Sciences, Ghent University, Belgium.,Lida Institute, Shanghai.,University of Wales, Wales.,School of Nursing, Fakeeh College, Jeddah, Saudia Arabia
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9
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Gaspar S, Peralta M, Budri A, Ferreira C, Gaspar de Matos M. Pressure ulcer risk profiles of hospitalized patients based on the Braden Scale: A cluster analysis. Int J Nurs Pract 2022; 28:e13038. [DOI: 10.1111/ijn.13038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 11/19/2021] [Accepted: 01/02/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Susana Gaspar
- Faculty of Human Kinetics, Aventura Social University of Lisbon Lisbon Portugal
- Faculty of Medicine, Environmental Health Institute (ISAMB) University of Lisbon Lisbon Portugal
| | - Miguel Peralta
- Faculty of Human Kinetics, Aventura Social University of Lisbon Lisbon Portugal
- Faculty of Medicine, Environmental Health Institute (ISAMB) University of Lisbon Lisbon Portugal
- Faculty of Human Kinetics, Interdisciplinary Center for the Study of Human Performance (CIPER) University of Lisbon Lisbon Portugal
| | - Aglécia Budri
- School of Nursing and Midwifery Royal College of Surgeon in Ireland Dublin Ireland
- Skin Wounds and Trauma (SWaT) Research Centre Royal College of Surgeon in Ireland Dublin Ireland
| | - Carlos Ferreira
- Faculty of Human Kinetics, Aventura Social University of Lisbon Lisbon Portugal
- Institute of Education, UIDEF University of Lisbon Lisbon Portugal
| | - Margarida Gaspar de Matos
- Faculty of Human Kinetics, Aventura Social University of Lisbon Lisbon Portugal
- Faculty of Medicine, Environmental Health Institute (ISAMB) University of Lisbon Lisbon Portugal
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10
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Kobara K, Nagata Y, Fujita D, Takahashi H, Osaka H, Suehiro T. Investigation of the effect of a 15-degree tilt-in-space on the fluctuation of shear forces exerted on the buttocks when the back support is reclined. J Phys Ther Sci 2021; 33:838-844. [PMID: 34776619 PMCID: PMC8575471 DOI: 10.1589/jpts.33.838] [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: 06/30/2021] [Accepted: 08/02/2021] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the effect of the combination of 15° tilt-in-space and recline angles on the fluctuation of shear forces exerted on the buttocks. [Participants and Methods] The participants were 11 healthy adult males. The parameters of the shear forces were the parallel and perpendicular forces exerted on the buttocks as measured by a force plate. The two conditions tested were T0R100-130 and T15R100-130. The tilt-in-space angles were set to 0° and 15° in the T0R100-130 and T15R100-130 conditions, respectively. The reclining angles were determined to be 100° to 130° in both conditions. [Results] Upon comparing the two conditions, the parallel and the perpendicular forces exerted on the buttocks in the T15R100-130 condition were significantly lower than those in the T0R100-130 condition in all positions of back support. Upon comparing the fluctuation values of the parallel and perpendicular forces, those applied in the T15R100-130 condition were significantly higher than those in the T0R100-130 condition. [Conclusion] These results suggest that the fluctuation of shear forces exerted on the buttocks could be decreased by using a combination of 15° tilt-in-space and reclining functions.
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Affiliation(s)
- Kenichi Kobara
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Yasuyuki Nagata
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Daisuke Fujita
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Hisashi Takahashi
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Hiroshi Osaka
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
| | - Tadanobu Suehiro
- Department of Physical Therapy, Faculty of Rehabilitation, Kawasaki University of Medical Welfare: 288 Matsushima, Kurashiki, Okayama 701-0193, Japan
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11
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Cathelain G, Perrier A, Folliot L, Le Gloanec C, Rarrbo M, Jouen F, Saudeau E, Costa G, Carlier R, Bergounioux J. Bench testing of tracheostomy tube-related insults using an instrumented manikin. Eur Arch Otorhinolaryngol 2021; 279:1593-1599. [PMID: 34499203 DOI: 10.1007/s00405-021-07054-3] [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: 05/16/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Choosing the right tracheal tube for the right patient is a daily preoccupation for intensivists and emergency physicians. Tracheal tubes can generate severe complications, which are chiefly due to the pressures applied by the tube to the trachea. We designed a bench study to assess the frequency of pressure levels likely to cause tracheal injury. METHODS We tested the pressure applied on the trachea by 17 tube models of a given size range. To this end, we added a pressure sensor to the posterior tracheal wall of a standardized manikin. RESULTS Only 2 of the 17 tubes generated pressures under the threshold likely to induce tracheal injury (30 mmHg/3.99 kPa). The force exerted on the posterior wall of the trachea varied widely across tube models. CONCLUSION Most models of tracheal tubes resulted in forces applied to the trachea that are usually considered capable of causing tracheal tissue injury. LEVEL OF EVIDENCE Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence: How common is the problem?: step 1; Is this diagnostic or monitoring test accurate? (Diagnosis) step 5; What will happen if we do not add a therapy? (Prognosis) n/a; Does this intervention help? (Treatment Benefits) step 5; What are the COMMON harms?(Treatment Harms) step 5; What are the RARE harms? (Treatment Harms) step 5; Is this (early detection) test worthwhile? (Screening) step 5.
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Affiliation(s)
- Guillaume Cathelain
- CHArt Laboratory, Ecole Pratique Des Hautes Etudes, PSL University, Paris, France
| | - Antoine Perrier
- Université Grenoble Alpes and CNRS, TIMC-IMAG, 38000, Grenoble, France.,Pitié-Salpêtrière Teaching Hospital, Assistance Publique Des Hôpitaux de Paris, Paris, France
| | - Ludivine Folliot
- DMU Smart Imaging, Radiology Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - Cyrielle Le Gloanec
- Clinical Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - Mohamed Rarrbo
- Clinical Pharmacy Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France
| | - François Jouen
- CHArt Laboratory, Ecole Pratique Des Hautes Etudes, PSL University, Paris, France
| | - Etienne Saudeau
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Guillaume Costa
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Robert Carlier
- DMU Smart Imaging, Radiology Department, Raymond Poincaré University Hospital, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France.,UMR 1179 End-iCap, UVSQ, Paris-Saclay, Versailles, France
| | - Jean Bergounioux
- Pediatric Intensive Care Unit, Assistance Publique Des Hôpitaux de Paris, Garches, Paris, France. .,Simone Veil Health Science Centre, Université Versailles SQY, Paris-Saclay, Versailles, France. .,Réanimation et Soins Intensifs Pédiatriques, Batiment Letulle, 3ème étage, Hôpital Universitaire Raymond Poincaré, APHP, 104 Boulevard Raymond Poincaré, Garches, 92380, Paris, France.
