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Jeong D, Lee JH, Lee GB, Shin KH, Hwang J, Jang SY, Yoo J, Jang WY. Application of extracorporeal shockwave therapy to improve microcirculation in diabetic foot ulcers: A prospective study. Medicine (Baltimore) 2023; 102:e33310. [PMID: 36930075 PMCID: PMC10019234 DOI: 10.1097/md.0000000000033310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
Extracorporeal shockwave therapy (ESWT) can induce wound healing by increasing tissue microcirculation. However, studies on the effect of ESWT on enhancing tissue microcirculation in diabetic foot ulcer (DFU), particularly on when the microcirculation increases after ESWT application, are still lacking. Therefore, we aimed to examine the effectiveness of ESWT in promoting microcirculation in DFU patients in a time-dependent manner. We included 50 feet of 25 patients with type 2 diabetes mellitus and Wagner grade I to II DFU in this study. The affected feet were used as the ESWT group and the unaffected contralateral feet were used as the control group. ESWT was performed in 3 sessions per week for a total of 3 weeks. Transcutaneous partial oxygen pressure (TcPO2) was used to evaluate the tissue microcirculation. The TcPO2 level (>43 mm Hg) in the ESWT group was recovered by the 2nd week of treatment, and statistical significance (P < .05) was demonstrated at the same time. From the 2nd week of ESWT, a significant increase in TcPO2 was observed in Wagner grade I and II DFU. These findings imply that the ESWT may improve microcirculation in patients with Wagner grades I to II DFU. However, this impact requires at least 2 weeks or more than 6 sessions. For better comparison, further studies with larger clinical groups and extended period are needed.
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Affiliation(s)
- Daun Jeong
- Department of Orthopedic Surgery, Korea University College of Medicine, Seoul, Korea
- Institute of Nano, Regeneration, Reconstruction, Korea University, Seoul, Korea
| | - Jin Hyuck Lee
- Institute of Nano, Regeneration, Reconstruction, Korea University, Seoul, Korea
- Department of Sports Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Gyu Bin Lee
- Department of Sports Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Ki Hun Shin
- Department of Sports Medical Center, Korea University College of Medicine, Seoul, Korea
| | - Jangsun Hwang
- Department of Orthopedic Surgery, Korea University College of Medicine, Seoul, Korea
- Institute of Nano, Regeneration, Reconstruction, Korea University, Seoul, Korea
| | - Se Youn Jang
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, Korea
| | - Jin Yoo
- Center for Biomaterials, Biomedical Research Institute, Korea Institute of Science and Technology (KIST), Seoul, Korea
| | - Woo Young Jang
- Department of Orthopedic Surgery, Korea University College of Medicine, Seoul, Korea
- Institute of Nano, Regeneration, Reconstruction, Korea University, Seoul, Korea
- Department of Sports Medical Center, Korea University College of Medicine, Seoul, Korea
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Lee TY, Yoon IJ, Han SK, Namgoong S, Jeong SH, Kim DW, Dhong ES. Skin hydration level cutoff value to predict wound healing potential in diabetic foot ulcers. Diabetes Res Clin Pract 2022; 193:110122. [PMID: 36272583 DOI: 10.1016/j.diabres.2022.110122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/08/2022] [Accepted: 10/14/2022] [Indexed: 11/24/2022]
Abstract
AIMS Transcutaneous oxygen pressure (TcPO2) is a reliable predictor of wound healing in diabetes patients; however, measurements are cumbersome. Previously, we demonstrated that skin hydration in the feet of patients with diabetic foot ulcers (DFU) is influenced by microcirculation rather than peripheral nerve function. Furthermore, skin hydration level before recanalization can predict wound healing better than TcPO2. This study investigated the skin hydration level cutoff value to predict DFU healing. METHODS We retrospectively enrolled 834 patients with DFU. Wound healing outcomes were graded as healed without amputation or with minor/major amputation. Receiver operating characteristic analysis was used to evaluate the ability of skin hydration to predict wound healing outcomes and determine the optimal cutoff value for subsequent analyses. RESULTS Average skin hydration values in the healed without and with amputation groups were 25.0 ± 7.4 arbitrary units (a.u.) and 17.5 ± 5.7 a.u., respectively (P < 0.001). The healing rate without amputation increased with skin hydration. A skin hydration value ≥ 21 a.u. significantly lowered the incidence of amputation. The cutoff value was 21 a.u. [(Youden's index, sensitivity, specificity, P-value) = (1.6, 92, 69.6, P < 0.001)]. CONCLUSIONS A minimal skin hydration value of 21 a.u. is required for diabetic wound healing.
