Use of homologous platelet gel to manage refractory diabetic lower extremity ulcers: additional experience at a tertiary hospital.

BACKGROUND: DLEUs are a major cause of morbidity. Appropriate treatment is essential, and newer methods to achieve ulcer healing have been described, including application of PG. OBJECTIVE: This study evaluated the effectiveness and safety of homologous PG in patients with chronic noninfected DLEU refractory to standard treatment as well as possible correlations between patient comorbidities and response to treatment. MATERIALS AND METHODS: Data from patients with chronic refractory DLEU managed with homologous PG between January 2014 and October 2022 were evaluated (comorbidities, wound characteristics, number and time of treatment, outcome). Outcome was classified as complete response (complete ulcer healing with reepithelialization), partial response (≥50% reduction in area and/or improvement of pain), or absence of response. The chi-square test was used to compare groups, with alpha level set at less than .05. RESULTS: A total of 81 patients (63 male, 18 female; median age, 65 years; median HbA1c, 7.6%; median ulcer area, 2.9 cm2) were proposed for PG application. A total of 62 patients had 3 or more comorbidities. Outcome was evaluated in 69 patients, with response observed in 49% (complete, 32%; partial, 17%). Worse outcomes occurred in patients with polyneuropathy (chi-square statistic: 4.183; P = .041). CONCLUSION: Homologous PG is a safe and possibly effective therapeutic alternative for DLEU that is unresponsive to standard therapies.

Testing the concurrent validity and reliability of a lipowise digital skinfold caliper to assess muscle mass in healthy young adults.

The aim of this study was to assess the validity and reliability of a novel tool to assess skinfolds and to compare the muscle mass measured through dual-x-ray-absorptiometry (DXA) and estimated using the Lee equation from the values of the skinfolds and girths in a healthy young adult population. Methods: The present study followed a cross-sectional design, including 38 participants, with 27 males (22.04 ± 5.20 years) and 11 females (21.55 ± 2.39 years). The measurement protocol included a DXA evaluation, basic measurements of body mass and stature, eight skinfolds with two skinfold calipers of different brands (Harpenden and Lipowise), and three girths. The order in which the skinfold calipers were used was randomized. The muscle mass was then calculated using the formula established by Lee et al. Results: No significant differences were found between the two skinfold calipers considering all the outcomes (p > 0.05). The correlation coefficients were between 0.724 and 0.991, which suggest very-large to nearly perfect correlations. The correlations performed revealed that muscle mass estimated from DXA is nearly perfectly correlated with both muscle mass estimated from the data obtained with the Harpenden skinfold caliper (r = 0.955) and muscle mass estimated from the data obtained with the Lipowise skinfold caliper (r = 0.954). From the results, we conclude that Lipowise caliper is an accurate skinfold caliper and it can be an alternative tool for the technician that need to assess body fat or muscle mass in precise, valid and time efficient evaluation. It should be noted that the caution to use skinfold calipers interchangeable with each other when evaluating skinfolds remains a necessity and is advisable to perform the measurements with the same brand and model of skinfold caliper when the purpose is to perform follow-up assessments.

Recycling of polypropylene by supercritical carbon dioxide for extraction of contaminants from beverage cups. A comparison with polyethylene terephthalate and polylactic acid.

BACKGROUND: EU policies towards a circular economy address plastic packaging as one of the significant concerns and sets ambitious recycling targets. Polyolefins (POs) cannot be recycled for food contact using conventional polyethylene terephthalate (PET) recycling approaches. Thermal degradation prevents the use of high temperatures and, consequently, decontamination of POs may be insufficient when using lower temperatures. Polypropylene (PP) beverage cups were decontaminated using supercritical fluid extraction with carbon dioxide (scCO2 ). Decontamination efficiencies (DEs) of selected markers were determined in challenge tests following European Food Safety Authority guidelines. The effects of time (10-60 min) for PET, polylactic acid (PLA), and PP and temperature (60-80 °C) for PP were studied at constant pressure. The physical properties, sensorial properties, and overall migration of treated scCO2 PP were analysed and compared with virgin PP. RESULTS: PP showed the highest average DE, and PET the lowest, for all the surrogates and in all time conditions. A relative increase in the DE with the increase in process time, particularly for PET and to some extent for PLA, was seen. For PP, no significant impact of time and temperature was observed under the conditions tested. The DE of volatile surrogates was higher than that of semi-volatiles. Results indicate that the scCO2 treatment did not affect the physical and sensorial properties, nor the overall migration of PP, although it contributes to a considerable reduction in extractable n < C24 alkanes. CONCLUSIONS: Results indicate that scCO2 can be used to decontaminate post-consumption PP beverage cups with higher DEs than those for PET and PLA, applying mild processing conditions. © 2022 Society of Chemical Industry.

Variations of Trail Runner's Fitness Measures across a Season and Relationships with Workload.

