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40 years after deadly quake, chinese seismologists trying to figure out when the big one will strike, At the tangshan earthquake museum well-water levels and abnormal animal behaviors from the field. China uses animals to predict quakes, Chinese scientists are using animals to try to predict when an earthquake may strike a member of staff at hongshan forest zoo, another monitoring site, says animals can be just as effective as specialist technology when trying to predict a quake..
40 years after deadly quake, chinese seismologists trying to figure out when the big one will strike - At the tangshan earthquake museum well-water levels and abnormal animal behaviors from the field. China uses animals to predict quakes - Chinese scientists are using animals to try to predict when an earthquake may strike a member of staff at hongshan forest zoo, another monitoring site, says animals can be just as effective as specialist technology when trying to predict a quake.. New earthquake prediction tools for chinese seismologists: chickens, fish and toads - Believing that by closely monitoring the behavior of barnyard animals, they will be able to successfully forecast earthquakes. The last of the earthquake predictors - In late winter of 1975, a seismologist named cao xianqing tracked a series of small earthquakes near haicheng, china, which he took to presage had boasted that prediction science would soon pay big dividends.
INDIAPOST – The winningest athlete in Olympic history is facing DUI charges for the second time after being arrested early Tuesday in his hometown of Baltimore, where police said he was clocked going nearly 40 mph over the speed limit and was unable to perform a series of field sobriety tests.
INDIAPOST – President Barack Obama has saluted the 2013 Major League Soccer champions Sporting Kansas City. SubscribeEnter your email address below to receive updates each time we publish new content.
INDIAPOST – All India Anna Dravida Munnetra Kazhagam (AIADMK) chief J Jayalalithaa suffered another setback on Wednesday as the vacation bench of the Karnataka High Court adjourned her petition seeking bail till October 7, Zee News reports. Background and Aim: Adiponectin is an adipocytokine secreted from adipose tissue, and plays an important role in type 2 diabetes, obesity, and cardiovascular disease.
Science, Technology and Medicine open access publisher.Publish, read and share novel research. Assessment of Microcirculation and the Prediction of Healing in Diabetic Foot UlcersShapiro Jarrod1 and Nouvong Aksone[1] Western University of Health Sciences, College of Podiatric Medicine, United States of America1.
Diabetic foot ulcers in a multidisciplinary setting: An economic analysis of primary healing and healing with amputation. The use of transcutaneous oxygen tension measurements in the diagnosis of peripheral vascular insufficiency.
Utility of transcutaneous oxygen tension measurements in peripheral arterial occlusive disease.
Skin perfusion pressure in the prediction of healing in diabetic patients with ulcers or gangrene of the foot. Superiority of transcutaneous oximetry in noninvasive vascular diagnosis in patients with diabetes.
2007A review of theclinical significance of tissue hypoxia measurements in lower extremity wound management. The predictability of the success of arterial reconstruction by means of transcutaneous oxygen tension measurements. 1996Transcutaneous oxygen(TcPO2) estimates probability of healing in the ischemic extremity. Percent change in wound area of diabetic foot ulcers over a 4 -week period is a robust predictor of complete healing in a 12-week prospective trial. Skin perfusion pressure of the foot is a good substitute for toe pressure in the assessment of limb ischemia. 2008 Clinical reliability and utility of skin perfusion pressure measurement in ischemic limbs- comparison with other noninvasive diagnostic methods.
2010A review of theclinical significance of tissue hypoxia measurements in lower extremity wound management. Having a fatality rate of up to 90%, the Ebola Virus Disease (also called Ebola Hemorrhagic Fever) is believed to be one of the deadliest virus infection all over the world. This study aimed to estimate the concentration of serum adiponectin in type 1 diabetic children and to establish its association with vascular complications of the disease. The utility of adiponectin and nitric oxide metabolites as biomarkers for prediction and follow-up of vascular complications in children with type 1 diabetes mellitus. Adipocyte-derived plasma protein adiponectin acts as a platelet-derived growth factor-BB-binding protein and regulates growth factor-induced common postreceptor signal in vascular smooth muscle cell. Overexpression of adiponectin receptors potentiates the antiinflammatory action of subeffective dose of globular adiponectin in vascular endothelial cells. Changes in serum adiponectin concentrations and endothelial function after intensive insulin treatment in people with newly diagnosed type 2 diabetes: A pilot study. Correlation between reactive oxygen metabolites and atherosclerotic risk factors in patients with type 2 diabetes mellitus. Changes in plasma nitric oxide metabolites concentration during glucose tolerance test in type 2 diabetic rats. Elevated serum levels of adiponectin in children, adolescents and young adults with type 1 diabetes and the impact of age, gender, body mass index and metabolic control: A longitudinal study. Possible relationship between adiponectin and renal tubular injury in diabetic nephropathy.
