scholarly journals The Role of Cutaneous Microcirculatory Responses in Tissue Injury, Inflammation and Repair at the Foot in Diabetes

2021 ◽  
Vol 9 ◽  
Author(s):  
Gayathri Victoria Balasubramanian ◽  
Nachiappan Chockalingam ◽  
Roozbeh Naemi
Keyword(s):  
Blood Flow ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Applied Pressure ◽  
Skin Perfusion ◽  
Increased Risk ◽  
Microcirculatory Function

Diabetic foot syndrome is one of the most costly complications of diabetes. Damage to the soft tissue structure is one of the primary causes of diabetic foot ulcers and most of the current literature focuses on factors such as neuropathy and excessive load. Although the role of blood supply has been reported in the context of macro-circulation, soft tissue damage and its healing in the context of skin microcirculation have not been adequately investigated. Previous research suggested that certain microcirculatory responses protect the skin and their impairment may contribute to increased risk for occlusive and ischemic injuries to the foot. The purpose of this narrative review was to explore and establish the possible link between impairment in skin perfusion and the chain of events that leads to ulceration, considering the interaction with other more established ulceration factors. This review highlights some of the key skin microcirculatory functions in response to various stimuli. The microcirculatory responses observed in the form of altered skin blood flow are divided into three categories based on the type of stimuli including occlusion, pressure and temperature. Studies on the three categories were reviewed including: the microcirculatory response to occlusive ischemia or Post-Occlusive Reactive Hyperaemia (PORH); the microcirculatory response to locally applied pressure such as Pressure-Induced Vasodilation (PIV); and the interplay between microcirculation and skin temperature and the microcirculatory responses to thermal stimuli such as reduced/increased blood flow due to cooling/heating. This review highlights how microcirculatory responses protect the skin and the plantar soft tissues and their plausible dysfunction in people with diabetes. Whilst discussing the link between impairment in skin perfusion as a result of altered microcirculatory response, the review describes the chain of events that leads to ulceration. A thorough understanding of the microcirculatory function and its impaired reactive mechanisms is provided, which allows an understanding of the interaction between functional disturbances of microcirculation and other more established factors for foot ulceration.

scholarly journals Occlusion Effect in Response to Stimulation by Soft Tissue Conduction-Implications

2020 ◽  
Vol 10 (2) ◽  
pp. 69-76
Author(s):  
Miriam Geal-Dor ◽  
Cahtia Adelman ◽  
Shai Chordekar ◽  
Haim Sohmer
Keyword(s):  
Blood Flow ◽  
Soft Tissue ◽  
Inner Ear ◽  
Statistical Difference ◽  
Soft Tissues ◽  
Bone Conduction ◽  
External Canal ◽  
Pure Tones ◽  
Occlusion Effect ◽  
Insight Into

To gain insight into the broader implications of the occlusion effect (OE—difference between unoccluded and occluded external canal thresholds), the OE in response to pure tones at 0.5, 1.0, 2.0 and 4.0 kHz to two bone conduction sites (mastoid and forehead) and two soft tissue conduction (STC) sites (under the chin and at the neck) were assessed. The OE was present at the soft tissue sites and at the bone conduction sites, with no statistical difference between them. The OE was significantly greater at lower frequencies, and negligible at higher frequencies. It seems that the vibrations induced in the soft tissues (STC) during stimulation at the soft tissue sites are conducted not only to the inner ear and elicit hearing, but also reach the walls of the external canal and initiate air pressures in the occluded canal which drive the tympanic membrane and excite the inner ear, leading to hearing. Use of a stethoscope by the internist to hear intrinsic body sounds (heartbeat, blood flow) serves as a clear demonstration of STC and its relation to hearing.

The Role of Hyaluronic Acid in the Correction of Soft Tissue Deficiencies: Review and Clinical Considerations

2015 ◽  
Vol 638 ◽  
pp. 270-273
Author(s):  
Andrei Carantino
Keyword(s):  
Hyaluronic Acid ◽  
Soft Tissue ◽  
Soft Tissues ◽  
Years Of Experience ◽  
Clinical Considerations ◽  
Surgical Operations

This paper presents some aspects from last 10 years of experience, when we used the hyaluronic acid produced and traded by a certain company, to obtain aesthetic good results in the treatment of the facial wrinkles, nazolabial folds, augmentation of the lips, face rejuvenation and hydration, correction of soft tissues deficiencies after major surgical operations.

