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Nasir NJM, Heemskerk H, Jenkins J, Hamadee NH, Bunte R, Tucker-Kellogg L. Myoglobin-derived iron causes wound enlargement and impaired regeneration in pressure injuries of muscle. eLife 2023; 12:85633. [PMID: 37267120 DOI: 10.7554/elife.85633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/25/2023] [Indexed: 06/04/2023] Open
Abstract
The reasons for poor healing of pressure injuries are poorly understood. Vascular ulcers are worsened by extracellular release of hemoglobin, so we examined the impact of myoglobin (Mb) iron in murine muscle pressure injuries (mPI). Tests used Mb-knockout or treatment with deferoxamine iron chelator (DFO). Unlike acute injuries from cardiotoxin, mPI regenerated poorly with a lack of viable immune cells, persistence of dead tissue (necro-slough), and abnormal deposition of iron. However, Mb-knockout or DFO-treated mPI displayed a reversal of the pathology: decreased tissue death, decreased iron deposition, decrease in markers of oxidative damage, and higher numbers of intact immune cells. Subsequently, DFO treatment improved myofiber regeneration and morphology. We conclude that myoglobin iron contributes to tissue death in mPI. Remarkably, a large fraction of muscle death in untreated mPI occurred later than, and was preventable by, DFO treatment, even though treatment started 12 hr after pressure was removed. This demonstrates an opportunity for post-pressure prevention to salvage tissue viability.
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Affiliation(s)
- Nurul Jannah Mohamed Nasir
- Cancer & Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
- Centre for Computational Biology, Duke-NUS Medical School, Singapore, Singapore
| | - Hans Heemskerk
- Cancer & Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
- BioSyM and CAMP Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, CREATE, Singapore, Singapore
| | - Julia Jenkins
- Cancer & Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | | | - Ralph Bunte
- Cancer & Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
| | - Lisa Tucker-Kellogg
- Cancer & Stem Cell Biology, Duke-NUS Medical School, Singapore, Singapore
- Centre for Computational Biology, Duke-NUS Medical School, Singapore, Singapore
- BioSyM and CAMP Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, CREATE, Singapore, Singapore
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2
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Mukhina E, Trebbi A, Rohan PY, Connesson N, Payan Y. In vivo quantification of 3D displacement in sacral soft tissues under compression: Relevance of 2D US-based measurements for pressure ulcer risk assessment. J Tissue Viability 2022; 31:593-600. [DOI: 10.1016/j.jtv.2022.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 09/19/2022] [Accepted: 09/22/2022] [Indexed: 11/17/2022]
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3
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Langemo D, Anderson J, Hanson D, Thompson P, Johnson E. The Conundrum of Turning/Repositioning Frequency, Sleep Surface Selection, and Sleep Disruption in Preventing Pressure Injury in Healthcare Settings. Adv Skin Wound Care 2022; 35:252-259. [PMID: 35442917 DOI: 10.1097/01.asw.0000824780.10098.d1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diane Langemo
- Diane Langemo, PhD, RN, FAAN, is Distinguished Professor Emeritus, College of Nursing and Professional Development, University of North Dakota, Grand Forks, United States. Julie Anderson, PhD, RN, is Dean, Winona State University, Minnesota. Also at the University of North Dakota, Darlene Hanson, PhD, RN, is Clinical Professor, College of Nursing and Professional Development; Patricia Thompson, MS, RN, is Clinical Assistant Professor, College of Nursing and Professional Development; and Erika Johnson, MLIS, is Clinical Campus Librarian, School of Medicine and Health Sciences. Submitted June 8, 2021; accepted in revised form October 20, 2021
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4
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Kawasaki S, Nishimura Y, Kouda K, Umemoto Y, Kinoshita T, Hashizaki T, Kawanishi M, Nakamura T, Tajima F. Follow-Up Study of Subdermal Low-Echoic Lesions in the Ischial Region in Wheelchair Users With Spinal Cord Injuries. Front Med (Lausanne) 2022; 9:848338. [PMID: 35355614 PMCID: PMC8959625 DOI: 10.3389/fmed.2022.848338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 02/14/2022] [Indexed: 11/19/2022] Open
Abstract
Objective: To follow up patients with spinal cord injuries with subdermal low-echoic lesions in the ischial region for abnormalities after 1 year. Design A retrospective cohort study. Setting A Japanese rehabilitation center. Participants We included patients with chronic spinal cord injuries and subdermal low-echoic lesions who underwent routine inspection and palpation examinations (n = 7). Interventions Education on pressure injury and instruction on pressure relief and seating was provided and the patients were followed up for abnormalities after 1 year. Self-reports were obtained on wheelchair sitting time, and interface pressure was recorded while the patients were seated on the wheelchair. Interface pressure measurements at the bilateral ischial regions were recorded with a force-sensitive application pressure mapping system. Outcome Measures The primary outcome was the presence of subdermal low-echoic lesions in the bilateral ischial regions on ultrasonography at the 1-year follow-up examination. Secondary outcomes included wheelchair sitting time and interface pressure in the bilateral ischial regions. Results Of the 10 areas that showed subdermal low-echoic lesions on ultrasonography, nine had improved after 1 year. One area that did not improve was an open wound. At the follow-up examination, the pressure duration was reduced in all patients, and the interface pressure could be reduced in 5/7 patients. Conclusions This is the first study to follow up with patients having spinal cord injuries and subdermal low-echoic lesions in the ischial region using ultrasonography. The low-echoic lesions improved within 1 year by reducing the pressure duration and interface pressure. Pressure injury prevention in patients with spinal cord injuries relies on the early detection of skin abnormalities, and education and instruction to change self-management behaviors are recommended.
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Affiliation(s)
- Shinji Kawasaki
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan.,Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Yukihide Nishimura
- Department of Rehabilitation Medicine, Iwate Medical University, Iwate, Japan
| | - Ken Kouda
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasunori Umemoto
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
| | - Tokio Kinoshita
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan.,Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Takamasa Hashizaki
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan.,Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Makoto Kawanishi
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan.,Division of Rehabilitation, Wakayama Medical University Hospital, Wakayama, Japan
| | - Taro Nakamura
- Department of Rehabilitation Medicine, Oita Nakamura Hospital, Oita, Japan
| | - Fumihiro Tajima
- Department of Rehabilitation Medicine, Wakayama Medical University, Wakayama, Japan
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5
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Lavigne T, Sciumè G, Laporte S, Pillet H, Urcun S, Wheatley B, Rohan PY. Société de Biomécanique Young Investigator Award 2021: Numerical investigation of the time-dependent stress-strain mechanical behaviour of skeletal muscle tissue in the context of pressure ulcer prevention. Clin Biomech (Bristol, Avon) 2022; 93:105592. [PMID: 35151107 DOI: 10.1016/j.clinbiomech.2022.105592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pressure-induced tissue strain is one major pathway for Pressure Ulcer development and, especially, Deep Tissue Injury. Biomechanical investigation of the time-dependent stress-strain mechanical behaviour of skeletal muscle tissue is therefore essential. In the literature, a viscoelastic formulation is generally assumed for the experimental characterization of skeletal muscles, with the limitation that the underlying physical mechanisms that give rise to the time dependent stress-strain behaviour are not known. The objective of this study is to explore the capability of poroelasticity to reproduce the apparent viscoelastic behaviour of passive muscle tissue under confined compression. METHODS Experimental stress-relaxation response of 31 cylindrical porcine samples tested under fast and slow confined compression by Vaidya and collaborators were used. An axisymmetric Finite Element model was developed in ABAQUS and, for each sample a one-to-one inverse analysis was performed to calibrate the specimen-specific constitutive parameters, namely, the drained Young's modulus, the void ratio, hydraulic permeability, the Poisson's ratio, the solid grain's and fluid's bulk moduli. FINDINGS The peak stress and consolidation were recovered for most of the samples (N=25) by the poroelastic model (normalised root-mean-square error ≤0.03 for fast and slow confined compression conditions). INTERPRETATION The strength of the proposed model is its fewer number of variables (N=6 for the proposed poroelastic model versus N=18 for the viscohyperelastic model proposed by Vaidya and collaborators). The incorporation of poroelasticity to clinical models of Pessure Ulcer formation could lead to more precise and mechanistic explorations of soft tissue injury risk factors.
