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Kay AD, Blazevich AJ, Tysoe JC, Baxter BA. Cross-Education Effects of Isokinetic Eccentric Plantarflexor Training on Flexibility, Strength, and Muscle-Tendon Mechanics. Med Sci Sports Exerc 2024; 56:1242-1255. [PMID: 38451696 DOI: 10.1249/mss.0000000000003418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
INTRODUCTION Large increases in joint range of motion (ROM) have been reported after eccentric resistance training; however, limited data exist describing the associated mechanisms or potential cross-education effects in the contralateral limb. Therefore, the effects of a 6-wk isokinetic eccentric plantarflexor training program were examined in 26 participants. METHODS Before and after the training program, dorsiflexion ROM, plantarflexor strength, and muscle-tendon unit (MTU) morphology and mechanics were measured in control ( n = 13) and experimental ( n = 13) young adult groups. Training consisted of 5 sets of 12 maximal isokinetic eccentric plantarflexor contractions twice weekly on the right limb. RESULTS Significant ( P < 0.05) increases in dorsiflexion ROM (4.0-9.5°), stretch tolerance (40.3-95.9%), passive elastic energy storage (47.5-161.3%), and isometric (38.1-40.6%) and eccentric (46.7-67.0%) peak plantarflexor torques were detected in both trained and contralateral limbs in the experimental group. Significant increases in gastrocnemius medialis and soleus thickness (5.4-6.1%), gastrocnemius medialis fascicle length (7.6 ± 8.5%), passive plantarflexor MTU stiffness (30.1 ± 35.5%), and Achilles tendon stiffness (5.3 ± 4.9%) were observed in the trained limb only. Significant correlations were detected between the changes in trained and contralateral limbs for dorsiflexion ROM ( r = 0.59) and both isometric ( r = 0.79) and eccentric ( r = 0.73) peak torques. No significant changes in any metric were detected in the control group. CONCLUSIONS Large ROM increases in the trained limb were associated with neurological, mechanical, and structural adaptations, with evidence of a cross-education effect in the contralateral limb being primarily driven by neurological adaptation (stretch tolerance). The large improvements in ROM, muscle size, and strength confirm that isokinetic eccentric training is a highly effective training tool, with potential for use in athletic and clinical populations where MTU function is impaired and current therapies are ineffective.
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Affiliation(s)
- Anthony D Kay
- Centre for Physical Activity and Life Sciences, Faculty of Art, Science and Technology, University of Northampton, Northamptonshire, UNITED KINGDOM
| | - Anthony J Blazevich
- Centre for Human Performance (CHP), School of Medical and Health Sciences, Edith Cowan University, Joondalup, AUSTRALIA
| | - Jessica C Tysoe
- Centre for Physical Activity and Life Sciences, Faculty of Art, Science and Technology, University of Northampton, Northamptonshire, UNITED KINGDOM
| | - Brett A Baxter
- Centre for Physical Activity and Life Sciences, Faculty of Art, Science and Technology, University of Northampton, Northamptonshire, UNITED KINGDOM
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Gulley Cox LI, Dias N, Zhang C, Zhang Y, Gorniak SL. Effects of Type II Diabetes on Proprioception during a Reach to Pinch Task. J Mot Behav 2023; 56:263-274. [PMID: 37997260 PMCID: PMC10957313 DOI: 10.1080/00222895.2023.2285888] [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: 04/03/2023] [Accepted: 11/09/2023] [Indexed: 11/25/2023]
Abstract
Older adults with type II diabetes (T2D) are at risk of developing nerve disorders that result in functional impairment. Most work in proprioceptive dysfunction in older adults with T2D has focused on functional deficits of the lower limb. The purpose of this study was to examine proprioceptive effects of T2D on the upper limb in older adults. Kinematic performance of a reach-to-pinch action toward a virtual target was assessed in a T2D group (60+ years old with T2D) and a healthy age- and sex-matched control group. Tactile and vibratory thresholds did not differ between T2D and controls. Task accuracy via mean pinch location was significantly worse for persons with T2D (pwT2D) with differences in wrist extension/flexion (ex/fl), wrist abduction/adduction (ab/ad), 1st carpometacarpal (CMC) ab/ad, 2nd metacarpophalangeal (MCP2) ex/fl, MCP2 ab/ad, and digit 1 and hand transport trajectories. Group differences persisted with consideration of body mass index; sex differences in task accuracy emerged. Findings indicate that proprioception of the upper extremity is altered in pwT2D such that they exhibit a unique aperture position and aiming strategy during a reach-to-pinch action. These findings characterize functional sensorimotor impairment of the upper limb in pwT2D with respect to workspaces without visual or tactile feedback.