Adiponectin-induced endothelial nitric oxide synthase activation and nitric oxide production are mediated by APPL1 in endothelial cells. Adiponectin-induced dilation of isolated porcine retinal arterioles via production of nitric oxide from endothelial cells. A novel role for epidermal growth factor receptor tyrosine kinase and its downstream endoplasmic reticulum stress in cardiac damage and microvascular dysfunction in type 1 diabetes mellitus. Relationship of serum adiponectin with blood lipids, HbA (1) c, and hs-CRP in type II diabetic postmenopausal women. IntroductionGlobally, diabetes mellitus has grown to pandemic proportions, affecting 194 million people worldwide and is expected to increase in prevalence to 344 million by the year 2030 (Wild, et al., 2004). Transcutaneous oxygen pressure (TcPO2) measures excess oxygen diffusion from red blood cells as they pass through the capillary circulation. TcPO2 has a wound healing predictive accuracy of 83% and is unaffected by diabetic status or chronic renal failure (Padberg, et al., 1996). Skin perfusion pressure (SPP) utilizes a laser doppler and pressure cuff to evaluate reactive hyperemia. SPP predicts a 90% healing ability above 30mmHg (Castronuovo, et al., 1997) and has a 100% negative predictive value (Adera, et al. Skin with wounds requires a greater amount of oxygen, without which healing will not occur. Patients are placed supine, and scans are obtained from various areas of the lower extremity, including the wound site. A healing index has been suggested for the use of ulcer healing prediction based on the ratio of oxyhemoglobin to deoxyhemoglobin. Howdieshell, The importance of engraftment in flap revascularization: confirmation by laser speckle perfusion imaging. Pictures can show the horrible symptoms that the victims are suffering; they can also show us why this infection kept on happening which can shed light on the things that can be done to lessen the cases of tragedy. The Ebola outbreak currently affecting West African countries Sierra Leone, Liberia, Guinea and Nigeria is the deadliest Ebola outbreak to have hit the continent.
The pictures that show the suffering victims are shocking, yet when you see the ones that fortunately recover from this disease, you will tear up. However, if proper supportive care is not provided, it can cause internal bleeding and death in just a few weeks. Obama paid tribute to the team Wednesday for winning the MLS trophy 10 months ago in a freezing penalty kick shootout.
Materials and Methods: A total of 25 children with type 1 diabetes were enrolled in the study.
Courtesy of Casa Colina Centers for Rehabilitation Wound Care and Hyperbaric Medicine Program.Table 1.


Of these patients, between 2 and 6% will develop a diabetic foot ulcer (DFU) yearly (Ramsey, et al., 1999). The standard 44 degrees Celsius causes vasodilation and a local reactive hyperthermia (Figures 1 and 2). In reference to the appropriate time to perform lower extremity salvage surgery using TcPO2 measurements after surgical intervention for arterial occlusion, Arroyo et al. SPP measures the pressure at which blood flow first returns to the capillary during the controlled release of occlusive pressure.Method. Hence, both oxygen delivery (measured by oxyhemoglobin) and oxygen extraction (measured by deoxyhemoglobin) into the wounded tissue can function as indicators of a wound’s capacity to heal. Higher levels of both molecules correlate with a greater potential for healing (Khaodhiar, et al., 2007). In this technique a laser illuminates an area of tissue which produces a backscattered light. The onset of a DFU often precipitates a complex chain of events that may lead to limb loss.
A laser sensor is placed on the desired location while a pressure cuff is placed at the ankle. In patients with critical limb ischemia SPP was 80% accurate in diagnosing this condition (Castronuovo, et al., 1997). This is done with the use of hyperspectral imaging (CombiVu-R System, HyperMed, Waltham, MA) which uses a spectral separator to vary the wavelength of light admitted to a detector. An approximately 30 second scan is obtained at a 12 inch distance from the site in question. This light forms a pattern of light and dark areas called a speckle pattern (Draijer, et al. The diabetic patients were classified into pre-pubertal and pubertal groups, and according to gender, into male and female groups. Infected DFUs account for 20% of hospital visits for this patient population (Bouter, et al. This reduction is proportional to the number of oxygen molecules (Mathieu and Mani 2007) and is measured as oxygen pressure. The cuff is inflated until occlusion of the arterial flow to the extremity occurs and is then released. Similarly, Faris and colleagues found SPP was useful in predicting healing of ulcers or gangrene of the feet in 35 of 40 diabetic patients with levels above 40mmHg.
