Foot reflexology in autoimmune diseases:Effectiveness and mechanisms

Foot reflexology(FR)is a Chinese-originated and non-invasive complementary therapy increasingly used by functional,alternative and para-medical professionals.Enhance attempts are made to study FR in non-functional organic conditions.The present invited Editorial discusses the application of FR in autoimmune diseases(AD),highlighting a few successful studies demonstrating symptomatic relief and objective improvements.Despite promising results,the FR domain remains under-investigated and an urgent need to confirm and understand the effect of FR in chronic diseases,including AD,is highly recommended.

Is it possible to foot reflexology for infants with sensorineural hearing loss?

Foot reflexology is a non-invasive and safe complementary therapy that works by massaging the reflex zones of the feet and exerts systemic or whole-body regulation through meridian nerve conduction.This therapy is commonly used in the treatment of various conditions such as autism and Parkinson's disease.However,there is limited reporting on the use of foot reflexology therapy for infants with sensorineural hearing loss(SNHL).Currently,there is no definitive conclusion on how foot reflexology therapy can influence hearing.This editorial holds some guiding significance regarding this clinical issue.The aim is to present physiological evidence of how foot reflexology therapy can impact infants with SNHL,thereby enhancing clinician’s awareness of foot reflexology in treating infants with SNHL.

Role of macrophage polarization in diabetic foot ulcer healing:A bibliometric study

BACKGROUND Diabetic foot ulcers(DFUs)are a significant contributor to disability and mortality in diabetic patients.Macrophage polarization and functional regulation are promising areas of research and show therapeutic potential in the field of DFU healing.However,the complex mechanism,the difficulty in clinical translation,and the large heterogeneity present significant challenges.Hence,this study was to comprehensively analyze the publication status and trends of studies on macrophage polarization and DFU healing.AIM To examine the relevant literature on macrophage polarization in DFU healing.METHODS A bibliometric analysis was conducted using the Web of Science database.Relevant literature was retrieved from the Web of Science Core Collection database between 2013 to 2023 using literature visualization and analysis software(VOSviewer and CiteSpace)and bibliometric online platforms.The obtained literature was then subjected to visualization and analysis of different countries/regions,institutions,journals,authors,and keywords to reveal the research’s major trends and focus.RESULTS The number of publications on the role of macrophage polarization in DFU healing increased rapidly from 2013 to 2023,especially in the latter period.Chinese researchers were the most prolific in this field,with 217 publications,while American researchers had been engaged in this field for a longer period.Qian Tan of Nanjing Drum Tower Hospital and Qian Ding of Nanjing University were the first to publish in this field.Shanghai Jiao Tong University was the institution with the most publications(27).The keywords“bone marrow”,“adjustment,replacement,response,tissue repair”,and“activation,repair,differentiation”appeared more frequently.The study of macrophage polarization in DFU healing focused on the regulatory mechanism,gene expression,and other aspects.CONCLUSION This study through the bibliometric method reveals the research trends and development trends in this field of macrophage polarization in DFU healing from 2013 to 2023 in the Web of Science Core Collection database.The key hotspots in this field mainly include the regulation of macrophage activation,gene expression,wound tissue repair,and new wound materials.This study provides references for future research directions.

Diabetic foot attack:Managing severe sepsis in the diabetic patient

Diabetic foot attack(DFA)is the most severe presentation of diabetic foot disease,with the patient commonly displaying severe sepsis,which can be limb or life threatening.DFA can be classified into two main categories:Typical and atypical.A typical DFA is secondary to a severe infection in the foot,often initiated by minor breaches in skin integrity that allow pathogens to enter and proliferate.This form often progresses rapidly due to the underlying diabetic pathophysiology of neuropathy,microvascular disease,and hyperglycemia,which facilitate infection spread and tissue necrosis.This form of DFA can present as one of a number of severe infective pathologies including pyomyositis,necrotizing fasciitis,and myonecrosis,all of which can lead to systemic sepsis and multiorgan failure.An atypical DFA,however,is not primarily infection-driven.It can occur secondary to either ischemia or Charcot arthropathy.Management of the typical DFA involves prompt diagnosis,aggressive infection control,and a multidisciplinary approach.Treatment can be guided by the current International Working Group on the Diabetic Foot/Infectious Diseases Society of America guidelines on diabetic foot infections,and the combined British Orthopaedic Foot and Ankle Society-Vascular Society guidelines.This article highlights the importance of early recognition,comprehensive management strategies,and the need for further research to establish standardized protocols and improve clinical outcomes for patients with DFA.