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Affiliation(s)
- Lauren I. Gulley Cox
- Department of Health and Human Performance, University of Houston, Houston, TX 77204
| | - Nicholas Dias
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204
| | - Chuan Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204
| | - Yingchun Zhang
- Department of Biomedical Engineering, University of Houston, Houston, TX 77204
| | - Stacey L. Gorniak
- Department of Health and Human Performance, University of Houston, Houston, TX 77204
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Lepesis V, Marsden J, Rickard A, Latour JM, Paton J. Systematic review and meta-analysis of the effects of foot and ankle physical therapy, including mobilisations and exercises, in people with diabetic peripheral neuropathy on range of motion, peak plantar pressures and balance. Diabetes Metab Res Rev 2023; 39:e3692. [PMID: 37431167 DOI: 10.1002/dmrr.3692] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 05/05/2023] [Accepted: 06/17/2023] [Indexed: 07/12/2023]
Abstract
To evaluate the effects of foot and ankle physical therapy on ankle and first metatarsophalangeal joint range of motion (ROM), peak plantar pressures (PPPs) and balance in people with diabetes. MEDLINE, EBSCO, Cochrane Database of Systematic Reviews, Joanna Briggs Institute Database of Systematic Reviews, PROSPERO, EThOS, Web of Science and Google Scholar were searched in April 2022. Randomised Controlled Trials (RCT), quasi-experimental, pre-post experimental design and prospective cohort studies were included. Participants were people with diabetes, neuropathy and joint stiffness. Interventions included physical therapy such as mobilisations, ROM exercises and stretches. Outcome measures focused on ROM, PPPs and balance. Methodological quality was assessed with Critical Appraisal Skills Programme RCT and Risk-of-Bias 2 tool. Meta-analyses used random-effects models and data was analysed using the inverse variance method. In total, 9 studies were included. Across all studies, participant characteristics were similar; however, type and exercise dosage varied greatly. Meta-analysis was performed with four studies. Meta-analysis showed significant effects of combined exercise interventions in increasing total ankle ROM (3 studies: MD, 1.76; 95% CI, 0.78-2.74; p = 0; I2 = 0%); and reducing PPPs in the forefoot area (3 studies; MD, -23.34; 95% CI, -59.80 to 13.13; p = 0.21, I2 = 51%). Combined exercise interventions can increase ROM in the ankle and reduce PPPs in the forefoot. Standardisation of exercise programmes with or without the addition of mobilisations in the foot and ankle joints needs further research.
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Affiliation(s)
- Vasileios Lepesis
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jonathan Marsden
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Alec Rickard
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Jos M Latour
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Joanne Paton
- School of Health Professions, Faculty of Health, University of Plymouth, Plymouth, UK
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Li S, Si H, Zhang S, Xu J, Liu Y, Shen B. Does diabetes mellitus impair the clinical results of total knee arthroplasty under enhanced recovery after surgery? J Orthop Surg Res 2023; 18:490. [PMID: 37430329 DOI: 10.1186/s13018-023-03982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) and osteoarthritis (OA) are common diseases that are predicted to increase in prevalence, and DM is a risk factor for OA progression and has a negative impact on the outcome. However, the evidence remains unclear on how it affects patients' clinical results of total knee arthroplasty (TKA) under enhanced recovery after surgery (ERAS). METHODS A retrospective single-center study was conducted comparing diabetic and non-diabetic patients who underwent TKA in West China Hospital of Sichuan University between September 2016 to December 2017 under ERAS. Consecutive propensity score matching (PSM) was conducted by 1:1 (DM: non-DM) matching analysis with all baselines as covariates. The primary clinical results were the improvement of knee joint function, the incidence of postoperative complications, and the FJS-12 sensory results 5 years after the operation between DM and Non-DM groups. The secondary clinical results were the postoperative length of stay (LOS), postoperative blood test and total blood loss (TBL). RESULT After PSM, the final analysis included 84 diabetic patients and 84 non-diabetic patients. Diabetic patients were more likely to experience early postoperative complications (21.4% vs. 4.8%, P = 0.003), of which wound complications are the most significant (10.7% vs. 1.2%, P = 0.022). Diabetic patients experienced longer postoperative LOS with a significant increase in patients with LOS exceeding 3 days (66.7% vs. 50%, P = 0.028) and showed less postoperative range of motion (ROM) (106.43 ± 7.88 vs. 109.50 ± 6.33 degrees, P = 0. 011). Diabetic patients also reported lower Forgotten joint score (FJS-12) than non-diabetic patients (68.16 + 12.16 vs. 71.57 + 10.75, P = 0.020) in the 5-year follow-up and were less likely to achieve a forgotten knee joint (10.7% vs. 1.2%, P = 0.022). In additional, Compared with non-diabetics, diabetic patients showed lower hemoglobin (Hb) (P < 0.001) and hematocrit (HCT) (P < 0.001) and were more likely to suffer from hypertension before TKA (P < 0.001). CONCLUSION Diabetic patients show increased risk for postoperative complications, and have lower lower postoperative ROM and lower FJS-12 compared with non-diabetic patients after TKA under ERAS. More perioperative protocols are still needed to be investigated and optimized for diabetic patients.
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Affiliation(s)
- Shuai Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Haibo Si
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Shaoyun Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Jiawen Xu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yuan Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Bin Shen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
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Crowley K, Scanaill PÓ, Hermanides J, Buggy DJ. Current practice in the perioperative management of patients with diabetes mellitus: a narrative review. Br J Anaesth 2023:S0007-0912(23)00128-9. [PMID: 37061429 PMCID: PMC10375498 DOI: 10.1016/j.bja.2023.02.039] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 02/08/2023] [Accepted: 02/23/2023] [Indexed: 04/17/2023] Open
Abstract
The prevalence of diabetes is increasing, and patients with diabetes mellitus have both an increased likelihood of requiring surgery and of developing postoperative complications when they do. We summarise available evidence underpinning current guidelines on preoperative assessment and optimisation, perioperative management of prescribed insulin and oral hypoglycaemic medication, intraoperative glycaemic control, and postoperative patient care.
