Comparison of macular thickness in diabetic patients acquired from optical coherence tomography mode and optical coherence tomography angiography mode in Cirrus HD-OCT 5000.

PURPOSE: To compare macular thickness obtained using two different modes of image acquisitions with Cirrus HD-OCT 5000. METHODS: Patients with diabetes were recruited and macular thickness were obtained using optical coherence tomography (OCT) mode and optical coherence tomography angiography (OCTA) mode. The OCT mode involved a Macular Cube (512×128 pixels) centred on the fovea covering a 6 × 6 mm2 macular region. The OCTA acquisition involved scanning of a 6 × 6 mm² scan (350×350 pixels) centred on the fovea. Data was exported and compared according to the Early Treatment Diabetic Retinopathy Study (ETDRS) subfields. Fixation deviation was defined as the deviation of the foveal point from the grid center in the OCT scan and OCTA scan. RESULTS: Eighty-six diabetic patients were recruited had similar macular thickness in all ETDRS subfield except the superior outer sector. The 95 % limits of agreement between the two modes were within 9.7µm to -9.0µm. It took longer to complete each OCTA mode (median of 7.4 s) than the OCT mode (median time of 5.8 s) (Wilcoxon test, p < 0.001), but OCTA generated a smaller fixation deviation (median 68.8µm) than the OCT mode (median 103.0µm) (Wilcoxon test, p = 0.014). CONCLUSIONS: Improved fixation in OCTA compared with OCT was evident, likely because of the faster scanning speed and higher sampling density of OCTA. Macular thickness was found similar. There appears no requirement to obtain macular thickness measurements using a separate OCT mode. This approach can reduce patient chair time, improve patient comfort, and streamline the clinical workflow.

Cross-Cultural Adaptation and Psychometric Properties of the Chinese Version of the Knee Osteoarthritis Fears and Beliefs Questionnaire.

This study aimed to adapt and validate the Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ) for Chinese patients, thereby advancing the understanding of fear-avoidance behaviors. Adopting a cross-sectional design, data were collected for 241 subjects (78.8% women; mean age 68.0 ± 7.8 years) across various healthcare settings in Hong Kong. Exploratory factor analysis resulted in an 11-item questionnaire with three distinct subscales, covering fears and beliefs related to physicians and disease (six items), daily living activities (three items), and sports and leisure activities (two items). The overall Cronbach's α coefficient was 0.86, indicating strong internal consistency. The questionnaire exhibited favorable convergent validity. Confirmatory factor analyses confirmed a good model fit. Test-retest reliability analysis indicated a high intraclass correlation coefficient of 0.93 (95% confidence interval: 0.88, 0.96), and a Bland-Altman plot revealed a slight bias in two measurements (0.97 [0.19]) without a systematic trend. The adapted Chinese version of the KOFBeQ demonstrated robust psychometric properties in terms of validity and reliability, providing an effective tool for surveying Chinese patients with knee osteoarthritis. These findings offer valuable insights for clinicians and patients, aiding in informed decision-making and improved rehabilitation strategies.

Effects of pulsed electromagnetic fields on learning and memory abilities of STZ-induced dementia rats.

INTRODUCTION: Recent studies have shown that pulsed electromagnetic field (EMF) has therapeutic potential for dementia, but the associated neurobiological effects are unclear. This study aimed to determine the effects of pulsed EMF on Streptozotocin (STZ)-induced dementia rats. METHODS: Forty Sprague-Dawley rats were randomly allocated to one of the four groups: (i) control, (ii) normal saline injection (sham group), (iii) STZ injection (STZ group) and (iv) STZ injection with pulsed EMF exposure (PEMF, 10 mT at 20 Hz) (STZ + MF group). Morris water maze was used to assess the learning and memory abilities. Insulin growth factors 1 and 2 (IGF-1 and IGF-2) gene expression were determined by quantitative PCR. RESULTS: The results showed that the mean escape latency in STZ-induced dementia rats was reduced by 66% under the exposure of pulsed EMF. Compared with the STZ group, the swimming distance and the time for first crossing the platform decreased by 55 and 41.6% in STZ + MF group, respectively. Furthermore, the IGF-2 gene expression significantly increased compared to that of the STZ group. CONCLUSIONS: Our findings indicate that the pulsed EMF exposure can improve the ability of learning and memory in STZ-induced dementia rats and this effect may be related to the process of IGF signal transduction, suggesting a potential role for the pulsed EMF for the amelioration of cognition impairment.

