A digital assessment and documentation tool evaluated for daily podiatric wound practice.

INTRODUCTION: Foot ulcers are a common complication of diabetes. Regular screening of patients with ulcers enables better treatment and reduces the number of amputations. The lack of wound specialists, especially in nonurban areas, drove the development of an IT-based system for analyzing wounds, the Wound Healing Analyzing Tool (WHAT). Digital images are scored and documented using software that runs on a laptop computer. The aim of this study was to evaluate WHAT's use in daily podiatry practice. METHODS: Eighteen ambulant patients presenting with diabetic foot ulcers at the participating podiatric clinic were recruited to the study. Digital ulcer images were obtained. To measure size and assess wound bed condition, the evaluated software recognizes the square mark, which is printed on a sticker and placed next to the ulcer. A trained, blinded physician assessed the same digital images and results were compared. RESULTS: Fifteen of the 18 results obtained with the digital tool for ulcer area and wound bed condition were in line with the visual assessment conducted by the blinded physician. Eighty-seven percent of the images were correctly scored, with the main problem being a missing or partially visible square mark in the photograph (n = 3/18). CONCLUSION: The results indicate that WHAT showed sufficient accuracy to be considered for use in clinical settings for determination of wound area and wound bed characteristics. The tool also seems to be an attractive option for digital consulting.

Lymphatic precollectors contain a novel, specialized subpopulation of podoplanin low, CCL27-expressing lymphatic endothelial cells.

Expression of the lymphoendothelial marker membrane mucoprotein podoplanin (podo) distinguishes endothelial cells of both blood and lymphatic lineages. We have previously discovered two distinct subpopulations of lymphatic endothelial cells (LECs) in human skin that were defined by their cell surface densities of podoplanin and were designated LEC podo-low and LEC podo-high. LEC podo-low is restricted to lymphatic precollector vessels that originate from initial LEC podo-high-containing lymphatic capillaries and selectively express several pro-inflammatory factors. In addition to the chemokine receptor protein Duffy blood group antigen receptor for chemokines, these factors include the constitutively expressed chemokine CCL27, which is responsible for the accumulation of pathogenic CCR10+ T lymphocytes in human inflammatory skin diseases. In this study, we report that CCR10+ T cells accumulate preferentially both around and within CCL27+ LEC podo-low precollector vessels in skin biopsies of human inflammatory disease. In transmigration assays, isolated CCR10+ T lymphocytes are chemotactically attracted by LEC podo-low in a CCL27-dependent fashion, but not by LEC podo-high. These observations indicate that LEC podo-low-containing precollector vessels constitute a specialized segment of the initial lymphatic microvasculature, and we hypothesize that these LEC podo-low-containing vessels are involved in the trafficking of CCR10+ T cells during skin inflammation.

The JAVA-based DICOM query interface DicoSE.

DICOM 3 is a very elaborate standard for the communication between medical image devices. It is published in several parts by the National Electrical Manufacturers Association (NEMA). To adequately visualize the data structure defined in parts 3, 5 and 6 of the DICOM standard, we implemented the web based Dicom Search Engine (DicoSE). It allows for querying the DICOM standard data dictionary for defined data fields and visualizes the topology of the data which is inherently present in DICOM datasets. For the administration of the underlying data a web based administration interface is provided. The service is entirely based on freely available software.

DicoSE--a Web-interface based on XML for visualizing and searching the topology of the data structure defined by the DICOM 3 standard.

To adequately visualize and interpret the data fields of DICOM 3 datasets the data structure defined in the DICOM 3 standard has to be applied. The DICOM 3 data structure is very extensive and therefore costly to implement. We are working on an open source system which provides the data structure via a Java-programming interface. The data is held in a freely available XML-database. As a spin-off we are providing the web-based Dicom Search Engine (DicoSE) which will be available via internet soon. DicoSE allows for searching the DICOM standard data dictionary for defined data fields and visualizes the topology of the data which is present in DICOM datasets acquired by various types of modalities. Thus, the interpretation of the meaning of data fields is supported. For maintaining the data stored in the database a web-based administration interface is provided.

Automated measurement of skin prick tests: an advance towards exact calculation of wheal size.

BACKGROUND: Using the Khoros image processing software environment, we developed a software-based system capable of extracting wheal size from skin prick tests (SPTs) in mm(2) for research and routine purposes. METHODS: At 20 min, the outlines of up to 20 wheals were marked with a pen and transferred with translucent adhesive tapes to a white paper form carrying predefined markings. The form was scanned at 200 dpi. The software automatically analysed the scanned image and calculated the sizes of the wheals. In a pilot study, serial SPTs with histamine in increasing dilutions were performed in 12 healthy volunteers in duplicate on both volar forearms. We matched the application results with a reference created from the scanned pictures. RESULTS: Bland-Altman analysis showed reference and software calculation reaching very high agreement. The comparison of reference/software resulted in a low centred coefficient of variation (COV) of 11.9%. This was superior to the conventional measurement of horizontal (COV 37.9%) or maximal/minimal diameter (COV 25.9%). CONCLUSION: We present an accurate tool for exactly calculating SPT wheal size in mm(2).

Automatic measurement of skin wheals provoked by skin prick tests.

Skin prick tests (SPT) represent the standard method for the diagnosis of type-1 allergies. The skin wheals provoked by the SPTs are considered positive above certain cut-off diameters, usually 3 mm. At present their size is mostly estimated by measuring the diameter with rulers. Since the shape of wheals usually is not circular, the measurement of diameters leads to imprecise results. Therefore, we developed an algorithm for precisely measuring the wheals' area in mm(2) automatically. The average deviation of the automatic measurement on a test set achieved with the developed algorithm was 6.9 %. Compared to the maximum standard deviation of 6.59 % when measuring the manually redrawn outlines, the automatic method works sufficiently well.