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Affiliation(s)
- Kieran Crowley
- Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland.
| | - Pádraig Ó Scanaill
- Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Donal J Buggy
- Department of Anaesthesiology & Perioperative Medicine, Mater University Hospital, School of Medicine, University College Dublin, Dublin, Ireland; Outcomes Research Cleveland Clinic, Cleveland, OH, USA.
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Kay AD, Baxter BA, Hill MW, Blazevich AJ. Effects of Eccentric Resistance Training on Lower-Limb Passive Joint Range of Motion: A Systematic Review and Meta-analysis. Med Sci Sports Exerc 2023; 55:710-721. [PMID: 36730587 DOI: 10.1249/mss.0000000000003085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Substantial increases in joint range of motion (ROM) have been reported after eccentric resistance training; however, between-study variability and sample size issues complicate the interpretation of the magnitude of effect. METHODS PubMed, Medline, and SPORTDiscus databases were searched for studies examining the effects of eccentric training on lower-limb passive joint ROM in healthy human participants. Meta-analysis used an inverse-variance random-effects model to calculate the pooled standardized difference (Hedge's g ) with 95% confidence intervals. RESULTS Meta-analysis of 22 ROM outcomes (17 studies, 376 participants) revealed a large increase in lower-limb passive joint ROM ( g = 0.86 (95% confidence intervals, 0.65-1.08)). Subgroup analyses revealed a moderate increase after 4-5 wk ( g = 0.63 (0.27-0.98)), large increase after 6-8 wk ( g = 0.98 (0.73-1.24)), and moderate increase after 9-14 wk ( g = 0.75 (0.03, 1.46)) of training. Large increases were found in dorsiflexion ( g = 1.12 (0.78-1.47)) and knee extension ( g = 0.82 (0.48-1.17)), but a small increase in knee flexion was observed ( g = 0.41 (0.05-0.77)). A large increase was found after isokinetic ( g = 1.07 (0.59-1.54)) and moderate increase after isotonic ( g = 0.77 (0.56-0.99)) training. CONCLUSIONS These findings demonstrate the potential of eccentric training as an effective flexibility training intervention and provide evidence for "best practice" guidelines. The larger effect after isokinetic training despite <50% training sessions being performed is suggestive of a more effective exercise mode, although further research is needed to determine the influence of contraction intensity and to confirm the efficacy of eccentric training in clinical populations.
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Affiliation(s)
- Anthony D Kay
- Centre for Physical Activity and Life Sciences, Faculty of Art, Science and Technology, University of Northampton, Northamptonshire, UNITED KINGDOM
| | - Brett A Baxter
- Centre for Physical Activity and Life Sciences, Faculty of Art, Science and Technology, University of Northampton, Northamptonshire, UNITED KINGDOM
| | - Mathew W Hill
- Centre for Sport, Exercise and Life Sciences, School of Life Sciences, Coventry University, Warwickshire, UNITED KINGDOM
| | - Anthony J Blazevich
- Centre for Human Performance (CHP), School of Medical and Health Sciences, Edith Cowan University, Joondalup, AUSTRALIA
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Aborajooh E, Alqaisi TM, Yassin M, Alqpelat E, Abofaraj A, Alrawajih T, Alzoubi H, Abu lubad M. Diabetic foot ulcer in Southern Jordan: A cross-sectional Study of Clinical and Microbiological Aspects. Ann Med Surg (Lond) 2022; 76:103552. [PMID: 35495384 PMCID: PMC9052288 DOI: 10.1016/j.amsu.2022.103552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/26/2022] [Accepted: 03/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background Materials and methods Results Conclusion Diabetic foot ulcer is a common complication of diabetes. This study is first of its kind in southern Jordan that combined clinical and microbiological aspects of diabetic foot ulcer. The most frequent bacterial isolates from diabetic foot ulcers are gram negative bacteria. Inappropriate previous use of antibiotics is the main determinant of multi-drug resistant isolates. High rates of multi-drug resistant isolates in this study reflect the loose implementation of antibiotics dispensing regulations in Jordan.
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Affiliation(s)
- Emad Aborajooh
- Department of General Surgery and Anesthesia, Mu'tah University, Kerak, 61710, Jordan
- Corresponding author.