Efficacy of Biophysical Energies on Healing of Diabetic Skin Wounds in Cell Studies and Animal Experimental Models: A Systematic Review.

We have systematically assessed published cell studies and animal experimental reports on the efficacy of selected biophysical energies (BPEs) in the treatment of diabetic foot ulcers. These BPEs include electrical stimulation (ES), pulsed electromagnetic field (PEMF), extracorporeal shockwave (ECSW), photo energies and ultrasound (US). Databases searched included CINAHL, MEDLINE and PubMed from 1966 to 2018. Studies reviewed include animal and cell studies on treatment with BPEs compared with sham, control or other BPEs. Information regarding the objective measures of tissue healing and data was extracted. Eighty-two studies were eventually selected for the critical appraisal: five on PEMF, four each on ES and ECSW, sixty-six for photo energies, and three about US. Based on the percentage of original wound size affected by the BPEs, both PEMF and low-level laser therapy (LLL) demonstrated a significant clinical benefit compared to the control or sham treatment, whereas the effect of US did not reveal a significance. Our results indicate potential benefits of selected BPEs in diabetic wound management. However, due to the heterogeneity of the current clinical trials, comprehensive studies using well-designed trials are warranted to confirm the results.

A Tailor-Made Exercise Program for Improving Balance and Mobility in Older Adults With Type 2 Diabetes.

Effectiveness of an exercise program designed for improving postural control and mobility in older adults with type 2 diabetes was investigated. Ninety-three adults 65 or older diagnosed with type 2 diabetes and able to walk unaided were recruited. The intervention group received exercise training focused on ankle strengthening and mobility twice per week for 10 weeks. The control group did not participate in any exercise program. After 10 weeks, the intervention group showed significantly greater improvement in the mean Sensory Organization Test composite score (4.4 vs. 0.3; p = 0.01) as well as visual ratio (0.1 vs. 0.002; p = 0.01) and vestibular ratio (0.1 vs. 0.003; p < 0.001) than the control group after adjusting for covariates. A greater trend of improvement in the Timed Up and Go and Single-Leg Stance Test was also found in the intervention group. Exercise training focusing on the ankle is effective in enhancing the postural stability of older adults with type 2 diabetes and can potentially be effective in improving single-leg standing balance and mobility. [Journal of Gerontological Nursing, 44(2), 41-48.].

Effects of pulsed electromagnetic fields on peripheral blood circulation in people with diabetes: A randomized controlled trial.

Cutaneous blood flow provides nourishment that plays an essential role in maintaining skin health. We examined the effects of pulsed electromagnetic fields (PEMFs) on cutaneous circulation of dorsal feet. Twenty-two patients with diabetes mellitus (DM) and 21 healthy control subjects were randomly allocated to receive either PEMFs or sham PEMFs (0.5 mT, 12 Hz, 30 min). Blood flow velocity and diameter of the small vein were examined by using ultrasound biomicroscopy; also, microcirculation at skin over the base of the 1st metatarsal bone (Flux1) and distal 1st phalange (Flux2) was measured by laser Doppler flowmetry before and after intervention. Results indicated that PEMFs produced significantly greater changes in blood flow velocity of the smallest observable vein than did sham PEMFs (both P < 0.05) in both types of subjects. However, no significant difference was found in changes of vein diameter, nor in Flux1 and Flux2, between PEMFs and sham PEMFs groups in subjects with or without DM. We hypothesized that PEMFs would increase blood flow velocity of the smallest observable vein in people with or without DM. Bioelectromagnetics. 37:290-297, 2016. © 2016 Wiley Periodicals, Inc.

Pulsed electromagnetic field (PEMF) promotes collagen fibre deposition associated with increased myofibroblast population in the early healing phase of diabetic wound.