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Affiliation(s)
- T Lavigne
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France; Arts et Metiers Institute of Technology, Univ. of Bordeaux, CNRS, Bordeaux INP, INRAE, I2M Bordeaux, Avenue d'Aquitaine, Pessac, 33607, France.
| | - G Sciumè
- Arts et Metiers Institute of Technology, Univ. of Bordeaux, CNRS, Bordeaux INP, INRAE, I2M Bordeaux, Avenue d'Aquitaine, Pessac, 33607, France
| | - S Laporte
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France
| | - H Pillet
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France
| | - S Urcun
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France; Arts et Metiers Institute of Technology, Univ. of Bordeaux, CNRS, Bordeaux INP, INRAE, I2M Bordeaux, Avenue d'Aquitaine, Pessac, 33607, France; Institute for Computational Engineering Sciences, Department of Engineering Sciences, Faculte des Sciences, de la Technologie et de Medecine, Universite du Luxembourg, Campus Kirchberg, 6, rue Coudenhove-Kalergi, Luxembourg, L-1359, Luxembourg
| | - B Wheatley
- Department of Mechanical Engineering, Bucknell University, 1 Dent Drive, Lewisburg 17837, PA, USA
| | - P-Y Rohan
- Arts et Metiers Institute of Technology, IBHGC, 151 bd de l'hopital, Paris, 75013, France
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6
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Stewart TP, Black JM, Alderden J, Yap TL. The Past, Present, and Future of Deep-Tissue (Pressure) Injury. Adv Skin Wound Care 2022; 35:78-80. [PMID: 35050914 DOI: 10.1097/01.asw.0000803592.21401.8f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Thomas P Stewart
- Thomas P. Stewart, PhD, is the founder of the National Pressure Injury Advisory Panel and Senior Associate Clinical Professor, Daemen College, Amherst, New York. Joyce M. Black, PhD, RN, FAAN, is Florence Niedfelt Professor in Nursing, University of Nebraska Medical Center, Omaha. Jenny Alderden, PhD, APRN, CCRN, CCNS, is Associate Professor, Boise State University, Idaho. Tracey L. Yap, PhD, RN, WCC, CNE, FGSA, FAAN, is Associate Professor, Duke University School of Nursing, Durham, North Carolina. This article is considered expert opinion and was not subject to peer review
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7
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Gefen A, Brienza DM, Cuddigan J, Haesler E, Kottner J. Our contemporary understanding of the aetiology of pressure ulcers/pressure injuries. Int Wound J 2021; 19:692-704. [PMID: 34382331 PMCID: PMC8874092 DOI: 10.1111/iwj.13667] [Citation(s) in RCA: 75] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 07/02/2021] [Accepted: 07/25/2021] [Indexed: 12/25/2022] Open
Abstract
In 2019, the third and updated edition of the Clinical Practice Guideline (CPG) on Prevention and Treatment of Pressure Ulcers/Injuries has been published. In addition to this most up‐to‐date evidence‐based guidance for clinicians, related topics such as pressure ulcers (PUs)/pressure injuries (PIs) aetiology, classification, and future research needs were considered by the teams of experts. To elaborate on these topics, this is the third paper of a series of the CPG articles, which summarises the latest understanding of the aetiology of PUs/PIs with a special focus on the effects of soft tissue deformation. Sustained deformations of soft tissues cause initial cell death and tissue damage that ultimately may result in the formation of PUs/PIs. High tissue deformations result in cell damage on a microscopic level within just a few minutes, although it may take hours of sustained loading for the damage to become clinically visible. Superficial skin damage seems to be primarily caused by excessive shear strain/stress exposures, deeper PUs/PIs predominantly result from high pressures in combination with shear at the surface over bony prominences, or under stiff medical devices. Therefore, primary PU/PI prevention should aim for minimising deformations by either reducing the peak strain/stress values in tissues or decreasing the exposure time.
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Affiliation(s)
- Amit Gefen
- The Herbert J. Berman Chair in Vascular Bioengineering, Department of Biomedical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv, Israel
| | - David M Brienza
- Departments of Rehabilitation Science and Technology & Bioengineering and the McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Janet Cuddigan
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Emily Haesler
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia.,Australian Centre for Evidence Based Aged Care, School of Nursing and Midwifery, LaTrobe University, Melbourne, Victoria, Australia.,Australian National University Medical School, Academic Unit of General Practice, Australian National University, Canberra, ACT, Australia
| | - Jan Kottner
- Charité Center 1 for Health and Human Sciences, Charité-Universitätsmedizin Berlin, Berlin, Germany
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8
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Evans V, Behr M, Gangwar A, Noseworthy MD, Kumbhare D. Potential Role of MRI Imaging for Myofascial Pain: A Scoping Review for the Clinicians and Theoretical Considerations. J Pain Res 2021; 14:1505-1514. [PMID: 34079365 PMCID: PMC8166277 DOI: 10.2147/jpr.s302683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 04/28/2021] [Indexed: 12/24/2022] Open
Abstract
The most common cause of chronic musculoskeletal pain is chronic myofascial pain syndrome (MPS). MPS often presents with increased muscle stiffness, and the myofascial trigger point (MTrP). Imaging modalities have been used to identify the MTrP, but their role in the detection and diagnosis of MPS remains unclear. The purpose of this review was to identify evidence in literature for the use of imaging in the role of classifying and explaining the physiology of MTrPs. Since few imaging techniques have been performed on MTrPs, we explored the imaging techniques that can effectively image complex skeletal muscle microstructure, and how they could be used. As part of a scoping review, we conducted a systematic search from three medical databases (CINAHL, EMBASE and MEDLINE) from year to year to analyze past MTrP imaging, as well as analyzing imaging techniques performed on the microstructure of muscle. Previously, ultrasound has been used to differentiate active, latent MTrPs, but these studies do not adequately address their underlying anatomical structure. MRI remains the standard method of imaging skeletal muscle. The existing MRI literature suggests that the DTI technique can quantify muscle injury, strain, and structure. However, theoretically, HARDI and DKI techniques seem to provide more information for complex structural areas, although these modalities have a disadvantage of longer scan times and have not been widely used on skeletal muscle. Our review suggests that DTI is the most effective imaging modality that has been used to define the microstructure of muscle and hence, could be optimal to image the MTrP. HARDI and DKI are techniques with theoretical potential for analysis of muscle, which may provide more detailed information representative of finer muscle structural features. Future research utilizing MRI techniques to image muscle are necessary to provide a more robust means of imaging skeletal muscle and the MTrP.
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Affiliation(s)
- Valerie Evans
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, Toronto, Ontario, Canada.,University Health Network - Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Michael Behr
- University Health Network - Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
| | - Anshika Gangwar
- University Health Network - Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | - Michael D Noseworthy
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Dinesh Kumbhare
- Institute of Biomaterials and Biomedical Engineering (IBBME), University of Toronto, Toronto, Ontario, Canada.,University Health Network - Toronto Rehabilitation Institute, Toronto, Ontario, Canada.,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
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9
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Predicting muscle tissue response from calibrated component models and histology-based finite element models. J Mech Behav Biomed Mater 2021; 117:104375. [PMID: 33578299 DOI: 10.1016/j.jmbbm.2021.104375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/21/2020] [Accepted: 01/27/2021] [Indexed: 12/17/2022]
Abstract
Skeletal muscle is an anisotropic soft biological tissue composed of muscle fibres embedded in a structurally complex, hierarchically organised extracellular matrix. In a recent work (Kuravi et al., 2021) we have developed 3D finite element models from series of histological sections. Moreover, based on decellularisation of fresh tissue samples, a novel set of experimental data on the direction dependent mechanical properties of collagenous ECM was established (Kohn et al., 2021). Together with existing information on the material properties of single muscle fibres, the combination of these techniques allows computing predictions of the composite tissue response. To this end, an inverse finite element procedure is proposed in the present work to calibrate a constitutive model of the extracellular matrix, and supplementary biaxial tensile tests on fresh and decellularised tissues are performed for model validation. The results of this rigorously predictive and thus unforgiving strategy suggest that the prediction of the tissue response from the individual characteristics of muscle cells and decellularised tissue is only possible within clear limits. While orders of magnitude are well matched, and the qualitative behaviour in a wide range of load cases is largely captured, the existing deviations point at potentially missing components of the model and highlight the incomplete experimental information in bottom-up multiscale approaches to model skeletal muscle tissue.
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10
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Lott DJ, Taivassalo T, Cooke KD, Park H, Moslemi Z, Batra A, Forbes SC, Byrne BJ, Walter GA, Vandenborne K. Safety, feasibility, and efficacy of strengthening exercise in Duchenne muscular dystrophy. Muscle Nerve 2020; 63:320-326. [PMID: 33295018 DOI: 10.1002/mus.27137] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/02/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND This two-part study explored the safety, feasibility, and efficacy of a mild-moderate resistance isometric leg exercise program in ambulatory boys with Duchenne muscular dystrophy (DMD). METHODS First, we used a dose escalation paradigm with varying intensity and frequency of leg isometric exercise to determine the dose response and safety in 10 boys. Second, we examined safety and feasibility of a 12-wk in-home, remotely supervised, mild-moderate intensity strengthening program in eight boys. Safety measures included T2 MRI, creatine kinase levels, and pain. Peak strength and function (time to ascend/descend four stairs) were also measured. RESULTS Dose-escalation revealed no signs of muscle damage. Seven of the eight boys completed the 12-wk in-home program with a compliance of 84.9%, no signs of muscle damage, and improvements in strength (knee extensors P < .01; knee flexors P < .05) and function (descending steps P < .05). CONCLUSIONS An in-home, mild-moderate intensity leg exercise program is safe with potential to positively impact both strength and function in ambulatory boys with DMD.
