A comparison of a step-initiation task in women with and without urinary incontinence. A case-control study.

AIMS: The aim of the study was to objectively determine differences in postural response by women with and without urinary incontinence during a step-initiation task depending on the degree of bladder filling. METHODS: The study comprised 22 women with stress urinary incontinence and 20 women without urinary incontinence. All women participated in four trials: unperturbed and perturbed (obstacle crossing) transition between platforms, step-up and step-down trials. Velocities of center of pressure displacement, double-support period, time from exit from steady standing until the lead foot resting on the other platform and time from raising the foot from the first platform until gaining quiet standing on the other platform were measured and compared. RESULTS: No significant differences were noted between the performance of a step-initiation task by incontinent women with full/empty bladder whereas continent women performed differently during unperturbed transition with full/empty bladder. The step-up trial revealed significant intergroup differences. The antero-posterior mean velocity of center of pressure during the empty bladder test was significantly higher in women with stress urinary incontinence (effect size = 1.02). During the same bladder condition the women with stress urinary incontinence performed significantly more slowly in unperturbed (effect size = 1.09) and perturbed (effect size = 0.84) transition compared to control group. CONCLUSIONS: Our results indicate that women with incontinence performed the step initiation task slowly on the empty bladder tests compare to continent women.

Randomized, controlled clinical pilot study of venous leg ulcers treated with using two types of shockwave therapy.

Background. Venous leg ulcers are difficult to heal wounds. The basis of their physiotherapeutic treatment is compression therapy. However, for many years, the search for additional or other methods to supplement the treatment of venous ulcers, which would shorten the duration of treatment, is underway. One of such methods is the shockwave therapy. Methods. The purpose of our study was to compare radial shockwave therapy (R-ESWT) with focused shockwave therapy (F-ESWT) in venous leg ulcers treatment. Patients were randomly assigned to tree groups. In the first group the radial shockwave therapy (0.17mJ/mm2, 100 impulses/cm2, 5 Hz), in the second group the focused shockwave therapy (0.173mJ/mm2, 100 impulses/cm2, 5 Hz) was used and in third group standard care was used. Patients in shockwave therapy groups were given 6 treatments at five-day intervals. Total area, circumference, Gilman index, maximum length and maximum width of ulcers were measured. The patients from the third group wet gauze dressing with saline and gently compressing elastic bandages were used (standard wound care SWC). Results. Analysis of the results shows that a complete cure of ulcers was achieved in 35% of patients who were treated with radial shockwave, 26% of patients with focused shockwave used. There is statistically significant difference between the standard care and radial shockwave therapy as well as between the standard care and focused shockwave therapy. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers (p> 0.05). Conclusion. There is no statistically significant difference between the use of radial and focused shockwave in the treatment of venous leg ulcers. Treatment of venous leg ulcers with shockwaves is more effective than the standard wound care.

Comparison of ultrasound therapy and radial shock wave therapy in the treatment of venous leg ulcers - clinical, pilot study.

INTRODUCTION: Venous insufficiency and venous leg ulcers each year affect more and more people, especially in developed countries. The challenge of our time is to find an effective method of treating venous leg ulcers, which will further shorten treatment time and reduce the cost of treatment. AIM: To compare the effects of treating venous leg ulcers using ultrasound therapy, radial shock wave therapy and standard care. MATERIAL AND METHODS: Group A consisted of 17 patients. Patients were treated with ultrasound therapy US power density 0.5 W/cm2, pulsed wave with a duty cycle of 1/5, and 1 MHz frequency. Group B consisted of 17 patients. Patients were treated with the radial shock wave R-ESWT using surface energy density 0.17 mJ/mm2, 100 impulses/cm2, frequency of 5 Hz and a pressure of 0.2 MPa. Group C (control group) consisted of 17 patients. Patients in this group received standard care: gauze dressing saturated in 0.9% sodium chloride and elastic bandages changed daily for 4 weeks. RESULTS: Ultrasound therapy with 1 MHz and energy power density 0.5 W/cm2 for 4 weeks resulted in an average reduction of 68% of the area of ulceration. We used for venous leg ulcers 4-week treatment with radial shock wave therapy resulting in a 38% mean percentage reduction of the ulceration area. Standard care reduces the area of ulceration by only 16%. CONCLUSIONS: The use of ultrasound therapy for the treatment of venous leg ulcers is more effective than the use of radial shock wave therapy or standard care alone.

Static postural stability in women with stress urinary incontinence: Effects of vision and bladder filling.