The present study evaluated the effects of PEMF on collagen fibre deposition, collagen fibril alignment and collagen fibre orientation. The potential relationships between collagen fibre deposition and myofibroblast population in diabetic wound healing were also examined. Forty young male streptozotocin-induced diabetic Sprague-Dawley rats were randomly assigned to PEMF group or control group. 2 cm × 2 cm square wounds were made at their back. The PEMF group received daily exposure of PEMF to the wounds, while control group was handled in the same manner except that the PEMF device was not activated. Wound tissues harvested on post-wounding day 7, 10 and 14 were fixed, processed and sectioned. The abundance, fibril alignment and fibre orientation of type I collagen were quantified with picro-sirius polarization method and image analysis software (Nikon NIS Element AR). Myofibroblast population data were adopted from our previous study. Correlation between myofibroblast population and collagen fibre deposition was examined. There was significantly greater abundance of type I collagen fibre in the PEMF group than in the control on day 7 (P = .013), but not on day 10 or 14. No significant between-group differences were found in collagen fibril alignment and collagen fibre orientation at any measured time points. Positive correlation was found between collagen fibre deposition and myofibroblast population only on day 7 (r = .729, P = .007). In conclusion, PEMF can significantly increase collagen fibre in the early phase of diabetic wound healing, which is associated with the enhancement of myofibroblast population.

Pulsed electromagnetic field therapy promotes healing and microcirculation of chronic diabetic foot ulcers: a pilot study.

OBJECTIVE: To examine the effects of pulsed electromagnetic field (PEMF) therapy on promoting the healing and microcirculation of chronic diabetic foot ulcers. DESIGN: A randomized, double-blind, placebo-controlled clinical trial on a homogenous subset of chronic diabetic foot ulcers. SETTING: Hospital and university. PATIENTS: Thirteen subjects (7 in the PEMF group and 6 in the control group) diagnosed with type 2 diabetes and had unsatisfactory healing of ulcer(s) in the preceding 4 weeks were recruited. INTERVENTIONS: Subjects were randomly allocated to receive either active PEMF therapy (duration: 60 minutes; frequency: 12 Hz; intensity: 12 Gauss) or nonactive PEMF for 14 sessions within 3 weeks. MAIN OUTCOME MEASURES: Assessment on wound closure, wound depth, and microcirculation were performed at the baseline, end of the treatment period, and 1-month follow-up. MAIN RESULTS: By the end of the treatment period, there was an 18% decrease in wound size in the active PEMF group as compared with a 10% decrease in the control group. The PEMF group demonstrated significant cumulative increase in cutaneous capillary blood velocity (by 28%) and 14% increase in capillary diameter. In contrast, the control group showed a decrease in both capillary blood velocity and diameter. CONCLUSION: In this study, PEMF therapy seemed to accelerate wound healing and improve microcirculation.

An innovative ultrasound foot scanner system for measuring the change in biomechanical properties of plantar tissue from sitting to standing.

The present study investigated the reliability of an innovative ultrasound foot scanner system in assessing the thickness and stiffness of plantar soft tissue and the comparison of stiffness and thickness in sitting and standing. Fifteen young healthy individuals were examined. The target sites on the foot sole for investigation included the heel pad, the fifth metatarsal head, the second metatarsal head, the first metatarsal head, and the pulp of the hallux. The test (day 1) and retest (day 2) were performed 1 week apart at the exact time with humidity and temperature of the assessment room under control. The thickness and stiffness of the plantar soft tissue obtained in sitting and standing positions on day 1 were used for comparison. The results showed significant test-retest reliability [intraclass correlation coefficient(3,2)>0.90, P<0.001] at all five sites in both sitting and standing positions. When changing from sitting to standing, the plantar soft tissue became significantly thinner (with decrease ranging from 10 to 14% at various sites) and stiffer (with increase ranging from 123 to 164% at various sites, all P<0.05). The present innovative system is a reliable device for the measurement of the thickness and stiffness of plantar soft tissue in either the sitting or the standing position. The change in positions from sitting to standing resulted in a significant thinning and stiffening of plantar soft tissues. This system could be a potential clinical device to monitor the biomechanical properties of plantar tissue in the elderly or in patients with diseases such as diabetes to estimate the risk of developing foot ulcer or other foot complications.