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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: 83] [Impact Index Per Article: 27.7] [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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Choi JS, Seok J, Eom MR, Jung E, Park SA, Joo SM, Jun YJ, Son KW, Kwon SK. Endoscopically Applied Biodegradable Stent in a Rabbit Model of Pediatric Tracheomalacia. Clin Exp Otorhinolaryngol 2021; 14:328-337. [PMID: 33081438 PMCID: PMC8373836 DOI: 10.21053/ceo.2020.01627] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 09/26/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES A polydioxanone (PDO) stent was developed to treat tracheomalacia in pediatric patients. However, its safety and efficacy need to be verified in animal studies before clinical trials in patients can be conducted. This study evaluated the safety and efficacy of a PDO stent in normal and tracheomalacia-model rabbits. METHODS In total, 29 New Zealand white rabbits were used: 13 for evaluating the biocompatibility of the PDO stent in normal rabbits and 16 for the creation of a tracheomalacia model. The tracheomalacia model was successfully established in 12 rabbits, and PDO stents were placed in eight of those rabbits. RESULTS The PDO stent was successfully positioned in the trachea of the normal rabbits using an endoscopic approach, and its degradation was observed 10 weeks later. The stent fragments did not induce distal airway obstruction or damage, and the mucosal changes that occurred after stent placement were reversed after degradation. The same procedure was performed on the tracheomalacia-model rabbits. The survival duration of the tracheomalacia rabbits with and without stents was 49.0±6.8 and 1.0±0.8 days, respectively. Thus, the PDO stent yielded a significant survival gain (P=0.001). In the tracheomalacia rabbits, stent degradation and granulation tissue were observed 7 weeks after placement, leading to airway collapse and death. CONCLUSION We successfully developed a PDO stent and an endoscopic guide placement system. The degradation time of the stent was around 10 weeks in normal rabbits, and its degradation was accelerated in the tracheomalacia model. The mucosal changes associated with PDO stent placement were reversible. Placement of the PDO stent prolonged survival in tracheomalacia-model rabbits.
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Affiliation(s)
- Ji Suk Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Min Rye Eom
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Eungee Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Su A Park
- Department of Nature-Inspired Nanoconvergence Systems, Korea Institute of Machinery and Materials, Daejeon, Korea
| | | | | | | | - Seong Keun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
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Soppi E, Knuuti J, Kalliokoski K. Positron emission tomography study of effects of two pressure-relieving support surfaces on pressure ulcer development. J Wound Care 2021; 30:54-62. [PMID: 33439081 DOI: 10.12968/jowc.2021.30.1.54] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVE To study the pathophysiological cascade of pressure ulcer (PU) development consisting of tissue deformation, inflammation and hypoxia. METHOD In this crossover study, deformation was measured with computerised tomography (CT) linked with contact area reflecting immersion and envelopment. Inflammation and hypoxia were measured using subepidermal moisture (SEM), skin temperature and tissue perfusion with positron emission tomography. These variables were investigated under 90 minutes of pressure exposure caused by two functionally different support surfaces-a regular foam mattress and a minimum pressure air (MPA) mattress. RESULTS A total of eight healthy volunteers took part in the study. There was major tissue deformation when the participants lay on a foam mattress while the tissues retained their original shape on the MPA mattress (p<0.0001). During the pressure exposure, the skin temperature increased significantly on both support surfaces but the final temperature on the foam mattress was about 1oC higher than on the MPA mattress (p<0.0001). SEM increased on both support surfaces compared with an unexposed reference site, but the cause may be different between the two support surfaces. Tissue perfusion was lowest in the skin followed by subcutaneous tissues and highest in the muscles. The pressure exposure did not cause any substantial changes in perfusion. The results showed that tissue deformation was more pronounced, the support surface contact area (envelopment), was smaller and the skin temperature higher on the foam mattress than on the MPA mattress, without significant differences in tissue perfusion. CONCLUSION In this study, the MPA mattress support surface had mechanobiological properties that counteracted tissue deformation and thereby may prevent PUs.
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Affiliation(s)
- Esa Soppi
- Outpatient Clinic, Eira Hospital, Laivurinkatu 29, FI-00150 Helsinki, Finland
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku, Finland
| | - Kari Kalliokoski
- Turku PET Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, Turku, Finland
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Wano N, Sanguanrungsirikul S, Keelawat S, Somboonwong J. The effects of whole-body vibration on wound healing in a mouse pressure ulcer model. Heliyon 2021; 7:e06893. [PMID: 33997412 PMCID: PMC8102430 DOI: 10.1016/j.heliyon.2021.e06893] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 04/11/2021] [Accepted: 04/21/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Pressure ulcers are one of the most common complications of immobility resulting from pressure and shear. Whole-body vibration (WBV) has been shown to increase skin blood flow but little information is known about its effect on pressure ulcers. This study investigated the effects of WBV on wound healing in a mouse pressure ulcer model. METHODS Two cycles of ischemia-reperfusion were performed by external application of two magnetic plates to dorsal skin to induce stage II pressure ulcers characterized by partial-thickness skin loss with exposed dermis. A total of 32 male ICR mice were randomly and equally divided into untreated control and the WBV groups. Immediately after the completion of 2-cycle ischemia-reperfusion injury, mice in the WBV group participated in a WBV program using a vibrator (frequency 45 Hz, peak acceleration 0.4 g, vertical motion) for 30 min/day and 5 consecutive days/week. At days 7 and 14 post-ulceration, wound closure rate was assessed. Wound tissues were harvested for determination of collagen deposition in Masson's trichrome stained sections, neutrophil infiltration and capillary density in hematoxylin and eosin-stained sections, as well as TNF-α and VEGF levels using ELISA. RESULTS TNF-α levels and neutrophil infiltration were significantly decreased in wounds on days 7 and 14 of WBV treatment. Moreover, wound closure rate and collagen deposition were remarkably accelerated on day 14. Tissue VEGF and capillary density were unaffected by WBV at either time point. CONCLUSIONS These findings suggest that WBV has the potential to promote the healing process of stage II pressure ulcers, as evidenced by attenuation of wound inflammation and enhancement collagen deposition.