AIMS: This case-control study was designed to compare static postural stability between women with stress urinary incontinence and continent women and it was hypothesized that women with incontinence aged around 50 years also have balance disorders. METHODS: Eighteen women with incontinence and twelve women without incontinence aged 50-55 years participated in two 60-s trials of each of four different testing conditions: eyes open/full bladder, eyes open/empty bladder, eyes closed/full bladder, eyes closed/empty bladder. The center of foot pressure (COP): sway range, root mean square, velocity (in the antero-posterior and medio-lateral directions), and COP area were recorded. The stabilograms were decomposed into rambling and trembling components. RESULTS: The groups of women with and without incontinence differed during the full bladder condition in antero-posterior COP sway range, COP area, and rambling trajectory (range in the antero-posterior and medio-lateral directions, root mean square in the antero-posterior and medio-lateral directions and velocity in the antero-posterior direction). CONCLUSION: The women with incontinence had more difficulty controlling their postural balance than continent women while standing with a full bladder. Therefore, developing therapeutic management focused on strengthening the women's core muscles and improving their postural balance seems advisable.

Evaluation of the Healing Progress of Pressure Ulcers Treated with Cathodal High-Voltage Monophasic Pulsed Current: Results of a Prospective, Double-blind, Randomized Clinical Trial.

OBJECTIVE: To investigate the effectiveness of high-voltage monophasic pulsed current (HVMPC) as an adjunct to a standard wound care for the treatment of Stage II and III pressure ulcers (PrUs). DESIGN: Prospective, randomized, double-blind, controlled clinical study. SETTING: Two nursing and care centers. PATIENTS: Patients with PrUs that did not respond to previous treatment for at least 4 weeks were randomly assigned to the electrical stimulation (ES) group (25 patients; mean age of 79.92 ± 8.50 years; mean wound surface area [WSA] of 10.58 ± 10.57 cm) or to the control group (24 patients; mean age of 76.33 ± 12.74 years; mean WSA of 9.71 ± 6.70 cm). INTERVENTIONS: Both the ES and control groups received standard wound care and respectively, cathodal HVMPC (154 microseconds; 100 pulses per second; 0.24 A; 250 µ/s) applied continuously for 50 minutes once a day, 5 times a week, or sham HVMPC. MAIN OUTCOME: Percentage area reduction over 6 weeks of intervention. MAIN RESULTS: In the ES group, there was a statistically significant decrease in WSA after 1 week of treatment (35% ± 30.5%) compared with 17.07% ± 34.13% in the control group (P = .032). After treatment, at week 6, percentage area reduction in the ES group was 80.31% ± 29.02% versus 54.65% ± 42.65% in the control group (P = .046). CONCLUSIONS: Cathodal HVMPC reduces the WSA of Stage II and III PrUs. The results are consistent with the results of other researchers who used HVMPC to treat PrUs.

A comparative clinical study on five types of compression therapy in patients with venous leg ulcers.

The aim of this study was to compare five types of compression therapy in venous leg ulcers (intermittent pneumatic vs. stockings vs. multi layer vs. two layer short stretch bandages vs. Unna boots). Primary study endpoints were analysis of changes of the total ulcer surface area, volume and linear dimensions inside observed groups. The secondary end points were comparisons between all groups the number of completely healed wounds (ulcer healing rates), Gilman index and percentage change of ulcer surface area. In total, 147 patients with unilateral venous leg ulcers were included to this study. Participants were randomly allocated to the groups: A, B, C, D and E. After two months the healing rate was the highest in group A (intermittent pneumatic compression) - 57.14%, 16/28 patients, B (ulcer stocking system) - 56.66%, 17/30 patients and C (multi layer short stretch bandage) - 58.62%, 17/29 patients. Significantly much worse rate found in group D (two layer short stretch bandages) - only 16.66%, 5/30 patients and E (Unna boots) - 20%, 6/30 patients. The analysis of changes of the percentage of Gilman index and wound total surface area confirmed that intermittent pneumatic compression, stockings and multi layer bandages are the most efficient. The two layer short - stretch bandages and Unna boots appeared again much less effective.

Serum levels of selected chemokines in systemic lupus erythematosus patients.