| | - Talal M. Alqaisi
- Department of General Surgery, Al-Karak Governmental Hospital, Kerak, Jordan
| | - Mohammad Yassin
- Department of Gastroenterology, King Hussein Medical Center, Amman, Jordan
| | | | | | | | - Hamed Alzoubi
- Department of Microbiology and Pathology, Mu'tah University, Kerak, 61710, Jordan
| | - Mohammad Abu lubad
- Department of Microbiology and Pathology, Mu'tah University, Kerak, 61710, Jordan
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Vrátná E, Husáková J, Jarošíková R, Dubský M, Wosková V, Bém R, Jirkovská A, Králová K, Pyšková B, Lánská V, Fejfarová V. Effects of a 12-Week Interventional Exercise Programme on Muscle Strength, Mobility and Fitness in Patients With Diabetic Foot in Remission: Results From BIONEDIAN Randomised Controlled Trial. Front Endocrinol (Lausanne) 2022; 13:869128. [PMID: 35865313 PMCID: PMC9294221 DOI: 10.3389/fendo.2022.869128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Diabetic foot syndrome (DFS) is a serious late diabetic complication characterised by limited joint mobility and other biomechanical and muscle abnormalities. AIM To evaluate the effect of an interventional exercise programme on anthropometric parameters, muscle strength, mobility and fitness in patients with diabetic foot in remission. DATA SOURCES AND STUDY SELECTION Thirty-eight patients with type 2 diabetes and DFS without active lesions (mean age 65 ± 6.9 years, BMI 32 ± 4.7 kg.m-2, waist-hip ratio (WHR)1.02 ± 0.06) were enrolled in our randomised controlled trial. All subjects were randomised into two groups: an intervention group (I; n=19) and a control group (C; n=19). The 12-week exercise intervention focused on ankle and small-joint mobility in the foot, strengthening and stretching of the lower extremity muscles, and improvements in fitness. Changes (Δ=final minus initial results) in physical activity were assessed using the International Physical Activity Questionnaire (IPAQ), with joint mobility detected by goniometry, muscle strength by dynamometry, and fitness using the Senior Fitness Test (SFT). DATA EXTRACTION Due to reulceration, 15.8% of patients from group I (3/19) and 15.8% of patients from group C were excluded. Based on the IPAQ, group I was more active when it came to heavy (p=0.03) and moderate physical activity (p=0.06) after intervention compared to group C. Group I improved significantly in larger-joint flexibility (p=0.012) compared to controls. In group I, dynamometric parameters increased significantly in both lower limbs (left leg; p=0.013, right leg; p=0.043) compared to group C. We observed a positive trend in the improvement of fitness in group I compared to group C. We also confirmed positive correlations between heavy physical activity and selected parameters of flexibility (r=0.47; p=0.007), SFT (r=0.453; p=0.011) and dynamometry (r=0.58; p<0.0025). Anthropometric parameters, such as BMI and WHR, were not significantly influenced by the intervention programme. CONCLUSION Our 12-week interventional exercise programme proved relatively safe, resulting in improved body flexibility and increased muscle strength in DF patients in remission.
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Affiliation(s)
- Eliška Vrátná
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
- Clinical Rehabilitation Division, Institute for Clinical and Experimental Medicine, Prague, Czechia
- *Correspondence: Eliška Vrátná,
| | - Jitka Husáková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Radka Jarošíková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
- Second Faculty of Medicine, Charles University, Prague, Czechia
| | - Michal Dubský
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Veronika Wosková
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Robert Bém
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Alexandra Jirkovská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Kateřina Králová
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Bára Pyšková
- Faculty of Physical Education and Sport, Charles University, Prague, Czechia
| | - Věra Lánská
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
| | - Vladimíra Fejfarová
- Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czechia
- Second Faculty of Medicine, Charles University, Prague, Czechia
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Wang J, Wu H, Zhao Y, Qin Y, Zhang Y, Pang H, Zhou Y, Liu X, Xiao Z. Extracellular Vesicles from HIF-1α-Overexpressing Adipose-Derived Stem Cells Restore Diabetic Wounds Through Accelerated Fibroblast Proliferation and Migration. Int J Nanomedicine 2021; 16:7943-7957. [PMID: 34887659 PMCID: PMC8652947 DOI: 10.2147/ijn.s335438] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/23/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Inhibition of cellular adaptation to hypoxia can cause persistent inflammation, thereby increasing tissue damage and complicating wound healing in diabetes patients. Regulating cellular adaptation to hypoxic environments can help in effective wound repair. Hypoxia-inducible factor (HIF)-1α is a key regulator of cell hypoxia. Extracellular vesicles (EVs) regulate wound repair. This study investigated the mechanism of HIF-1α overexpression in adipose-derived stem cell extracellular vesicles (ADSCs-hEVs) in the repair of diabetic wounds. MATERIALS AND METHODS HIF-1α expression in diabetes patients and healthy participants was studied. High-throughput sequencing, GO, and KEGG analysis revealed that ADSCs small extracellular vesicle hypoxia environments may increase HIF-1α expression by affecting cell metabolism, differentiation, and TGF-β secretion, or by altering the PI3K/AKT pathway. Effect of addition of ADSCs-hEVs on cell proliferation and migration was investigated using Western blotting, EdU assay, transwell assay, and migration. In vivo, after 7, 14, and 21 days, important factors for diabetic wound healing were evaluated by immunohistochemistry, qRT-PCR, Masson staining, and H&E staining. RESULTS HIF-1α expression decreased in the skin of diabetes patients; interleukin (IL)-6 expression increased, and growth factor-related indexes decreased. ADSCs-hEVs significantly increased the expression and secretion of growth factors, compared with ADSCs-EVs. In vivo, ADSC-hEV treatment accelerated the healing rate and improved the healing quality of diabetic wounds compared with ADSCs-EVs. CONCLUSION Speed and quality of wound healing increased significantly in the ADSCs-hEVs group, which could inhibit early inflammation while promoting the secretion and expression of growth factors and extracellular matrix-related indexes.