Red blood cells in the skin are struck with this variable light which is reflected back toward the detector.
A thicker border surrounding the wound decreases the ability of HSI to discriminate well from poorly vascularized tissues. Results: The results obtained showed a significant elevation in the serum adiponectin value in diabetic children compared to control.
1993) and precede roughly 85% of lower extremity amputations in patients with diabetes (Pecoraro, et al.
Common locations of measurement include the dorsum of the foot, anteromedial calf approximately 10 cm below the patella, and the thigh 10 cm above the patella. In regards to predicting amputation healing Katsamouris and colleagues found that a level of 40mmHg at the anterior skin surface was predictive of successful healing after partial foot and lower leg amputations (Katsamouris, et al. As arteriolar flow is restored and the subsequent reactive hyperemia occurs, the laser sensor reads the resulting arteriolar pressures.Interpretation of Findings. Since the wavelengths of light absorbed and emitted by oxygenated red blood cells (RBCs with oxyhemoglobin) differs by that emitted by deoxygenated red blood cells (RBCs with deoxyhemoglobin) the machine is able to detect the respective levels of these molecules with a high level of accuracy (Gillies, et al 2004, Greenman, et al.
Oxyhemoglobin levels are associated with varying colors while deoxyhemoglobin is demonstrated by varying levels of brightness.
Sheehan and colleagues in their study of clinical healing indicators found a 91% sensitivity, 58% specificity, 58% positive predictive value, and 91% negative predictive value using the percent change in area over a four week time period to predict ulcer healing (Sheehan, et al., 2006).
In 2007 a new device, the Full-Field Laser Perfusion Imager (FLPI) (Moor Instruments, Essex, UK), was released for commercial use (McGuire & Howdieshell, 2010). Serum adiponectin level showed a highly significant increase in patients with diabetic nephropathy and neuropathy than those without the complications.
The subclavicular region is often used as a reference point due to its close anatomic location to coronary perfusion and low likelihood of arterial insufficiency. Skin perfusion pressures greater than 40mmHg are considered non-ischemic while marginal ischemia is noted between 30 and 40mmHg. This device images skin to a depth no greater than 1 mm and results in images of blood flow within the skin (McGuire and Howdieshell 2010). On the other hand, no significant increase in serum adiponectin was observed in patients with retinopathy compared to those without retinopathy. The long-term outcome for a diabetic patient after a major limb amputation is grave with 50% of these patients deceased at 5 years (Moulik, et al. Pressure measurements may be enhanced by having the patient exercise, increasing the metabolic demand and need for oxygen. Similarly, Ballard and colleagues successfully used TcPO2 measurements to determine the severity of foot ischemia and guide treatment. The data is then compared using a computer with standardized data for these molecules, and an image is provided with a color bar legend for comparison, and colored scans are used to demonstrate levels of oxygenation (Gilles, et al. Future directions for microcirculation testingThe assessment of microangiopathic disease is a new science with early clinical applications. Serum nitric acid metabolites showed a significant reduction in type 1 diabetes children compared to the control group.
Placing the leg in a dependent position additionally augments oxygenation, providing further information about the arterial reserves available. Additionally, since the results are not affected by sclerosis of the tunica media of arteries this is a viable test in patients with diabetes and renal disease (Hauser, et al.
The limitations of SPP are that it provides data regarding the limited area of skin under the sensor.
As new technologies are developed physicians will increasingly be able to extract information about the vascular status of potentially ischemic areas while providing a greater understanding of the pathophysiology of the diabetic lower extremity. This new technology is advantageous in providing real-time video images of microvascular blood flow (Thompson and Andrews 2010) and represents the potential future ability to view the dynamic microvascular environment within the skin. A negative significant correlation was found between serum adiponectin and serum nitric acid metabolites levels, and a positive significant correlation was detected between serum adiponectin and random blood glucose, HbA1C, urinary microalbuminuria, blood urea nitrogen, creatinine, total cholesterol, and LDL in the same patients.
Additionally, the cost to treat this disease places a significant strain on the health-care system. TcPO2 measurement may also be performed in patients in which arterial claudication is suspected. Multiple separate readings are necessary to obtain a global understanding of pedal microvasculature.
