The management of neuropathic ulcers of the foot in diabetes by shock wave therapy

<p>Abstract</p> <p>Background</p> <p>Diabetes is becoming one of the most common chronic diseases, and ulcers are its most serious complication. Beginning with neuropathy, the subsequent foot wounds frequently lead to lower extremity amputation, even in the absence of critical limb ischemia. In recent years, some researchers have studied external shock wave therapy (ESWT) as a new approach to soft tissue wound healing. The rationale of this study was to evaluate if ESWT is effective in the management of neuropathic diabetic foot ulcers.</p> <p>Methods</p> <p>We designed a randomized, prospective, controlled study in which we recruited 30 patients affected by neuropathic diabetic foot ulcers and then divided them into two groups based on different management strategies. One group was treated with standard care and shock wave therapy. The other group was treated with only standard care. The healing of the ulcers was evaluated over 20 weeks by the rate of re-epithelization.</p> <p>Results</p> <p>After 20 weeks of treatment, 53.33% of the ESWT-treated patients had complete wound closure compared with 33.33% of the control patients, and the healing times were 60.8 and 82.2 days, respectively (p < 0.001). Significant differences in the index of the re-epithelization were observed between the two groups, with values of 2.97 mm²/die in the ESWT-group and 1.30 mm²/die in the control group (p < 0.001).</p> <p>Conclusion</p> <p>Therefore, ESWT may be a useful adjunct in the management of diabetic foot ulceration.</p> <p>Trial registration</p> <p>Current Controlled Trials ISRCTN21800909</p

Medium-energy shock wave therapy in the treatment of rotator cuff calcifying tendinitis

To evaluate the results of the treatment with medium-energy extracorporeal shock wave therapy (ESWT) in rotator cuff calcifying tendinitis. Fifty-four non-consecutive patients, who were referred to our institute for rotator cuff calcifying tendinitis, were managed with a standardized protocol in four sessions of medium-energy (0.11mJ/mm2) ESWT administered with an electromagnetic lithotriptor. Pain was evaluated at the end of each session, functional state of shoulder was assessed at 1 and 6months after the end of procedure. All patients underwent radiographs and sonography imaging. No systemic or local complications. Thirty-eight patients (70%) reported satisfactory functional results. Radiographs and sonographs showed a disappearance of calcium deposit in 29 patients (54%) and in 19 patients (35%) it appeared to be reduced more than a half. A correlation was found between residual calcium deposit and the clinical outcome, but some patients showed a reduced pain without modification of calcium deposit. These results were unmodified at 6months follow-up. Our protocol of medium-energy ESWT provides good results overall about pain modulatio

Multilobulated popliteal cyst after a failed total knee arthroplasty

Popliteal cyst is a rare finding after total knee arthroplasty (TKA), but when present, it might indicate a malfunction of the TKA related to generation of wear-particles, or loosening. We present a case of a multilobulated popliteal cyst developing in a patient 8years after primary TKA. The cyst was associated with a mechanical prosthetic loosening. The primary complaint of the patient was pain in the posterior region of the knee. A two-stage procedure consisting of cyst excision at first, followed after 5months by a revision TKA was performed. Intraoperatively, a darkish, multilobulated cyst with a well-defined thick wall filled with fluid containing polyethylene debris, communicating with the knee joint was found. After 3years of follow-up, the patient was satisfied and walked without the support of a cane. The patient presented a satisfactory knee range of motion. Clinical, radiological and ultrasound investigations ruled out popliteal cyst recurrence. A dissecting popliteal cyst associated with a failed TKA should be excised because it contains polyethylene debris that constitutes an induced factor for prosthetic loosening. A two-stage procedure with quite a long time in-between, as presented in this paper, can be a useful alternative to manage such a problem, in particular in very old patients associated with other medical problem

