Diabetic foot infections: a team-oriented review of medical and surgical management

As the domestic and international incidence of diabetes and metabolic syndrome continues to rise, health care providers need to continue improving management of the long-term complications of the disease. Emergency department visits and hospital admissions for diabetic foot infections are increasingly commonplace, and a like-minded multidisciplinary team approach is needed to optimize patient care. Early recognition of severe infections, medical stabilization, appropriate antibiotic selection, early surgical intervention, and strategic plans for delayed reconstruction are crucial components of managing diabetic foot infections. The authors review initial medical and surgical management and staged surgical reconstruction of diabetic foot infections in the inpatient setting

The cystic fibrosis microbiome in an ecological perspective and its impact in antibiotic therapy

The recent focus on the cystic fibrosis (CF) complex microbiome has led to the recognition that the microbes can interact between them and with the host immune system, affecting the disease progression and treatment routes. Although the main focus remains on the interactions between traditional pathogens, growing evidence supports the contribution and the role of emergent species. Understanding the mechanisms and the biological effects involved in polymicrobial interactions may be the key to improve effective therapies and also to define new strategies for disease control. This review focuses on the interactions between microbe-microbe and host-microbe, from an ecological point of view, discussing their impact on CF disease progression. There are increasing indications that these interactions impact the success of antimicrobial therapy. Consequently, a new approach where therapy is personalized to patients by taking into account their individual CF microbiome is suggested.Portuguese Foundation for Science and Technology (FCT), the strategic funding of UID/BIO/04469/2013-CEB and UID/EQU/00511/2013-LEPABE units. This study was also supported by FCT and the European Community fund FEDER, through Program COMPETE, under the scope of the Projects “DNA mimics” PIC/IC/82815/2007, RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462), “BioHealth—Biotechnology and Bioengineering approaches to improve health quality”, Ref. NORTE-07-0124-FEDER-000027 and NORTE-07-0124-FEDER-000025—RL2_ Environment and Health, co-funded by the Programa Operacional Regional do Norte (ON.2 – O Novo Norte), QREN, FEDER. The authors also acknowledge the grant of Susana P. Lopes (SFRH/BPD/95616/2013) and of the COST-Action TD1004: Theragnostics for imaging and therapy

Polycystic ovary syndrome

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Polycystic ovary syndrome (PCOS) affects 5-20% of women of reproductive age worldwide. The condition is characterized by hyperandrogenism, ovulatory dysfunction and polycystic ovarian morphology (PCOM) - with excessive androgen production by the ovaries being a key feature of PCOS. Metabolic dysfunction characterized by insulin resistance and compensatory hyperinsulinaemia is evident in the vast majority of affected individuals. PCOS increases the risk for type 2 diabetes mellitus, gestational diabetes and other pregnancy-related complications, venous thromboembolism, cerebrovascular and cardiovascular events and endometrial cancer. PCOS is a diagnosis of exclusion, based primarily on the presence of hyperandrogenism, ovulatory dysfunction and PCOM. Treatment should be tailored to the complaints and needs of the patient and involves targeting metabolic abnormalities through lifestyle changes, medication and potentially surgery for the prevention and management of excess weight, androgen suppression and/or blockade, endometrial protection, reproductive therapy and the detection and treatment of psychological features. This Primer summarizes the current state of knowledge regarding the epidemiology, mechanisms and pathophysiology, diagnosis, screening and prevention, management and future investigational directions of the disorder.Robert J Norman, Ruijin Wu and Marcin T Stankiewic

Validation of the Omni-cycle scale of perceived exertion in the elderly

This study examined the concurrent and construct validity of the OMNI-Cycle Rating of Perceived Exertion (RPE) Scale, using elderly men and women. Seventy-six participants performed a load-incremented cycle-ergometer exercise test. Concurrent validity was determined by correlating OMNI-RPE responses with oxygen uptake, relative peak oxygen uptake, pulmonary ventilation, heart rate, respiratory rate, and respiratory-exchange ratio during a load-incremented cycle-ergometer protocol. Construct validity was established by correlating RPE derived from the OMNI-Cycle Scale with RPE from the Borg (6–20) Scale. Multilevel, mixed linear-regression models indicated that OMNI-RPE distributed as a significant (p < .05) positive linear function (r = .81–.92) for all physiological measures. OMNI-RPE was positively (p < .01) and linearly related to Borg-RPE in elderly men (r = .97) and women (r = .96). This study demonstrates both concurrent and construct validity of the OMNI-Cycle RPE Scale. These findings support the use of this scaling metric with elderly men and women to estimate RPE during cycle-ergometer exercise

Validation of the Italian version of the OMNI Scale of Perceived Exertion in a sample of Italian-speaking adults