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Affiliation(s)
- Jie Wang
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China
| | - Hao Wu
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China
| | - Yue Zhao
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China
| | - Youyou Qin
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China
| | - Yingbo Zhang
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China
| | - Hao Pang
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China
| | - Yongting Zhou
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China
| | - Xueyi Liu
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China
| | - Zhibo Xiao
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, People’s Republic of China
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Comparison of Plantar Pressures Between Upright and Recumbent Stationary Bicycles. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Knowledge, Practice and Attitude towards Foot Ulcers and Foot Care among Adults Living with Diabetes in Tobago: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158021. [PMID: 34360314 PMCID: PMC8345419 DOI: 10.3390/ijerph18158021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/14/2021] [Accepted: 07/26/2021] [Indexed: 12/15/2022]
Abstract
Globally, the prevalence of diabetes has risen significantly by 62% over the last ten years. A complication of unmanaged diabetes is diabetic foot ulcer (DFU), which adversely affects the quality of life of individuals with diabetes and inflicts a huge economic burden on the family, government, and health care services. However, this complication is preventable with adequate patient knowledge and practice regarding DFU and foot care. The present study was aimed at assessing the knowledge, attitude, and practice of adults with diabetes on foot ulcers and foot care in Tobago using a qualitative exploratory design. Purposeful sampling technique was used to recruit 20 participants from the lifestyle and diabetes foot clinics of Scarborough Health Centre, Tobago. Telephone interviews were conducted with the use of a semi-structured interview guide. The data obtained from participants were analyzed using thematic content analysis. Four major themes, namely foot ulcer problems, participants’ knowledge on DFU, knowledge on foot care, and practice and attitude of foot care, emerged from the study. The findings from the study revealed that the majority of participants had poor knowledge regarding DFU but exhibited awareness about foot care, especially on foot cleaning and inspection, preventing irritation after washing, appropriate footwear, and not walking barefooted. The participants had good attitudes and practices of foot care despite their poor knowledge of DFU. However, participants reported inadequate health education on DFU and foot care from healthcare personnel. There should be improved health education, information, and communication on DFU and foot care centred and tailored to the understanding of people living with diabetes. This will prevent DFU and reduce the mortality arising from this complication, which is a major target of the sustainable development goals (SDG) in mitigating the burden of non-communicable diseases (NCD) such as diabetes.
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Wang J, Wu H, Peng Y, Zhao Y, Qin Y, Zhang Y, Xiao Z. Hypoxia adipose stem cell-derived exosomes promote high-quality healing of diabetic wound involves activation of PI3K/Akt pathways. J Nanobiotechnology 2021; 19:202. [PMID: 34233694 PMCID: PMC8261989 DOI: 10.1186/s12951-021-00942-0] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 06/23/2021] [Indexed: 12/15/2022] Open
Abstract
Refractory diabetic wounds can cause persistent inflammation and delayed healing due to hypoxia. Currently, no optimal solution is available. Exosomes of adipose stem cells (ADSCs-exo) may promote skin wound healing, however, molecular mechanisms remains mysterious. We found significantly enhanced survival and proliferation of adipose stem cells after hypoxia induction compared to normoxia. Here, we aimed to investigate if hypoxic adipose stem cells exosomes (HypADSCs-exo) participate in hypoxia adaptability and accelerate diabetic wound healing. Based on high-throughput sequencing, 215 microRNAs (miRNAs) were upregulated and 369 miRNAs downregulated in HypADSCs-exo compared to ADSCs-exo. Up-regulated miR-21-3p, miR-126-5p, miR-31-5p whereas down-regulated gene miR-99b and miR-146-a correlated with wound healing. According to Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG), miRNAs might regulate cell metabolism, differentiation and Transforming growth factor-β (TGF-β) function. Consistently, HpyADSCs-exo could promote diabetic wounds healing and inhibit inflammation through PI3K/AKT signaling pathway. Collectively, HpyADSCs-exo can promote diabetic wound healing as an alternative strategy to improve wound healing.
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Affiliation(s)
- Jie Wang
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Hao Wu
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Yixuan Peng
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Yue Zhao
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Youyou Qin
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Yingbo Zhang
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, People's Republic of China
| | - Zhibo Xiao
- Department of Plastic and Aesthetic Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150081, People's Republic of China.
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13
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Zhang S, Chong M, Lau BPH, Ng YH, Wang X, Chua W. Do Patients With Diabetes Have Poorer Improvements in Patient-Reported Outcomes After Total Knee Arthroplasty? J Arthroplasty 2021; 36:2486-2491. [PMID: 33775468 DOI: 10.1016/j.arth.2021.02.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/21/2021] [Accepted: 02/24/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Diabetes is one of the most common comorbidities in patients undergoing total knee arthroplasty (TKA) for osteoarthritis. However, the evidence remains unclear on how it affects patient-reported outcome measures after TKA. METHODS We reviewed prospectively collected data of 2840 patients who underwent primary unilateral TKA between 2008 and 2018, of which 716 (25.2%) had diabetes. All patients had their HbA1c measured within 1 month before surgery, and only well-controlled diabetics (HbA1c <8.0%) were allowed to proceed with surgery. Patient demographics and comorbidities were recorded, and multiple regression was performed to evaluate the impact of diabetes on improvements in patient-reported outcome measures (Short Form 36 (SF-36), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Knee Society Score (KSS)) and knee range of motion (ROM). RESULTS Compared with nondiabetics, patients with diabetes were more likely to possess a higher body mass index (P-value <.001), more comorbidities (P-value <.001), and poorer preoperative SF-36 Physical Component Summary (PCS) (P-value <.001), WOMAC (P-value = .002), KSS-function (P-value <.001), and knee ROM (P-value <.001). Multiple regression showed that diabetic patients experienced marginally poorer improvements in KSS-knee (-1.22 points, P-value = .025) and knee ROM (-1.67°, P-value = .013) than nondiabetics. However, there were no significant differences in improvements for SF-36 PCS (P-value = .163), Mental Component Summary (P-value = .954), WOMAC (P-value = .815), and KSS-function (P-value = .866). CONCLUSION Patients with well-controlled diabetes (HbA1c <8.0%) can expect similar improvements in general health and osteoarthritis outcomes (SF-36 PCS and Mental Component Summary, WOMAC, and KSS-function) compared with nondiabetics after TKA. Despite having marginally poorer improvements in knee-specific outcomes (KSS-knee and knee ROM), these differences are unlikely to be clinically significant.