Acellular fish skin grafts in diabetic foot ulcer care:Advances and clinical insights

Diabetic foot ulcers(DFUs)represents a significant public health issue,with a rising global prevalence and severe potential complications including amputation.Traditional treatments often fall short due to various limitations such as high recurrence rates and extensive resource utilization.This editorial explores the innovative use of acellular fish skin grafts as a transformative approach in DFU management.Recent studies and a detailed case report highlight the efficacy of acellular fish skin grafts in accelerating wound closure,reducing dressing changes,and enhancing patient outcomes with a lower socio-economic burden.Despite their promise,challenges such as limited availability,patient acceptance,and the need for further research persist.Addressing these through more extensive randomized controlled trials and fostering a multidisciplinary treatment approach may optimize DFU care and reduce the global health burden associated with these complex wounds.

Risk factors and a predictive model of diabetic foot in hospitalized patients with type 2 diabetes

BACKGROUND The risk factors and prediction models for diabetic foot(DF)remain incompletely understood,with several potential factors still requiring in-depth investigations.AIM To identify risk factors for new-onset DF and develop a robust prediction model for hospitalized patients with type 2 diabetes.METHODS We included 6301 hospitalized patients with type 2 diabetes from January 2016 to December 2021.A univariate Cox model and least absolute shrinkage and selection operator analyses were applied to select the appropriate predictors.Nonlinear associations between continuous variables and the risk of DF were explored using restricted cubic spline functions.The Cox model was further employed to evaluate the impact of risk factors on DF.The area under the curve(AUC)was measured to evaluate the accuracy of the prediction model.RESULTS Seventy-five diabetic inpatients experienced DF.The incidence density of DF was 4.5/1000 person-years.A long duration of diabetes,lower extremity arterial disease,lower serum albumin,fasting plasma glucose(FPG),and diabetic nephropathy were independently associated with DF.Among these risk factors,the serum albumin concentration was inversely associated with DF,with a hazard ratio(HR)and 95%confidence interval(CI)of 0.91(0.88-0.95)(P<0.001).Additionally,a U-shaped nonlinear relationship was observed between the FPG level and DF.After adjusting for other variables,the HRs and 95%CI for FPG<4.4 mmol/L and≥7.0 mmol/L were 3.99(1.55-10.25)(P=0.004)and 3.12(1.66-5.87)(P<0.001),respectively,which was greater than the mid-range level(4.4-6.9 mmol/L).The AUC for predicting DF over 3 years was 0.797.CONCLUSION FPG demonstrated a U-shaped relationship with DF.Serum albumin levels were negatively associated with DF.The prediction nomogram model of DF showed good discrimination ability using diabetes duration,lower extremity arterial disease,serum albumin,FPG,and diabetic nephropathy(Clinicaltrial.gov NCT05519163).

Evaluating the effectiveness of ultrasound-assisted wound debridement in managing diabetic foot ulcers:A systematic review and meta-analysis

BACKGROUND Diabetic foot ulcers(DFUs)present a significant clinical challenge due to their high prevalence and profound impact on morbidity.Ultrasound-assisted wound debridement(UAWD)has emerged as a potential therapeutic modality to improve healing outcomes in DFU management.AIM To evaluate the efficacy of UAWD in treating DFUs on wound closure rates,treatment duration,and quality of life outcomes.METHODS This systematic review and meta-analysis followed PRISMA guidelines,systematically searching PubMed,Embase,Web of Science,and the Cochrane Library with no date restrictions.Randomized controlled trials(RCTs)that evaluated the efficacy of UAWD in DFU treatment were included.Data were independently extracted by two reviewers,with discrepancies resolved through consensus or third-party consultation.The risk of bias was assessed using the Cochrane tool.χ2 and I2 statistics assessed heterogeneity,informing the use of fixed or random-effects models for meta-analysis,supplemented by sensitivity analysis and publication bias assessment through funnel plots and Egger's test.RESULTS From 1255 articles,seven RCTs met the inclusion criteria.The studies demonstrated that UAWD significantly reduced DFU healing time(standardized mean difference=-0.78,95%CI:-0.97 to-0.60,P<0.001)and increased healing rates(odds ratio=9.96,95%CI:5.99 to 16.56,P<0.001)compared to standard care.Sensitivity analysis confirmed the stability of these results,and no significant publication bias was detected.CONCLUSION UAWD is a promising adjunctive treatment for DFUs,significantly reducing healing times and increasing healing rates.These findings advocate for the integration of UAWD into standard DFU care protocols.