Antibiotic Resistance in Diabetic Foot Soft Tissue Infections: A Series From Greece

2017 ◽  
Vol 16 (4) ◽  
pp. 255-259 ◽  
Author(s):  
Maria Demetriou ◽  
Nikolaos Papanas ◽  
Periklis Panagopoulos ◽  
Maria Panopoulou ◽  
Efstratios Maltezos
Keyword(s):  
Antibiotic Resistance ◽  
Soft Tissue ◽  
Diabetic Foot ◽  
Soft Tissues ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Soft Tissue Infections ◽  
Diabetic Foot Infections ◽  
Initial Choice ◽  
Gram Positive Cocci

Diabetic foot infections are a common and serious problem for all health systems worldwide. The aim of this study was to examine the resistance to antibiotics of microorganisms isolated from infected soft tissues of diabetic foot ulcers, using tissue cultures. We included 113 consecutive patients (70 men, 43 women) with a mean age of 66.4 ± 11.2 years and a mean diabetes duration of 14.4 ± 7.6 years presenting with diabetic foot soft tissue infections. Generally, no high antibiotic resistance was observed. Piperacillin-tazobactam exhibited the lowest resistance in Pseudomonas, as well as in the other Gram-negative pathogens. In methicillin-resistant Staphylococcus aureus isolates, there was no resistance to anti-Staphylococcus agents. Of note, clindamycin, erythromycin, and amoxycillin/clavulanic acid exhibited high resistance in Gram-positive cocci. These results suggest that antibiotic resistance in infected diabetic foot ulcers in our area is not high and they are anticipated to prove potentially useful in the initial choice of antibiotic regimen.

scholarly journals Staged Subtalar Fusion for Severe Calcaneus Fractures with Bone Loss

2013 ◽  
Vol 7 (1) ◽  
pp. 614-618 ◽  
Author(s):  
Chad G. Williams ◽  
Michael J. Coffey ◽  
Peter Shorten ◽  
James D. Lyions ◽  
Richard T. Laughlin
Keyword(s):  
Soft Tissue ◽  
Bone Loss ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
High Energy ◽  
Fusion Procedure ◽  
Subtalar Fusion ◽  
Thorough Debridement ◽  
Calcaneus Fractures

Background: With high energy fractures to the calcaneus there is the potential for significant bone loss. The loss of bone can make it difficult to fully regain calcaneal alignment. In addition these fractures are often associated with significant soft tissue injury. These two factors make it difficult to address this injury in a single stage, and can have significant complications. To address these issues our initial goal in treatment has been restoration of calcaneal alignment and stabilization of the surrounding soft tissue, followed by delayed/staged subtalar arthrodesis. Methods: Patients with calcaneus fractures treated by a single surgeon from 2002 to 2012 were reviewed. Injuries which were found to have medial extrusion of the posterior facet and bone loss, and subsequently underwent a staged protocol involving early provisional fixation and late subtalar fusion were included. Results: We treated 6 calcaneus fractures with bone loss. All patients were treated with staged subtalar fusion after initial irrigation and debridement and provisional fixation. No soft-tissue complications were noted after the fusion procedure in any of the six cases. Fusion occurred in all six patients at an average of 20.6 weeks (range, 13-23 weeks). All patients were able to ambulate and wear a regular shoe by one year following the initial injury. Conclusion: It is important in the high energy calcaneus fracture to assess for both soft tissue integrity and bone loss. A thorough debridement of both the soft tissues and any devitalized bone should be performed as well as provisional fixation which attempts to restore near normal calcaneal anatomy. Definitive fusion should not be performed until the soft tissues have fully recovered.

scholarly journals Intra- and interobserver agreement on the Oestern and Tscherne classification of soft tissue injury in periarticular lower-limb closed fractures