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Affiliation(s)
- Donovan J Lott
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Tanja Taivassalo
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida, USA
| | - Korey D Cooke
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Hyunjun Park
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Zahra Moslemi
- Department of Applied Physiology & Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Abhinandan Batra
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Sean C Forbes
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
| | - Barry J Byrne
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Glenn A Walter
- Department of Physiology and Functional Genomics, University of Florida, Gainesville, Florida, USA
| | - Krista Vandenborne
- Department of Physical Therapy, University of Florida, Gainesville, Florida, USA
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11
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Van Damme N, Van Hecke A, Remue E, Van den Bussche K, Moore Z, Gefen A, Verhaeghe S, Beeckman D. Physiological processes of inflammation and edema initiated by sustained mechanical loading in subcutaneous tissues: A scoping review. Wound Repair Regen 2019; 28:242-265. [DOI: 10.1111/wrr.12777] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 09/23/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Nele Van Damme
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Eline Remue
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- Nursing departmentGhent University Hospital Ghent Belgium
| | - Karen Van den Bussche
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
| | - Zena Moore
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI) Dublin Ireland
| | - Amit Gefen
- Department of Biomedical Engineering, Faculty of EngineeringTel Aviv University Tel Aviv Israel
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- Department of Health CareVIVES University of Applied Sciences Roeselare Belgium
| | - Dimitri Beeckman
- Skin Integrity Research Group (SKINT), University Centre for Nursing and Midwifery, Department of Public HealthGhent University Ghent Belgium
- School of Nursing & MidwiferyRoyal College of Surgeons in Ireland (RCSI) Dublin Ireland
- School of Health SciencesÖrebro University Örebro Sweden
- Research Unit of Plastic Surgery, Department of Clinical Research, Faculty of Health SciencesUniversity of Southern Denmark Odense Denmark
- School of Nursing and MidwiferyMonash University Melbourne Australia
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12
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Hariri A, Chen F, Moore C, Jokerst JV. Noninvasive staging of pressure ulcers using photoacoustic imaging. Wound Repair Regen 2019; 27:488-496. [PMID: 31301258 PMCID: PMC8043767 DOI: 10.1111/wrr.12751] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 06/30/2019] [Indexed: 01/07/2023]
Abstract
Ulcers including pressure ulcers and diabetic foot ulcers damage the skin and underlying tissue in people with compromised blood circulation. They are classified into four stages of severity and span from mild reddening of the skin to tissue damage and muscle/bone infections. Here, we used photoacoustic imaging as a noninvasive method for detecting early tissue damage that cannot be visually observed while also staging the disease using quantitative image analysis. We used a mouse model of pressure ulcers by implanting subdermal magnets in the dorsal flank and periodically applying an external magnet to the healed implant site. The magnet-induced pressure was applied in cycles, and the extent of ulceration was dictated by the number of cycles. We used both laser- and light-emitting diode (LED)-based photoacoustic imaging tools with 690 nm excitation to evaluate the change in photoacoustic signal and depth of injury. Using laser-based photoacoustic imaging system, we found a 4.4-fold increase in the photoacoustic intensity in stage I vs. baseline (no pressure). We also evaluated the depth of injury using photoacoustics. We measured a photoacoustic ulcer depth of 0.38 ± 0.09 mm, 0.74 ± 0.11 mm, 1.63 ± 0.4 mm, and 2.7 ± 0.31 mm (n = 4) for stages I-IV, respectively. The photoacoustic depth differences between each stage were significant (p < 0.05). We also used an LED-based photoacoustic imaging system to detect early stage (stage I) pressure ulcers and observed a 2.5-fold increase in photoacoustic signal. Importantly, we confirmed the capacity of this technique to detect dysregulated skin even before stage I ulcers have erupted. We also observed significant changes in photoacoustic intensity during healing suggesting that this approach can monitor therapy. These findings were confirmed with histology. These results suggest that this photoacoustic-based approach might have clinical value for monitoring skin diseases including pressure ulcers.
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Affiliation(s)
- Ali Hariri
- Department of NanoEngineering, University of California San Diego, La Jolla, California, 92093
| | - Fang Chen
- Department of NanoEngineering, University of California San Diego, La Jolla, California, 92093
- Material Science and Engineering Program, University of California San Diego, La Jolla, California, 92093
| | - Colman Moore
- Department of NanoEngineering, University of California San Diego, La Jolla, California, 92093
| | - Jesse V. Jokerst
- Department of NanoEngineering, University of California San Diego, La Jolla, California, 92093
- Material Science and Engineering Program, University of California San Diego, La Jolla, California, 92093
- Department of Radiology, University of California San Diego, La Jolla, California, 92093
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13
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Nelissen JL, Sinkus R, Nicolay K, Nederveen AJ, Oomens CW, Strijkers GJ. Magnetic resonance elastography of skeletal muscle deep tissue injury. NMR IN BIOMEDICINE 2019; 32:e4087. [PMID: 30897280 PMCID: PMC6593838 DOI: 10.1002/nbm.4087] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 05/31/2023]
Abstract
The current state-of-the-art diagnosis method for deep tissue injury in muscle, a subcategory of pressure ulcers, is palpation. It is recognized that deep tissue injury is frequently preceded by altered biomechanical properties. A quantitative understanding of the changes in biomechanical properties preceding and during deep tissue injury development is therefore highly desired. In this paper we quantified the spatial-temporal changes in mechanical properties upon damage development and recovery in a rat model of deep tissue injury. Deep tissue injury was induced in nine rats by two hours of sustained deformation of the tibialis anterior muscle. Magnetic resonance elastography (MRE), T2 -weighted, and T2 -mapping measurements were performed before, directly after indentation, and at several timepoints during a 14-day follow-up. The results revealed a local hotspot of elevated shear modulus (from 3.30 ± 0.14 kPa before to 4.22 ± 0.90 kPa after) near the center of deformation at Day 0, whereas the T2 was elevated in a larger area. During recovery there was a clear difference in the time course of the shear modulus and T2 . Whereas T2 showed a gradual normalization towards baseline, the shear modulus dropped below baseline from Day 3 up to Day 10 (from 3.29 ± 0.07 kPa before to 2.68 ± 0.23 kPa at Day 10, P < 0.001), followed by a normalization at Day 14. In conclusion, we found an initial increase in shear modulus directly after two hours of damage-inducing deformation, which was followed by decreased shear modulus from Day 3 up to Day 10, and subsequent normalization. The lower shear modulus originates from the moderate to severe degeneration of the muscle. MRE stiffness values were affected in a smaller area as compared with T2 . Since T2 elevation is related to edema, distributing along the muscle fibers proximally and distally from the injury, we suggest that MRE is more specific than T2 for localization of the actual damaged area.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
- Biomedical Engineering and Physics, Academic Medical CenterAmsterdamThe Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical CenterAmsterdamThe Netherlands
| | - Ralph Sinkus
- Image Sciences & Biomedical Engineering, King's College LondonLondonUK
| | - Klaas Nicolay
- Biomedical NMR, Biomedical EngineeringEindhoven University of TechnologyEindhovenThe Netherlands
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical CenterAmsterdamThe Netherlands
| | - Cees W.J. Oomens
- Soft Tissue Engineering and Mechanobiology, Biomedical EngineeringEindhoven University of TechnologyThe Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical CenterAmsterdamThe Netherlands
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Traa WA, van Turnhout MC, Nelissen JL, Strijkers GJ, Bader DL, Oomens CWJ. There is an individual tolerance to mechanical loading in compression induced deep tissue injury. Clin Biomech (Bristol, Avon) 2019; 63:153-160. [PMID: 30897463 DOI: 10.1016/j.clinbiomech.2019.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 02/14/2019] [Accepted: 02/22/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Deep tissue injury is a type of pressure ulcer which originates subcutaneously due to sustained mechanical loading. The relationship between mechanical compression and damage development has been extensively studied in 2D. However, recent studies have suggested that damage develops beyond the site of indentation. The objective of this study was to compare mechanical loading conditions to the associated damage in 3D. METHODS An indentation test was performed on the tibialis anterior muscle of rats (n = 39). Changes in the form of oedema and structural damage were monitored with MRI in an extensive region. The internal deformations were evaluated using MRI based 3D finite element models. FINDINGS Damage propagates away from the loaded region. The 3D analysis indicates that there is a subject specific tolerance to compression induced deep tissue injury. INTERPRETATION Individual tolerance is an important factor when considering the mechanical loading conditions which induce damage.
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Affiliation(s)
- Willeke A Traa
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.