Comprehensive review on diabetic foot ulcers and neuropathy: Treatment, prevention and management

Diabetic foot(DF)is a major public health concern.As evident from numerous previous studies,supervision of DF ulcer(DFU)is crucial,and a specific quality check-up is needed.Patients should be educated about glycaemic management,DFUs,foot lesions,proper care for injuries,diet,and surgery.Certain reasonably priced treatments,such as hyperbaric oxygen and vacuum-assisted closure therapy,are also available for DFUs,along with modern wound care products and techniques.Nonetheless,DF care(cleaning,applying antimicrobial cream when wounded,and foot reflexology),blood glucose monitoring to control diabetes,and monthly or quarterly examinations in individuals with diabetes are effective in managing DFUs.Between 50%and 80%of DF infections are preventable.Regardless of the intensity of the lesion,it needs to be treated carefully and checked daily during infection.Tissue regeneration can be aided by cleaning,dressing,and application of topical medicines.The choice of shoes is also important because it affects blood circulation and nerve impulses.In general,regular check-ups,monitoring of the patient’s condition,measuring blood glucose levels,and providing frequent guidance regarding DFU care are crucial.Finally,this important clinical problem requires involvement of multiple professionals to properly manage it.

Effect of surface crack on the bearing capacity of strip footing placed on rock mass

In hilly regions,the existence of surface cracks in rock mass induces a potential threat to structural stability.Thus,the present research aims to explore the impact of surface cracks on the loadbearing capacity of strip footing placed on the rock mass.By taking into account the various boundary constraints across the surface of crack edges,the study investigates the presence of two categories of surface cracks,namely(1)separated crack,and(2)fine crack.The lower bound limit analysis is employed in conjunction with the finite element method(LBFELA)to conduct the numerical analysis.In order to evaluate rock mass yielding,the power conic programming(PCP)method is utilized to implement the generalized Hoek-Brown(GHB)failure criterion.The stability of the strip footing is analyzed by determining the bearing capacity factor(Nσγ),which is presented in the form of design charts by varying the strength parameters of rock,including the Geological Strength Index(GSI),Hoek-Brown material parameter(mi),Disturbance factor(D),and Normalised Uniaxial Compressive Strength(σci/γB),whereγis the unit weight of rock mass,and B is the width of strip footing.The study also investigates the impact of cracks on strip footings,considering different positions of the crack(LC)and depths of the crack(DC).The results demonstrate that the influence of the fine crack is only noticeable until the LC/B ratio reaches 6.However,for the separated crack,its impact remains significant even when the LC/B ratio exceeds 16.The appearance of fine crack at the edge of the footing results in a decrease in the magnitude Nσγof up to 45%,indicating a substantial reduction in the stability of the footing.The failure patterns are presented and discussed in detail for various cases in this study to examine the effect of surface cracks on the strip footing and to address the extent of the plastic collapse.

Correlation between key indicators of continuous glucose monitoring and the risk of diabetic foot

