Impact of Diabetic Foot Multidisciplinary Unit on Incidence of Lower-Extremity Amputations by Diabetic Foot

BACKGROUND

One of the most devastating complications of diabetes is diabetes-related foot disease (DFD), which is a priority for public health systems. The 2016-2020 Catalonia Health Plan aimed to reduce the incidence of total and major lower-extremity amputations (LEAs) due to DFD by 10% in the population aged 45-74 years. The aim of the present study was to compare the incidence of LEA-DFD 5 years before and after the creation of the Diabetic Foot Multidisciplinary Unit at our Hospital.

METHODS

We prospectively collected all cases of LEA-DFD performed at Vall d'Hebron University Hospital from 1 January 2016 to 31 December 2020. Cases of LEA-DFD performed from 1 January 2011 to 31 December 2015 were retrospectively reviewed. The incidence of LEA-DFD between these periods was compared.

RESULTS

A total of 457 LEAs due to DFD were performed in 316 patients. We observed a reduction of 27.9% [CI: 23.7-32.1%] in the incidence of total LEA in the 2016-2020 period in comparison with the period 2011-2016 (0.8 ± 0.1 vs. 1.1 ± 0.3 per 10.000 inhabitants/year, p < 0.001), as well as a reduction of 49.3% [CI: 44.6-53.9%] in the incidence of major LEA-DFD (0.15 ± 0.1 vs. 0.30 ± 0.1 per 10.000 inhabitants/year, p < 0.001).

CONCLUSIONS

The implementation of a Diabetic Foot Multidisciplinary Unit resulted in a significant reduction in the rate of amputations due to DFD in the population with diabetes in North Barcelona.

Capturing Interpersonal Synergies in Social Settings: An Example within a Badminton Cooperative Task

In social contexts of racket sports, the interactive behaviour between players in the same team is supported by visual coupling. Visual cues allow the players to dynamically coordinate their movements and maintain a suitable interpersonal distance, thereby decreasing the odds of missing score a point. The dynamic feature of this interpersonal coordination requiring reciprocal nonlinear behavioural adjustments to stabilize a relative position may be considered an interpersonal synergy. We used the Uncontrolled Manifold Hypothesis (UCM) methodology to test this hypothesis and capture interpersonal synergies in badminton doubles. The variability of the distance between players was utilized as a performance variable and the variability of player velocities were used as task-relevant elements. To our knowledge, this is the first study to identify interpersonal synergies in a cooperative task in badminton doubles at different moments within the same rally. Eight male badminton players were randomly assigned in four doubles with similar technical and tactical level. The participants performed 154 trials over two matches. Interpersonal synergies were found on approximately half of the trials examined. Moreover, the results reveal that shortest interpersonal distances create better conditions for the nonlinear adjustments required for interpersonal synergy formation in badminton doubles.

Sport science integration: An evolutionary synthesis

The aim of the paper is to point out one way of integrating the supposedly incommensurate disciplines investigated in sports science. General, common principles can be found among apparently unrelated disciplines when the focus is put on the dynamics of sports-related phenomena. Dynamical systems approaches that have recently changed research in biological and social sciences among others, offer key concepts to create a common pluricontextual language in sport science. This common language, far from being homogenising, offers key synthesis between diverse fields, respecting and enabling the theoretical and experimental pluralism. It forms a softly integrated sports science characterised by a basic dynamic explanatory backbone as well as context-dependent theoretical flexibility. After defining the dynamic integration in living systems, unable to be captured by structural static approaches, we show the commonalities between the diversity of processes existing on different levels and time scales in biological and social entities. We justify our interpretation by drawing on some recent scientific contributions that use the same general principles and concepts, and diverse methods and techniques of data analysis, to study different types of phenomena in diverse disciplines. We show how the introduction of the dynamic framework in sport science has started to blur the boundaries between physiology, biomechanics, psychology, phenomenology and sociology. The advantages and difficulties of sport science integration and its consequences in research are also discussed.