| | - Mark C van Turnhout
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jules L Nelissen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Gustav J Strijkers
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Amsterdam UMC, University of Amsterdam, Biomedical Engineering and Physics, Meibergdreef 9, Amsterdam, the Netherlands
| | - Dan L Bader
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands; Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Cees W J Oomens
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
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15
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Yapp JH, Raja Ahmad RMK, Mahmud R, Mohtarrudin N, Mohamad Yusof L, Abdul Rahim E, Ahmad SA, Abu Bakar MZ. Determining weight‐bearing tissue condition using peak reactive hyperemia response trend and ultrasonographic features: Implications for pressure ulcer prevention. Wound Repair Regen 2019; 27:225-234. [DOI: 10.1111/wrr.12698] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 10/03/2018] [Accepted: 01/08/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Jong Heng Yapp
- Department of Electrical and Electronic Engineering, Faculty of EngineeringUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Raja Mohd Kamil Raja Ahmad
- Department of Electrical and Electronic Engineering, Faculty of EngineeringUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Rozi Mahmud
- Cancer Resource and Education Center, Faculty of Medicine and Health SciencesUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Norhafizah Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health SciencesUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Loqman Mohamad Yusof
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary MedicineUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Ezamin Abdul Rahim
- Department of Imaging, Faculty of Medicine and Health SciencesUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Siti Anom Ahmad
- Department of Electrical and Electronic Engineering, Faculty of EngineeringUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
| | - Md Zuki Abu Bakar
- Department of Veterinary Pre‐Clinical Science, Faculty of Veterinary MedicineUniversiti Putra Malaysia Serdang Selangor Darul Ehsan Malaysia
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16
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The 3rd Joint Symposium of the International and National Neurotrauma Societies and AANS/CNS Section on Neurotrauma and Critical Care August 11–16, 2018 Toronto, Canada. J Neurotrauma 2018. [DOI: 10.1089/neu.2018.29013.abstracts] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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17
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Sonenblum SE, Ma J, Sprigle SH, Hetzel TR, McKay Cathcart J. Measuring the impact of cushion design on buttocks tissue deformation: An MRI approach. J Tissue Viability 2018; 27:162-172. [DOI: 10.1016/j.jtv.2018.04.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 04/06/2018] [Accepted: 04/23/2018] [Indexed: 12/17/2022]
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18
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Nelissen JL, Traa WA, de Boer HH, de Graaf L, Mazzoli V, Savci-Heijink CD, Nicolay K, Froeling M, Bader DL, Nederveen AJ, Oomens CWJ, Strijkers GJ. An advanced magnetic resonance imaging perspective on the etiology of deep tissue injury. J Appl Physiol (1985) 2018; 124:1580-1596. [DOI: 10.1152/japplphysiol.00891.2017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Early diagnosis of deep tissue injury remains problematic due to the complicated and multifactorial nature of damage induction and the many processes involved in damage development and recovery. In this paper, we present a comprehensive assessment of deep tissue injury development and remodeling in a rat model by multiparametric magnetic resonance imaging (MRI) and histopathology. The tibialis anterior muscle of rats was subjected to mechanical deformation for 2 h. Multiparametric in vivo MRI, consisting of T2, T2*, mean diffusivity (MD), and angiography measurements, was applied before, during, and directly after indentation as well as at several time points during a 14-day follow-up. MRI readouts were linked to histological analyses of the damaged tissue. The results showed dynamic change in various MRI parameters, reflecting the histopathological status of the tissue during damage induction and repair. Increased T2 corresponded with edema, muscle cell damage, and inflammation. T2* was related to tissue perfusion, hemorrhage, and inflammation. MD increase and decrease was reported on the tissue’s microstructural integrity and reflected muscle degeneration and edema as well as fibrosis. Angiography provided information on blockage of blood flow during deformation. Our results indicate that the effects of a single damage-causing event of only 2 h of deformation were present up to 14 days. The initial tissue response to deformation, as observed by MRI, starts at the edge of the indentation. The quantitative MRI readouts provided distinct and complementary information on the extent, temporal evolution, and microstructural basis of deep tissue injury-related muscle damage. NEW & NOTEWORTHY We have applied a multiparametric MRI approach linked to histopathology to characterize damage development and remodeling in a rat model of deep tissue injury. Our approach provided several relevant insights in deep tissue injury. Response to damage, as observed by MRI, started at some distance from the deformation. Damage after a single indentation period persisted up to 14 days. The MRI parameters provided distinct and complementary information on the microstructural basis of the damage.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Willeke A. Traa
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Hans H. de Boer
- Department of Pathology, Academic Medical Center, Amsterdam, The Netherlands
| | - Larry de Graaf
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Valentina Mazzoli
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
- Orthopedic Research Laboratory, Radboud UMC, Nijmegen, The Netherlands
| | | | - Klaas Nicolay
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Dan L. Bader
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Aart J. Nederveen
- Department of Radiology and Nuclear Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Cees W. J. Oomens
- Soft Tissue Engineering and Mechanobiology, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
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Bader DL, Worsley PR. Technologies to monitor the health of loaded skin tissues. Biomed Eng Online 2018; 17:40. [PMID: 29650012 PMCID: PMC5897925 DOI: 10.1186/s12938-018-0470-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 03/24/2018] [Indexed: 01/18/2023] Open
Abstract
There are many situations where the skin and underlying soft tissues are compromised by mechanical loading in the form or pressure, or pressure in combination with shear. If sustained, this can lead to damage in the tissues particularly adjacent to bony prominences, resulting in chronic wounds. An array of bioengineering technologies have been adopted to assess the integrity of loaded soft tissues. This paper aims to review these approaches for the quantification, simulation and early detection of mechanically-induced skin damage. The review considers different measurements at the interface between the skin and support surface/medical device, involving pressure, shear, friction and the local microclimate. The potential of the techniques to monitor the physiological response of the skin to these external stimuli including biophysical measurement devices and sampling of biofluids are critically analysed. In addition, it includes an analysis of medical imaging technologies and computational modelling to provide a means by which tissue deformation can be quantified and thresholds for tissue damage defined. Bioengineering measurement and imaging technologies have provided an insight into the temporal status of loaded skin. Despite the advances in technology, to date, the translation to clinical tools which are robust and cost effective has been limited. There is a need to adapt existing technologies and simulation platforms to enable patients, carers and clinicians to employ appropriate intervention strategies to minimise soft tissue damage.
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Affiliation(s)
- Dan L Bader
- Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
| | - Peter R Worsley
- Skin Health Group, Faculty of Health Sciences, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
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20
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Sonenblum SE, Sprigle SH. Buttock tissue response to loading in men with spinal cord injury. PLoS One 2018; 13:e0191868. [PMID: 29415014 PMCID: PMC5802854 DOI: 10.1371/journal.pone.0191868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/13/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE/BACKGROUND Despite the fact that most people with a spinal cord injury who use a wheelchair for mobility are considered at-risk for pressure ulcer (PrU) development, there still exists a spectrum of risk amongst this group. Efforts to differentiate risk level would benefit from clinical tools that can measure or predict the buttocks response to loading. Therefore, the goal of this study was to identify how tissue compliance and blood flow were impacted by clinically-measurable risk factors in young men with SCI. METHODS Blood flow at the ischial tuberosity was measured using laser Doppler flowmetry while the seated buttock was unloaded, and loaded at lower (40-60 mmHg) and high (>200 mmHg) loads. Tissue compliance of the buttock was measured using the Myotonometer while subject were lifted in a Guldmann Net. RESULTS Across 28 participants, blood flow was significantly reduced at high loads, while no consistent, significant changes were found at lower loads. At 40-60 mmHg, blood flow decreased in participants with a pressure ulcer history and lower BMI, but stayed the same or increased in most other participants. The buttock displaced an average of 9.3 mm (2.7 mm) at 4.2 N, which represented 82% (7%) of maximum displacement. BMI was related to the amount of buttock tissue displacement while smoking status explained some of the variation in the percent of max displacement. CONCLUSION Wide variability in tissue compliance and blood flow responses across a relatively homogeneous population indicate that differences in biomechanical risk may provide an explanation for the spectrum of PrU risk among persons with SCI.
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Affiliation(s)
- Sharon Eve Sonenblum
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
| | - Stephen H. Sprigle
- George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, Georgia, United States of America
- School of Industrial Design, Georgia Institute of Technology, Atlanta, Georgia, United States of America
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21
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An MRI investigation of the effects of user anatomy and wheelchair cushion type on tissue deformation. J Tissue Viability 2018; 27:42-53. [DOI: 10.1016/j.jtv.2017.04.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 04/03/2017] [Accepted: 04/10/2017] [Indexed: 11/18/2022]
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22
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Nelissen JL, de Graaf L, Traa WA, Schreurs TJL, Moerman KM, Nederveen AJ, Sinkus R, Oomens CWJ, Nicolay K, Strijkers GJ. A MRI-Compatible Combined Mechanical Loading and MR Elastography Setup to Study Deformation-Induced Skeletal Muscle Damage in Rats. PLoS One 2017; 12:e0169864. [PMID: 28076414 PMCID: PMC5226723 DOI: 10.1371/journal.pone.0169864] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 12/23/2016] [Indexed: 02/01/2023] Open
Abstract
Deformation of skeletal muscle in the proximity of bony structures may lead to deep tissue injury category of pressure ulcers. Changes in mechanical properties have been proposed as a risk factor in the development of deep tissue injury and may be useful as a diagnostic tool for early detection. MRE allows for the estimation of mechanical properties of soft tissue through analysis of shear wave data. The shear waves originate from vibrations induced by an external actuator placed on the tissue surface. In this study a combined Magnetic Resonance (MR) compatible indentation and MR Elastography (MRE) setup is presented to study mechanical properties associated with deep tissue injury in rats. The proposed setup allows for MRE investigations combined with damage-inducing large strain indentation of the Tibialis Anterior muscle in the rat hind leg inside a small animal MR scanner. An alginate cast allowed proper fixation of the animal leg with anatomical perfect fit, provided boundary condition information for FEA and provided good susceptibility matching. MR Elastography data could be recorded for the Tibialis Anterior muscle prior to, during, and after indentation. A decaying shear wave with an average amplitude of approximately 2 μm propagated in the whole muscle. MRE elastograms representing local tissue shear storage modulus Gd showed significant increased mean values due to damage-inducing indentation (from 4.2 ± 0.1 kPa before to 5.1 ± 0.6 kPa after, p<0.05). The proposed setup enables controlled deformation under MRI-guidance, monitoring of the wound development by MRI, and quantification of tissue mechanical properties by MRE. We expect that improved knowledge of changes in soft tissue mechanical properties due to deep tissue injury, will provide new insights in the etiology of deep tissue injuries, skeletal muscle damage and other related muscle pathologies.