Trail running involves off-road running over different surfaces of positive and negative unevenness. Given these particularities and the associated physical demands, it is essential to understand this relationship and how fitness levels influence performance. This study aimed to analyze fitness level variations during different times of the season and establish a relationship between changes in fitness levels and accumulated load. Twenty-five trail running athletes (age: 36.23 ± 8.30 years) were monitored over 52 weeks. Three periods of assessment were implemented, while load between those periods was calculated. Athletes were monitored daily by global positioning systems. The collected data included distance covered, duration, and rate of perceived exertion (RPE), which were used to obtain session-RPE. Additionally, maximal aerobic speed, vertical jump, and dynamic balance were tested periodically. Moderate inverse correlations were found between assessment 1 and 2 for total sRPE and vertical jump: countermovement jump (VJ: CMJ) (r = -0.349), and Y balance test: left posterolateral (YBT: LPL) (r = -0.494). Similar correlations were found between assessment 2 and 3 for total sRPE and VJ: CMJ (r = -0.397), and vertical jump: drop jump (VJ: DJ) (r = -0.395). The results suggest that trail running coaches should monitor and assess dose-response relationships and possible anterior asymmetries of dynamic balance performance.

Running-related injuries in Portuguese trail runners: a retrospective cohort study.

BACKGROUND: The purpose of this study was to characterize trail running injuries within a cohort of Portuguese male and female recreational trail running athletes. METHODS: The study was retrospective (12 months), with data collected through an online survey. A total of 719 athletes participated (529 male and 190 female, average age: 38.01±7.78 years). A valid questionnaire was used to collect: 1) demographic information; 2) general information; 3) training typology; 4) physical information; 5) injuries (body location, number, type, reason, treatment, time without practice); and 6) general information concerning the effects of injuries on respondents' daily lives. RESULTS: The results revealed that 87.8% of the sample contracted an injury resulting from this practice, with the toenails (24.8%), knees (17.5%), and ankles (14.5%) being the most-often reported locations of injuries and blisters (20%), irritation (chafing) (14%), superficial wounds (12%), sprains (11%), and iliotibial band syndrome (7%) being the most common injuries. The result of 10.0 injuries per 1000 h was found, with a negative and medium correlation (r=-0.344; P=0.000) between total exposure time and injuries per 1000 h. It was also found that those who do not perform warm-up have a significantly increased injury rate (P<0.05). CONCLUSIONS: The gathered evidence demonstrated a large number of dermatological and musculoskeletal injuries, and these tended to have higher incidences in athletes with less exposure time and who devalue warm-up exercises.

Performance and Training Load Profiles in Recreational Male Trail Runners: Analyzing Their Interactions during Competitions.

Endurance sports like trail running constitute an extensive individual modality causing numerous physiological changes to occur in the athlete. In this sense, an adequate monitoring of training load appears to be essential to improve competition performance. The aim of this study was two-fold: (i) to analyze trail runners' weekly load variations in the four weeks leading up to a trail running competition, and (ii) to determine the relationship between the runners' pacing in competitions and their physical fitness and workload parameters. Twenty-five amateur male trail runners (age: 36.23 ± 8.30 years old; minimum International Trail Running Association performance index: 600) were monitored daily for the duration of a season (52 weeks). External load (distance covered, pace) and internal load (rate of perceived exertion) were measured daily. Additionally, weekly workload measures of acute:chronic workload ratio (ACWR), training monotony, and training strain were calculated. The runners were also assessed for maximal aerobic speed (MAS) every four months. No significant differences in workload measures (p > 0.05) were observed in the four weeks leading up to each short trail competition; however, leading up to the long trail, ultra-trail medium, and ultra-trail long/extra-long competitions, the differences in the runners' workload measures were significant (p < 0.05). In the short trail, pace was found to be moderately correlated with the ACWR of total distance (r = -0.334) and with training monotony of rate of perceived exertion (RPE) (r = -0.303). In the ultra-trail, a large correlation was observed between pace and elevation accumulated (r = 0.677). We concluded that significant workload differences from one week to the next only occurred in preparation for longer-distance competitions, with sudden acute load decreases and very low ACWR values reported mainly in weeks 1 and 2 of the taper. Meaningful relationships were found between performance (pace) and MAS for longer trails and between pace and MAS for ultra-trail competitions.

Evolutionary trends in bacteria isolated from moderate and severe diabetic foot infections in a Portuguese tertiary center.

INTRODUCTION: Diabetic Foot infections (DFI) are a major cause of hospitalization in patients with diabetes. The microbiological study of diabetic ulcers is essential to adequate antibiotic therapy and to minimize the selection of resistant microorganisms. The aim of this study was to characterize and to compare the evolution of isolated microorganisms between the biennium 2010-2011 and 2016-2017, in hospitalized patients with DFI. MATERIAL AND METHODS: Retrospective evaluation of the clinical and analytical data of patients who were admitted due to DFI in 2010-2011 (group 2010/11) and 2016-2017 (group 2016/17). Only the first hospitalization for each patient was included. An adequate descriptive and comparative statistical analysis was performed. RESULTS: There were 274 admissions due to DFI, 151 in 2010/11 and 123 in 2016/17. There was an increase in admissions due to neuroischemic DFI (51.0% in 2010/11 to 61.8% in 2016/17, p = 0.048). Staphylococcus aureus (SA) was the most common isolate in 2010/11 (26.7%). In 2016/17 most cultures were mixed polymicrobial and isolation of Enterobacteriaceae and Pseudomonas aeruginosa increased from 2010/11 to 2016/17 (15.9% to 30.6%, p = 0.001, and 9.1% to 13.7%, p = 0.048, respectively). CONCLUSION: There was an increase in the prevalence of neuroischemic DFU. The Enterobacteriaceae family replaced SA as the most prevalent pathogen in DFI, with an increase in the isolation of gram-negative microorganisms and mixed polymicrobial cultures. Chronic neuroischemic infected ulcers usually present distinct bacterial isolates; knowledge about the most common agents is warranted in order to better select empiric antibiotic therapy.