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Affiliation(s)
- Nattaya Wano
- Medical Science Program, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | | | - Somboon Keelawat
- Department of Pathology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Juraiporn Somboonwong
- Department of Physiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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16
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Modeling force application configurations and morphologies required for cancer cell invasion. Biomech Model Mechanobiol 2021; 20:1187-1194. [PMID: 33683515 DOI: 10.1007/s10237-021-01441-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/17/2021] [Indexed: 10/24/2022]
Abstract
We show that cell-applied, normal mechanical stresses are required for cells to penetrate into soft substrates, matching experimental observations in invasive cancer cells, while in-plane traction forces alone reproduce observations in non-cancer/noninvasive cells. Mechanobiological interactions of cells with their microenvironment drive migration and cancer invasion. We have previously shown that invasive cancer cells forcefully and rapidly push into impenetrable, physiological stiffness gels and indent them to cell-scale depths (up to 10 μm); normal, noninvasive cells indent at most to 0.7 μm. Significantly indenting cells signpost increased cancer invasiveness and higher metastatic risk in vitro and in vivo, as verified experimentally in different cancer types, yet the underlying cell-applied, force magnitudes and configurations required to produce the cell-scale gel indentations have yet to be evaluated. Hence, we have developed finite element models of forces applied onto soft, impenetrable gels using experimental cell/gel morphologies, gel mechanics, and force magnitudes. We show that in-plane traction forces can only induce small-scale indentations in soft gels (< 0.7 μm), matching experiments with various single, normal cells. Addition of a normal force (on the scale of experimental traction forces) produced cell-scale indentations that matched observations in invasive cancer cells. We note that normal stresses (force and area) determine the indentation depth, while contact area size and morphology have a minor effect, explaining the origin of experimentally observed cell morphologies. We have thus revealed controlling features facilitating invasive indentations by single cancer cells, which will allow application of our model to complex problems, such as multicellular systems.
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The mechanobiology theory of the development of medical device-related pressure ulcers revealed through a cell-scale computational modeling framework. Biomech Model Mechanobiol 2021; 20:851-860. [PMID: 33606118 PMCID: PMC7893381 DOI: 10.1007/s10237-021-01432-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 02/03/2021] [Indexed: 12/17/2022]
Abstract
Pressure ulcers are localized sites of tissue damage which form due to the continuous exposure of skin and underlying soft tissues to sustained mechanical loading, by bodyweight forces or because a body site is in prolonged contact with an interfacing object. The latter is the common cause for the specific sub-class of pressure ulcers termed ‘medical device-related pressure ulcers’, where the injury is known to have been caused by a medical device applied for a diagnostic or therapeutic purpose. Etiological research has established three key contributors to pressure ulcer formation, namely direct cell and tissue deformation, inflammatory edema and ischemic damage which are typically activated sequentially to fuel the injury spiral. Here, we visualize and analyze the above etiological mechanism using a new cell-scale modeling framework. Specifically, we consider here the deformation-inflicted and inflammatory contributors to the damage progression in a medical device-related pressure ulcer scenario, forming under a continuous positive airway pressure ventilation mask at the microarchitecture of the nasal bridge. We demonstrate the detrimental effects of exposure to high-level continuous external strains, which causes deformation-inflicted cell damage almost immediately. This in turn induces localized edema, which exacerbates the cell-scale mechanical loading state and thereby progresses cell damage further in a nonlinear, escalating pattern. The cell-scale quantitative description of the damage cascade provided here is important not only from a basic science perspective, but also for creating awareness among clinicians as well as industry and regulators with regards to the need for improving the design of skin-contacting medical devices.
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Reflections on pressure ulcers. J Tissue Viability 2021; 30:1-2. [PMID: 33485787 DOI: 10.1016/j.jtv.2021.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Mansur R, Peko L, Shabshin N, Cherbinski L, Neeman Z, Gefen A. Ultrasound elastography reveals the relation between body posture and soft-tissue stiffness which is relevant to the etiology of sitting-acquired pressure ulcers. Physiol Meas 2021; 41:124002. [PMID: 33126232 DOI: 10.1088/1361-6579/abc66d] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Sitting-acquired pressure ulcers (PUs) are common in wheelchair users. These PUs are often serious and may involve deep tissue injury (DTI). Investigating the mechanical properties of the tissues susceptible to DTI may help in guiding the prevention and early detection of PUs. In this study, shear wave elastography (SWE) was used to measure the normative mechanical properties of the soft tissues of the buttocks, i.e. skeletal muscle and subcutaneous fat, under the ischial tuberosities, in a convenient sample of healthy adults without weight bearing and with weight bearing of different times. APPROACH We compared the stiffness properties of these soft tissues between the lying prone and sitting postures, to determine whether there are detectable property changes that may be associated with the type of posture. We hypothesized that muscle contractions and 3D tissue configurations associated with the posture may influence the measured tissue stiffnesses. MAIN RESULTS Our results have shown that indeed, SWE values differed significantly across postures, but not over time in a specific posture or for the right versus left sides of the body. SIGNIFICANCE We have therefore demonstrated that soft-tissue stiffness increases when sitting with weight bearing and may contribute to increasing the potential PU risk in sitting compared to lying prone, given the stiffer behavior of tissues observed in sitting postures.
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Affiliation(s)
- Ruba Mansur
- Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
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20
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Role of microRNAs in Pressure Ulcer Immune Response, Pathogenesis, and Treatment. Int J Mol Sci 2020; 22:ijms22010064. [PMID: 33374656 PMCID: PMC7793489 DOI: 10.3390/ijms22010064] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 12/16/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023] Open
Abstract
Pressure ulcers are preventable, yet highly prevalent, chronic wounds that have significant patient morbidity and high healthcare costs. Like other chronic wounds, they are characterized by impaired wound healing due to dysregulated immune processes. This review will highlight key biochemical pathways in the pathogenesis of pressure injury and how this signaling leads to impaired wound healing. This review is the first to comprehensively describe the current literature on microRNA (miRNA, miR) regulation of pressure ulcer pathophysiology.