Extracorporeal shock wave therapy in runners with a symptomatic heel spur

The aim of this paper is to assess the benefit to treat plantar fasciitis with low-dose energy extracorporeal shock wave therapy (ESWT) and the efficacy of such treatment to abate the painful symptoms allowing a rapid return to the running activity. Our study included 54 running athletes treated for plantar fasciitis associated with a heel spur who received four sessions (once weekly) of low-dose ESWT, and followed prospectively on average 45days, 6 and 24months after their last session. The clinical results were excellent in 59% of cases, good in 12%, satisfactory in 21% and distinctly unsatisfactory in 8%. No patient was observed a significant modification of the heel spur at the follow-up X-ray. The ultrasound examination at 24months showed a disappearance of the inflammation signs in 61% of cases. A strong correlation between ultrasound improvement and clinical results were found. Low-energy ESWT seems to be a good mean to treat plantar fasciitis in runners with a 71% of good or excellent results and a persistent improvement lasting 24months. A randomized multicentric study seems to be necessary to define the type of energy that should be used in the future to treat plantar fasciitis, in particular in the athletic patients, to allow a faster return to sports activitie

Effects of NSAIDs and paracetamol (acetaminophen) on protein kinase C epsilon translocation and on substance P synthesis and release in cultured sensory neurons.

Celecoxib, diclofenac, ibuprofen, and nimesulide are nonsteroidal anti-inflammatory drugs (NSAIDs) very commonly used for the treatment of moderate to mild pain, together with paracetamol (acetaminophen), a very widely used analgesic with a lesser anti-inflammatory effect. In the study reported here, we tested the efficacy of celecoxib, diclofenac, and ibuprofen on preprotachykinin mRNA synthesis, substance P (SP) release, prostaglandin E(2) (PGE(2)) release, and protein kinase C epsilon (PKC\u25b) translocation in rat cultured sensory neurons from dorsal root ganglia (DRGs). The efficacy of these NSAIDs was compared with the efficacy of paracetamol and nimesulide in in vitro models of hyperalgesia (investigated previously). While nimesulide and paracetamol, as in previous experiments, decreased the percentage of cultured DRG neurons showing translocation of PKC\u25b caused by 100 nM thrombin or 1 \u3bcM bradykinin in a dose-dependent manner, the other NSAIDs tested did not have a significant effect. The amount of SP released by peptidergic neurons and the expression level of preprotachykinin mRNA were assessed in basal conditions and after 70 minutes or 36 hours of stimulation with an inflammatory soup (IS) containing potassium chloride, thrombin, bradykinin, and endothelin-1. The release of SP at 70 minutes was inhibited only by nimesulide, while celecoxib and diclofenac were effective at 36 hours. The mRNA basal level of the SP precursor preprotachykinin expressed in DRG neurons was reduced only by nimesulide, while the increased levels expressed during treatment with the IS were significantly reduced by all drugs tested, with the exception of ibuprofen. All drugs were able to decrease basal and IS-stimulated PGE(2) release. Our study demonstrates novel mechanisms of action of commonly used NSAIDS

Nimesulide inhibits protein kinase C epsilon and substance P in sensory neurons – comparison with paracetamol

In this paper we describe new actions of nimesulide and paracetamol in cultured peripheral neurons isolated from rat dorsal root ganglia (DRG). Both drugs were able to decrease in a dose-dependent fashion the number of cultured DRG neurons showing translocation of protein kinase C epsilon (PKCɛ) caused by exposure to 1 μM bradykinin or 100 nM thrombin. In addition, the level of substance P (SP) released by DRG neurons and the level of preprotachykinin mRNA expression were measured in basal conditions and after 70 minutes or 36 hours of stimulation with nerve growth factor (NGF) or with an inflammatory soup containing bradykinin, thrombin, endothelin-1, and KCl. Nimesulide (10 μM) significantly decreased the mRNA levels of the SP precursor preprotachykinin in basal and in stimulated conditions, and decreased the amount of SP released in the medium during stimulation of neurons with NGF or with the inflammatory soup. The effects of paracetamol (10 μM) on such response was lower. Nimesulide completely inhibited the release of prostaglandin E2 (PGE2) from DRG neurons, either basal or induced by NGF and by inflammatory soup, while paracetamol decreased PGE2 release only partially. Our data demonstrate, for the first time, a direct effect of two drugs largely used as analgesics on DRG neurons. The present results suggest that PKCɛ might be a target for the effect of nimesulide and paracetamol, while inhibition of SP synthesis and release is clearly more relevant for nimesulide than for paracetamol mechanism of action