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Affiliation(s)
- Siyuan Zhang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mark Chong
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Bernard Puang Huh Lau
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Yau Hong Ng
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Xinyu Wang
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
| | - Weiliang Chua
- Department of Orthopaedic Surgery, National University Hospital, Singapore, Singapore
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14
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Levy N, Lirk P. Regional anaesthesia in patients with diabetes. Anaesthesia 2021; 76 Suppl 1:127-135. [PMID: 33426661 DOI: 10.1111/anae.15258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2020] [Indexed: 12/11/2022]
Abstract
Diabetes is the most common metabolic condition worldwide and about 20% of surgical patients will have this condition. It is a major risk-factor for worse outcomes after surgery including mortality; infective and non-infective complications; and increased length of stay. However, diabetes is a modifiable risk-factor, and programs to improve medical management have the potential to reduce peri-operative complications and the risk of harm. Regional anaesthesia has well-documented benefits in promoting the restoration of function but there are legitimate concerns that the incidence of complications of regional anaesthesia in patients with diabetes is higher. The aim of this review is to explore in detail the various potential advantages and disadvantages of regional anaesthesia in patients with diabetes. This, in turn, will allow practitioners to undertake more informed shared decision-making and potentially modify their anaesthetic technique for patients with diabetes.
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Affiliation(s)
- N Levy
- Department of Anaesthesia, West Suffolk Hospital, Bury St. Edmunds, Suffolk, UK
| | - P Lirk
- Department of Anesthesiology, Peri-operative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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15
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Hastings MK, Jeong HJ, Sorensen CJ, Zellers JA, Chen L, Bohnert KL, Snozek D, Mueller MJ. Relationships within and between lower and upper extremity dysfunction in people with diabetes. Foot (Edinb) 2020; 44:101680. [PMID: 32679515 PMCID: PMC7483835 DOI: 10.1016/j.foot.2020.101680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/22/2020] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Diabetes mellitus (DM) is associated with systemic musculoskeletal system impairments suggesting concurrent development of lower and upper extremity musculoskeletal problems. This study aims to examine relationships between lower and upper extremity function in people with DM. METHODS Sixty people with type 2 DM and peripheral neuropathy [mean (standard deviation); 67(6) years old, DM duration 14(10) yrs] completed the following measures: 1) Self-reports of function: Foot and Ankle Ability Measure (FAAM; higher = better function) and Shoulder Pain and Disability Index (SPADI; lower = better function), 2) Range of motion (goniometry): ankle dorsiflexion and shoulder flexion, and 3) Strength: unilateral heel rise power (UHR, 3D kinetics) and hand grip dynamometry. Pearson correlations examined associations between lower and upper extremity measures, p < .05. RESULTS Forty of 60 (67%) reported pain/disability in both the foot/ankle and shoulder and 95% of study participants had some limitation in foot or shoulder function. Significant between extremity correlations: FAAM and SPADI (r = -0.39), ankle dorsiflexion and shoulder flexion range of motion (r = 0.35), and UHR and hand grip strength (r = 0.40). Significant within extremity correlations: FAAM and UHR (r = .47) and SPADI with shoulder flexion (r = -0.44). CONCLUSION Upper and lower extremity inter- and intra-relationships indicate systemic musculoskeletal impairments in people with DM. Healthcare practitioners should consider the potential for concurrent and disabling musculoskeletal problems in people with DM.
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Affiliation(s)
- Mary K. Hastings
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108
| | - Hyo-Jung Jeong
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108
| | - Christopher J. Sorensen
- Bernard Becker Medical Library, Washington University School of Medicine, St. Louis MO 63108
| | - Jennifer A. Zellers
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108,Bernard Becker Medical Library, Washington University School of Medicine, St. Louis MO 63108,Division of Biostatistics, Washington University School of Medicine, St. Louis MO 63110
| | - Ling Chen
- Division of Biostatistics, Washington University School of Medicine, St. Louis MO 63110
| | - Kathryn L. Bohnert
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108
| | - Darrah Snozek
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108
| | - Michael J. Mueller
- Program in Physical Therapy, Washington University School of Medicine, St. Louis MO 63108
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16
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Polikandrioti M, Vasilopoulos G, Koutelekos I, Panoutsopoulos G, Gerogianni G, Babatsikou F, Zartaloudi A, Toulia G. Quality of Life in Diabetic Foot Ulcer: Associated Factors and the Impact of Anxiety/Depression and Adherence to Self-Care. INT J LOW EXTR WOUND 2020; 19:165-179. [PMID: 31973632 DOI: 10.1177/1534734619900415] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Diabetic foot ulcer (DFU) is a major complication of diabetes mellitus that needs a multidisciplinary approach. The purpose of this study was to assess the impact of patients’ characteristics, anxiety/depression, and adherence to guidelines on the QoL of patients with diabetic ulcer. The sample of the study consisted of 195 patients. Data collected by the completion of SF-36 Health Survey, the Hospital Anxiety and Depression Scale, and a questionnaire that measured adherence to self-care activities. Patients had moderate- to high-quality levels in emotional well-being, pain, social functioning, and energy/fatigue (median: 68, 68, 63, and 60, respectively), while they had low levels of quality in physical functioning, role physical, and role emotional (median: 21, 0, and 33, respectively). In their general health, patients had moderate levels (median: 50). High levels of anxiety and depression were observed in 13.8% and 20.0% of the participants, respectively. After multiple regression, regarding general QoL, patients living in the capital city had 9.89 points worse general health than patients living in Attica (β = −9.89, 95% confidence interval [CI] = −16.86 to 2.93, P = .006). Patients with moderate or high levels of anxiety had 9.37 and 16.08 points, respectively, worse general health than those with low levels (β = −9.37, 95% CI = −17.04 to 1.70, P = .017, and β = −16.08, 95% CI = −26.65 to −5.51, P = .003, respectively). Clinically, these findings may help health professionals attain effective treatment of emotional burden to DFU patients and increase adherence to self-care.