BACKGROUND Continuous glucose monitoring(CGM)metrics,such as time in range(TIR)and glycemic risk index(GRI),have been linked to various diabetes-related complications,including diabetic foot(DF).AIM To investigate the association between CGM-derived indicators and the risk of DF in individuals with type 2 diabetes mellitus(T2DM).METHODS A total of 591 individuals with T2DM(297 with DF and 294 without DF)were enrolled.Relevant clinical data,complications,comorbidities,hematological parameters,and 72-hour CGM data were collected.Logistic regression analysis was employed to examine the relationship between these measurements and the risk of DF.RESULTS Individuals with DF exhibited higher mean blood glucose(MBG)levels and increased proportions of time above range(TAR),TAR level 1,and TAR level 2,but lower TIR(all P<0.001).Patients with DF had significantly lower rates of achieving target ranges for TIR,TAR,and TAR level 2 than those without DF(all P<0.05).Logistic regression analysis revealed that GRI,MBG,and TAR level 1 were positively associated with DF risk,while TIR was inversely correlated(all P<0.05).Achieving TIR and TAR was inversely correlated with white blood cell count and glycated hemoglobin A1c levels(P<0.05).Additionally,achieving TAR was influenced by fasting plasma glucose,body mass index,diabetes duration,and antidiabetic medication use.CONCLUSION CGM metrics,particularly TIR and GRI,are significantly associated with the risk of DF in T2DM,emphasizing the importance of improved glucose control.

Assessment of bearing capacity of interfering strip footings located near sloping surface considering artificial neural network technique

The bearing capacity of interfering footings located near the slope face suffers from reduced bearing capacity due to the formation of the curtailed passive zone. Depending upon the position of the footing, their spacing and steepness of the slope different extents of bearing capacity reduction can be exhibited. A series of finite element investigation has been done with the aid of Plaxis 3 D v AE.01 to elucidate the influence of various geotechnical and geometrical parameters on the ultimate bearing capacity of interfering surface strip footings located at the crest of the natural soil slope. Based on the large database obtained from the numerical simulation, a6-8-1 Artificial Neural Network architecture has been considered for the assessment of the ultimate bearing capacity of interfering strip footings placed on the crest of natural soil slope. Sensitivity analyses have been conducted to establish the relative significance of the contributory parameters, which exhibited that for the stated problem, apart from shear strength parameters, the setback ratio and spacing of footing are the prime contributory parameters.

Settlement predictions of footings on sands using probabilisticanalysis

The design of footings on sands is often controlled by settlement rather than bearing capacity.Therefore,settlement predictions are essential in the design of shallow foundations.However,predicted settlements of footings are highly dependent on the chosen elastic modulus and the used method.This paper presents the use of probabilistic analysis to evaluate the variability of predicted settlements of footings on sands,focusing on the load curve(predicted settlements)characterization.Three methodologies,the first-and second-order second-moment(FOSM and SOSM),and Monte Carlo simulation(MCS),for calculating the mean and variance of the estimated settlements through Schmertmann(1970)’s equation,are presented and discussed.The soil beneath the footing is treated as an uncorrelated layered material,so the total settlement and variance are found by adding up the increments of the layers.The deformability modulus(ESi)is considered as the only independent random variable.As an example of application,a hypothetical case of a typical subsoil in the state of Espirito Santo,southeast of Brazil,is evaluated.The results indicate that there is a significant similarity between the SOSM and MCS methods,while the FOSM method underestimates the results due to the non-consideration of the high-order terms in Taylor’s series.The contribution of the knowledge of the uncertainties in settlement prediction can provide a safer design.

Seismic bearing capacity of strip footings on rock masses using the Hoeke Brown failure criterion

In this paper,the bearing capacity of strip footings on rock masses has been studied in the seismic case.The stress characteristics or slip line method was used for analysis.The problem was analyzed in the plane strain condition using the Hoeke Brown failure criterion.First,the equilibrium equations along the stress characteristics were obtained and the rock failure criterion was applied.Then,the equations were solved using the finite difference method.A computer code has been provided for analysis.Given the footing and rock parameters,the code can calculate the stress characteristics network and obtain the stress distribution under the footing.The seismic effects have been applied as the horizontal and vertical pseudo-static coefficients.The results of this paper are very close to those of the other studies.The seismic bearing capacity of weightless rock masses can be obtained using the proposed equations and graphs without calculating the whole stress characteristics network.