The association between physical characteristics of the ankle joint and the mobility performance in elderly people with type 2 diabetes mellitus.

Previous studies showed that older adults with diabetes have a worse mobility performance as compared with those without diabetes. Studies also demonstrated that older adults with diabetes have weakened ankle muscle strength, reduced joint range in ankle dorsiflexion and worsened ankle joint proprioception as compared with control population. The purpose of the present study was to examine the relationship between the physical characteristics of the ankle joint and the mobility performance in older adults with type 2 diabetes. Older adults with type 2 diabetes (n=85) were recruited, and Timed Up and Go test (TUG) for mobility assessment was performed. Active ankle joint repositioning test was used for assessing the ankle joint proprioception sense; peak torque of ankle dorsiflexors and plantar flexors were tested by using a Cybex Norm dynamometer, and weight-bearing lunge test (WBLT) was used for assessing the stiffness of ankle dorsiflexion. Our results showed that age, body mass index (BMI), normalized peak torque of plantar flexors and dorsiflexors, active ankle joint repositioning test errors and the WBLT distance were significantly correlated with the TUG (all p<0.001). These ankle characteristics, together with the demographic data of the subjects, contributed 59.9% of the variance in the TUG by multiple regression analysis. Body mass, ankle plantar flexors strength and ankle joint proprioception are important factors contributing to the physical mobility of the older adults with type 2 diabetes.

Pulsed electromagnetic fields (PEMF) promote early wound healing and myofibroblast proliferation in diabetic rats.

Reduced collagen deposition possibly leads to slow recovery of tensile strength in the healing process of diabetic cutaneous wounds. Myofibroblasts are transiently present during wound healing and play a key role in wound closure and collagen synthesis. Pulsed electromagnetic fields (PEMF) have been shown to enhance the tensile strength of diabetic wounds. In this study, we examined the effect of PEMF on wound closure and the presence of myofibroblasts in Sprague-Dawley rats after diabetic induction using streptozotocin. A full-thickness square-shaped dermal wound (2 cm × 2 cm) was excised aseptically on the shaved dorsum. The rats were randomly divided into PEMF-treated (5 mT, 25 Hz, 1 h daily) and control groups. The results indicated that there were no significant differences between the groups in blood glucose level and body weight. However, PEMF treatment significantly enhanced wound closure (days 10 and 14 post-wounding) and re-epithelialization (day 10 post-wounding), although these improvements were no longer observed at later stages of the wound healing process. Using immunohistochemistry against α-smooth muscle actin (α-SMA), we demonstrated that significantly more myofibroblasts were detected on days 7 and 10 post-wounding in the PEMF group when compared to the control group. We hypothesized that PEMF would increase the myofibroblast population, contributing to wound closure during diabetic wound healing.

The potential influence of diabetic history on peripheral blood flow in superficial skin.

Vascular complication occurrence increases with the duration of diabetes. The present study compared the peripheral blood flow in superficial skin among subjects with a short or long history of diabetes as compared to a healthy control group. Thirty-two subjects with type 2 diabetes were recruited and stratified into a group of those with a short history of diabetes (i.e., shorter than or equal to ten years) and a group of those with a long history of diabetes (i.e., over ten years). Thirty-eight healthy age-matched volunteers were recruited as the control. The blood flow velocity of the superficial small veins in the skin over the base of the 1st metatarsal bone was measured by ultrasound biomicroscopy. The blood flow (flux) of the cutaneous microcirculation over the base of the 1st metatarsal bone (Flux1) and over the distal 1st phalanges bone (Flux2) was measured by Laser Doppler Flowmetry. One-way analysis of variance was used to analyze the differences between the three groups. No significant between-group difference was found in any outcome (all P>0.05). However, the group with a long history of diabetes tended to have a more reduced blood flow than did the healthy control group. A difference was found between the diabetes group and the healthy control in any outcomes. A trend of hemodynamic changes in the three groups was observed, but the difference did not reach significance. Ten years seems to be the time when angiopathy becomes noticeable among people with diabetes.