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17
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Francia P, Sorelli M, Piccini B, Iannone G, Capirchio L, Toni S, Gulisano M, Bocchi L. Glycemic Control Maintained over Time and Joint Stiffness in Young Type 1 Patients: What Is the Mathematical Relationship? J Diabetes Sci Technol 2019; 13:728-733. [PMID: 30255709 PMCID: PMC6610591 DOI: 10.1177/1932296818802840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is widely known that diabetes can induce stiffness and adversely affect joint mobility even in young patients with type 1 diabetes mellitus (T1D). The aim of this study was to identify a mathematical model of diabetes mellitus long-term effects on young T1D patients. METHODS Ankle joint mobility (AJM) was evaluated using an inclinometer in 48 patients and 146 healthy, sex- BMI-, and age-matched controls. Assuming time invariance and linear superposition of the effects of hyperglycemia, the influence of T1D on AJM was formalized as an impulse response putting into relationship past supernormal HbA1c concentrations with the ankle total range of motion. The proposed model was identified by means of a nonlinear evolutionary optimization algorithm. RESULTS AJM was significantly reduced in young T1D patients (P < .001). AJM in both plantar and dorsiflexion was significantly lower in subjects with diabetes than in controls (P < .001). The identified impulse response indicates that impaired metabolic control requires 3 months to bring out its maximum effect on the reduction of AJM, while the following long-lasting decay phase with the expected AJM recovery times, normally depends on the slow turnover of collagen. HbA1c concentration levels above 7.2% are sufficient to produce a reduction of ankle ROM. CONCLUSIONS In young patients with T1D the lack of glycemic control over time affects AJM. HbA1c levels can serve as a relevant prognostic factor for assessing the progression of LJM in subjects with diabetes.
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Affiliation(s)
- Piergiorgio Francia
- Department of Clinical and Experimental
Medicine, University of Florence, Florence, Italy
- Piergiorgio Francia, BSc, Department of
Clinical and Experimental Medicine, University of Florence, 50121 Florence,
Italy.
| | - Michele Sorelli
- Department of Information Engineering,
University of Florence, Florence, Italy
| | | | - Giulia Iannone
- ANIMO, National Association of Movement
Sciences, Florence, Italy
| | | | - Sonia Toni
- Diabetes Unit, Meyer Children’s
Hospital, Florence, Italy
| | - Massimo Gulisano
- Department of Clinical and Experimental
Medicine, University of Florence, Florence, Italy
| | - Leonardo Bocchi
- Department of Information Engineering,
University of Florence, Florence, Italy
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18
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Sorelli M, Francia P, Bocchi L, De Bellis A, Anichini R. Assessment of cutaneous microcirculation by laser Doppler flowmetry in type 1 diabetes. Microvasc Res 2019; 124:91-96. [PMID: 30959000 DOI: 10.1016/j.mvr.2019.04.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The burden of type 1 diabetes (T1D) is growing worldwide, stressing the requirement to limit the threat of its long-term complications. In this regard, the development of methods for the early diagnosis and non-invasive monitoring of vascular abnormalities is widely recognized as one of the greatest priorities of the clinical research in this field. OBJECTIVE To assess the deterioration of physiological properties extracted from laser Doppler flowmetry (LDF) signals of microvascular perfusion and, secondly, to investigate their association with the quality of long-term metabolic control. METHODS Microvascular perfusion was recorded at the hallux of 63 control subjects and 47 T1D patients, whose glycaemic control was characterized in terms of the annual average levels of glycosylated haemoglobin (HbA1c). Pulse Decomposition Analysis was applied to the LDF data, in order to derive non-invasive markers of vascular stiffness based on a multi-Gaussian representation of the peripheral pulse waveforms; furthermore, wavelet transform analysis was used to evaluate the microvascular myogenic vasomotion and, finally, a physiological model of the reactive hyperaemia to a local thermal stimulus at 43 was used to test the integrity of the neurovascular pathways. RESULTS Compared to the control group, T1D patients showed a lower microvascular perfusion at baseline, and a larger vasodilatory reserve upon local heating, but no significant difference in myogenic activity. Moreover, the results of the PDA carried out on the LDF pulse waves, indicate the presence of a significant strong relation between large artery stiffness and the overall loss of glycaemic control over the past year.