Load eccentricity effects on behavior of circular footings reinforced with geogrid sheets

In this paper, an experimental study for an eccentrically loaded circular footing, resting on a geogridreinforced sand bed, is performed. To achieve this aim, the steel model footing of 120 mm in diameterand sand in relative density of 60% are used. Also, the effects of depth of first and second geogrid layersand number of reinforcement layers （1e4） on the settlement-load response and tilt of footing undervarious load eccentricities （0 cm, 0.75 cm, 1.5 cm, 2.25 cm and 3 cm） are investigated. Test results indicatethat ultimate bearing capacity increases in comparison with unreinforced condition. It is observed thatwhen the reinforcements are placed in the optimum embedment depth （u/D ？0.42 and h/D ？0.42）, thebearing capacity ratio （BCR） increases with increasing load eccentricity to the core boundary of footing,and that with further increase of load eccentricity, the BCR decreases. Besides, the tilt of footing increaseslinearly with increasing settlement. Finally, by reinforcing the sand bed, the tilt of footing decreases at 2layers of reinforcement and then increases by increasing the number of reinforcement layers.

The use of the node-based smoothed finite element method to estimate static and seismic bearing capacities of shallow strip footings

The node-based smoothed finite element method(NS-FEM)is shortly presented for calculations of the static and seismic bearing capacities of shallow strip footings.A series of computations has been performed to assess variations in seismic bearing capacity factors with both horizontal and vertical seismic accelerations.Numerical results obtained agree very well with those using the slip-line method,revealing that the magnitude of the seismic bearing capacity is highly dependent upon the combinations of various directions of both components of the seismic acceleration.An upward vertical seismic acceleration reduces the seismic bearing capacity compared to the downward vertical seismic acceleration in calculations.In addition,particular emphasis is placed on a separate estimation of the effects of soil and superstructure inertia on each seismic bearing capacity component.While the effect of inertia forces arising in the soil on the seismic bearing capacity is non-trivial,and the superstructure inertia is the major contributor to reductions in the seismic bearing capacity.Both tables and charts are given for practical application to the seismic design of the foundations.

Surgical management of the diabetic foot:The current evidence

The prevalence of diabetes mellitus and its associated complications,particularly diabetic foot pathologies,poses significant healthcare challenges and economic burdens globally.This review synthesises current evidence on the surgical management of the diabetic foot,focusing on the interplay between neuropathy,ischemia,and infection that commonly culminates in ulcers,infections,and,in severe cases,amputations.The escalating incidence of diabetes mellitus underscores the urgency for effective management strategies,as diabetic foot complications are a leading cause of hospital admissions among diabetic patients,significantly impacting morbidity and mortality rates.This review explores the pathophysiological mechanisms underlying diabetic foot complications and further examines diabetic foot ulcers,infections,and skeletal pathologies such as Charcot arthropathy,emphasising the critical role of early diagnosis,comprehensive management strategies,and interdisciplinary care in mitigating adverse outcomes.In addressing surgical interventions,this review evaluates conservative surgeries,amputations,and reconstructive procedures,highlighting the importance of tailored approaches based on individual patient profiles and the specific characteristics of foot pathologies.The integration of advanced diagnostic tools,novel surgical techniques,and postoperative care,including offloading and infection control,are discussed in the context of optimising healing and preserving limb function.

Effect of foot reflexology on an infant with sensorineural hearing loss:A case report

BACKGROUND Our study contributes to the further understanding of the mechanism of foot reflexology.Foot reflexology has been reported to affect hearing recovery,but no physiological evidence has been provided.This lack of evidence hampers the acceptance of the technique in clinical practice.CASE SUMMARY A girl was taken to North Sichuan Medical University Affiliated Hospital for a hearing screen by her parents.Her parents reported that her hearing level was the same as when she was born.The girl was diagnosed with sensorineural hearing loss(SNHL)by a doctor in the otolaryngology department.After we introduced the foot reflexology project,the parents agreed to participate in the experiment.After 6 months of foot reflexology treatment,the hearing threshold of the girl recovered to a normal level,below 30 dB.CONCLUSION Foot reflexology should be encouraged in clinical practice and for families of infants with SNHL.

