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Pettersen EM, Hoel H, Torp H, Hisdal J, Seternes A. The effect of 12-week treatment with intermittent negative pressure on blood flow velocity and flowmotion, measured with a novel Doppler device (earlybird). Secondary outcomes from a randomized sham-controlled trial in patients with peripheral arterial disease. Ann Vasc Surg 2022; 86:144-157. [PMID: 35472497 DOI: 10.1016/j.avsg.2022.04.025] [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: 12/10/2021] [Revised: 03/27/2022] [Accepted: 04/15/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Treatment with intermittent negative pressure (INP) is proposed as an adjunct to standard care in patients with peripheral arterial disease (PAD). The aims of this study were to evaluate the applicability of a novel ultrasound Doppler device (earlybird) to assess blood flow characteristics in patients with PAD during a treatment session with INP, and whether certain flow-properties could determine whom could benefit INP treatment. METHODS Secondary outcomes of data from a randomized sham-controlled trial were explored. Patients were randomized to 12 weeks of treatment with 40 mmHg or 10 mmHg INP, for one hour twice daily. Earlybird blood flow velocity recordings were made before and after the 12-week treatment-period and consists of a 5-minute recording in rest, 3-minute during INP treatment and 5-minute recording after ended INP test-treatment. Mean blood flow velocity (vmean), relative changes in flow and frequency spectrum by Fourier-transform of the respective bandwidths of endothelial, sympathetic, and myogenic functions, were analyzed for the different series of blood flow measurements. RESULTS In total, 62 patients were eligible for analysis, where 32 patients were treated with 40 mmHg INP. The acquired recordings were of good quality and was used for descriptive analyses of flow characteristics. An immediate increase in vmean during the negative pressure periods of the INP test-treatment was observed in the 40 mmHg INP treatment group at both pre- and post-test. There was a significant difference between the treatment groups, with a difference between the medians of 13.7 (p < 0.001) at pretest and 10.7 (p < 0.001) at posttest. This finding was confirmed with spectrum analysis by Fourier-transform of the bandwidth corresponding to INP treatment. The change in amplitude corresponding to myogenic function after 12 weeks of treatment, was significantly different in favor of the 40 mmHg INP treatment group. We were not able to detect specific flow characteristics indicating whom would benefit INP-treatment. CONCLUSIONS Earlybird is an applicable tool for assessing blood flow velocity in patients with PAD. Analysis of the flow velocity recordings shows that INP induce an immediate increase in blood flow velocities during INP. The positive effects of INP may be attributed to recruitment of arterioles, and thereby increasing blood flow. In these analyses no flow characteristics was determined which could predict whom would benefit INP-treatment.
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Affiliation(s)
- Erik Mulder Pettersen
- Department of circulation and medical imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Vascular Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway; Department of Surgery, Sørlandet Hospital Kristiansand, Kristiansand, Norway.
| | - Henrik Hoel
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Section of Vascular Investigations, Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway; Otivio AS, Oslo, Norway
| | - Hans Torp
- Department of circulation and medical imaging, Norwegian University of Science and Technology, Trondheim, Norway; CIMON Medical, NTNU Technology Transfer AS, Trondheim, Norway
| | - Jonny Hisdal
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Section of Vascular Investigations, Department of Vascular Surgery, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Oslo, Norway
| | - Arne Seternes
- Department of circulation and medical imaging, Norwegian University of Science and Technology, Trondheim, Norway; Department of Vascular Surgery, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Evans RW, Shackleton CL, West S, Derman W, Laurie Rauch HG, Baalbergen E, Albertus Y. Robotic Locomotor Training Leads to Cardiovascular Changes in Individuals With Incomplete Spinal Cord Injury Over a 24-Week Rehabilitation Period: A Randomized Controlled Pilot Study. Arch Phys Med Rehabil 2021; 102:1447-1456. [PMID: 33839105 DOI: 10.1016/j.apmr.2021.03.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/09/2021] [Accepted: 03/02/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To describe the effect of robotic locomotor training (RLT) and activity-based training (ABT) on cardiovascular indices during various physiological positions in individuals with spinal cord injury. DESIGN Randomized controlled pilot study. SETTING Private practice: Therapy & Beyond Centre - Walking with Brandon Foundation, Sports Science Institute of South Africa, Cape Town, South Africa. PARTICIPANTS Participants with chronic traumatic motor incomplete tetraplegia (N=16) who resided in the Western Cape, South Africa. INTERVENTION Robotic locomotor training (Ekso GT) and activity-based training over a 24-week intervention. MAIN OUTCOME MEASURES Brachial and ankle blood pressure, heart rate, heart rate variability, and cardiovascular efficiency during 4 physiological positions. RESULTS No differences between groups or over time were evident in resting systolic and diastolic blood pressure, ankle systolic pressure, ankle brachial pressure index, and heart rate variability. Standing heart rate at 24 weeks was significantly higher in the ABT group (95.58±12.61 beats/min) compared with the RLT group (75.14±14.96 beats/min) (P=.05). In the RLT group, no significant changes in heart rate variability (standard deviation R-R interval and root mean square of successive differences) was found between the standing and 6-minute walk test physiological positions throughout the intervention. Cardiovascular efficiency in the RLT group during the 6-minute walk test improved from 11.1±2.6 at baseline to 7.5±2.8 beats per meter walked at 6 weeks and was maintained from 6 to 24 weeks. CONCLUSIONS Large effect sizes and significant differences between groups found in this pilot study support the clinical effectiveness of RLT and ABT for changing cardiovascular indices as early as 6 weeks and up to 24 weeks of rehabilitation. RLT may be more effective than ABT in improving cardiac responses to orthostatic stress. Based on heart rate variability metrics, the stimulus of standing has comparable effects to RLT on the parasympathetic nervous system. Cardiovascular efficiency of exoskeleton walking improved, particularly over the first 6 weeks. Both the RLT and ABT interventions were limited in their effect on brachial and ankle blood pressure. A randomized controlled trial with a larger sample size is warranted to further examine these findings.