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Affiliation(s)
- Michele Sorelli
- Dept. of Information Engineering, University of Florence, Italy.
| | | | - Leonardo Bocchi
- Dept. of Information Engineering, University of Florence, Italy
| | - Alessandra De Bellis
- Dept. of Internal Medicine, Diabetes Unit, San Jacopo Hospital of Pistoia, Italy
| | - Roberto Anichini
- Dept. of Internal Medicine, Diabetes Unit, San Jacopo Hospital of Pistoia, Italy
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19
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Francia P, Bellis AD, Seghieri G, Tedeschi A, Iannone G, Anichini R, Gulisano M. Continuous Movement Monitoring of Daily Living Activities for Prevention of Diabetic Foot Ulcer: A Review of Literature. Int J Prev Med 2019; 10:22. [PMID: 30820309 PMCID: PMC6390424 DOI: 10.4103/ijpvm.ijpvm_410_17] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Accepted: 12/21/2017] [Indexed: 01/17/2023] Open
Abstract
Lower extremity ulcers represent the most ominous, feared, and costly complications of diabetes mellitus. The aim of this review is to highlight the role of daily life physical activities (PAs) and continuous movement monitoring (CMM) in the prevention of foot ulcers. Peripheral neuropathy and peripheral vascular disease are the main causes of foot ulceration and contribute, in turn, to the development of additional risk factors such as foot deformities and/or joint and muscular alterations. Moreover, a deficit of balance, posture abnormalities, followed by gait alterations, increases the risk of ulceration. PA can play a key role in the management of patients with diabetes and in the prevention of ulcers; however, even if it has been reported that some of these risk factors significantly improve after a few weeks of exercise therapy (ET), the real preventive role of ET has not yet been demonstrated. These uncertain results can occur due to some limitations in the management of the same relationship between PA and diabetic foot prevention. Technological advances during the last years enable timely management of overall daily PA. The use of these modern technologies and devices allows CMM assessment and description of daily PA even in the long term. The data collected from these devices can be used to properly manage patients' PA and thus contribute to the prevention of foot ulcers.
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Affiliation(s)
- Piergiorgio Francia
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | | | | | | | | | | | - Massimo Gulisano
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
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20
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Francia P, Toni S, Iannone G, Seghieri G, Piccini B, Vittori A, Santosuosso U, Casalini E, Gulisano M. Type 1 diabetes, sport practiced, and ankle joint mobility in young patients: What is the relationship? Pediatr Diabetes 2018; 19:801-808. [PMID: 29493073 DOI: 10.1111/pedi.12643] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 12/26/2017] [Accepted: 12/27/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND/OBJECTIVE It is known that patients with diabetes can develop limited joint mobility (LJM) and that this can depend on the metabolic control maintained and the duration of the disease. The aims of this study were to verify the presence of ankle joint mobility (AJM) deficits in both plantar and dorsiflexion in young type 1 diabetic patients (T1D) considering also the possible role of sport practiced as a further factor, able to modify AJM. METHODS AJM was evaluated by an inclinometer in 82 T1D patients (M/F: 48/34), mean age 12.9 ± 2.6 years, body mass index (BMI) 19.7 ± 3.6 kg/m2 , duration of diabetes 5.6 ± 3.3 years, mean HbA1c 7.5 ± 1.0% and in 226 healthy controls (M/F: 146/80), age-, gender-, and BMI-matched practicing different sports (soccer, volleyball, basketball, and dance). RESULTS The patients' ankle range of motion was significantly lower than that in controls (132.7 ± 22.3° vs 126.1 ± 17.9°; P < .017). In particular, ankle plantar flexion was significantly lower in the patients group (31.6° ± 7.9° vs 28.5° ± 6.6°; P < .002). Soccer players showed lower AJM in both groups: patients (120.1 ± 15.9° vs 127.3 ± 18.1) and controls (119.4 ± 21.1° vs 142.0 ± 18.1; P < .0001) than subjects practicing other sports or who were sedentary. In both groups, patients and controls, age, sex, duration of disease, hemoglobin 1Ac, and BMI have not been shown to be correlated to the mobility assessed. CONCLUSIONS The results of this study, in addition to confirming the negative effect of diabetes on AJM of young T1D patients, suggest that during these evaluations the sport-related effect should be considered because it can induce significant changes of AJM.
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Affiliation(s)
- Piergiorgio Francia
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | - Sonia Toni
- Diabetes Unit, Meyer Children's Hospital, Florence, Italy
| | - Giulia Iannone
- National Association of Movement Sciences (ANIMO), Florence, Italy
| | | | | | - Alessandro Vittori
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | - Ugo Santosuosso
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
| | | | - Massimo Gulisano
- Department of Experimental and Clinical Medicine, School of Human Health Sciences, University of Florence, Florence, Italy
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Impaired cutaneous T-cell attracting chemokine elevation and adipose-derived stromal cell migration in a high-glucose environment cause poor diabetic wound healing. Kaohsiung J Med Sci 2018; 34:539-546. [PMID: 30309481 DOI: 10.1016/j.kjms.2018.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 04/26/2018] [Accepted: 05/03/2018] [Indexed: 12/20/2022] Open
Abstract
Diabetic wound care is a major health care concern. The major cause of non-healing of wounds in patients with diabetes mellitus (DM) patients mainly involves poor glycemic control, which hinders the migration of progenitor cells including mesenchymal stem cells to the wound site. In this study, we introduced adipose-derived stromal cells (ADSCs) into wound sites and demonstrated that the local transplantation of ADSCs accelerated DM-related wound healing. Furthermore, the migration ability of ADSCs, which diminishes in a high-glucose environment, was partially restored by the exogenous replenishment of the cutaneous T-cell attracting chemokine (CTACK/CCL27). Our findings suggest that CTACK is a potential novel therapeutic target in DM-related wound healing.
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