The cost to manage these foot disorders is estimated at several billion dollars annually (Wild, et al. As with the above mentioned studies, this group also found a threshold of 40mmHg as predictive of healing ulceration or gangrene but with a slightly lower sensitivity and specificity (72% and 88%, respectively) (Yamada, et al. 2004), while the individual cost of a major limb amputation is estimated at almost $45,000 (Apelqvist, et al. However, when stress is applied to the extremity, oxygen demands increase and exceed the oxygen supplied by the now insufficient arterial flow (Franzeck, et al.
The study included all patients who met the criteria of type 1 diabetes, [2] with age of 18 years or less, and the parents of such patients accepted the participation in the study through written consents. TcPO2 cannot be measured under certain physical conditions (edema, dry flaky skin, maceration, callused or plantar skin, cellulitis, or skin over bones and tendons) (Dooley, et al.


In 85 limbs of 71 patients referred to a vascular laboratory, skin perfusion pressure measurement was found to correlate closely with toe pressure measurements (Tsai, et al. We excluded from the study patients with type 1 diabetes who were receiving any medications other than insulin and those with the duration of diabetes less than one year; this was because serum adiponectin level is not elevated in children with type 1 diabetes except after more than 6 months. With the combination of excessive cost to treat diabetes complications coupled with the major detrimental health effects on individual patients, it is necessary to develop and employ new technological methods to predict healing of diabetic foot ulcers.Once a diabetic patient develops a pedal ulceration it becomes incumbent on the physician to evaluate the ulcer’s healing potential. To test this, transcutaneous oxygen tension measurements may be performed while the patient exercises.
It is also important to consider that resting TcPO2 measurement is more likely to diagnose disease in more severe occlusions due to the lack of metabolic demand when the patient is at rest during the examination. This is a significant benefit in certain circumstances since it may be impractical to determine toe pressures due to the commonality of wounds on the toes.6. The examination included neurological (motor and sensory) and fundus examination in addition to a complete cardiac and peripheral vascular examination. Clinically, it has been shown that a 50% decrease in area over a 4-week period with standard wound care adequately predicts ulcer healing at 12 weeks (Sheehan, et al., 2006). Since the electrode probe is placed on intact adjacent skin rather than directly on the wound itself this method does not measure oxygen tension within the wound. Laboratory investigations included random blood glucose, measurement of mean HbA1c percentage (HbA1c%) using quantitative calorimetric determination of glycohemoglobin in whole blood, measurement of blood urea nitrogen and serum creatinine, quantitative determination of urinary microalbuminuria using morning urine samples, serum total cholesterol, high-density lipoprotein (HDL - Cholesterol), and low-density lipoprotein (LDL - Cholesterol) were also measured in addition to NOx. The disadvantage of this method, however, is the delay in treatment that occurs as a result of the natural time deferment in this process. The need to warm the extremity causes temperature differences between sites and subjects leading to false readings. As such, newer technologies have utilized the determination of microcirculation to predict ulcer healing. They found TcPO2 to have a sensitivity of 100% following exercise but falling to 77% at rest (Byrne, et al.
TcPO2 is reliable in the normal but not in the low range, resulting in a high false positive rate for critical limb ischemia (Byrne, et al. This chapter focuses on the application of these new technologies to determine microvascular circulation and predict diabetic foot ulcer healing.
Large artery (macrocirculatory) disease has been well documented elsewhere with disease at the infrapopliteal region (Bembi, et al. Pearson and Spearman's correlation test were used to correlate each parameter with different variants in the same group to differentiate between positive and negative correlations and to find significant difference. Additionally, a significant amount of time is necessary to obtain pressure measurements with calibration, sensor maintenance and skin preparation delaying a reliable reading upwards of 45 minutes. Comparison of clinical characteristics of the groups was done using Analysis of Variance (ANOVA) test.
Various noninvasive vascular testing modalities exist to determine large vessel luminal disease. These include dual mode ultrasound, segmental leg pressures, ankle brachial indices, pulse volume recordings, toe pressures, and toe brachial indices. The above tests have been found to yield useful clinical data regarding large vessel disease and often function as safe precursors to more advanced imaging techniques such as magnetic resonance arteriography. At the same time, the random blood glucose, HbA1c%, and microalbuminuria levels were significantly higher in pubertal diabetic patients, while NOx was significantly lower in this patient group. According to [Table 4], no significant difference was noticed between diabetic children with and without retinopathy with regard to serum adiponectin levels. Peripheral arterial disease and the pathophysiology of microvascular disease in diabetesThe pathogenesis of macrocirculatory disease has been discussed in depth elsewhere. These microvessels are arranged in two horizontal network patterns with a superficial subpapillary plexus and a deeper cutaneous plexus with capillary blood flow providing nutrition and arteriovenous shunts that serve a thermoregulatory function (Chao & Cheing, 2009). The nutritional capillaries are organized into functional units within the papillary layer of the dermis. A precapillary sphincter is situated just upstream of the capillary which controls vasodilation and constriction (LaFontaine, et al., 2006).