Chemokines promote leukocyte traffic into the site of inflammation. Serum levels of monocyte chemotactic protein 1 (MCP-1), stromal cell-derived factor-1 (SDF-1), interferon-gamma-inducible protein 10 (IP-10), and interleukin-8 (IL-8) were evaluated in 48 treated women with systemic lupus erythematosus (SLE) and mild-to-moderate disease severity. The results were compared between the whole SLE group and the control (29 women). The relationships between chemokines, their concentrations, and peripheral blood leukocyte count and between the chemokines and individual leukocyte populations (polymorphonuclear leukocytes-PMNs, lymphocytes-Ls, monocytes-Ms, eosinophils) counts were determined. The relationships between the analyzed chemokines were also determined in the control. SLE subjects had significantly higher MCP-1, SDF-1, IP-10, and lower IL-8 concentrations compared to the control. Moderate, positive correlations between MCP-1/SDF-1, SDF-1/IP-10 and a negative correlation between MCP-1/IL8 were observed in the patient group. Moderate, negative correlations were found between SDF-1/total leukocyte count, SDF-1/absolute number of PMNs as well as between IP-10/total leukocyte count, IP-10/absolute PMNs, Ls, and Ms counts in peripheral blood of SLE group. We suggest that the obtained results and correlations observed between the examined parameters might be used to monitor SLE course and progression. However, further randomized clinical studies should be carried out on in untreated and treated patients with SLE.

[Serum level of selected chemokines in systemic lupus erythematosus patients taking into consideration the peripheral blood leukocyte counts]. / Stezenie wybranych chemokin u chorych na toczen rumieniowaty ukladowy z uwzglednieniem liczby leukocytów we krwi obwodoweJ.

UNLABELLED: Chemokines promote leukocyte traffic into the site of inflammation. It depends on the repertoire of chemokines synthesized locally, and the temporal expression of chemokine receptors on leukocytes among them lymphocytes B and T which play crucial role in the pathogenesis of autoimmune diseases for example in systemic lupus erythematosus (SLE). RANTES (regulated upon activation in normal T cells expressed and secreted) is chemokine influencing T cells and BLC 1 (B-lymphocyte chemoattractant 1) is chemokine which affects B cells. The aim of the study was to evaluate serum concentration of the above mentioned chemokines in treated SLE patients and to analyze the relationships between their concentration in patients group and the control one. Another aim of our study was to assess the relationships between serum levels of these chemokines and the total peripheral blood leukocyte count and between serum levels of these chemokines and absolute peripheral blood counts of the individual forms of these cells in SLE patients. MATERIAL AND METHODS: Serum levels of RANTES and BLC 1 were determined in 48 treated women with SLE and mild-to-moderate disease severity. The results were compared between the total SLE group and the control (29 healthy women). The correlation between chemokines and between their levels and peripheral blood leukocyte count were evaluated. The relationships between the analyzed chemokines were also determined in the control group. RESULTS: Lower level of RANTES in serum was revealed in patients with SLE compared to the control and the tendency to higher concentration of BLC 1 in serum was observed. No relationships were observed between the levels of these chemokines both in the SLE patients and in the control group. Whereas the negative correlations between BLC 1 and total leukocyte count and BLC 1 and absolute number of neutrophils were found without such correlation between BLC 1 the subgroup of patients with concomitant neutropenia. CONCLUSION: We suggest that in treated patients with SLE lowered level of RANTES and tendency to higher level of BLC 1 is observed which have not any connections with the peripheral blood leukocyte counts and individual forms of these cells counts.

Physical therapy in the treatment of venous leg ulcers: biophysical mechanisms.

UNLABELLED:  The present study sought to estimate the hemodynamic effects inside wounds after applying infrared thermography. Clinical results were analyzed to evaluate any correspondence with hemodynamic events occurring inside the wounds. METHODS: Group 1 consisted of 20 patients with venous leg ulcers (12 women, 8 men). Patients from group 1 received 1 high-voltage stimulation (HVS) procedure. Group 2 consisted of 23 patients (16 women, 7 men). Patients from group 2 received 1 ultrasound (US) procedure. Group 3 consisted of 21 patients (13 women, 8 men). Patients from group 3 received 1 low-level laser therapy (LLLT) procedure. Group 4 consisted of 23 patients (15 women, 8 men). Patients from group 4 received 1 compression therapy (CT) procedure. Group 5 consisted of 19 patients (11 women, 8 men). Patients from group 5 received 1 quasi-CT procedure. Infrared thermography was used to monitor arterial hemodynamic effects for each ulcer. Infrared thermography, based on analysis of wound surface temperatures, was used to reflect normal or abnormal arterial circulation in capillaries. The average and maximal temperatures before and after each physical procedure were measured 5, 10, 15, and 30 minutes afterward. RESULTS: The application of HVS and LLLT did not change the temperature inside the wounds. A significant temperature increase was noted after application of US and CT. The quasi-CT induced a thermal effect (only for a few minutes), but was not as intense as the effect of the compression stockings. The measurements showed a prolonged and steady thermal effect. CONCLUSION: The hemodynamic effect (improvement of arterial microcirculation inside the venous leg ulcer) is one of the most significant biophysical mechanisms of healing after clinically efficient compression therapy. Hemodynamic reactions are not basic mechanisms of high voltage stimulation and ultrasound therapy during the healing of venous leg ulcers. Computed thermography is a simple and useful tool to measure hemodynamic effects in wound healing. .