2014 ◽  
pp. 173-178 ◽  
Author(s):  
Carlos Oliver Valderrama-Molina ◽  
Mauricio Estrada-Castrillón ◽  
Jorge Andres Hincapie ◽  
Luz Helena Lugo-Agudelo
Keyword(s):  
Soft Tissue ◽  
Tibial Plateau ◽  
Interobserver Agreement ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Soft Tissue Injury ◽  
Case Series ◽  
Lower Extremities ◽  
Tibial Pilon ◽  
Pilon Fractures

Background: The soft tissues injury in periarticular fractures of the lower extremities determines the proper time to perform bone fixation. Objetive: The aim of this study was to determine the intra and interobserver agreement in the Tscherne classification. Methods: This is a descriptive, prospective study for patients admitted to the Pablo Tobón Uribe Hospital (PTUH) with tibial plateau or tibial pilon fractures. We performed a standardize evaluation using video photography at the time of admission and 24, 48, and 72 h after admission. Fifteen five reviewers who had various levels of training produced a total of 1,200 observations. The intra- and interobserver agreement was assessed using a weighted kappa for multiple raters and more than two categories. Results: Twenty patients were admitted with tibial plateau and tibial pilon fractures. The intraobserver agreement for all 15 raters was kappa 0.81 (95% CI 0.79-0.83), and the interobserver agreement for all 15 raters was kappa 0.65 (95% CI 0.55-0.73). The interobserver agreement at 24 h was kappa 0.67 (95% CI 0.46-0.86). Conclusions:Classifying the severity of soft tissue injury is critical in planning the surgical management of fractures of the lower extremities. Based on our results, we can reasonably argue that the Tscherne classification produced an adequate level of agreement and could be used to standardize and to guide the treatment, and to conduct research studies. Level of Evidence: Level IV, Case Series

scholarly journals JNK Signaling as a Key Modulator of Soft Connective Tissue Physiology, Pathology, and Healing

2020 ◽  
Vol 21 (3) ◽  
pp. 1015 ◽  
Author(s):  
Georgia Nikoloudaki ◽  
Sarah Brooks ◽  
Alexander P. Peidl ◽  
Dylan Tinney ◽  
Douglas W. Hamilton
Keyword(s):  
Wound Healing ◽  
Soft Tissue ◽  
Cell Biology ◽  
Soft Tissues ◽  
Tissue Injury ◽  
Cell Types ◽  
Cell Phenotype ◽  
Cell Behavior ◽  
Molecular Processes ◽  
Different Cell Types

In healthy individuals, the healing of soft tissues such as skin after pathological insult or post injury follows a relatively predictable and defined series of cell and molecular processes to restore tissue architecture and function(s). Healing progresses through the phases of hemostasis, inflammation, proliferation, remodeling, and concomitant with re-epithelialization restores barrier function. Soft tissue healing is achieved through the spatiotemporal interplay of multiple different cell types including neutrophils, monocytes/macrophages, fibroblasts, endothelial cells/pericytes, and keratinocytes. Expressed in most cell types, c-Jun N-terminal kinases (JNK) are signaling molecules associated with the regulation of several cellular processes involved in soft tissue wound healing and in response to cellular stress. A member of the mitogen-activated protein kinase family (MAPK), JNKs have been implicated in the regulation of inflammatory cell phenotype, as well as fibroblast, stem/progenitor cell, and epithelial cell biology. In this review, we discuss our understanding of JNKs in the regulation of cell behaviors related to tissue injury, pathology, and wound healing of soft tissues. Using models as diverse as Drosophila, mice, rats, as well as human tissues, research is now defining important, but sometimes conflicting roles for JNKs in the regulation of multiple molecular processes in multiple different cell types central to wound healing processes. In this review, we focus specifically on the role of JNKs in the regulation of cell behavior in the healing of skin, cornea, tendon, gingiva, and dental pulp tissues. We conclude that while parallels can be drawn between some JNK activities and the control of cell behavior in healing, the roles of JNK can also be very specific modes of action depending on the tissue and the phase of healing.