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The Effect of Antioxidants on Photoreactivity and Phototoxic Potential of RPE Melanolipofuscin Granules from Human Donors of Different Age. Antioxidants (Basel) 2020; 9:antiox9111044. [PMID: 33114498 PMCID: PMC7693403 DOI: 10.3390/antiox9111044] [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: 08/28/2020] [Revised: 10/16/2020] [Accepted: 10/19/2020] [Indexed: 11/17/2022] Open
Abstract
One of the most prominent age-related changes of retinal pigment epithelium (RPE) is the accumulation of melanolipofuscin granules, which could contribute to oxidative stress in the retina. The purpose of this study was to determine the ability of melanolipofuscin granules from younger and older donors to photogenerate reactive oxygen species, and to examine if natural antioxidants could modify the phototoxic potential of this age pigment. Electron paramagnetic resonance (EPR) oximetry, EPR-spin trapping, and time-resolved detection of near-infrared phosphorescence were employed for measuring photogeneration of superoxide anion and singlet oxygen by melanolipofuscin isolated from younger and older human donors. Phototoxicity mediated by internalized melanolipofuscin granules with and without supplementation with zeaxanthin and α-tocopherol was analyzed in ARPE-19 cells by determining cell survival, oxidation of cellular proteins, organization of the cell cytoskeleton, and the cell specific phagocytic activity. Supplementation with antioxidants reduced aerobic photoreactivity and phototoxicity of melanolipofuscin granules. The effect was particularly noticeable for melanolipofuscin mediated inhibition of the cell phagocytic activity. Antioxidants decreased the extent of melanolipofuscin-dependent oxidation of cellular proteins and disruption of the cell cytoskeleton. Although melanolipofuscin might be involved in chronic phototoxicity of the aging RPE, natural antioxidants could partially ameliorate these harmful effects.
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Kobara K, Takahashi H, Nagata Y, Osaka H, Suehiro T, Fujita D. An investigation into the effectiveness of a novel wheelchair seat-cover assembly for the reduction of forces exerted onto the buttocks. Disabil Rehabil Assist Technol 2020; 17:304-309. [PMID: 32552176 DOI: 10.1080/17483107.2020.1780484] [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: 10/24/2022]
Abstract
Purpose: This purpose was to investigate developed seat-cover assemblies' effect on decreasing the fluctuation of the shear force exerted onto the buttocks as the factors causing decubitus ulcers when the back-support was inclined.Materials and Methods: The participants were 10 wheelchair users. The force plate was used to measure the horizontal force as the shear force. The back-support was inclined at increasing angles, starting from the upright position (IUP), then proceeding to a fully reclined position (FRP), and returning to the upright position (RUP). The experimental conditions were two conditions; the seat-cover assembly conditions and without the seat-cover assembly as the control conditions.Results: The average values in the seat-cover assembly condition were 14.4 ± 3.3, 13.9 ± 2.3, and 17.3 ± 3.3% body weight in the IUP, FRP, and RUP, respectively. The average values in the control condition were 14.8 ± 2.6, 11.4 ± 1.7, and 24.0 ± 6.7% body weight in the IUP, FRP, and RUP, respectively. In the FUP and the RUP, there were significant differences between two conditions (p < .01).Conclusion: These results suggested that the shear force exerted onto the buttocks may to be decreased by using novel seat-cover assembly.Implications for rehabilitationIt is possible to decrease the fluctuations in the shear force by moving the body up and down according the novel seat-cover assembly attached the back-support incline.Disabled, older individuals can be provided with a comfortable life on a reclining wheelchair while preventing decubitus ulcers.
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Affiliation(s)
- Kenichi Kobara
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Hisashi Takahashi
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Yasuyuki Nagata
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Hiroshi Osaka
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Tadanobu Suehiro
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
| | - Daisuke Fujita
- Department of Physical Therapy, Kawasaki University of Medical Welfare, Kurashiki, Okayama, Japan
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Black RA, Houston G. 40th Anniversary Issue: Reflections on papers from the archive on "Biomechanics". Med Eng Phys 2020; 72:70-71. [PMID: 31554579 DOI: 10.1016/j.medengphy.2019.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Richard A Black
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK.
| | - Gregor Houston
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK
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Black RA, Houston G. 40th Anniversary Issue: Reflections on papers from the archive on "Mechanobiology". Med Eng Phys 2020; 72:76-77. [PMID: 31554582 DOI: 10.1016/j.medengphy.2019.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Richard A Black
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK.
| | - Gregor Houston
- Department of Biomedical Engineering, University of Strathclyde, Glasgow, Scotland, UK
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Yoshimura M, Ohura N, Santamaria N, Watanabe Y, Akizuki T, Gefen A. High body mass index is a strong predictor of intraoperative acquired pressure injury in spinal surgery patients when prophylactic film dressings are applied: A retrospective analysis prior to the BOSS Trial. Int Wound J 2020; 17:660-669. [PMID: 32067390 DOI: 10.1111/iwj.13287] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 12/12/2022] Open
Abstract
We reported the efficacy of soft silicone multilayered foam dressings in preventing intraoperatively acquired pressure injuries (IAPIs) in the prone position using a Relton-Hall frame (BOSS trial). The aim of this study was to clarify the incidence and extract the risk factors for IAPIs in cases in which polyurethane film dressing was used against IAPIs before the BOSS trial period. This study conducted as a retrospective dual-center cohort study between August 2014 and Jun 2015 using the medical records in the operating room. The incidence of IAPIs that developed within 24 hours after surgery was 7.1% (7/99). The multivariate logistic regression analysis revealed that body mass index (BMI) (P = .0016, odds ratio [OR]: 1.22, 95% confidence interval (CI) 1.08-1.4) and length of surgery (P < .0001, OR 2.47, 95% CI 1.86-3.51) were independently associated with the development of IAPIs. Since high BMI was not extracted in BOSS trial, we conclude that the application of soft silicone multilayer foam dressings is important for preventing the development of IAPIs in patients with high BMI values.