Using Physical Modalities in the Treatment of Venous Leg Ulcers: A 14-year Comparative Clinical Study.

UNLABELLED: Venous ulcers are prevalent, challenging wounds; their incidence is rising with the increasing age of the general population. Physical mo- dalities often are used to help heal these chronic wounds. A prospective study was conducted to investigate the application of high-voltage stimu- lation (HVS), ultrasound therapy (US), low-level laser therapy (LLLT, 810 nm, 65 mW, 4 J/cm2), and compression therapy (CT), with and without surgical intervention; along with standard of care comprising drug therapy (micronized flavonoid fraction in two 500-mg tablets once daily) and wet dressings of 0.9% sodium chloride on venous leg ulcer healing. METHODS: The 305-patient study was conducted between 1994 and 2008 among persons with venous ulcers in 3 facilities in Poland. After surgery involving crossectomy, partial [short] stripping of the greater or short saphenous vein, local phlebectomy, and ligation of insufficient perforators, 4 groups of patients were treated with the standard of care drug/dressing therapy and HVS, US, LLLT, or CT, and 1 group received the drug/dressing ther- apy only. Four non-surgical groups received HVS, US, LLLT, or CT and drug/dressing therapy, and 1 group received drug/dressing therapy only. Changes in wound area and volume were compared among all the groups receiving the various treatments using the Gilman index. In all groups therapy lasted 7 weeks. The computed planimetry method for observation of healing process was used. RESULTS: The Gilman index values at 4 weeks were significantly higher in the compression plus surgery compared with other groups (P = 0.01). After therapy for patients from the CT + surgery group, the Gilman index was 1.18 cm (P ≤ 0.001 compared with other groups). The percentage total surface area regression analysis confirmed that compression plus surgery is the most efficient in venous leg ulcer therapy (61.89% reduction after 4 weeks of therapy and 78.19% at the end of study) compared to the other groups (P ≤ 0.001). The HVS and US appeared useful only in conservatively treated patients (P < 0.05). The LLLT did not accelerate reduction of the ulceration surface. CONCLUSION: Venous surgery plus compression therapy is the most effi- cient treatment for venous leg ulcers. Compression therapy should be provided to both surgically and conservatively non-surgically treated pa- tients. High-voltage stimulation and ultrasound therapy are useful meth- ods in conservative treatment of venous leg ulcers. For surgically treated patients, these physical modalities are not effective. Low-level laser ther- apy is not an efficient method for treating venous leg ulcers. .

A comparative study of the efficacy of radial and focused shock wave therapy for tennis elbow depending on symptom duration.

INTRODUCTION: In physical therapy, the duration and severity of pain complaints determine the choice of an appropriate physical agent and parameters needed. The aim of this study was to compare the therapeutic efficacy of focused and radial shock waves for tennis elbow with respect to the dysfunction period. MATERIAL AND METHODS: The patients with acute (n = 27) and chronic (n = 31) tennis elbow were randomly assigned to a treatment arm: focused shock wave therapy (3 sessions, 2000 shocks, 4 Hz, 0.2 mJ/mm²) or radial shock wave therapy (3 sessions, 2000 shocks, 8 Hz, 2.5 bar). In order to objectivize therapy effects, the severity of pain complaints (Visual Analog Scale), strength of wrist flexors and extensors and grip strength were assessed. We performed pre-intervention measurements and short-term follow-up at 1, 6 and 12 weeks of therapy completion. RESULTS: At 6 and 12 weeks of therapy completion, all groups exhibited significantly reduced pain complaints (p < 0.05). The most noticeable changes in grip strength, wrist extensors and flexors strength were observed in the affected extremities of all experimental groups while changes within the unaffected extremities were slight. Grip strength as well as the strength of flexor and extensor muscles of the affected limb were significantly greater at 12 weeks of therapy completion compared to pre-intervention values (p < 0.05). At the same time point, percent changes of all study parameters were comparable for all groups (p > 0.05). CONCLUSIONS: Focused and radial shock wave therapy tend to show a significant and comparable short-term therapeutic effect for acute and chronic tennis elbow.