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Affiliation(s)
- Jules L. Nelissen
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
- * E-mail:
| | - Larry de Graaf
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Willeke A. Traa
- Soft Tissue Biomechanics and Engineering, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Tom J. L. Schreurs
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
| | - Kevin M. Moerman
- Center for Extreme Bionics, Media lab, MIT, Cambridge, MA, United States of America
| | - Aart J. Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, The Netherlands
| | - Ralph Sinkus
- Image Sciences & Biomedical Engineering, King’s College London, London, United Kingdom
| | - Cees W. J. Oomens
- Soft Tissue Biomechanics and Engineering, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Klaas Nicolay
- Biomedical NMR, Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Gustav J. Strijkers
- Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, The Netherlands
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Akins JS, Vallely JJ, Karg PE, Kopplin K, Gefen A, Poojary-Mazzotta P, Brienza DM. Feasibility of freehand ultrasound to measure anatomical features associated with deep tissue injury risk. Med Eng Phys 2016; 38:839-44. [DOI: 10.1016/j.medengphy.2016.04.026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/01/2016] [Accepted: 04/28/2016] [Indexed: 11/28/2022]
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24
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Pressure Combined with Ischemia/Reperfusion Injury Induces Deep Tissue Injury via Endoplasmic Reticulum Stress in a Rat Pressure Ulcer Model. Int J Mol Sci 2016; 17:284. [PMID: 26927073 PMCID: PMC4813148 DOI: 10.3390/ijms17030284] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 02/16/2016] [Accepted: 02/17/2016] [Indexed: 12/14/2022] Open
Abstract
Pressure ulcer is a complex and significant health problem in long-term bedridden patients, and there is currently no effective treatment or efficient prevention method. Furthermore, the molecular mechanisms and pathogenesis contributing to the deep injury of pressure ulcers are unclear. The aim of the study was to explore the role of endoplasmic reticulum (ER) stress and Akt/GSK3β signaling in pressure ulcers. A model of pressure-induced deep tissue injury in adult Sprague-Dawley rats was established. Rats were treated with 2-h compression and subsequent 0.5-h release for various cycles. After recovery, the tissue in the compressed regions was collected for further analysis. The compressed muscle tissues showed clear cellular degenerative features. First, the expression levels of ER stress proteins GRP78, CHOP, and caspase-12 were generally increased compared to those in the control. Phosphorylated Akt and phosphorylated GSK3β were upregulated in the beginning of muscle compression, and immediately significantly decreased at the initiation of ischemia-reperfusion injury in compressed muscles tissue. These data show that ER stress may be involved in the underlying mechanisms of cell degeneration after pressure ulcers and that the Akt/GSK3β signal pathway may play an important role in deep tissue injury induced by pressure and ischemia/reperfusion.
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25
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Jagannathan NS, Tucker-Kellogg L. Membrane permeability during pressure ulcer formation: A computational model of dynamic competition between cytoskeletal damage and repair. J Biomech 2015; 49:1311-1320. [PMID: 26772800 DOI: 10.1016/j.jbiomech.2015.12.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 12/11/2015] [Accepted: 12/14/2015] [Indexed: 10/22/2022]
Abstract
Pressure ulcers are debilitating wounds that arise frequently in people who have lost mobility. Mechanical stress, oxidative stress and ischemia-reperfusion injury are potential sources of damage during pressure ulcer formation, but cross-talk between these sources has rarely been investigated. In vitro experiments with mechanically-induced cell damage previously demonstrated that non-lethal amounts of static cell deformation could induce myoblast membrane permeabilization. Permeabilization, in turn, has the potential to induce oxidative stress via leakage of calcium, myoglobin or alarmins. In this work, we constructed a hypothetical causal network of cellular-scale effects resulting from deformation and permeabilization, and we investigated the theoretical sensitivity of cell death toward various parameters and pathways of the model. Simulations showed that the survival/death outcome was particularly sensitive to the speed of membrane repair. The outcome was also sensitive to whether oxidative stress could decrease the speed of membrane repair. Finally, using the assumption that apoptosis and necrosis would have opposite effects on membrane leakage in dying cells, we showed that promoting apoptosis might under certain conditions have the paradoxical effect of decreasing, rather than increasing, total cell death. Our work illustrates that apoptosis may have hidden benefits at preventing spatial spread of death. More broadly, our work shows the importance of membrane repair dynamics and highlights the need for experiments to measure the effects of ischemia, apoptosis induction, and other co-occurring sources of cell stress toward the speed of membrane repair.
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Affiliation(s)
- N Suhas Jagannathan
- Centre for Computational Biology, and Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore
| | - Lisa Tucker-Kellogg
- Centre for Computational Biology, and Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore; Program in Cancer and Stem Cell Biology, Duke-NUS Graduate Medical School Singapore, 8 College Road, Singapore; BioSystems and Micromechanics (BioSyM) Singapore-MIT Alliance for Research and Technology, 1 Create Way, Singapore.
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26
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Nemunaitis G, Roach MJ, Boulet M, Nagy JA, Kaufman B, Mejia M, Hefzy MS. The Effect of a Liner on the Dispersion of Sacral Interface Pressures During Spinal Immobilization. Assist Technol 2015; 27:9-17. [PMID: 26132220 DOI: 10.1080/10400435.2014.940473] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Sacral pressure ulcers are a significant problem following spinal cord injury and are felt to be in part due to the high interface-pressures generated while strapped to the spine board. The objective of this study was to determine sacral interface-pressure and sensing area in healthy volunteers on a spine board and the effects of a gel pressure dispersion liner. Thirty-seven volunteers were placed on a pressure-sensing mat between the subject and the spine board. Measurements were carried out with and without a gel liner. Pressures and sensing area were recorded every minute for 40 minutes. The highest pressure was generated at the sacral prominence of each subject. Mean interface-pressures were higher on the spine board alone than with the gel liner (p < .0001). Overall, mean sensing area was lower on the spine board than with the gel liner (p < .0001). Standard spinal immobilization causes high sacral interface-pressures. The addition of a gel liner on the spine board decreased overall mean sacral pressures and increased mean sensing area. Generation of sacral pressure ulcers may be related to the initial interface-pressures generated while the patient is strapped to the spine board. The addition of a gel liner may reduce the incidence of sacral pressure ulcers.
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Affiliation(s)
- Greg Nemunaitis
- a MetroHealth Rehabilitation Institute of Ohio , Cleveland , Ohio , USA
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27
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Sari Y, Sanada H, Minematsu T, Nakagami G, Nagase T, Huang L, Noguchi H, Mori T, Yoshimura K, Sugama J. Vibration inhibits deterioration in rat deep-tissue injury through HIF1-MMP axis. Wound Repair Regen 2015; 23:386-93. [PMID: 25801385 DOI: 10.1111/wrr.12286] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 03/16/2015] [Indexed: 11/29/2022]
Abstract
Deep-tissue injury (DTI) is a unique type of pressure ulcer (PU) in which deep-tissue damage expands outwards to the superficial skin. DTI progresses rapidly into a severe PU, despite initially appearing as only a bruise or darkened tissue in the superficial skin. Although some DTI detection methods are available, there is currently no strategy for treating deteriorating DTI. This study investigated the efficacy of vibration therapy for preventing DTI deterioration through down-regulation of the hypoxia-inducible factor-1 matrix metalloproteinase (MMP) axis in rats. We prepared a conventional PU rat model (PU group) and a DTI deterioration rat model (DTI group). The DTI group was further divided into two groups subjected to vibration and control treatments, respectively. Macroscopic and histological features, hypoxia, oxidative stress, apoptosis, and MMP2 and MMP9 activities in compressed skin were analyzed. Hypoxia, oxidative stress, and MMP activity were enhanced in the DTI group compared with the PU group. Vibration remarkably inhibited DTI deterioration, hypoxia, and the expression/activities of MMP2 and MMP9. These results suggest that vibration therapy can effectively attenuate deterioration of DTI. This report provides the first evidence for a therapeutic treatment for deteriorating DTI.