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Affiliation(s)
- Mine Yoshimura
- Department of Nursing, Tokyo Medical University Hospital, Tokyo, Japan
| | - Norihiko Ohura
- Department of Plastic and Reconstructive Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Nick Santamaria
- Department of Nursing, Faculty of Medicine Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Yorikatsu Watanabe
- Department of Plastic, Reconstructive & Aesthetic Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Tanetaka Akizuki
- Department of Plastic, Reconstructive & Aesthetic Surgery, Tokyo Metropolitan Police Hospital, Tokyo, Japan
| | - Amit Gefen
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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Dannemiller NG, Hendrickson DA. In vitro evaluation and in vivo use of a novel surgical stent to minimize suture pressure necrosis. Vet Surg 2020; 49:741-747. [PMID: 31916617 DOI: 10.1111/vsu.13371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 10/22/2019] [Accepted: 12/07/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the efficacy of stents to distribute pressure when incorporated into tension-relieving sutures. STUDY DESIGN An in vitro study and case report. ANIMAL One common bottlenose dolphin (Tursiops truncates). METHODS Three novel silicone stents, a traditional stent, and a control were tested in vitro by using a suture simulator. Stent surface area was measured by using a pressure mapping sensor. Pressure was derived from the measured surface area and the downward force of the suture simulator. Novel silicone stents were also used in the closure of an incision in a bottlenose dolphin. RESULTS No difference was found in surface area or pressure among the three silicone stents (adjusted P > .05). Silicone stents yielded an average, 2.69 cm2 more surface area and 842.37 kPa less pressure compared with the control as well as 1.67 cm2 more surface area and 110.67 kPa less pressure compared with the traditional stent. The traditional stent yielded 1.02 cm2 more surface area and 731.7 kPa less pressure compared with the control. Incision site and silicone stent assessment performed postoperatively revealed no obvious pressure necrosis. CONCLUSION Stents improved distribution of suture pressure, and novel silicone stents were more effective compared with traditional stents. Novel silicone stents appear to have preliminary clinical success in vivo. CLINICAL SIGNIFICANCE Our study provides evidence that stents effectively help distribute suture pressure, and their incorporation might minimize the risk of suture pressure necrosis. Novel silicone stents should be integrated into tension-relieving suture patterns when closing wounds and incisions, particularly in aquatic animals.
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Affiliation(s)
- Nicholas G Dannemiller
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - Dean A Hendrickson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
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Finite element analysis reveals an important role for cell morphology in response to mechanical compression. Biomech Model Mechanobiol 2019; 19:1155-1164. [PMID: 31838604 DOI: 10.1007/s10237-019-01276-5] [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] [Received: 06/22/2019] [Accepted: 12/07/2019] [Indexed: 12/18/2022]
Abstract
Mechanical loading naturally controls cell phenotype, development, motility and various other biological functions; however, prolonged or substantial loading can cause cell damage and eventual death. Loading-induced mechanobiological and mechanostructural responses of different cell types affect their morphology and the internal architecture and the mechanics of the cellular components. Using single, mesenchymal stem cells, we have developed a cell-specific three-dimensional finite-element model; cell models were developed from phase-contrast microscopy images. This allowed us to evaluate the mechanostructural response of the naturally occurring variety of cell morphologies to increase sustained compressive loading. We focus on the morphology of the cytoplasm and the nucleus, as the main mechanically responsive elements, and evaluate formation of tensional strains and area changes in cells undergoing increasing uniaxial compressions. Here, we study mesenchymal stem cells as a model, due to their important role in tissue engineering and regenerative medicine; the method and findings are, however, applicable to any cell type. We observe variability in the cell responses to compression, which correlate directly with the morphology of the cells. Specifically, in cells with or without elongated protrusions (i.e., lamellipodia) tensional strains were, respectively, distributed mostly in the thin extensions or concentrated around the stiff nucleus. Thus, through cell-specific computational modeling of mechanical loading we have identified an underlying cause for stiffening (by actin recruitment) along the length of lamellipodia as well as a role for cell morphology in inducing cell-to-cell variability in mechanostructural response to loading.
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How medical engineering has changed our understanding of chronic wounds and future prospects. Med Eng Phys 2019; 72:13-18. [DOI: 10.1016/j.medengphy.2019.08.010] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 08/27/2019] [Indexed: 12/26/2022]
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30
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Naschitz J. Calf pressure ulcers—fact defying the concept. Postgrad Med J 2019; 95:565. [DOI: 10.1136/postgradmedj-2019-136813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 06/21/2019] [Accepted: 06/28/2019] [Indexed: 11/04/2022]
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Mayer D, Armstrong D, Schultz G, Percival S, Malone M, Romanelli M, Keast D, Jeffery S. Cell salvage in acute and chronic wounds: a potential treatment strategy. Experimental data and early clinical results. J Wound Care 2019; 27:594-605. [PMID: 30204575 DOI: 10.12968/jowc.2018.27.9.594] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
On 9 May 2018, the authors took part in a closed panel discussion on the impact of cell salvage in acute and chronic wounds. The goal was to deliberate the possible use of plurogel micelle matrix (PMM) as a new treatment strategy for wound healing and the authors openly shared their experiences, thoughts, experimental data and early clinical results. The outcome of the panel discussion has been abridged in this paper. The cell membrane consists of a lipid bilayer, which provides a diffusion barrier separating the inside of a cell from its environment. Cell membrane injury can result in acute cellular necrosis when defects are too large and cannot be resealed. There is a potential hazard to the body when these dying cells release endogenous alarm signals referred to as 'damage (or danger) associated molecular patterns' (DAMPs), which trigger the innate immune system and modulate inflammation. Cell salvage by membrane resealing is a promising target to ensure the survival of the individual cell and prevention of further tissue degeneration by inflammatory processes. Non-ionic surfactants such as poloxamers, poloxamines and PMM have the potential to resuscitate cells by inserting themselves into damaged membranes and stabilising the unstable portions of the lipid bilayers. The amphiphilic properties of these molecules are amenable to insertion into cell wall defects and so can play a crucial, reparative role. This new approach to cell rescue or salvage has gained increasing interest as several clinical conditions have been linked to cell membrane injury via oxidative stress-mediated lipid peroxidation or thermal disruption. The repair of the cell membrane is an important step in salvaging cells from necrosis to prevent further tissue degeneration by inflammatory processes. This is applicable to acute burns and chronic wounds such as diabetic foot ulcers (DFUs), chronic venous leg ulcers (VLUs), and pressure ulcers (PUs). Experimental data shows that PMM is biocompatible and able to insert itself into damaged membranes, salvaging their barrier function and aiding cell survival. Moreover, the six case studies presented in this paper reveal the potential of this treatment strategy.