Assessment of the efficacy and safety of low frequency, low intensity magnetic fields in patients after knee endoprosthesis plasty. Part 1: in vitro safety.

The purpose of this in vitro study was to assess the potential influence of low frequency, low intensity magnetic fields (rectangular pulse, 5 mT, 30 Hz) applied in therapy on the temperature, contact electric potential, and magnetization in knee endoprosthesis, which might be dangerous for implantation and stability of knee prosthesis, and later slacking it off, causing postoperative complications. The experimental investigation was carried out on a knee endoprosthesis which had been placed in a container with physiological saline. The prosthesis located inside the container was under the exposure of the magnetic field applied by a solenoid. The results indicated that magnetic fields did not influence thermal and electromagnetic properties of knee endoprosthesis in vitro. The magnetic fields of examined parameters should not be dangerous for implantation and stability of knee endoprosthesis.

Assessment of the efficacy and safety of low frequency, low intensity magnetic fields in patients after knee endoprosthesis plasty. Part 2: a clinical study.

The purpose of this clinical study was to assess low frequency, low intensity magnetic fields in the enhancement of the physical rehabilitation of patients after knee endoprosthesis surgery. The study included 62 patients who underwent total knee arthroplasty. Group A consisted of 32 patients who were physically rehabilitated. Group B consisted of 30 patients who were physically rehabilitated and treated additionally with pulsing magnetic fields (5 mT, 30 Hz, 20 min once a day, 5 days weekly). Therapy lasted 3 weeks for both groups. The rehabilitation process was evaluated using a goniometer, tensometer, goniometric pendulum test, Lysholm scale for knee function, and a visual analogue scale (VAS) questionnaire for pain and activity. The changes of measured rates were comparable in both groups. Low frequency and low intensity magnetic fields of examined parameters were not demonstrated to effectively improve the rehabilitation of patients after knee endoprosthesis surgery.

Electromyographic characteristics of pelvic floor muscles in women with stress urinary incontinence following sEMG-assisted biofeedback training and Pilates exercises.

The aim of this study was to compare the effect of pelvic floor muscle training with surface electromyographic (sEMG) biofeedback (BF group) and Pilates exercises (P group) on the bioelectrical activity of pelvic floor muscles in women with stress urinary incontinence. The other aim aim was to compare changes in voiding diaries and scores on quality of life questionnaire against baseline values and between the groups. Women in the BF group (n = 18) participated in pelvic floor muscle training with sEMG biofeedback; the P group (n = 13) participated in basic level Pilates workouts. Both protocols were continued for eight weeks. Voiding diary, quality of life and electromyographic characteristics of the pelvic floor muscles were assessed at the three-time points: at baseline, after eight weeks' training, and at month six post-training. The sEMG activity of the pelvic floor muscles was tested during five trials in two positions. There was no marked improvement in bioelectrical activity of the pelvic floor muscles during contraction following training with sEMG biofeedback or Pilates exercises. Following eight weeks of sEMG biofeedback training, a decrease was noted in resting bioelectrical activity of pelvic floor muscles and during relaxation after sustained contraction but only in supine-lying. No such effect was observed in the Pilates group. In the BF group, the number of incontinence episodes after end of treatment (timpepoints: 1vs. 2) and at six month follow-up (timpepoints: 1vs. 3) decreased by 68.5% and 89.3%, respectively. The respective values in the P group were 78.6%, and 86.4%. The intergroup differences did not reach the level of statistical significance. As regards the quality of life, the questionnaire demonstrated that Pilates exercises had significantly better effects compared to biofeedback training both at the end of the eight-week exercise program and (p = 0.003) and at six month follow-up (p = 0.0009). The International Consultation on Incontinence Questionnaire-Short Form (ICIQ- SF) showed comparable efficacy of Pilates exercises and training with sEMG biofeedback. Intragroup improvements in micturition frequency, incontinence (leakage) episodes, and nocturia frequency were comparable. Alleviation of urinary incontinence symptoms was comparable in both groups, whereas the improvement in the quality of life was more notable in the Pilates group. The obtained results failed to demonstrate the superiority of any of the two methods regarding the bioelectrical activity of pelvic floor muscles in patients with stress urinary incontinence.

Pressure Injuries Treated With Anodal and Cathodal High-voltage Electrical Stimulation: the Effect on Blood Serum Concentration of Cytokines and Growth Factors in Patients With Neurological Injuries. A Randomized Clinical Study.