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Affiliation(s)
- Yunita Sari
- Department of Gerontological Nursing/Wound Care Management, The University of Tokyo, Tokyo, Japan.,Department of Nursing, Jenderal Soedirman University, Purwokerto, Indonesia
| | - Hiromi Sanada
- Department of Gerontological Nursing/Wound Care Management, The University of Tokyo, Tokyo, Japan
| | - Takeo Minematsu
- Department of Gerontological Nursing/Wound Care Management, The University of Tokyo, Tokyo, Japan
| | - Gojiro Nakagami
- Department of Gerontological Nursing/Wound Care Management, The University of Tokyo, Tokyo, Japan
| | - Takashi Nagase
- Department of Gerontological Nursing/Wound Care Management, The University of Tokyo, Tokyo, Japan
| | - Lijuan Huang
- Department of Gerontological Nursing/Wound Care Management, The University of Tokyo, Tokyo, Japan
| | - Hiroshi Noguchi
- Department of Life Support Technology (Molten), The University of Tokyo, Tokyo, Japan
| | - Taketoshi Mori
- Department of Life Support Technology (Molten), The University of Tokyo, Tokyo, Japan
| | - Kotaro Yoshimura
- Department of Plastic Surgery, The University of Tokyo, Tokyo, Japan
| | - Junko Sugama
- Wellness Promotion Science Center, Kanazawa University, Ishikawa, Japan
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Demarre L, Verhaeghe S, Van Hecke A, Clays E, Grypdonck M, Beeckman D. Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial. J Adv Nurs 2014; 71:391-403. [PMID: 25134858 DOI: 10.1111/jan.12497] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2014] [Indexed: 11/28/2022]
Abstract
AIMS To identify predictive factors associated with the development of pressure ulcers in patients at risk who receive standardized preventive care. BACKGROUND Numerous studies have examined factors that predict risk for pressure ulcer development. Only a few studies identified risk factors associated with pressure ulcer development in hospitalized patients receiving standardized preventive care. DESIGN Secondary analyses of data collected in a multicentre randomized controlled trial. METHODS The sample consisted of 610 consecutive patients at risk for pressure ulcer development (Braden Score <17) receiving standardized preventive care measures. Patient demographic information, data on skin and risk assessment, medical history and diagnosis were collected during 26 months (December 2007-January 2010). Predictive factors were identified using multivariate statistics. RESULTS Pressure ulcers in category II-IV were significantly associated with non-blanchable erythema, urogenital disorders and higher body temperature. Predictive factors significantly associated with superficial pressure ulcers were admission to an internal medicine ward, incontinence-associated dermatitis, non-blanchable erythema and a lower Braden score. Superficial sacral pressure ulcers were significantly associated with incontinence-associated dermatitis. CONCLUSIONS Despite the standardized preventive measures they received, hospitalized patients with non-blanchable erythema, urogenital disorders and a higher body temperature were at increased risk for developing pressure ulcers. RELEVANCE TO CLINICAL PRACTICE Improved identification of at-risk patients can be achieved by taking into account specific predictive factors. Even if preventive measures are in place, continuous assessment and tailoring of interventions is necessary in all patients at risk. Daily skin observation can be used to continuously monitor the effectiveness of the intervention.
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Affiliation(s)
- Liesbet Demarre
- University Centre for Nursing and Midwifery, Ghent University, Belgium
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Hamaluik K, Moussa W, Ferguson-Pell M. Numerical characterization of quasi-static ultrasound elastography for the detection of deep tissue injuries. IEEE TRANSACTIONS ON MEDICAL IMAGING 2014; 33:1410-1421. [PMID: 24691120 DOI: 10.1109/tmi.2014.2313082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Deep tissue injuries are subcutaneous regions of tissue breakdown associated with excessive mechanical pressure for extended period of time. These wounds are currently clinically undetectable in their early stages and result in severe burdens on not only the patients who suffer from them, but the health care system as well. The goal of this work was to numerically characterize the use of quasi-static ultrasound elastography for detecting formative and progressive deep tissue injuries. In order to numerically characterize the technique, finite-element models of sonographic B-mode imaging and tissue deformation were created. These models were fed into a local strain-estimation algorithm to determine the detection sensitivity of the technique on various parameters. Our work showed that quasi-static ultrasound elastography was able to detect and characterize deep tissue injuries over a range of lesion parameters. Simulations were validated using a physical phantom model. This work represents a step along the path to developing a clinically relevant technique for detecting and diagnosing early deep tissue injuries.
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Kawamata S, Kurose T, Kubori Y, Muramoto H, Honkawa Y. Effects of the magnitude of pressure on the severity of injury and capillary closure in rat experimental pressure ulcers. Med Mol Morphol 2014; 48:24-32. [DOI: 10.1007/s00795-014-0073-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 03/03/2014] [Indexed: 11/29/2022]
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Sierra E, Fernández A, Espinosa de los Monteros A, Arbelo M, Díaz-Delgado J, Andrada M, Herráez P. Histopathological muscle findings may be essential for a definitive diagnosis of suspected sharp trauma associated with ship strikes in stranded cetaceans. PLoS One 2014; 9:e88780. [PMID: 24551162 PMCID: PMC3923832 DOI: 10.1371/journal.pone.0088780] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 01/15/2014] [Indexed: 11/19/2022] Open
Abstract
Ship strikes are a major issue for the conservation of may cetacean species. Certain gross and microscopic criteria have been previously reported for establishing a diagnosis of death due to ship strikes in these animals. However, some ship-strike injuries may be masked by advanced carcass decomposition and may be undetectable due to restricted access to the animals. In this report we describe histopathological muscular findings in 13 cetaceans with sharp trauma from ship strikes as the cause of death. Skeletal muscle samples were taken from the incision site and from the main locomotor muscle, the longissimus dorsi, in areas not directly affected by the sharp injury. The microscopic findings in tissues from both sites mainly consisted of haemorrhages; oedema; flocculent, granular or/and hyalinised segmentary degeneration; contraction band necrosis; and discoid degeneration or fragmentation of myofibres. We propose that skeletal muscle histopathology provides evidence of ante-mortem injuries even if the sample was taken elsewhere in the carcass and not only within or adjacent to the sharp trauma site and despite the advanced decomposition of some of the carcasses. This method helps to establish the diagnosis of ship strike as the cause of death.
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Affiliation(s)
- Eva Sierra
- Unit of Histology and Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Canary Islands, Spain
| | - Antonio Fernández
- Unit of Histology and Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Canary Islands, Spain
| | - Antonio Espinosa de los Monteros
- Unit of Histology and Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Canary Islands, Spain
| | - Manuel Arbelo
- Unit of Histology and Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Canary Islands, Spain
| | - Josué Díaz-Delgado
- Unit of Histology and Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Canary Islands, Spain
| | - Marisa Andrada
- Unit of Histology and Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Canary Islands, Spain
| | - Pedro Herráez
- Unit of Histology and Veterinary Pathology, Institute for Animal Health, Veterinary School, University of Las Palmas de Gran Canaria, Arucas (Las Palmas), Canary Islands, Spain
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Sprigle S, Sonenblum S, Conner-Kerr T. mobilityRERC state of the science conference: individualizing pressure ulcer risk and prevention strategies. Disabil Rehabil Assist Technol 2013; 8:454-61. [DOI: 10.3109/17483107.2013.823574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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34
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Sari Y, Minematsu T, Huang L, Noguchi H, Mori T, Nakagami G, Nagase T, Oe M, Sugama J, Yoshimura K, Sanada H. Establishment of a novel rat model for deep tissue injury deterioration. Int Wound J 2013; 12:202-9. [PMID: 23651215 DOI: 10.1111/iwj.12082] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 03/04/2013] [Accepted: 03/25/2013] [Indexed: 11/29/2022] Open
Abstract
Deep tissue injuries (DTIs) can become significant problems because of their rapid deterioration into deep pressure ulcers. Presently, no animal model of DTI deterioration has been developed. By concentrating pressure and shear stress in deep tissues while minimising pressure and shear stress in the overlying skin, we produced an effective rat model of DTI deterioration. Two-dimensional finite element method (FEM) simulated the distribution of pressure and shear stress under several pressure-loading conditions. FEM showed that concentrated shear stress in deep tissue with minimum shear stress in the overlying skin could be created by using a prominence and a cushion, respectively. On the basis of the results of FEM analysis, we selected suitable conditions for testing the rat DTI deterioration model. The compressed area was macroscopically observed until day 13, and histopathologic analysis via haematoxylin and eosin (H&E) staining was performed on days 3, 7 and 13. H&E staining showed that the distribution of tissue damage was similar to the predicted FEM results. Deep ulceration and tissue damage extending from deep tissues to the overlying skin and surrounding tissues were observed in the DTI deterioration model, which are similar to the clinical manifestations of DTI deterioration. In conclusion, a representative DTI deterioration model was established by concentrating high shear stress in deep tissues while minimising shear stress in the overlying skin. This model will allow a better understanding of the mechanisms behind DTI deterioration and the development of preventative strategies.
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Affiliation(s)
- Yunita Sari
- Department of Gerontological Nursing/Wound Care Management, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Nursing, Jenderal Soedirman University, Purwokerto, Indonesia
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Loerakker S, Bader DL, Baaijens FP, Oomens CW. Which factors influence the ability of a computational model to predict thein vivodeformation behaviour of skeletal muscle? Comput Methods Biomech Biomed Engin 2013; 16:338-45. [DOI: 10.1080/10255842.2011.621423] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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37
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Sin TK, Pei XM, Teng BT, Tam EW, Yung BY, Siu PM. Oxidative stress and DNA damage signalling in skeletal muscle in pressure-induced deep tissue injury. Pflugers Arch 2013; 465:295-317. [PMID: 23322113 DOI: 10.1007/s00424-012-1205-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 11/16/2012] [Accepted: 12/09/2012] [Indexed: 10/27/2022]
Abstract
The molecular mechanisms that contribute to the pathogenesis of pressure-induced deep tissue injury are largely unknown. This study tested the hypothesis that oxidative stress and DNA damage signalling mechanism in skeletal muscle are involved in deep tissue injury. Adult Sprague Dawley rats were subject to an experimental protocol to induce deep tissue injury. Two compression cycles with a static pressure of 100 mmHg was applied to an area of 1.5 cm(2) over the mid-tibialis region of right limb of the rats. The left uncompressed limb served as intra-animal control. Muscle tissues underneath compression region were collected for examination. Our analyses indicated that pathohistological characteristics including rounding contour of myofibres and extensive nuclei accumulation were apparently shown in compressed muscles. The elevation of 8OHdG immunopositively stained nuclei indicated the presence of oxidative DNA damage. Increase in oxidative stress was revealed by showing significant elevation of 4HNE and decreases in mRNA abundance of SOD1, catalase and GPx, and protein content of SOD2 in compressed muscles relative to control muscles. Increase in nitrosative stress was demonstrated by significant elevation of nitrotyrosine and NOS2 mRNA content. The activation of tumor suppressor p53 signalling was indicated by the remarkable increases in protein contents of total p53 and serine-15 phosphorylated p53. The transcript expression of the DNA-repairing enzyme, Rad23A, was significantly suppressed in compressed muscles. Our time-course study indicated that increased oxidative/nitrosative stress and proapoptotic signalling were maintained in muscles receiving increasing amount of compression cycles and post-compression time. Furthermore, resveratrol was found to attenuate the histological damage, oxidative/nitrosative stress and proapoptotic signalling in response to prolonged moderate compression. In conclusion, our findings are consistent with the hypothesis that oxidative stress and DNA damage signalling in skeletal muscle are involved in the underlying mechanisms responsible for the pathogenesis of pressure-induced deep tissue injury.