The Role of Biology in the Fossilization of Embryos and Other Soft-Bodied Organisms: Microbial Biofilms and Lagerstätten

2014 ◽  
Vol 20 ◽  
pp. 83-100
Author(s):  
Rudolf A. Raff ◽  
Elizabeth C. Raff
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
Active Role ◽  
Microbial Interactions ◽  
Skin Texture ◽  
Microbial Biofilms ◽  
Insect Wings ◽  
Large Animals ◽  
Simple Systems

Soft-tissue fossils are among the most striking and informative remains of extinct organisms. Although relatively rare, they are diverse, ranging from single microbial cells to nuclei and chromosomes; algae; metazoan embryos and larvae; flowers; complete, small, soft-bodied metazoans, metazoan tissues; integumentary structures such as melanosomes; skin texture, vertebrate feathers and hair, insect wings with color patterns, and sometimes even the entire bodies of large animals. The susceptibility of newly dead soft tissues to physical destruction, consumption, and microbial decay makes their preservation unlikely under most taphonomic conditions. In addition, their vulnerability to rapid autolysis, bioturbation, and destructive physical processes requires that rapid biological events must occur as the critical first steps of fossilization. An understanding of the processes by which biological remains enter the fossil record is important in inferring what non-microbial and microbial processes were operative in Lagerstätten. Paleontologists have recognized that microbial biofilms often accompany soft-tissue fossils, and have suggested that bacteria play an active role in soft tissue fossilization, but that role must be determined experimentally with living bacteria and dead tissue.Marine embryos and marine bacteria are used to investigate the processes that mediate early steps in soft-tissue preservation because they offer simple systems for laboratory investigation of the roles of autolysis-blocking environments, microbial interactions, biofilm formation, and authigenic mineralization in taphonomy. Understanding microbially mediated preservation of embryos may supply new insights into a more general biology of fossilization.

scholarly journals The role of obesity and adipokines in coronary microvascular dysfunction: a systematic review and meta-analysis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
M Spezia ◽  
A Bonato ◽  
G De Fortunato ◽  
A Bossi ◽  
M Glauber
Keyword(s):  
Systematic Review ◽  
Blood Flow ◽  
Coronary Flow ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Cochrane Library ◽  
Flow Reserve ◽  
Increased Risk ◽  
Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with obesity present structural and functional changes in the heart and in the coronary circulation, which ultimately leads to an increased risk of cardiovascular disease. Obesity is associated with a low chronic state of inflammation which seems to be linked to a compromised coronary vasoreactivity, which is shown to be a forerunner and a long-term predictor of clinically relevant cardiovascular events. Methods A systematic review was performed by searching PubMed, Embase and Cochrane Library database. Selection criteria were applied leading to the inclusion of studies of any level of evidence published in peer-reviewed journals reporting clinical or preclinical results. Relative data were extracted and critically analysed. PRISMA guidelines were applied and risk of bias was assessed, as well as the methodological quality of the included studies. After this assessment, we excluded all the articles with serious risk of bias and/or low quality. Meta-analysis was conducted on the data collected regarding coronary blood flow (CFR) and hyperemic myocardial blood flow (MBF), while for the other parameters a descriptive analysis was performed. Results After applying the described criteria, we included 15 articles on human and animal literature assessed as medium or high quality. The data of 1399 patients were examined, 456 of which with obesity (BMI ≥ 30). A pooled effect size analysis shows that coronary flow reserve (CFR) is significantly reduced in patients with obesity [Random Effect (RE): -47.7%, 95% confidence interval (CI) -80.2% – -15.2%; n = 422]. Increased BMI is associated with reduced CFR. The same trend is found evaluating pharmacological induced stress MBF, which was reduced in patients with obesity [RE: -47.8%, 95% CI -73.7% – -21.8%; n = 409]. Nevertheless, MBF at rest did not show a significant difference in patients with obesity from our analysis [RE: 15%, 95% CI -24% - 53%; n = 409]. Pro-inflammatory adipokines secretion, as leptin and CRP, seems to correlate with a significant decrease of stress-induced MBF and reduced CFR. Conclusions Obesity is associated with a significant higher risk of coronary microvascular disfunction, which is reflected by diminished CFR and stress MBF. Systemic inflammation and the imbalance of adipokines related to obesity has been closely linked to a blunt coronary flow. CMD is a pre-clinical heart conditions that often remains undiagnosed. Further evidence is required to clear out the role of Obesity from a molecular point of view on the coronary endothelium.

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