This result could be explained by variation in adiponectin concentration by the differences in fat distribution and function between diabetic and non-diabetic individuals. Arteriovenous anastomoses exist between the arterioles and venules to allow normal shunting of blood under physiologic conditions. This endothelium lies on a basement membrane which is normally thicker in the foot than other body locations due to the increased hydrostatic pressure associated with stance (LaFontaine, et al., 2006). Bottner and Mantzoros [18] agreed with this finding, adding that adiponectin levels decrease significantly in boys than girls in healthy children and adolescents, and also at the end of puberty. Additionally, the endothelial basement membrane regulates blood flow and the local inflammatory response via vasoactive substances (Guerci, et al. 2001).The pathogenesis of microvascular disease in diabetics is complex and multifactorial.
The hemodynamic hypothesis of microangiopathic disease was first described by Parving, et al (Parving, et al. Blood flow dysregulation, caused by neuropathic changes to the sympathetic nerve fibers, is mediated by hyperglycemia.
The resulting stimulation of the polyol pathway decreases nitric oxide production, increasing blood flow and capillary pressure. This increased pressure leads to thickening of the basement membrane which resists vasodilation and increases capillary permeability with ensuing chronic edema.A second mechanism that has gained experimental support is the “capillary steal syndrome” (Uccioli, et al.
In agreement with these findings, various studies approved that numerous mechanisms are involved in the development of microvascular problems in patients with diabetes, which can lead to endothelial dysfunction as, decreasing the production of endogenous vasodilators such as nitric oxide (NO), with subsequent reduction in NOx in addition to the release of endogenous vasoconstrictors such as endothelin-1 or angiotensin II. This is thought to result from sympathetic denervation with chronic vasodilation, resulting in an increased blood flow through the arteriovenous shunt away from the arterioles in the papillary dermis. As blood moves more rapidly toward the postcapillary venule, nutrition, metabolite, and oxygen exchange are significantly reduced (Boulton, et al, 1982). It is unknown which pathway is dominant or if another mechanism is responsible, though there is most likely a combination of both pathogenic pathways that end with functional ischemia, reduced nutritional capacity, and increased metabolic end products that function together to limit healing capacity in the face of skin ulceration.3. Current methods to assess healing potential in diabetic foot ulcersLarge vessel disease is evaluated through several noninvasive methods including dual mode ultrasound, segmental leg pressures, ankle brachial indices, pulse volume recordings, toe pressures, toe brachial indices, magnetic resonance angiography, and computed tomographic angiography. However, these modalities only characterize blockages of large arteries and do not assist with prediction of direct wound healing on the lower extremity. Contemporary microvascular technologies utilize the above pathogenic principles to evaluate microangiopathic changes and predict ulcer healing. The following discussion will review the currently available methods to clinically assess microvascular blood flow and predict the healing potential of diabetic foot ulcers.4. This was in accordance with the findings of other investigators, who correlated low NOx levels with endothelial dysfunction and suggested it to be a common link of all cardiovascular risk factors.
As adiponectin possesses anti-inflammatory effects, the increase in its levels in diabetic children with endothelial dysfunction may serve as a modulator for macrophage foam cell formation in addition to the suppression of the adherence of monocytes to human endothelial cells, which seems to act as an endogenous regulator for endothelial cells in response to inflammatory diseases to counteract the development of microangiopathy and macroangiopathy. In conclusion, in type 1 diabetes, adiponectin may be enhanced and acts as a physiological counter regulatory response to diminish endothelial and vascular damage and reduction in serum NOx was verified to be correlated with endothelial dysfunction and vascular complications.
Thus, regular estimation of adiponectin with NOx may be a useful biomarker for early prediction and follow-up of diabetic vascular complications. However, the disease-specific association of adiponectin with macrovascular complications as coronary artery diseases and peripheral artery disease in type 1 diabetic patients has to be evaluated with more studies.



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