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Affiliation(s)
| | | | | | | | - Matt Malone
- South West Sydney Limb Preservation and Wound Research, South Western Syndey Local Health District, Ingham Institute of Applied Medical Research, Syndey, Australia and Infectious Disease and Microbiology, School of Medicine, Western Sydney University, Sydney, Australia
| | | | | | - Steven Jeffery
- The Queen Elizabeth Hospital, Birmingham, UK and Birmingham City University
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Alvarez-Elizondo MB, Barenholz-Cohen T, Weihs D. Sodium pyruvate pre-treatment prevents cell death due to localised, damaging mechanical strains in the context of pressure ulcers. Int Wound J 2019; 16:1153-1163. [PMID: 31407500 DOI: 10.1111/iwj.13173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/26/2019] [Indexed: 12/27/2022] Open
Abstract
We demonstrate sodium pyruvate (NaPy) pre-treatment as a successful approach for pressure ulcer (PU) prevention by averting their aetiological origin-cell-level damage and death by large, sustained mechanical loads. We evaluated the NaPy pre-treatment effect on permeability changes in the cell's plasma membrane (PM) following application of in vitro damaging-level strains. Fibroblasts or myoblasts, respectively, models for superficial or deep-tissue damage were grown in 0 or 1 mM NaPy, emulating typical physiological or cell culture conditions. Cells were pre-treated for 4 hours with 0 to 5 mM NaPy prior to 3-hour sustained, damaging-level loads (12% strain). PM permeability was quantified by the cell uptake of small (4 kDa), fluorescent dextran compared with unstrained control using fluorescence-activated cell sorting (FACS). Pre-treatment with 1 mM, and especially 5 mM, NaPy significantly reduces damage to PM integrity. Long-term NaPy pre-exposure can improve protective treatment, affecting fibroblasts and myoblasts differently. Pre-treating with NaPy, a natural cell metabolite, allows cells under damaging-level mechanical loads to maintain their PM integrity, that is, to avoid loss of homeostasis and inevitable, eventual cell death, by preventing initial, microscale stages of PU formation. This pre-treatment may be applied prior to planned periods of immobility, for example, planned surgery or transport, to prolong safe time in a position by preventing initial cell damage that can cascade and lead to PU formation.
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Affiliation(s)
| | - Tamar Barenholz-Cohen
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
| | - Daphne Weihs
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel
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Abstract
In this article, the vulnerability of the soft tissues of the heel to pressure ulcers (injuries) is explained from a biomechanical engineering perspective, and emerging technologies for protecting the heel, particularly low-friction garments, are reviewed. Sustained deformations in the soft tissue of the weight-bearing posterior heel cause progressive cell and tissue damage due to loss of homeostasis in the cells, as the cytoskeleton and plasma membranes of the affected cells lose integrity and functionality. This deformation damage onsets and evolves rapidly when there is no relief of the tissue distortion (e.g. in supine motionless lying). Hence, prevention should be timely and be applied across all patient populations that are at risk. In particular there is a need to protect tissues from the action of frictional forces that are shearing not only the skin but also the deep tissue structures of the heel. The internal anatomy and physiology of the posterior heel, the common hospital conditions (lying supine, head of the bed elevated) and medical conditions involving neuropathy and perfusion impairments may impose specific risk for heel (pressure) ulcers. There is growing evidence that low-friction-fabric garments may provide added benefits in preventing heel ulcers when used in addition to standard clinical and technology-supported pressure ulcer prevention strategies, as the low-friction fabric structures absorb frictional forces before these are able to considerably distort the susceptible heel tissues.
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Affiliation(s)
- Amit Gefen
- Professor in Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Israel
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Gould LJ, Bohn G, Bryant R, Paine T, Couch K, Cowan L, McFarland F, Simman R. Pressure ulcer summit 2018: An interdisciplinary approach to improve our understanding of the risk of pressure‐induced tissue damage. Wound Repair Regen 2019; 27:497-508. [DOI: 10.1111/wrr.12730] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 02/12/2019] [Accepted: 05/07/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Lisa J. Gould
- South Shore Hospital Center for Wound Healing Weymouth Massachusetts
| | | | - Ruth Bryant
- Abbott Northwestern Hospital Minneapolis Minnesota
| | - Tim Paine
- Department of RehabilitationLitchfield Hills Orthopedic Torrington Connecticut
| | - Kara Couch
- Wound Healing and Limb Preservation CenterGeorge Washington University Hospital Washington District of Columbia
| | - Linda Cowan
- Center of Innovation on Disability and Rehabilitation ResearchVirginia Health Care Richmond Virginia
| | | | - Richard Simman
- Jobst Vascular InstituteUniversity of Toledo College of Medicine Toledo Ohio
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Atkin L, Bućko Z, Montero EC, Cutting K, Moffatt C, Probst A, Romanelli M, Schultz GS, Tettelbach W. Implementing TIMERS: the race against hard-to-heal wounds. J Wound Care 2019; 23:S1-S50. [DOI: 10.12968/jowc.2019.28.sup3a.s1] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Leanne Atkin
- Vascular Nurse Consultant. Mid Yorkshire NHS Trust/University of Huddersfield, England
| | - Zofia Bućko
- Head of Non-Healing Wounds Department, Centrum Medycznym HCP, Poznań, Poland
| | - Elena Conde Montero
- Specialist in Dermatology. Hospital Universitario Infanta Leonor, Madrid, Spain
| | - Keith Cutting
- Clinical Research Consultant, Hertfordshire, Honorary, Tissue Viability Specialist, First Community Health and Care, Surrey, England
| | - Christine Moffatt
- Professor of Clinical Nursing Research, University of Nottingham, and Nurse Consultant, Derby Hospitals NHS Foundation Trust Lymphoedema Service, England
| | - Astrid Probst
- Advanced Nurse Practitioner Wound Care, Klinikum am Steinenberg/Ermstalklinik, Reutlingen, Germany
| | - Marco Romanelli
- President WUWHS, Associate Professor of Dermatology, Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - Gregory S Schultz
- Researcher, Professor of Obstetrics and Gynaecology, University of Florida, Gainesville, Florida, US
| | - William Tettelbach
- Associate Chief Medical Officer, MiMedx, Georgia. Adjunct Assistant Professor, Duke University School of Medicine, Durham, North Carolina. Medical Director of Wound Care and Infection Prevention, Landmark Hospital, Salt Lake City, Utah, US
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Santamaria N, Creehan S, Fletcher J, Alves P, Gefen A. Preventing pressure injuries in the emergency department: Current evidence and practice considerations. Int Wound J 2019; 16:746-752. [PMID: 30815991 DOI: 10.1111/iwj.13092] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/16/2019] [Accepted: 01/21/2019] [Indexed: 12/13/2022] Open
Abstract
The emergency department (ED) is at the front line of hospital pressure injury (PI) prevention, yet ED clinicians must balance many competing clinical priorities in the care of seriously ill patients. This paper presents the current biomechanical and clinical evidence and management considerations to assist EDs to continue to develop and implement evidence-based PI prevention protocols for the high-risk emergency/trauma patient. The prevention of hospital-acquired pressure injuries has received significant focus internationally over many years because of the additional burden that these injuries place on the patient, the additional costs and impact to the efficiency of the hospital, and the potential for litigation. The development of a PI is the result of a complex number of biomechanical, physiological, and environmental interactions. Our understanding of the interaction of these factors has improved significantly over the past 10 years. We have demonstrated that large reductions in PI incidence rates can be achieved in critical care and general hospital wards through the application of advanced evidence-based prevention protocols and believe that further improvement can be achieved through the application of these approaches in the ED.