Training Load, Aerobic Capacity and Their Relationship With Wellness Status in Recreational Trail Runners.

The present study aimed to analyze the relationship between variables related to the internal and external loads of training and competition races as well as to athletes' perceptions of well-being measured throughout the course of a 4-week mesocycle. It also aimed to analyze the intra- and inter-week variations in terms of training load and well-being. The study included the participation of 47 male recreational athletes competing in the national championships of trail running in Portugal (age: 34.85 ± 8.88 years; height: 1.77 ± 0.58 m; body mass: 65.89 ± 3.17 kg). During the 4 weeks, subjective perception of effort (RPE), training time (min), session-RPE (sRPE), distance covered (km), and perception of well-being (Hooper's questionnaire) were monitored. Weekly RPE was greater in week 1 than in week 3 (p = 0.001; d = 0.563, small effect). Moreover, weekly sRPE was greater in week 1 than in week 2 (p = 0.001; d = 0.441, small effect). The correlations between the well-being variables and RPE that were found to be significant with small magnitudes are those between sleep and RPE (r = 0.287; p = 0.001), stress and RPE (r = 0.217; p = 0.001), fatigue and RPE (r = 0.191; p = 0.001), muscle soreness and RPE (r = 0.240; p = 0.001), and Hooper's index and RPE (r = 0.279; p = 0.001). Among the variables of the Cooper test and the competition race load, it was verified that VO2max had a negative correlation of an average magnitude with pace (r = -0.396, p = 0.015). The findings of the study suggest that small variations in training stimulus during the period of analysis and increases in maximal oxygen uptake result in improvements in the performance of trail running athletes when considering the running speed in the race.

Topic platelet gel application in chronic diabetic foot ulcers.

In this observational study performed during 45 months we evaluated patients with chronic and recalcitrant diabetic ulcers who were treated with homologous platelet gel. METHODS: platelet gels were obtained from homologous platelet concentrates that were aliquoted and freezed, being then activated with calcium gluconate and applied in the ulcer after cleaning and debridement. We evaluated patient's comorbidities, wound characteristics (size, tissue, inflammatory signs, pain), number and time of treatment as well as outcome (classified as complete epithelialization; partial improvement- 50% reduction in wound size or pain relief; no evolution). RESULTS: Fifty-two patients (42 males, 10 females), with a median age of 65 years (range 43-85) were proposed for platelet gel. The following associated comorbidities were observed: hypertension (n = 41), dyslipidemia (n = 29), polyneuropathy (n = 30), peripheral arteriopathy (n = 32), retinopathy (n = 21), nephropathy (n = 15), cardiac ischemic disease (n = 14), obesity (n = 9). Thirty-eight patients presented with 3 or more associated comorbidities. The more frequent ulcer locations were sole of the foot (n = 13) and heel (n = 10). The median number of applications was 16, during 8.5 weeks. Nineteen patients (44%) achieved complete healing, 3 patients (7%) had a partial response and 21 (49%) had no progression. We did not observe a statistically significant relationship between patient age and response nor between number of comorbidities and response. We observed a more favorable evolution in patients with good compliance and good glycemic control. CONCLUSION: Platelet gel is an effective therapeutic alternative, provided compliance and effective metabolic control are ensured.

Health professionals moving to... and from Portugal.

The mobility of health professionals in the European Union is a phenomenon which policy-makers must take into account to provide the conditions to adjust for demand and supply of health services. This paper presents the case of Portugal, a country which at the same time imports and exports health workers. Since the early 1990s Portugal became a destination country receiving foreign health care professionals. This situation is now changing with the current economic situation as fewer immigrants come and more Portuguese emigrate. Foreigners coming to Portugal do so in part for similar reasons that bring Portuguese to want to emigrate, mainly the search for better work conditions and professional development opportunities. The emigration of Portuguese health professionals is also stimulated by the difficulty for recently graduated nurses, dentists and diagnostic and therapeutic technicians to find employment, low salaries in the public and private sectors, heavy workloads, remuneration not related to performance and poor career prospects. The paradoxes described in this study illustrate the consequences of the absence of a policy for the health professions. Strategies based on evidence, and on an integrated information system that captures the dynamic evolution of the workforce in health are not only necessary but also a good investment.