The assessment of Buerger's exercise on dorsal foot skin circulation in patients with vasculopathic diabetic foot ulcer by using wireless near-infrared spectroscope: a cohort prospective study.

The improvement of peripheral circulation is crucial for the care of vasculopathic diabetic foot ulcer (DFU). Near-infrared spectroscopy (NIRS) was used to investigate the effects of Buerger's exercise on dorsal foot skin circulation with novel technique of measuring the absorption difference in wavelength of light between oxy-hemoglobin (HbO2) and deoxy-hemoglobin (HbR). Patients with vasculopathic DFU who could tolerate Buerger's exercise three times a day at home for at least 8 weeks were enrolled (group A). They were divided into two subgroups: without previous percutaneous transluminal angioplasty (PTA) (group A1) vs. with previous PTA (group A2). Wireless NIRS were applied on patients' dorsal foot to assess the peripheral circulation in follow-up clinics. The patients' wound condition, follow-up time, and concentration of HbO2 and total hemoglobin (HbT) before and after exercise rehabilitation program were documented. From May 2015 to February 2016, 14 patients with average age of 70.2 ± 11.2 were enrolled in this study (group A), including eight without previous PTA (group A1), and six with previous PTA (group A2). The concentration of HbO2 and HbT were significantly increased after exercise rehabilitation program training in group A (p = 0.024 in HbO2, p = 0.02 in HbT, n = 14) and group A2 (p = 0.021 in HbO2, p = 0.028 in HbT, n = 6), while the concentration in group A1 were improved with borderline significance after exercise (p = 0.055 in HbO2, p = 0.058 in HbT, n = 8). The majority of the ulcers were either completely healed (11/14 = 78.57%) or improving (3/14 = 21.43%). Buerger's exercise improved the peripheral circulation and wound condition in patients with vasculopathic DFU. The wireless apparatus is a novel and efficient tool to monitor rehabilitation program.

Reliability of cerebral oximeter in non-invasive diagnosis and follow-up of hypercapnia.

In this study, aimed to evaluate the sensitivity and specificity of cerebral oximetry and EtCO2 values in non-invasive diagnosis and monitoring of hypercapnia. This study enrolled pediatric patients admitted to and mechanically ventilated at the Pediatric Intensive Care Unit of Gaziantep University Faculty of Medicine Hospital between January 2014 and January 2015. Patients' age, gender, diagnosis, ventilatory parameters, a measured of the mean end-tidal carbon dioxide value stream method, and the simultaneously monitored arterial blood gas PaCO < sub > 2 < /sub > level and near infrared spectroscopy device (NIRS) measurements were recorded. The mean age of patients was 61 months (min 4-max 193), and there were 8 (53.4%) female and 7 (46.6%) male subjects. A significant correlation was found between PCO2 and NIRS, PCO < sub > 2 < /sub > and EtCO < sub > 2 < /sub > (r = 0.571, p < 0.001). There was a significant positive correlation between EtCO2 and NIRS (r = 0.479, p < 0.001). NIRS levels were significantly higher (p < 0.001) in the group with pCO < sub > 2 < /sub > > 45; EtCO < sub > 2 < /sub > > 40 and pH < 7.35, compared to the group with PCO < sub > 2 < /sub > < 45 EtCO < sub > 2 < /sub > < 40 and ph≥7.35 . The best cut-off point for NIRS to distinguish the groups with PCO < sub > 2 < /sub > > 45 with PCO < sub > 2 < /sub > < 45 was 80.5, with a sensitivity of 65.3%, specificity of 84.3%, and positive and negative predictive values of 81.9% and 69.1%, respectively. The best cut-off point for NIRS to distinguish the groups with EtCO < sub > 2 < /sub > > 40 and EtCO < sub > 2 < /sub > < 40 was 81, with a sensitivity of 62.2%, specificity 77.9%, and positive and negative predictive values of 61.2% and 72.3%, respectively. As for pH < 7.35 and PaCO < sub > 2 < /sub > > 45, while sensitivity of EtCO < sub > 2 < /sub > (at a cut-off point of 40) was 64.9%; the sensitivity of NIRS (at a cut-off point of 80.5) was 28.1%, with EtCO < sub > 2 < /sub > being significantly more sensitive than NIRS (p < 0.001). The results of the present study suggest that NIRS values of above 80 should alert clinicians for hypercapnia associated with increased cerebral blood flow.