The purpose was to examine whether the translation of verbal descriptors from English to Italian affects the validity of the OMNI Scale of Perceived Exertion. 82 people for whom Italian was the primary language performed an orientation trial and a maximal graded exercise test on a cycle ergometer. Ratings of perceived exertion for the overall body and physiological responses were measured during each exercise stage. Significant correlations were found between perceptual responses of the Italian version of the OMNI Cycle Scale of Perceived Exertion and oxygen uptake, pulmonary ventilation, heart rate, respiratory rate, and respiratory exchange ratio responses to a maximal graded exercise test on a cycle ergometer. These findings indicate that the Italian version of the OMNI Scale of Perceived Exertion gives a valid estimate of effort during cycle ergometer exercise

Gender-based differences in substrate use during exercise at a self-selected pace

The aim of this study was to investigate gender-based differences in substrate use during exercise at a self-selected pace. Seventeen men and 17 women performed a maximal exercise test and a 20-minute bout of self-paced treadmill walking to determine carbohydrate and fat oxidation rates. Gas exchange measurements were performed throughout the tests, and stoichiometric equations were used to calculate substrate oxidation rates. For each individual, a best-fit polynomial curve was constructed using fat oxidation rate (gmin21) vs. exercise intensity (percentage of maximal oxygen uptake, % _ VO2max). Each individual curve was used to obtain the following variables: maximal fat oxidation (MFO), the peak rate of fat oxidation measured over the entire range of exercise intensities; fatmax, the exercise intensity at which the MFO was observed; and fatmax zone, range of exercise intensities with fat oxidation rates within 10% of fat oxidation rates at fatmax. Although the MFO was similar between genders, fatmax was lower in men than in women. Similarly, the ‘‘low’’ and ‘‘high’’ borders of the fatmax zone were lower in men than in women. During exercise at a self-selected pace, carbohydrate oxidation rates were greater in men than in women, despite no gender-based differences in fat oxidation rates. However, fat oxidation contribution to total energy expenditure (EE) was greater in women than in men, despite no gender-based differences in the exercise intensity. In conclusion, although both genders self-selected a similar exercise intensity, the contribution of fat oxidation to EE is greater in women than in men. Interestingly, both genders selfselected an exercise intensity that falls within the fatmax zone

Psychophysiological Responses to Self-paced Treadmill and Overground Exercise

Speculation exists that a positive affective response experienced during exercise may play an important role in predicting exercise adherence. Previous studies using self-paced exercise protocols have been associated with health benefits and pleasant experiences. However, all of these studies were conducted in laboratories, and consequently, the external validity of the findings may be questionable. PURPOSE: To determine whether environmental settings (treadmill vs overground) differentially influence physiological, perceptual, and affective responses to exercise at a self-selected pace. METHODS: Thirty-four individuals (17 men and 17 women) between 18 and 30 yr volunteered to participate in this study. During the orientation session, individuals underwent an initial screening, anthropometric measurements, and familiarization with the experimental procedures. Next, subjects underwent a maximal treadmill test. In the two experimental trials, participants performed 20-min bouts of treadmill and overground walking at a self-selected pace, which were completed in a counterbalanced order. At least 48 h separated experimental trials. RESULTS: Using repeated-measures ANOVA, overground walking speed was significantly faster than treadmill walking speed (P < 0.01) during the 20-min bout of self-paced exercise. However, exercise intensity (%VO2R and %HRR) and perceived exertion during the session of overground walking were significantly lower (P < 0.05) when compared with those during the treadmill session. In addition, affective valence was more positive during the session of overground walking than during the treadmill session (P < 0.01). CONCLUSIONS: These data extend previous findings by showing that environmental setting influences physiological, perceptual, and affective responses during exercise at a self-selected pace. Self-paced exercise performed over ground resulted in lower perceptual and more positive affective responses

Age and physiological, perceptual, and affective responses during walking at a self-selected pace

The aim of this study was to examine physiological, perceptual, and affective responses during self-paced walking for three age groups. 66 adult women were assigned into three groups by age: 20–25 yr. (n = 22), 30–35 yr. (n = 22), and 40–45 yr. (n = 22). Each participant completed a maximal exercise test and a 20-min. bout of walking at a self-selected pace. The preferred walking speed was similar for all age groups, whereas physiological responses relative to maximal and ventilatory threshold values were greater in the 40–45 yr. group than the other two groups. Nevertheless, perceptual and affective responses were similar for all age groups. These findings suggest that physiological responses, but not perceptual and affective responses, of sedentary women are associated with age during walking at a self-selected pace

Locating Shadows in Aerial Photographs Using Imprecise Elevation Data

Realistic images of terrain can be created by texture mapping aerial photographs onto elevation data. However, lighting and shadows in the original photographs are a problem when multiple aerial photos are merged, or when the sun direction used for the generated image is different from the original aerial photograph. Our goal is to generate a terrain surface reflectance map from an aerial photograph. This will be used to simulate a new aerial photograph with different lighting and viewing directions. We are concentrating on forest and mountain areas for use in ecosystem management and modeling applications. One key to generating realistic new images is finding shadows cast by the terrain in the original aerial photographs. Digital elevation values are uncertain due to vertical imprecision in the measurement process and coarse sample spacing. This uncertainty can result in substantial differences between calculated shadow positions and actual shadow locations in photographs when convent..