The effect of aging on the biomechanical properties of plantar soft tissues.

BACKGROUND: Foot problems are common in elderly people and stiffened plantar soft tissues may lead to ulceration in people with Diabetes Mellitus. It is unclear how the biomechanical properties of plantar soft tissues change with advancing age. Therefore, this study examined the age-related differences in the biomechanical properties of plantar soft tissues. METHODS: Sixty healthy volunteers without foot problems, aged from 41 to 83 years, were examined using tissue ultrasound palpation system. The thickness and stiffness of the plantar soft tissues under the big toe, first metatarsal head, third metatarsal head, fifth metatarsal head, and heel were measured. The load-deformation curve of the plantar soft tissues was plotted. The correlation between age and biomechanical properties was examined and comparisons were made between four age groups. FINDINGS: The mean stiffness of the plantar soft tissues at big toe, first metatarsal head, third metatarsal head, fifth metatarsal head, and the heel significantly increased with age (P<0.001). The plantar soft tissues at the heel were the thickest (P<0.001), with the plantar soft tissue tending to be increasingly thicker with age, although there was no statistical significance. Strong positive correlations between age and stiffness of the plantar soft tissues were found at the big toe (r=0.608), first metatarsal head (r=0.549), third metatarsal head (r=0.657), fifth metatarsal head (r=0.633), and heel (r=0.584) (all P<0.001). INTERPRETATION: The loss of compliance in the plantar soft tissues may be one of the factors responsible for the higher incidence of foot problems in elderly individuals.

The use of auricular examination for screening hepatic disorders.

Researches on auricular acupuncture (AA) have examined mainly its treatment effects. This study aimed to investigate the accuracy and precision of using auricular examination (AE) as a complementary diagnostic tool for screening hepatic disorders. Twenty patients suffering from liver dysfunction and 25 controls aged 18-60 years were recruited from an acute hospital. Participants were examined using three AE methods including visual inspection, electrical skin resistance measurement, and tenderness testing on the liver AA zone of both ears. Significant differences were found in visual inspection and electrical skin resistance on the AA zones between the two groups. Patients suffering from liver dysfunction tended to have at least one abnormality in skin color, appearance, presence of papules, abundance of capillary and desquamation on the ear (Relative Risk-Right ear: RR = 2.9, 95% confidence interval (CI) 1.4, 6.2; Left: RR = 1.8, 95% CI, 1.01, 3.1). The sensitivity for visual inspection was 0.7 for both ears; specificity was 0.76 for the (R) and 0.6 for the (L) ear. The mean difference in electrical skin resistance was 4.3 MOmega (95% CI, 1.7, 6.9) for the (L) ear; 4.5 MOmega (95% CI, 1.5, 7.6) for the (R) ear. Our results suggest that malfunction of the liver appeared to be reflected by the presence of morphological changes on the liver AA zone. Visual inspection and electrical skin resistance on the liver AA zone are potentially sensitive to screen hepatic disorders.

Effects of 904-nm low-level laser therapy in the management of lateral epicondylitis: a randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate the effectiveness of 904-nm low-level laser therapy (LLLT) in the management of lateral epicondylitis. BACKGROUND DATA: Lateral epicondylitis is characterized by pain and tenderness over the lateral elbow, which may also result in reduction in grip strength and impairment in physical function. LLLT has been shown effective in its therapeutic effects in tissue healing and pain control. METHODS: Thirty-nine patients with lateral epicondylitis were randomly assigned to receive either active laser with an energy dose of 0.275 J per tender point (laser group) or sham irradiation (placebo group) for a total of nine sessions. The outcome measures were mechanical pain threshold, maximum grip strength, level of pain at maximum grip strength as measured by the Visual Analogue Scale (VAS) and the subjective rating of physical function with Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. RESULTS: Significantly greater improvements were shown in all outcome measures with the laser group than with the placebo group (p < 0.0125), except in the two subsections of DASH. CONCLUSION: This study revealed that LLLT in addition to exercise is effective in relieving pain, and in improving the grip strength and subjective rating of physical function of patients with lateral epicondylitis.