Global trends in publications regarding macrophages-related diabetic foot ulcers in the last two decades

BACKGROUND Diabetic foot ulcers(DFUs)are one of the most severe and popular complications of diabetes.The persistent non-healing of DFUs is the leading cause of amputation,which causes significant mental and financial stress to patients and their families.Macrophages are critical cells in wound healing and perform essential roles in all phases of wound healing.However,no studies have been carried out to systematically illustrate this area from a scientometric point of view.Although there have been some bibliometric studies on diabetes,reports focusing on the investigation of macrophages in DFUs are lacking.AIM To perform a bibliometric analysis to systematically assess the current state of research on macrophage-related DFUs.METHODS The publications of macrophage-related DFUs from January 1,2004,to December 31,2023,were retrieved from the Web of Science Core Collection on January 9,2024.Four different analytical tools:VOSviewer(v1.6.19),CiteSpace(v6.2.R4),HistCite(v12.03.07),and Excel 2021 were used for the scientometric research.RESULTS A total of 330 articles on macrophage-related DFUs were retrieved.The most published countries,institutions,journals,and authors in this field were China,Shanghai Jiao Tong University of China,Wound Repair and Regeneration,and Aristidis Veves.Through the analysis of keyword co-occurrence networks,historical direct citation networks,thematic maps,and trend topics maps,we synthesized the prevailing research hotspots and emerging trends in this field.CONCLUSION Our bibliometric analysis provides a comprehensive overview of macrophage-related DFUs research and insights into promising upcoming research.

Research progress and challenges in stem cell therapy for diabetic foot: Bibliometric analysis and perspectives

BACKGROUND Stem cell therapy has shown great potential for treating diabetic foot(DF).AIM To conduct a bibliometric analysis of studies on the use of stem cell therapy for DF over the past two decades,with the aim of depicting the current global research landscape,identifying the most influential research hotspots,and providing insights for future research directions.METHODS We searched the Web of Science Core Collection database for all relevant studies on the use of stem cell therapy in DF.Bibliometric analysis was carried out using CiteSpace,VOSviewer,and R(4.3.1)to identify the most notable studies.RESULTS A search was conducted to identify publications related to the use of stem cells for DF treatment.A total of 542 articles published from 2000 to 2023 were identified.The United States had published the most papers on this subject.In this field,Iran’s Shahid Beheshti University Medical Sciences demonstrated the highest productivity.Furthermore,Dr.Bayat from the same university has been an outstanding researcher in this field.Stem Cell Research&Therapy is the journal with the highest number of publications in this field.The main keywords were“diabetic foot ulcers,”“wound healing,”and“angiogenesis.”CONCLUSION This study systematically illustrated the advances in the use of stem cell therapy to treat DF over the past 23 years.Current research findings suggested that the hotspots in this field include stem cell dressings,exosomes,wound healing,and adipose-derived stem cells.Future research should also focus on the clinical translation of stem cell therapies for DF.

Acute effect of foot strike patterns on in vivo tibiotalar and subtalar joint kinematics during barefoot running

Background:Foot kinematics,such as excessive eversion and malalignment of the hindfoot,are believed to be associated with running-related injuries.The maj ority of studies to date show that different foot strike patterns influence these specific foot and ankle kinematics.However,technical deficiencies in traditional motion capture approaches limit knowledge of in vivo joint kinematics with respect to rearfoot and forefoot strike patterns(RFS and FFS,respectively).This study uses a high-speed dual fluoroscopic imaging system(DFIS)to determine the effects of different foot strike patterns on 3D in vivo tibiotalar and subtalar joints kinematics.Methods:Fifteen healthy male recreational runners underwent foot computed tomography scanning for the construction of 3-dimensional models.A high-speed DFIS(100 Hz)was used to collect 6 degrees of freedom kinematics for participants’tibiotalar and subtalar joints when they adopted RFS and FFS in barefoot condition.Results:Compared with RFS,FFS exhibited greater internal rotation at 0%-20%of the stance phase in the tibiotalar joint.The peak internal rotation angle of the tibiotalar joint under FFS was greater than under RFS(p<0.001,Cohen’s d=0.92).RFS showed more dorsiflexion at 0%-20%of the stance phase in the tibiotalar joint than FFS.RFS also presented a larger anterior translation(p<0.001,Cohen’s d=1.28)in the subtalar joint at i nitial contact than FFS.Conclusion:Running with acute barefoot FFS increases the internal rotation of the tibiotalar joint in the early stance.The use of high-speed DFIS to quantify the movement of the tibiotalar and subtalar joint was critical to revealing the effects of RF S and FFS during running.