It remains unclear whether electrical currents can affect biological factors that determine chronic wound healing in humans. PURPOSE: The aim of this study was to determine whether anodal and cathodal high-voltage monophasic pulsed currents (HVMPC) provided to the area of a pressure injury (PI) change the blood level of cytokines (interleukin [IL]-1ß, IL-10, and tumor necrosis factor [TNF]-α) and growth factors (insulin-like growth factor [IGF]-1 and transforming growth factor [TGF]-ß1) in patients with neurological injuries and whether the level of circulatory cytokines and growth factors correlates with PI healing progression. METHODS: This study was part of a randomized clinical trial on the effects of HVMPC on PI healing. All patients with neurological injuries (spinal cord injury, ischemic stroke, and blunt trauma to the head) and a stage 2, stage 3, or stage 4 PI of at least 4 weeks' duration hospitalized in one rehabilitation center were eligible to participate if older than 18 years of age and willing to consent to donating blood samples. Exclusion criteria included local contraindications to electrical stimulation (cancer, electronic implants, osteomyelitis, tunneling, necrotic wounds), PIs requiring surgical intervention, patients with poorly controlled diabetes mellitus (HbA1C > 7%), critical wound infection, and/or allergies to standard wound treatment. Participants were randomly assigned to 1 of 3 groups: anodal (AG) or cathodal (CG) HVMPC treatment (154 µs; 100 Hz; 360 µC/sec; 1.08 C/day) or a placebo (PG, sham) applied for 50 minutes a day, 5 days per week, for 8 weeks. TNF-α, IL-1ß, IL-10, TGF-ß1, and IGF-1 levels in blood serum were assessed using the immunoenzyme method (ELISA) and by chemiluminescence, respectively, at baseline and week 4. Wound surface area measurements were obtained at baseline and week 4 and analyzed using a digitizer connected to a personal computer. Statistical analyses were performed using the maximum-likelihood chi-squared test, the analysis of variance Kruskal-Wallis test, the Kruskal-Wallis post-hoc test, and Spearman's rank order correlation; the level of significance was set at P ≤.05. RESULTS: Among the 43 participants, 15 were randomized to AG (mean age 53.87 ± 13.30 years), 13 to CG (mean age 51.08 ± 20.43 years), and 15 to PG treatment (mean age 51.20 ± 14.47 years). Most PIs were located in the sacral region (12, 74.42%) and were stage 3 (11, 67.44%). Wound surface area baseline size ranged from 1.00 cm2 to 58.04 cm2. At baseline, none of the variables were significantly different. After 4 weeks, the concentration of IL-10 decreased in all groups (AG: 9.8%, CG: 38.54%, PG: 27.42%), but the decrease was smaller in the AG than CG group (P = .0046). The ratio of pro-inflammatory IL-10 to anti-inflammatory TNF-α increased 27.29% in the AG and decreased 26.79% in the CG and 18.56% in the PG groups. Differences between AG and CG and AG and PG were significant (AG compared to CG, P = .0009; AG compared to PG, P = .0054). Other percentage changes in cytokine and growth factor concentration were not statistically significant between groups. In the AG, the decrease of TNF-α and IL-1ß concentrations correlated positively with the decrease of PI size (P <.05). CONCLUSION: Anodal HVMPC elevates IL-10/TNF-α in blood serum. The decrease of TNF-α and IL-1ß concentrations in blood serum correlates with a decrease of PI wound area. More research is needed to determine whether the changes induced by anodal HVMPC improve PI healing and to determine whether and how different electrical currents affect the activity of biological agents responsible for specific wound healing phases, both within wounds and in patients' blood. In clinical practice, anodal HVMPC should be used to increase the ratio of anti-inflammatory IL-10 to pro-inflammatory TNF-α , which may promote healing.

Efficiency of Therapeutic Ultrasound for Healing Venous Leg Ulcers in Surgically-treated Patients.