Elders’ experience with augmented gaze:preliminary observations

Research on elders’ acceptance of virtual technologies is much needed. Here we studied the user experience of elders (N = 10, mean age = 88.2 years) during virtual biking, an exergame where participants pedal on a cycle ergometer and wear a Head-Mounted Display that provides them an immersive experience of a bike ride. We tested the effects of augmented gaze on user experience. Augmented gaze is a condition in which horizontal head turns yield amplified visual shifts, which is assumed to facilitate visual exploration. User experience was measured by asking participants to rate satisfaction, motivation, sense of presence and sense of safety. We found a very good acceptance of virtual bikingand no signs of negative effects of augmented gaze. These preliminary observations suggest that augmented gaze may be a viable optimization of elders’ experience with certain virtual reality applications

Enhancing Visual Exploration through Augmented Gaze:High Acceptance of Immersive Virtual Biking by Oldest Olds

The diffusion of virtual reality applications dedicated to aging urges us to appraise its acceptance by target populations, especially the oldest olds. We investigated whether immersive virtual biking, and specifically a visuomotor manipulation aimed at improving visual exploration (augmented gaze), was well accepted by elders living in assisted residences. Twenty participants (mean age 89.8 years, five males) performed three 9 min virtual biking sessions pedalling on a cycle ergometer while wearing a Head-Mounted Display which immersed them inside a 360-degree pre-recorded biking video. In the second and third sessions, the relationship between horizontal head rotation and contingent visual shift was experimentally manipulated (augmented gaze), the visual shift being twice (gain = 2.0) or thrice (gain = 3.0) the amount of head rotation. User experience, motion sickness and visual exploration were measured. We found (i) very high user experience ratings, regardless of the gain; (ii) no effect of gain on motion sickness; and (iii) increased visual exploration (slope = +46%) and decreased head rotation (slope = &minus;18%) with augmented gaze. The improvement in visual exploration capacity, coupled with the lack of intolerance signs, suggests that augmented gaze can be a valuable tool to improve the &ldquo;visual usability&rdquo; of certain virtual reality applications for elders, including the oldest olds

Use of compositional analysis to distinguish farmed and wild gilthead seabream (Sparus aurata)

Recent food scares have emphasized the need for traceability in the food chain. This is particularly true in the fish sector, where a large difference in the final price between wild and farmed fish and even between farmed fish reared in different countries exists. So for these commercial and hygienic reasons it is very important to find useful tools for the characterization of quality of fish and for the differentiation of fish from different production methods and from different countries, in accordance with EC Regulation No. 2065/2001 and Italian Ministry of Agriculture Decree No. 27.03.02, that allow retail trade of fishery and aquaculture products only against the indication of the official commercial name, the method of production and the geographical origin of fish (Moretti et al., 2003)

Genetic and environmental effects on a meat spotting defect in seasoned dry-cured ham

Purpose of this investigation was to determine the nature of a visible spotting defect on the slice of dry-cured ham and assess environmental and genetic causes of this frequent problem. A group of 233 pigs from commercial cross-breeding lines, progeny of ten boars and forty seven sows, was raised in a single herd to obtain the “Italian Heavy Pig”, typically slaughtered at 160 ± 10 kg live weight and older than 9 months of age. A quality evaluation of their right dry-cured hams, seasoned according to the Parma P.D.O. protocol, was undertaken. Each ham was cross-sectioned to obtain a slice of Semimembranosus, Semitendinosus and Biceps Femoris muscles. The focused phenotype was the presence/absence of brownish spots in these muscles, which represent a remarkable meat defect with strong impact on the final sale price. Environmental and management factors were considered in order to evaluate variability related to the phenotype. Animals were raised on two different flooring types (concrete and slatted floor) and a Vitamin C diet was also supplemented in the last 45 days before slaughtering to half of the animals. While the pre-planned environmental effects did not show any significant contribution to the total variability of the phenotype, the genetic analysis showed a near to zero value for heritability with a consistent 0.32 repeatability. The proportion of the total phenotypic variance was explained by an important dominance genetic component (0.26) indicating that the technological seasoning process may play a secondary role on the expression of this phenotype