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Affiliation(s)
- Nick Santamaria
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
| | - Sue Creehan
- Department of Nursing, Virginia Commonwealth University, Richmond, Virginia
| | | | - Paulo Alves
- Department of Nursing, Catholic University of Portugal, Lisbon, Portugal
| | - Amit Gefen
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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Marom A, Berkovitch Y, Toume S, Alvarez-Elizondo MB, Weihs D. Non-damaging stretching combined with sodium pyruvate supplement accelerate migration of fibroblasts and myoblasts during gap closure. Clin Biomech (Bristol, Avon) 2019; 62:96-103. [PMID: 30711737 DOI: 10.1016/j.clinbiomech.2019.01.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 01/09/2019] [Accepted: 01/27/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Sustained, low- and mid-level (3-6%), radial stretching combined with varying concentrations of sodium pyruvate (NaPy) supplement increase the migration rate during microscale gap closure following an in vitro injury; NaPy is a physiological supplement often used in cell-culture media. Recently we showed that low-level tensile strains accelerate in vitro kinematics during en masse cell migration; topically applied mechanical deformations also accelerate in vivo healing in larger wounds. The constituents and nutrients at injury sites change. Thus, we combine a supplement with stretching conditions to effectively accelerate wound healing. METHODS Monolayers of murine fibroblasts (NIH3T3) or myoblasts (C2C12) were cultured in 1 mM NaPy on stretchable, linear-elastic substrates. Monolayers were subjected to 0, 3, or 6% stretching using a custom three-dimensionally printed stretching apparatus, micro-damage was immediately induced, media was replaced with fresh media containing 0, 1, or 5 mM NaPy, and cell migration kinematics during gap-closure were quantitatively evaluated. FINDINGS In myoblasts, the smallest evaluated strain (3%, minimal risk of damage) combined with preinjury (1 mM) and post-injury exogenous NaPy supplements accelerated gap closure in a statistically significant manner; response was NaPy concentration dependent. In both fibroblasts and myoblasts, when cells were pre-exposed to NaPy, yet no supplement was provided post-injury, mid-level stretches (6%) compensated for post-injury deficiency in exogenous NaPy and accelerated gap-closure in a statistically significant manner. INTERPRETATION Small deformations combined with NaPy supplement prior-to and following cell-damage accelerate en masse cell migration and can be applied in wound healing, e.g. to preventatively accelerate closure of microscale gaps.
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Affiliation(s)
- Anat Marom
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Yulia Berkovitch
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | - Samer Toume
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel
| | | | - Daphne Weihs
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa 3200003, Israel.
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Schofield A. Mitigating the damaging effects of tissue distortions by using a low-friction heel protector. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2018; 27:S27-S34. [PMID: 29944428 DOI: 10.12968/bjon.2018.27.sup12.s27] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article reports the finding of a small non-controlled evaluation over a 2-week period in three different care settings: a residential care home, an acute stroke unit and a community intermediate care hospital. At initial recruitment 30 patients were identified by clinical assessment as being at high risk of developing a heel pressure ulcer. Further inclusion criteria were identifying heels that had signs of pressure damage occurring, blanching and non-blanching erythema, blistering and category 2 ulceration. In all, 15 patients fully completed the evaluation over a 14-day period. The mean age was 86 years. The low-friction bootee was worn constantly while in bed and seated in chairs, only being removed for heel checks and hygiene care. No patients were independently mobile during the evaluation; products were not worn to walk in due to a risk of falling-patients in the community hospital who had to mobilise for rehabilitation removed the bootees for this activity. All had pressure mapping and ultrasound of pedal pulses prior and after evaluation by the tissue viability specialist nurse. Results of pressure mapping showed a reduction of peak heel pressures on application of the bootees and a final review of reduction in visual signs of heel damage, reduced pain, increased comfort and ease of use. These results indicate that a standardised care pathway approach to heel protection using low-friction heel bootees is effective in all care settings for the reduction and prevention of heel pressure damage.