 The aim of this study was to evaluate the efficiency of therapeutic ultrasound (US) for healing of venous leg ulcers in surgically treated patients. Study endpoints were the number of completely healed wounds and the clinical parameters predicting the outcome. Seventy patients with venous leg ulcers were included in this study, and ultimately allocated into two comparative groups. Group A consisted of 33 patients (21 women, 12 men). They were treated with the US, compression stockings, and drug therapy. Group B (control) consisted of 37 patients (22 women, 15 men). They were treated with the compression stockings and drug therapy only, administered just as in group A. Ten patients in group A and 12 in group B healed completely (P > 0.05). Comparison of Gilman Index and relative change of the total surface area, length, width, and volume did not demonstrate any difference (P > 0.05) between the groups. A more statistically efficient decrease of pus (P = 0.03) and greater promotion of granulation (P = 0.03) were observed in group A compared to group B. However, the noted changes did not have an influence on acceleration of therapy or final stage of the wound healing process because no differences were detected in the epidermization rate of the ulcers in either group. There are no specific indications that US application promotes healing in patients after surgical operation.

[Evaluation of efficiency of the sonotherapy in enhancement of venous leg ulcer healing in patients after surgical and conservative treatment]. / Ocena skutecznosci sonoterapii we wspomaganiu gojenia owrzodzen zylnych goleni u chorych po leczeniu chirurgicznym i zachowawczym.

UNLABELLED: The aim of the study was to evaluate the application of sonotherapy in enhancement venous leg ulcer healing after conservative and surgical therapy. MATERIAL AND METHODS: The 60 patients were included into the study. The 30 patients, who agreed on operation and were accepted by medical team to the surgical treatment, had been included to A and B group. The others, 30 patients were treated conservatively, and had been included to C and D group. The patients in group A and C were additionally treated in use of sonotherapy. The evaluated factors were to estimate the sonotherapy promotes total wound closure and causes any changes of the relative surface, longest and widest dimensions, and volume of tissue defect, pus and granulation degree. RESULTS: After study in all groups, we noticed a therapeutic effect. Treatment was more efficient in patients after surgical operation than in patients after conservative methods. Beneficial effects of sonotherapy in conservative enhancement of ulcer healing were observed. No impact of sonotherapy after surgical procedure was noticed. CONCLUSIONS: The sonotherapy is useful and efficient method only in enhancement of venous leg ulcer healing after conservative treatment. In surgically treated patients is not efficient method, because there is no accelerating impact on wound healing. As well conducted surgical operation more efficiently enhance a healing process than conservative pharmacological procedures.

A Randomized, Controlled Clinical Study to Assess the Effect of Anodal and Cathodal Electrical Stimulation on Periwound Skin Blood Flow and Pressure Ulcer Size Reduction in Persons with Neurological Injuries.

The use of electrical stimulation (ES) should be considered for treating nonhealing pressure ulcers (PUs), but optimal ES wound treatment protocols have yet to be established. A randomized, controlled, double-blind clinical study was conducted to evaluate the effects of cathodal and anodal high-voltage monophasic pulsed current (HVMPC) on periwound skin blood flow (PSBF) and size reduction of Stage 2 to Stage 4 PUs of at least 4 weeks' duration. Persons >18 years of age, hospitalized with neurological injuries, at high risk for PU development (Norton scale <14 points; Waterlow scale >15 points), and with at least 1 Stage 2 to Stage 4 PU were eligible to participate in the study. Persons with necrotic wounds, osteomyelitis, electronic or metal implants in the PU area, PUs in need of surgical intervention, acute wound inflammation, diabetes (HBA1c >7%), diabetic neuropathy, cancer, and/or allergies to standard wound treatments were excluded. Patients were randomly assigned to 1 of 3 groups: anodal (AG), cathodal (CG), or placebo (PG) ES. All groups received individualized PU prevention and standard wound care. In the PG, sham ES was applied; the AG and CG were treated with anodal and cathodal HVMPC, respectively (154 µs 100 Hz; 360 µC/second; 1.08 C/day), 50 minutes per day, 5 days per week, for a maximum of 8 weeks. PSBF was measured using laser Doppler flowmetry at baseline, week 2, and week 4, and wound surface area measurements were obtained and analyzed using a digitizer connected to a personal computer. Data analysis utilized the maximum-likelihood chi-squared test, the analysis of variance Kruskal-Wallis test, the Kruskal-Wallis post-hoc test, and Spearman's rank order correlation. Nonlinear approximation based on exponential function was used to calculate treatment time needed to reduce the wound area by 50%. In all tests, the level of significance was set at P ≤.05. Of the 61 participating patients, 20 were in the AG (mean age 53.2 ± 13.82 years), 21 in the CG (mean age 55.67 ± 17.83 years), and 20 in the PG (mean age 52.5 ± 13.18 years). PUs (baseline size range 1.01 cm2 to 59.57 cm2; duration 4 to 48 weeks) were most frequently located in the sacral region (73.77%) and classified as Stage 3 (62.29%). PSBF at week 2 was significantly higher in the AG and CG than in the PG (P <.05). Week 4 differences were not statistically significant. Wound percentage area reduction calculated at week 8 for the AG (64.10% ± 29.22%) and CG (74.06% ± 23.23%) were significantly different from PG ulcers (41.42% ± 27.88%; P = .0391 and P = .0024, respectively). In both ES groups, PSBF at week 4 and percent wound surface area reductions between weeks 4 and 8 were positively correlated, but only the AG correlation was statistically significant (P = .049). In this study, both ES modalities improved blood flow and wound area reduction rate. Studies examining optimal ES treatment times for healing to occur, the effect of comorbidities and baseline wound variables on ES outcomes, and the nature of the relationship between blood flow and healing are necessary.