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Affiliation(s)
- Tae-Yul Lee
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - In-Jae Yoon
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Seung-Kyu Han
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea.
| | - Sik Namgoong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Seong-Ho Jeong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Deok-Woo Kim
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
| | - Eun-Sang Dhong
- Department of Plastic Surgery, Korea University College of Medicine, Seoul, South Korea
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Mei J, Pang L, Jiang Z. The effect of extracorporeal shock wave on osteonecrosis of femoral head: a systematic review and meta-analysis. PHYSICIAN SPORTSMED 2022; 50:280-288. [PMID: 34058957 DOI: 10.1080/00913847.2021.1936685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION This study aims to determine whether ESWT (extracorporeal shock wave therapy) affects ONFH (osteonecrosis of femoral head) in clinical outcomes and radiography outcomes. METHOD Two authors independently search the papers on the treatment of femoral head necrosis with extracorporeal shock wave in CNKI (China National Knowledge Infrastructure), VIP (China Science and Technology Journal Database), CSPD (China Science Periodical Database), Pubmed, Embase, and Springer databases. Search period from the inception dates to 2 June 2020 and have no limitations in language; two authors independently conducted a quality evaluation and data extraction for included studies and performed a meta-analysis with data extracted and calculate by using RevMan5. Registration number: CRD42020213580. RESULT Nine articles with 409 patients are included in this meta-analysis. The pooled results of HHS (Harris hip score) in eight studies with 337 hips show that ESWT achieves higher Harris scores compared to before treatment (MD = -19.95; 95% CI: -26.27, -13.64) and the difference is statistically significant (p < 0.01). The pooled results of VAS (visual analogue score) in seven studies with 253 hips show that ESWT achieves lower VAS compared to baseline (MD = 2.77; 95% CI: 1.88, 3.65) and the difference is statistically significant (p < 0.01). The pooled results of lesion of MRI with 164 hips show that ESWT decreases the lesion area of MRI (SMD = 1.03; CI: 0.75,1.30) and the difference is statistically significant (p < 0.01). CONCLUSION ESWT has an effect on pain relief and has a limited effect on motion function. Its effect may be better than surgical groups (core decompression and core decompression with bone grafting). But it cannot decrease the lesion area of the femoral head on MRI and stop disease progression.
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Affiliation(s)
- Jin Mei
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Lili Pang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhongchao Jiang
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Zhang H, Kim HT, Feeley BT, Lin G, Lue TF, Liu M, Banie L, Liu X. Microenergy acoustic pulses promotes muscle regeneration through in situ activation of muscle stem cells. J Orthop Res 2022; 40:1621-1631. [PMID: 34657315 PMCID: PMC9013392 DOI: 10.1002/jor.25184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/16/2021] [Accepted: 09/30/2021] [Indexed: 02/06/2023]
Abstract
Microenergy acoustic pulses (MAP) is a modified low-intensity extracorporeal shock wave therapy that currently used for treating musculoskeletal disorders. However, its function on muscle regeneration after ischemia-reperfusion injury (IRI) remains unknown. This study aimed to explore the effect of MAP on muscle injury after IRI and its underlying mechanisms. Ten-week-old C57BL/6J mice underwent unilateral hindlimb IRI followed with or without MAP treatment. Wet weight of tibialis anterior muscles at both injury and contralateral sides were measured followed with histology analysis at 3 weeks after IRI. In in vitro study, the myoblasts, endothelial cells and fibro-adipogenic progenitors (FAP) were treated with MAP. Cell proliferation and differentiation were assessed, and related gene expressions were measured by real-time PCR. Our results showed that MAP significantly increased the muscle weight and centrally nucleated regenerating muscle fiber size along with a trend in activating satellite cells. In vitro data indicated that MAP promoted myoblast proliferation and differentiation and endothelial cells migration. MAP also induced FAP brown/beige adipogenesis, a promyogenic phenotype of FAPs. Our findings demonstrate the beneficial function of MAP in promoting muscle regeneration after IR injury by inducing muscle stem cells proliferation and differentiation.