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Affiliation(s)
- Alison Schofield
- Tissue Viability Service Lead and Trust Quality Pressure Ulcer Prevention Lead, North Lincolnshire and Goole NHS Foundation Trust
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39
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Park S, Kim CG, Ko JW. The use of sub-epidermal moisture measurement in predicting blanching erythema in jaundice patients. J Wound Care 2018; 27:342-349. [DOI: 10.12968/jowc.2018.27.5.342] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Seungmi Park
- Associate Professor, Department of Nursing, Hoseo University, 20, Hoeo-ro 79 beon-gil, Baebang-eup, Asan-si, Chungnam, Republic of Korea
| | - Chul-Gyu Kim
- Associate Professor, Department of Nursing, Chungbuk National University, Chungdae-ro 1, Seowon-Gu, Cheongju, Chungbuk, Republic of Korea 28644
| | - Ji Woon Ko
- Assistant Professor, Department of Nursing Science, Sunmoon University, 221 Sunmoon-ro, Tangjeong-myeon, Asan-si, Chungnam, Republic of Korea
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40
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Santamaria N, Gerdtz M, Kapp S, Wilson L, Gefen A. A randomised controlled trial of the clinical effectiveness of multi-layer silicone foam dressings for the prevention of pressure injuries in high-risk aged care residents: The Border III Trial. Int Wound J 2018; 15:482-490. [PMID: 29635842 DOI: 10.1111/iwj.12891] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/31/2017] [Indexed: 12/11/2022] Open
Abstract
Pressure injuries are prevalent in highly dependent aged care residents. This study investigated the clinical effectiveness of the application of the Mepilex Border Sacrum and Mepilex Heel dressings to prevent the development of facility-acquired pressure injuries. A total of 288 recently admitted residents were enrolled from 40 Australian nursing homes into a randomised controlled trial. Residents randomised to standard care (n = 150) received pressure injury prevention as recommended by international guidelines. Residents randomised to the intervention (n = 138) received standard pressure injury prevention care and had dressings applied to their sacrum and heels. Participants were comparable on demographic and physiological parameters. More residents in the control group developed pressure injuries than in the intervention group (16 vs 3, P = 0.004), and they developed more pressure injuries in total than residents in the intervention group. The results represent a relative risk reduction of 80% for residents treated with the dressings and for every 12 patients that we treated we prevented one pressure injury. Based on our findings, we conclude that the use of the Mölnlycke Mepilex Border Sacrum and Mepilex Heel dressings confers a significant additional protective benefit to nursing home residents with a high risk of developing a facility-acquired pressure injury.
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Affiliation(s)
- Nick Santamaria
- Department of Nursing, University of Melbourne, Melbourne, Australia
| | - Marie Gerdtz
- Department of Nursing, University of Melbourne, Melbourne, Australia
| | - Suzanne Kapp
- Department of Nursing, University of Melbourne, Melbourne, Australia
| | - Lauren Wilson
- Department of Nursing, University of Melbourne, Melbourne, Australia
| | - Amit Gefen
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
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Bates-Jensen BM, McCreath HE, Nakagami G, Patlan A. Subepidermal moisture detection of heel pressure injury: The pressure ulcer detection study outcomes. Int Wound J 2017; 15:297-309. [PMID: 29250926 DOI: 10.1111/iwj.12869] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 09/15/2017] [Accepted: 10/30/2017] [Indexed: 11/28/2022] Open
Abstract
We examined subepidermal moisture (SEM) and visual skin assessment of heel pressure injury (PrI) among 417 nursing home residents in 19 facilities over 16 weeks. Participants were older (mean age 77 years), 58% were female, over half were ethnic minorities (29% African American, 12% Asian American, 21% Hispanic), and at risk for PrI (mean Braden Scale Risk score = 15.6). Blinded concurrent visual assessments and SEM measurements were obtained at heels weekly. Visual skin damage was categorised as normal, erythema, stage 1 PrI, deep tissue injury (DTI) or stage 2 or greater PrI. PrI incidence was 76%. Off-loading occurred with pillows (76% of residents) rather than heel boots (21%) and often for those with DTI (91%). Subepidermal moisture was measured with a device where higher readings indicate greater moisture (range: 0-70 tissue dielectric constant), with normal skin values significantly different from values in the presence of skin damage. Subepidermal moisture was associated with concurrent damage and damage 1 week later in generalised multinomial logistic models adjusting for age, diabetes and function. Subepidermal moisture detected DTI and differentiated those that resolved, remained and deteriorated over 16 weeks. Subepidermal moisture may be an objective method for detecting PrI.
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Affiliation(s)
- Barbara M Bates-Jensen
- School of Nursing, University of California, Los Angeles, California, Los Angeles.,Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, California, Los Angeles
| | - Heather E McCreath
- Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, California, Los Angeles
| | | | - Anabel Patlan
- School of Nursing, University of California, Los Angeles, California, Los Angeles.,Division of Geriatrics, David Geffen School of Medicine, University of California, Los Angeles, California, Los Angeles
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Sinha R, Verdonschot N, Koopman B, Rouwkema J. Tuning Cell and Tissue Development by Combining Multiple Mechanical Signals. TISSUE ENGINEERING PART B-REVIEWS 2017; 23:494-504. [DOI: 10.1089/ten.teb.2016.0500] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Ravi Sinha
- Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Nico Verdonschot
- Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart Koopman
- Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Jeroen Rouwkema
- Department of Biomechanical Engineering, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
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43
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Affiliation(s)
- Amit Gefen
- Professor in Biomedical Engineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University
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44
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Clinical and biomechanical perspectives on pressure injury prevention research: The case of prophylactic dressings. Clin Biomech (Bristol, Avon) 2016; 38:29-34. [PMID: 27564577 DOI: 10.1016/j.clinbiomech.2016.08.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 08/10/2016] [Accepted: 08/11/2016] [Indexed: 02/07/2023]
Abstract
In this perspective paper, we discuss clinical and biomechanical viewpoints on pressure injury (or pressure ulcer) prevention research. We have selected to focus on the case of prophylactic dressings for pressure injury prevention, and the background of the historical context of pressure injury research, as an exemplar to illuminate some of the good and not so good in current biomechanical and clinical research in the wound prevention and care arena. Investigators who are conducting medical or clinical research in academia, in medical settings or in industry to determine the efficacy of wound prevention and care products could benefit from applying some basic principles that are detailed in this paper, and that should leverage the research outcomes, thereby contributing to setting higher standards in the field.
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45
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A multiscale modeling framework for studying the mechanobiology of sarcopenic obesity. Biomech Model Mechanobiol 2016; 16:275-295. [DOI: 10.1007/s10237-016-0816-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Accepted: 08/08/2016] [Indexed: 01/08/2023]
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