Effects of emphasising opposition and cooperation on collective movement behaviour during football small-sided games

Optimizing collective behaviour helps to increase performance in mutual tasks. In team sports settings, the small-sided games (SSG) have been used as key context tools to stress out the players' awareness about their in-game required behaviours. Research has mostly described these behaviours when confronting teams have the same number of players, disregarding the frequent situations of low and high inequality. This study compared the players' positioning dynamics when manipulating the number of opponents and teammates during professional and amateur football SSG. The participants played 4v3, 4v5 and 4v7 games, where one team was confronted with low-superiority, low- and high-inferiority situations, and their opponents with low-, medium- and high-cooperation situations. Positional data were used to calculate effective playing space and distances from each player to team centroid, opponent team centroid and nearest opponent. Outcomes suggested that increasing the number of opponents in professional teams resulted in moderate/large decrease in approximate entropy (ApEn) values to both distance to team and opponent team centroid (i.e., the variables present higher regularity/predictability pattern). In low-cooperation game scenarios, the ApEn in amateurs' tactical variables presented a moderate/large increase. The professional teams presented an increase in the distance to nearest opponent with the increase of the cooperation level. Increasing the number of opponents was effective to overemphasise the need to use local information in the positioning decision-making process from professionals. Conversely, amateur still rely on external informational feedback. Increasing the cooperation promoted more regularity in spatial organisation in amateurs and emphasise their players' local perceptions.

Scintigraphy, angiography and computed tomography in unilateral hyperlucent lung due to obliterative bronchiolitis

This study examines the value of different imaging methods in assessing the anatomic structures of unilateral hyperlucent lung due to obliterative bronchiolitis. We studied 9 patients, 5 males and 4 females, suffering from UHL (mean age 49 years). Ventilation-perfusion scan (VPS) and computed tomography (CT) of the chest were performed in all, and conventional angiography or digital substraction angiography (DSA) in 7 patients. The VPS showed the characteristic pattern of a matched ventilation-perfusion defect and considerable air trapping during the washout phase. Conventional angiography and DSA displayed a smaller pulmonary artery on the affected side, with a poor peripheral vasculature. CT displayed a loss of lung volume in all cases, with diminished mean attenuation values, a markedly diminished vasculature and integrity of the main airways. In contrast to other imaging modalities, CT imaged bronchiectasis, which was the cause of the patients' clinical symptoms of bronchorrhea and hemoptysis. We conclude that CT of the chest is the most valuable imaging method for evaluating unilateral hyperlucent lung, particularly in symptomatic patients.

CT of primary bilateral adrenal lymphoma

Two cases of bilateral primary adrenal lymphoma are presented. One case had a cystic appearance and the other a homogeneous density.

[CT in radiation enteritis]

The computed tomography findings of 18 patients who had received radiation therapy for pelvic malignancies were reviewed retrospectively. They include bowel wall thickening, mainly in central areas and in contact with anterior abdominal wall, mesenteric thickening, without masses and rectal and presacral space involvement. The differential diagnosis of these findings is discussed.

[The radiologic manifestations of bronchiolitis obliterans]

We reviewed the radiological findings in 19 patients suffering obliterans bronchiolitis, all of whom were classified as idiopathic obliterans bronchiolitis with organizing pneumonia. In most cases, above 80%, X-rays showed alveolar opacities in patches; other less frequent findings were the presence of an interstitial pattern and cavitation (10%). Radiological findings are not specific being most useful in posttreatment patient follow-up.

[Spinal epidural lymphoma. A study using computed tomography]

We have gone through the computerized tomographies (CT) of four cases of spinal epidural lymphomas (SEL) studied in our department. Paraparesis with a sensitive level was the beginning of the disease three times; sciatic pain with recurrent fever once. A myelography followed by CT was done in the three cases of paraparesis while a non-contrast CT and a contrast-enhanced study was done in the case of sciatic pain. An homogeneous intraspinal mass stretching at least along one vertebral segment was the most usual finding. This mass spread into paraspinal tissue effacing fat lines. The mass was hyperdense in relation to dural sack and was limited to intraspinal space in one occasion. We have revised bibliography about osseous lesions in SEL and have found out disagreement on it. We have found them only once in our study. Intrathecal contrast was useless in determining tumour nature but useful in delimiting intraspinal extent. We have searched for tomographic features in order to establish differential diagnosis with other spinal epidural diseases. We did not find any SEL-exclusive features but we found that an homogeneous intra-extraspinal mass, extended at least along one vertebral segment and either producing or not producing osseous lesions can make us think of the presence of spinal epidural lymphoma.