[The impact of the sonotherapy and compression therapy on enhancement of healing venous leg ulcers after surgical treatment]. / Wplyw sono- i kompresoterapii na wspomaganie gojenia owrzodzen zylnych goleni po leczeniu chirurgicznym.

UNLABELLED: The aim of this paper was to describe the impact of the sonotherapy and compression therapy on enhancement of healing venous leg ulcers after surgical treatment. MATERIAL AND METHODS: Three comparative groups of patients--A, B and C were made at random from patients with venous leg ulcers, which had been earlier operated by modified Babcock' method. The 24 patients were included (in use of software Monte Carlo) to the group A, 25 patients to the group B and 24 patients to the group C (control group). The patients in all comparative groups were treated pharmacologically. Ulcerations at patients in group A were additionally treated in use of ultrasound. And ulcerations at patients in group B were additionally treated in use of compression therapy. The evaluated factors were to estimate the sonotherapy and compression therapy causes any changes of the surface, longest and widest dimensions, and volume of tissue defect. For all comparative groups calculated the Gilman parameter. The weekly speed of changes of surface and volume were estimated too. RESULTS: After therapy there was statistically significant decrease of whole surface and pus-covered and granulation area, longest and widest dimensions, and volume of ulcers in all groups while there was no statistically significant difference--except pus-covered areas--between the groups observed. Comparison in terms of pus-covered area indicated a significant difference between all groups, in favor groups A and B than C. CONCLUSIONS: There are no special reasons for application of ultrasound and compression therapy in enhancement of healing process--however the following results must be verified on bigger population and longer patient observation. The sonotherapy and compression therapy promote only decontamination process compared with control group.

The Efficacy of Pressure Ulcer Treatment With Cathodal and Cathodal-Anodal High-Voltage Monophasic Pulsed Current: A Prospective, Randomized, Controlled Clinical Trial.

BACKGROUND: Studies show that anode and cathode electrical stimulation (ES) promotes the healing of wounds, but specific protocols for both electrodes are not available. OBJECTIVE: To compare the effectiveness of cathodal versus cathodal+anodal ES in the treatment of Category II-IV pressure ulcers (PrUs). DESIGN: Prospective, randomized, controlled, clinical study. SETTING: Three nursing and care centers. PATIENTS: Sixty-three participants with PrUs were randomly formed into a cathodal ES group (CG: N = 23; mean age of 79.35; SD 8.48), a cathodal+anodal ES group (CAG: N = 20; mean age of 79.65; SD 11.44) and a placebo ES group (PG: N = 20; mean age of 76.75; SD 12.24). INTERVENTION: All patients were treated with standard wound care and high-voltage monophasic pulsed current (HVMPC; twin-peak impulses; 154 µs; 100 pps; 0.25 A; 250 µC/s) for 50 minutes per day, 5 times a week, for 6 weeks. The CG, CAG, and PG received, respectively, cathodal, cathodal+anodal, and sham ES through electrodes placed on a moist gauze pad. The treatment electrode was placed on the wound, and the return electrode was positioned on healthy skin at least 20 cm from the PrU. MEASUREMENTS: Measurements were made at baseline, and after each of the 6 weeks of treatment. Primary outcome was percentage wound surface area reduction at week 6. RESULTS: Wound surface area decreased in the CG by 82.34% (95% confidence interval [CI] 70.06-94.63) and in the CAG by 70.77% (95% CI 53.51-88.04). These reductions were significantly greater than in the PG (40.53%; 95% CI 23.60-57.46). The CG and CAG were not statistically significantly different regarding treatment results. LIMITATIONS: The time of treatment proved insufficient for PrUs to close. CONCLUSIONS: Cathodal and cathodal+anodal HVMPC similarly reduced the area of Category II-IV PrUs.