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Affiliation(s)
- Robert W Evans
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Claire L Shackleton
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Sacha West
- Department of Sport Management, Cape Peninsula University of Technology, Cape Town
| | - Wayne Derman
- Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Faculty of Medicine and Health Sciences, University of Stellenbosch, Cape Town; IOC Research Centre, South Africa
| | - H G Laurie Rauch
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town
| | - Ed Baalbergen
- Rehabilitation Unit, Life Vincent Pallotti Hospital, Cape Town, South Africa
| | - Yumna Albertus
- Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town.
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Hoel H, Hisdal J. The FlowOx device for the treatment of peripheral artery disease: current status and future prospects. Expert Rev Med Devices 2021; 18:217-220. [PMID: 33632040 DOI: 10.1080/17434440.2021.1895750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Henrik Hoel
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway.,Otivio AS, Oslo, Norway
| | - Jonny Hisdal
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.,Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
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Ye C, Zhang Y, Han C, Mao S, Ni L, Liu J, Wu J, Zhang J. A Wound Treatment Strategy for "Super Long-Term Difficult-to-Heal Wounds": A Single-Center Retrospective Study. INT J LOW EXTR WOUND 2020; 21:483-491. [PMID: 32962469 DOI: 10.1177/1534734620960292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Chronic wounds are a challenge for clinicians. Treating chronic wounds in elderly patients is difficult due to comorbidities and poor immunity, tissue renewal, and regeneration. This study shared the therapeutic experiences of 40 patients with super long-term difficult-to-heal wounds and to describe the effects of negative pressure wound therapy (NPWT)-assisted debridement and autologous scalp grafting. Elderly patients with chronic wounds for more than 60 years who underwent NPWT-assisted debridement and autologous scalp grafting between 2015 and 2017 were retrospectively analyzed. Forty patients were identified and analyzed. Among all patients, the average wound area was 56 (interquartile range 30-90) cm2. The wound infection rate was 82.1%, and that before the first autologous scalp grafting was 51.3%. The average total number of surgeries was 3, and the number of times the NPWT device was replaced was once. A total of 97.4% of patients had one autologous scalp grafting performed. The transplanted scalp survived completely in 97.4% of patients. One hundred percent of patients had no postoperative complications and healed. The average wound healing time was 34.5 ± 10.1 days. This study showed that NPWT-assisted debridement and autologous scalp grafting have the advantages of high survival rate of the skin and decreased wound recurrence and may be a suitable treatment for super long-term difficult-to-heal wounds in elderly patients.
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Affiliation(s)
| | | | - Chunmao Han
- Second Affiliated Hospital of Medical College, Zhejiang University, Hangzhou, China
| | | | | | - Jia Liu
- Zhejiang Quhua Hospital, Quzhou, China
| | - Junmei Wu
- Zhejiang Quhua Hospital, Quzhou, China
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Wagh A, Jain S, Mukherjee A, Agu E, Pedersen P, Strong D, Tulu B, Lindsay C, Liu Z. Semantic Segmentation of Smartphone Wound Images: Comparative Analysis of AHRF and CNN-Based Approaches. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2020; 8:181590-181604. [PMID: 33251080 PMCID: PMC7695230 DOI: 10.1109/access.2020.3014175] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Smartphone wound image analysis has recently emerged as a viable way to assess healing progress and provide actionable feedback to patients and caregivers between hospital appointments. Segmentation is a key image analysis step, after which attributes of the wound segment (e.g. wound area and tissue composition) can be analyzed. The Associated Hierarchical Random Field (AHRF) formulates the image segmentation problem as a graph optimization problem. Handcrafted features are extracted, which are then classified using machine learning classifiers. More recently deep learning approaches have emerged and demonstrated superior performance for a wide range of image analysis tasks. FCN, U-Net and DeepLabV3 are Convolutional Neural Networks used for semantic segmentation. While in separate experiments each of these methods have shown promising results, no prior work has comprehensively and systematically compared the approaches on the same large wound image dataset, or more generally compared deep learning vs non-deep learning wound image segmentation approaches. In this paper, we compare the segmentation performance of AHRF and CNN approaches (FCN, U-Net, DeepLabV3) using various metrics including segmentation accuracy (dice score), inference time, amount of training data required and performance on diverse wound sizes and tissue types. Improvements possible using various image pre- and post-processing techniques are also explored. As access to adequate medical images/data is a common constraint, we explore the sensitivity of the approaches to the size of the wound dataset. We found that for small datasets (< 300 images), AHRF is more accurate than U-Net but not as accurate as FCN and DeepLabV3. AHRF is also over 1000x slower. For larger datasets (> 300 images), AHRF saturates quickly, and all CNN approaches (FCN, U-Net and DeepLabV3) are significantly more accurate than AHRF.