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Affiliation(s)
- Thomas K Sin
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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38
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Solis LR, Twist E, Seres P, Thompson RB, Mushahwar VK. Prevention of deep tissue injury through muscle contractions induced by intermittent electrical stimulation after spinal cord injury in pigs. J Appl Physiol (1985) 2012; 114:286-96. [PMID: 23172030 DOI: 10.1152/japplphysiol.00257.2012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep tissue injury (DTI) is a severe medical complication that commonly affects those with spinal cord injury. It is caused by prolonged external loading of the muscles, entrapping them between a bony prominence and the support surface. The entrapment causes excessive mechanical deformation and increases in interstitial pressure, leading to muscle breakdown deep around the bony prominences. We proposed the use of intermittent electrical stimulation (IES) as a novel prophylactic method for the prevention of DTI. In this study, we assessed the long-term effectiveness of this technique in pigs that had received a partial spinal cord injury that paralyzed one hindlimb. The pigs recovered for 2 wk postsurgery, and subsequently, their paralyzed limbs were loaded to 25% of their body weights 4 h/day for 4 consecutive days each week for 1 mo. One group of pigs (n = 3) received IES during the loading, whereas another group (n = 3) did not. DTI was quantified using magnetic resonance imaging (MRI) and postmortem histology. In the group that did not receive IES, MRI assessments revealed signs of tissue damage in 48% of the volume of the loaded muscle. In the group that did receive IES, only 8% of the loaded muscle volume showed signs of tissue damage. Similar findings were found through postmortem histology. This study demonstrates, for the first time, that IES may be an effective technique for preventing the formation of DTI in loaded muscles after spinal cord injury.
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Affiliation(s)
- Leandro R Solis
- Rehabilitation Science Program, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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39
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Leopold E, Gefen A. A simple stochastic model to explain the sigmoid nature of the strain-time cellular tolerance curve. J Tissue Viability 2012; 21:27-36. [DOI: 10.1016/j.jtv.2011.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 11/20/2011] [Accepted: 11/29/2011] [Indexed: 12/12/2022]
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Slomka N, Gefen A. Relationship Between Strain Levels and Permeability of the Plasma Membrane in Statically Stretched Myoblasts. Ann Biomed Eng 2011; 40:606-18. [DOI: 10.1007/s10439-011-0423-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Accepted: 09/27/2011] [Indexed: 01/21/2023]
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41
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Loerakker S, Manders E, Strijkers GJ, Nicolay K, Baaijens FPT, Bader DL, Oomens CWJ. The effects of deformation, ischemia, and reperfusion on the development of muscle damage during prolonged loading. J Appl Physiol (1985) 2011; 111:1168-77. [DOI: 10.1152/japplphysiol.00389.2011] [Citation(s) in RCA: 101] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Deep tissue injury (DTI) is a severe form of pressure ulcer where tissue damage starts in deep tissues underneath intact skin. In the present study, the contributions of deformation, ischemia, and reperfusion to skeletal muscle damage development were examined in a rat model during a 6-h period. Magnetic resonance imaging (MRI) was used to study perfusion (contrast-enhanced MRI) and tissue integrity (T2-weighted MRI). The levels of tissue deformation were estimated using finite element models. Complete ischemia caused a gradual homogeneous increase in T2 (∼20% during the 6-h period). The effect of reperfusion on T2 was highly variable, depending on the anatomical location. In experiments involving deformation, inevitably associated with partial ischemia, a variable T2 increase (17–66% during the 6-h period) was observed reflecting the significant variation in deformation (with two-dimensional strain energies of 0.60–1.51 J/mm) and ischemia (50.8–99.8% of the leg) between experiments. These results imply that deformation, ischemia, and reperfusion all contribute to the damage process during prolonged loading, although their importance varies with time. The critical deformation threshold and period of ischemia that cause muscle damage will certainly vary between individuals. These variations are related to intrinsic factors, such as pathological state, which partly explain the individual susceptibility to the development of DTI and highlight the need for regular assessments of individual subjects.
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Affiliation(s)
| | - E. Manders
- Soft Tissue Biomechanics and Engineering and
| | - G. J. Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; and
| | - K. Nicolay
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands; and
| | | | - D. L. Bader
- Soft Tissue Biomechanics and Engineering and
- Faculty of Health Sciences, University of Southampton, Southampton, United Kingdom
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Adjunctive use of noncontact low-frequency ultrasound for treatment of suspected deep tissue injury: a case series. J Wound Ostomy Continence Nurs 2011; 38:394-403. [PMID: 21606861 DOI: 10.1097/won.0b013e31821e87eb] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE We lack a clear understanding of the mechanisms of damage associated with suspected deep tissue injuries (SDTI) and sufficient evidence to determine the efficacy of various preventive interventions. The purpose of this article is to evaluate noncontact low-frequency ultrasound (NLFU) as one component of a preventive program designed for preventing SDTI from progressing to higher-stage pressure ulcers. CASES In March 2009, we added NLFU treatments daily for 5 days, then every other day until healed, to our prevention protocol in order to prevent progression of SDTI to a higher-stage pressure ulcer. We report the course and outcomes of 6 SDTIs that were treated adjunctively with NLFU. Treatment was limited to patients with an SDTI identified within 3 to 4 days of onset. CONCLUSION Following the addition of NLFU to the SDTI plan of care, these 6 cases of SDTI did not progress to advanced-stage pressure ulcers. These initial findings suggest that the addition of NLFU to SDTI identified within 3 to 4 days of onset may be effective for preventing progression to higher-stage pressure ulcers.
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Teng BT, Tam EW, Benzie IF, Siu PM. Protective effect of caspase inhibition on compression-induced muscle damage. J Physiol 2011; 589:3349-69. [PMID: 21540338 DOI: 10.1113/jphysiol.2011.209619] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
There are currently no effective therapies for treating pressure-induced deep tissue injury. This study tested the efficacy of pharmacological inhibition of caspase in preventing muscle damage following sustained moderate compression. Adult Sprague-Dawley rats were subjected to prolonged moderate compression. Static pressure of 100 mm Hg compression was applied to an area of 1.5 cm2 in the tibialis region of the right limb of the rats for 6 h each day for two consecutive days. The left uncompressed limb served as intra-animal control. Rats were randomized to receive either vehicle (DMSO) as control treatment (n =8) or 6 mg kg⁻¹ of caspase inhibitor (z-VAD-fmk; n =8) prior to the 6 h compression on the two consecutive days.Muscle tissues directly underneath the compression region of the compressed limb and the same region of control limb were harvested after the compression procedure.Histological examination and biochemical/molecular measurement of apoptosis and autophagy were performed. Caspase inhibition was effective in alleviating the compression-induced pathohistology of muscle. The increases in caspase-3 protease activity, TUNEL index, apoptotic DNA fragmentation and pro-apoptotic factors (Bax, p53 and EndoG) and the decreases in anti-apoptotic factors (XIAP and HSP70) observed in compressed muscle of DMSO-treated animals were not found in animals treated with caspase inhibitor. The mRNA content of autophagic factors (Beclin-1, Atg5 and Atg12) and the protein content of LC3, FoxO3 and phospho-FoxO3 that were down-regulated in compressed muscle of DMSO-treated animals were all maintained at their basal level in the caspase inhibitor treated animals. Our data provide evidence that caspase inhibition attenuates compression-induced muscle apoptosis and maintains the basal autophagy level. These findings demonstrate that pharmacological inhibition of caspase/apoptosis is effective in alleviating muscle damage as induced by prolonged compression.
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Affiliation(s)
- Bee T Teng
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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Siu PM, Teng BT, Pei XM, Tam EW. Proteasome inhibition alleviates prolonged moderate compression-induced muscle pathology. BMC Musculoskelet Disord 2011; 12:58. [PMID: 21385343 PMCID: PMC3058073 DOI: 10.1186/1471-2474-12-58] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Accepted: 03/07/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The molecular mechanism initiating deep pressure ulcer remains to be elucidated. The present study tested the hypothesis that the ubiquitin proteasome system is involved in the signalling mechanism in pressure-induced deep tissue injury. METHODS Adult Sprague Dawley rats were subjected to an experimental compression model to induce deep tissue injury. The tibialis region of the right hind limb was subjected to 100 mmHg of static pressure for six hours on each of two consecutive days. The compression pressure was continuously monitored by a three-axial force transducer within the compression indentor. The left hind limb served as the intra-animal control. Muscle tissues underneath the compressed region were collected and used for analyses. RESULTS Our results demonstrated that the activity of 20S proteasome and the protein abundance of ubiquitin and MAFbx/atrogin-1 were elevated in conjunction with pathohistological changes in the compressed muscle, as compared to control muscle. The administration of the proteasome inhibitor MG132 was found to be effective in ameliorating the development of pathological histology in compressed muscle. Furthermore, 20S proteasome activity and protein content of ubiquitin and MAFbx/atrogin-1 showed no apparent increase in the MG132-treated muscle following compression. CONCLUSION Our data suggest that the ubiquitin proteasome system may play a role in the pathogenesis of pressure-induced deep tissue injury.