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Affiliation(s)
- He Zhang
- Department of Physical Education, Central South University, Hunan, China,Department of Orthopaedic Surgery, San Francisco Veterans Affair Health Care System, San Francisco, CA, USA,Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Hubert T. Kim
- Department of Orthopaedic Surgery, San Francisco Veterans Affair Health Care System, San Francisco, CA, USA,Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Brian T. Feeley
- Department of Orthopaedic Surgery, San Francisco Veterans Affair Health Care System, San Francisco, CA, USA,Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Guiting Lin
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Tom F. Lue
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Mengyao Liu
- Department of Orthopaedic Surgery, San Francisco Veterans Affair Health Care System, San Francisco, CA, USA,Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA, USA
| | - Lia Banie
- Knuppe Molecular Urology Laboratory, Department of Urology, School of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Xuhui Liu
- Department of Orthopaedic Surgery, San Francisco Veterans Affair Health Care System, San Francisco, CA, USA,Department of Orthopaedic Surgery, University of California at San Francisco, San Francisco, CA, USA,Corresponding author: Xuhui Liu, MD, 1700 Owens Street, San Francisco, CA 94158, Tel: 415-575-0546, Fax: 415-750-2181,
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Ren W, Xu L, Zheng X, Pu F, Li D, Fan Y. Effect of different thermal stimuli on improving microcirculation in the contralateral foot. Biomed Eng Online 2021; 20:14. [PMID: 33531012 PMCID: PMC7856788 DOI: 10.1186/s12938-021-00849-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 01/15/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The lower extremities of the body often suffer from impaired microcirculation, particularly in the elderly or people with underlying conditions such as diabetes. Especially for people suffering from peripheral vascular diseases, skin lesions or wearing an external fixator in one side of limbs, direct contact treatments are not suitable for them to improve microcirculation. Heating the contralateral limb has been reported to improve blood flow in the impaired limb. However, its effect on plantar microvascular responses has not been previously investigated. Thus, the aim of this study was to explore how heating by warm bath and infrared radiation affects the circulations in the contralateral foot. Twelve healthy adults participated in this study and were randomly assigned to either placing the left foot in a warm bath or exposing it to infrared radiation for 10 min intervention every other day. The skin temperature (Temp) and skin blood flow (SBF) in the second metatarsal head of the contralateral foot were measured before and after the intervention. RESULTS The results showed that both Temp (Bath: from 29.05 ± 3.56 °C to 31.03 ± 4.14 °C; Infrared: from 29.98 ± 3.86 °C to 31.07 ± 3.92 °C) and SBF (Bath: from 62.26 ± 48.12 PU to 97.76 ± 63.90 PU; Infrared: from 63.37 ± 39.88 PU to 85.27 ± 47.62 PU) in the contralateral foot were significantly increased after heating in both tests (p < 0.05). However, the contralateral SBF increased for 5 min after heating in warm bath test, but only for 1 min in infrared radiation test. CONCLUSIONS The results of this study show that both heating methods are the effective at increasing contralateral Temp and SBF, but the warm bath has a stronger residual thermal effect.
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Affiliation(s)
- Weiyan Ren
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing, People's Republic of China
| | - Liqiang Xu
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Xuan Zheng
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
| | - Fang Pu
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China
- State Key Laboratory of Virtual Reality Technology and Systems, Beihang University, Beijing, People's Republic of China
| | - Deyu Li
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China.
- School of Biological Science and Medical Engineering, Beihang University, No.37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
| | - Yubo Fan
- Key Laboratory of Rehabilitation Technical Aids of Ministry of Civil Affair, School of Biological Science and Medical Engineering, Beihang University, Beijing, People's Republic of China.
- Beijing Key Laboratory of Rehabilitation Technical Aids for Old-Age Disability, Key Laboratory of Human Motion Analysis and Rehabilitation Technology of the Ministry of Civil Affairs, National Research Center for Rehabilitation Technical Aids, Beijing, People's Republic of China.
- School of Biological Science and Medical Engineering, Beihang University, No.37 Xueyuan Road, Haidian District, Beijing, 100191, People's Republic of China.
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