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Affiliation(s)
- Ameya Wagh
- Computer Science Department, Worcester Polytechnic Institute, Worcester, MA, USA, 01609
| | - Shubham Jain
- Computer Science Department, Worcester Polytechnic Institute, Worcester, MA, USA, 01609
| | - Apratim Mukherjee
- Computer Science Department, Manipal Institute of Technology, Manipal, Karnataka, India, 576104
| | - Emmanuel Agu
- Computer Science Department, Worcester Polytechnic Institute, Worcester, MA, USA, 01609
| | - Peder Pedersen
- Computer Science Department, Worcester Polytechnic Institute, Worcester, MA, USA, 01609
| | - Diane Strong
- Computer Science Department, Worcester Polytechnic Institute, Worcester, MA, USA, 01609
| | - Bengisu Tulu
- Computer Science Department, Worcester Polytechnic Institute, Worcester, MA, USA, 01609
| | - Clifford Lindsay
- Radiology Department, University of Massachusetts Medical School, Worcester MA, USA, 01655
| | - Ziyang Liu
- Computer Science Department, Worcester Polytechnic Institute, Worcester, MA, USA, 01609
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Holder SM, Dawson EA, Brislane Á, Hisdal J, Green DJ, Thijssen DHJ. Fluctuation in shear rate, with unaltered mean shear rate, improves brachial artery flow-mediated dilation in healthy, young men. J Appl Physiol (1985) 2019; 126:1687-1693. [DOI: 10.1152/japplphysiol.00009.2019] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Increase in mean shear stress represents an important and potent hemodynamic stimulus to improve conduit artery endothelial function in humans. No previous study has examined whether fluctuations in shear rate patterns, without altering mean shear stress, impacts conduit artery endothelial function. This study examined the hypothesis that 30-min exposure to fluctuations in shear rate patterns, in the presence of unaltered mean shear rate, improves brachial artery flow-mediated dilation. Fifteen healthy men (27.3 ± 5.0 yr) completed the study. Bilateral brachial artery flow-mediated dilation was assessed before and after unilateral exposure to 30 min of intermittent negative pressure (10 s, −40mmHg; 7 s, 0 mmHg) to induce fluctuation in shear rate, while the contralateral arm was exposed to a resting period. Negative pressure significantly increased shear rate, followed by a decrease in shear rate upon pressure release (both P < 0.001). Across the 30-min intervention, mean shear rate was not different compared with baseline ( P = 0.458). A linear mixed model revealed a significant effect of time observed for flow-mediated dilation ( P = 0.029), with exploratory post hoc analysis showing an increase in the intervention arm (∆FMD +2.0%, P = 0.008), but not in the contralateral control arm (∆FMD +0.5%, P = 0.664). However, there was no effect for arm ( P = 0.619) or interaction effect ( P = 0.096). In conclusion, we found that fluctuations in shear patterns, with unaltered mean shear, improves brachial artery flow-mediated dilation. These novel data suggest that fluctuations in shear pattern, even in the absence of altered mean shear, represent a stimulus to acute change in endothelial function in healthy individuals. NEW & NOTEWORTHY Intermittent negative pressure applied to the forearm induced significant fluctuations in antegrade and retrograde shear rate, while mean shear was preserved relative to baseline. Our exploratory study revealed that brachial artery flow-mediated dilation was significantly improved following 30-min exposure to intermittent negative pressure. Fluctuations in blood flow or shear rate, with unaltered mean shear, may have important implications for vascular health; however, further research is required to identify the underlying mechanisms and potential long-term health benefits.
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Affiliation(s)
- Sophie M. Holder
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Ellen A. Dawson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
| | - Áine Brislane
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- School of Sport and Exercise Science, York St. John University, York, United Kingdom
| | - Jonny Hisdal
- Section of Vascular Investigations, Division of Cardiovascular and Pulmonary Diseases, Department of Vascular Surgery, Oslo University Hospital, Oslo, Norway
| | - Daniel J. Green
- School of Human Sciences (Exercise and Sports Science), The University of Western Australia, Crawley, Western Australia, Australia
| | - Dick H. J. Thijssen
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, United Kingdom
- Radboud Institute for Health Sciences, Department of Physiology, Radboud University Medical Center, Radboud, the Netherlands
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