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Affiliation(s)
- Parco M Siu
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China.
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Gentian Violet 1% Solution in the Treatment of Wounds in the Geriatric Patient: A Retrospective Study. Geriatr Nurs 2011; 32:85-95. [DOI: 10.1016/j.gerinurse.2010.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2010] [Revised: 10/27/2010] [Accepted: 11/01/2010] [Indexed: 11/18/2022]
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Loerakker S, Oomens CWJ, Manders E, Schakel T, Bader DL, Baaijens FPT, Nicolay K, Strijkers GJ. Ischemia-reperfusion injury in rat skeletal muscle assessed with T2-weighted and dynamic contrast-enhanced MRI. Magn Reson Med 2011; 66:528-37. [PMID: 21360588 DOI: 10.1002/mrm.22801] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 11/15/2010] [Accepted: 12/10/2010] [Indexed: 11/07/2022]
Abstract
Pressure ulcers are localized areas of soft tissue breakdown due to mechanical loading. Susceptible individuals are subjected to pressure relief strategies to prevent long loading periods. Therefore, ischemia-reperfusion injury may play an important role in the etiology of pressure ulcers. To investigate the inter-relation between postischemic perfusion and changes in skeletal muscle integrity, the hindlimbs of Brown Norway rats were subjected to 4-h ischemia followed by 2-h reperfusion. Dynamic contrast-enhanced MRI was used to examine perfusion, and changes in skeletal muscle integrity were monitored with T2-weighted MRI. The dynamic contrast-enhanced MRI data showed a heterogeneous postischemic profile in the hindlimb, consisting of areas with increased contrast enhancement (14-76% of the hindlimb) and regions with no-reflow (5-77%). For T2, a gradual increase in the complete leg was observed during the 4-h ischemic period (from 34 to 41 msec). During the reperfusion phase, a heterogeneous distribution of T2 was observed. Areas with increased contrast enhancement were associated with a decrease in T2 (to 38 msec) toward preischemic levels, whereas no-reflow areas exhibited a further increase in T2 (to 42 msec). These results show that reperfusion after prolonged ischemia may not be complete, thereby continuing the ischemic condition and aggravating tissue damage.
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Affiliation(s)
- S Loerakker
- Soft Tissue Biomechanics and Engineering, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
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Teng BT, Pei XM, Tam EW, Benzie IF, Siu PM. Opposing responses of apoptosis and autophagy to moderate compression in skeletal muscle. Acta Physiol (Oxf) 2011; 201:239-54. [PMID: 20670304 DOI: 10.1111/j.1748-1716.2010.02173.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AIM The molecular mechanism that contributes to the pathogenesis of deep pressure ulcer remains to be elucidated. This study tested the hypotheses that: (1) apoptosis and autophagy are activated in compression-induced muscle pathology and (2) apoptotic and autophagic changes precede pathohistological changes in skeletal muscle in response to prolonged moderate compression. METHODS Adult Sprague-Dawley rats were subjected to an experimental model of pressure-induced deep tissue injury. Static pressure of 100 mmHg was applied to an area of 1.5 cm(2) over the mid-tibialis region of right limb of rats for one single session of 6-h compression (1D) or two sessions of 6-h compression over two consecutive days with rats sacrificed one day (2D) or immediately after (2D-IM) the compression. The left uncompressed limb served as the intra-animal control. Muscle tissues underneath compression region were collected for analysis. RESULTS Our histological analysis indicated that pathohistological characteristics including rounding contour of myofibres and massive nuclei accumulation were apparently demonstrated in muscles of 2D and 2D-IM. In contrast, these pathohistological changes were generally not found in muscle following 1D. Apoptotic DNA fragmentation, terminal dUTP nick-end labelling index and caspase-3 protease activity were significantly elevated in compressed muscles of all groups. Caspase-9 enzymatic activity was found to be significantly increased in compressed muscles of 2D and 2D-IM whereas increase in caspase-8 activity was exclusively found in compressed muscle of 1D. According to our immunoblot analysis, FoxO3 was significantly reduced in compressed muscles of all groups whereas Beclin-1 was decreased only in 2D. LC3-I was significantly reduced in compressed muscles of all groups while LC3-II was decreased in 2D and 1D. No significant differences were found in the protein abundance of Akt and phospho-Akt in muscles among all groups. CONCLUSION These data demonstrate the opposing responses of apoptosis and autophagy to moderate compression in muscle. Moreover, our findings suggest that cellular changes in apoptosis and autophagy have already taken place in the very early stage in which apparent histopathology has yet to develop in the process of compression-induced muscle pathology.
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Affiliation(s)
- B T Teng
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
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Rich SE, Margolis D, Shardell M, Hawkes WG, Miller RR, Amr S, Baumgarten M. Frequent manual repositioning and incidence of pressure ulcers among bed-bound elderly hip fracture patients. Wound Repair Regen 2011; 19:10-8. [PMID: 21134034 PMCID: PMC3059225 DOI: 10.1111/j.1524-475x.2010.00644.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Frequent manual repositioning is an established part of pressure ulcer prevention, but there is little evidence for its effectiveness. This study examined the association between repositioning and pressure ulcer incidence among bed-bound elderly hip fracture patients, using data from a 2004-2007 cohort study in nine Maryland and Pennsylvania hospitals. Eligible patients (n=269) were age ≥ 65 years, underwent hip fracture surgery, and were bed-bound at index study visits (during the first 5 days of hospitalization). Information about repositioning on the days of index visits was collected from patient charts; study nurses assessed presence of stage 2+ pressure ulcers 2 days later. The association between frequent manual repositioning and pressure ulcer incidence was estimated, adjusting for pressure ulcer risk factors using generalized estimating equations and weighted estimating equations. Patients were frequently repositioned (at least every 2 hours) on only 53% (187/354) of index visit days. New pressure ulcers developed at 12% of visits following frequent repositioning vs. 10% following less frequent repositioning; the incidence rate of pressure ulcers per person-day did not differ between the two groups (incidence rate ratio 1.1, 95% confidence interval 0.5-2.4). No association was found between frequent repositioning of bed-bound patients and lower pressure ulcer incidence, calling into question the allocation of resources for repositioning.
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Affiliation(s)
- Shayna E Rich
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Mak AF, Zhang M, Tam EW. Biomechanics of Pressure Ulcer in Body Tissues Interacting with External Forces during Locomotion. Annu Rev Biomed Eng 2010; 12:29-53. [PMID: 20415590 DOI: 10.1146/annurev-bioeng-070909-105223] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Forces acting on the body via various external surfaces during locomotion are needed to support the body under gravity, control posture, and overcome inertia. Examples include the forces acting on the body via the seating surfaces during wheelchair propulsion, the forces acting on the plantar foot tissues via the insole during gait, and the forces acting on the residual-limb tissues via the prosthetic socket during various movement activities. Excessive exposure to unwarranted stresses at the body-support interfaces could lead to tissue breakdowns commonly known as pressure ulcers, often presented as deep-tissue injuries around bony prominences or as surface damage on the skin. In this article, we review the literature that describes how the involved tissues respond to epidermal loading, taking into account both experimental and computational findings from in vivo and in vitro studies. In particular, we discuss related literature about internal tissue deformation and stresses, microcirculatory responses, and histological, cellular, and molecular observations.
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Affiliation(s)
- Arthur F.T. Mak
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | | | - Eric W.C. Tam
- Department of Health Technology and Informatics, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
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Olesen CG, de Zee M, Rasmussen J. Missing links in pressure ulcer research—An interdisciplinary overview. J Appl Physiol (1985) 2010; 108:1458-64. [DOI: 10.1152/japplphysiol.01006.2009] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This paper surveys the literature on the etiology of sitting-acquired deep tissue pressure ulcers from three different viewpoints. The first viewpoint is identification of risk factors related to seated posture. The second viewpoint focuses on the external factors that can cause necrosis to human cells, such as ischemia and compression. The third viewpoint focuses on computational models of the human buttocks to calculate where stress concentrations occur. Each viewpoint contributes to the understanding of pressure ulcer etiology, but in combination they cover the multiple scales from cell to organism, and the combined insight can provide important information toward a full understanding of the phenomenon. It is concluded that the following three questions must be answered by future research. 1) Does compressive stress alone explain cell death, or is it necessary to consider the full three-dimensional strain tensor in the tissues? 2) How does the change in posture-induced load applied on the human buttocks change the stress distribution in the deep muscle tissue? 3) Is it possible to optimize the seated posture in a computational model to reduce the deeper tissue loads?
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Affiliation(s)
- Christian Gammelgaard Olesen
- Departments of 1Mechanical and Manufacturing Engineering and
- Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mark de Zee
- Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - John Rasmussen
- Departments of 1Mechanical and Manufacturing Engineering and
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