Reducing high mechanical stress is imperative to heal diabetes-related foot ulcers. We explored the association of cumulative plantar tissue stress (CPTS) and plantar foot ulcer healing, and the ...feasibility of measuring CPTS, in two prospective cohort studies (Australia (AU) and The Netherlands (NL)). Both studies used multiple sensors to measure factors to determine CPTS: plantar pressures, weight-bearing activities, and adherence to offloading treatments, with thermal stress response also measured to estimate shear stress in the AU-study. The primary outcome was ulcer healing at 12 weeks. Twenty-five participants were recruited: 13 in the AU-study and 12 in the NL-study. CPTS data were complete for five participants (38%) at baseline and one (8%) during follow-up in the AU-study, and one (8%) at baseline and zero (0%) during follow-up in the NL-study. Reasons for low completion at baseline were technical issues (AU-study: 31%, NL-study: 50%), non-adherent participants (15% and 8%) or combinations (15% and 33%); and at follow-up refusal of participants (62% and 25%). These underpowered findings showed that CPTS was non-significantly lower in people who healed compared with non-healed people (457 117; 727, 679 312; 1327 MPa·s/day). Current feasibility of CPTS seems low, given technical challenges and non-adherence, which may reflect the burden of treating diabetes-related foot ulcers.
Tongue mobility has shown to be a clinically interesting parameter on functional results after tongue cancer treatment which can be objectified by measuring the Range Of Motion (ROM). Reliable ...measurements of ROM would enable us to quantify the severity of functional impairments and use these for shared decision making in treatment choices, rehabilitation of speech and swallowing disturbances after treatment.
Nineteen healthy participants, eighteen post-chemotherapy patients and seventeen post-surgery patients were asked to perform standardized tongue maneuvers in front of a 3D camera system, which were subsequently tracked and corrected for head and jaw motion. Indicators, such as the left-right tongue range and the deflection angle with the horizontal axis were extracted from the tongue trajectory to serve as a quantitative measure for the impaired tongue mobility.
The range and deflection angle showed an excellent intra- and interrater reliability (ICC 0.9) The repeatability experiment showed an average standard deviation of 2.5 mm to 3.5 mm for every movement, except the upward movement. The post-surgery patient group showed a smaller tongue range and higher deflection angle overall than the healthy participants. Post-chemoradiation patients showed less difference in tongue ROM compared with healthy participants. Only a few patients showed asymmetrical movement after treatment, which could not always be explained by T-stage or the side of treatment alone.
We introduced a reliable and reproducible method for measuring the ROM and to quantify for motion impairments, that was able to show differences in tongue ROM between healthy subjects and patients after chemoradiation or surgery. Future research should focus on measuring patients with oral cancer pre- and post-treatment in combination with the collection of detailed information about the individual tongue anatomy, so that the full ROM trajectory can be used to identify changes over time and to quantify functional impairment.
Using a BESIII-data sample of 1.31 × 109 J/ψ events collected in 2009 and 2012, the glueball-sensitive decay J/ψ→γpp¯ is analyzed. In the past, an exciting near-threshold enhancement X (pp¯) showed ...up. Furthermore, the poorly-understood properties of the ηc resonance, its radiative production, and many other interesting dynamics can be studied via this decay. The high statistics provided by BESIII enables to perform a partial-wave analysis (PWA) of the reaction channel. With a PWA, the spin-parity of the possible intermediate glueball state can be determined unambiguously and more information can be gained about the dynamics of other resonances, such as the ηc. The main background contributions are from final-state radiation and from the J/ψ→π0(γγ)pp¯ channel. In a follow-up study, we will investigate the possibilities to further suppress the background and to use data-driven methods to control them.
The importance of tongue mobility on speech, oral food transport, and swallowing is well recognized. However, whether the individual tongue mobility influences postoperative function in oral cancer ...treatment remains to be elucidated. This study assesses the ability to perform five tongue movements as rolling, twisting (two sides), folding, and the ‘cloverleaf’ in a healthy population. Because a tumor in oral cancer patients often restricts the mobility of the tongue, it might be helpful to know if it is possible to recall any of those movements without demonstrating it. Two observers asked 387 Dutch healthy adults if they could perform one of the five specific tongue movements and were subsequently asked to demonstrate the five movements. The distribution in the Dutch population is: rolling: 83.7%, cloverleaf: 14.7%, folding: 27.5%, twisting left: 36.1% and twisting right: 35.6%. The percentage of people that can fold their tongue is almost ten times higher (3% versus 27.5%) than in previous research, and it was found that the ability to roll the tongue is not a prerequisite for folding of the tongue. A relationship between gender or right-handedness and the ability to perform certain tongue movements could not be found. Of the participants, 9.9% and 13.1% incorrectly assumed that they could demonstrate tongue rolling and cloverleaf. Tongue folding and twisting (left or right) were incorrectly assumed in 36.9%, 24.1%, and 25.4% of the cases. Rolling and cloverleaf are preferred for future prediction models because these movements are easy to recall without demonstrating.
For advanced tongue cancer, the choice between surgery and organ-sparing treatment is often dependent on the expected loss of tongue functionality after treatment. Biomechanical models might assist ...in this choice by simulating the post-treatment function loss. However, this function loss varies between patients and should, therefore, be predicted for each patient individually. In the present study, the goal was to better predict the postoperative range of motion (ROM) of the tongue by personalizing biomechanical models using diffusion-weighted MRI and constrained spherical deconvolution reconstructions of tongue muscle architecture. Diffusion-weighted MRI scans of ten healthy volunteers were obtained to reconstruct their tongue musculature, which were subsequently registered to a previously described population average or atlas. Using the displacement fields obtained from the registration, the segmented muscle fiber tracks from the atlas were morphed back to create personalized muscle fiber tracks. Finite element models were created from the fiber tracks of the atlas and those of the individual tongues. Via inverse simulation of a protruding, downward, left and right movement, the ROM of the tongue was predicted. This prediction was compared to the ROM measured with a 3D camera. It was demonstrated that biomechanical models with personalized muscles bundles are better in approaching the measured ROM than a generic model. However, to achieve this result a correction factor was needed to compensate for the small magnitude of motion of the model. Future versions of these models may have the potential to improve the estimation of function loss after treatment for advanced tongue cancer.
Tongue cancer treatment often results in impaired speech, swallowing, or mastication. Simulating the effect of treatments can help the patient and the treating physician to understand the effects and ...impact of the intervention. To simulate deformations of the tongue, identifying accurate mechanical properties of tissue is essential. However, not many succeeded in characterizing in-vivo tongue stiffness. Those who did, measured the tongue At Rest (AR), in which muscle tone subsides even if muscles are not willingly activated. We expected to find an absolute rest state in participants ‘under General Anesthesia’ (GA).
We elaborated on previous work by measuring the mechanical behavior of the in-vivo tongue under aspiration using an improved volume-based method. Using this technique, 5 to 7 measurements were performed on 10 participants both AR and under GA. The obtained Pressure-Shape curves were first analyzed using the initial slope and its variations. Hereafter, an inverse Finite Element Analysis (FEA) was applied to identify the mechanical parameters using the Yeoh, Gent, and Ogden hyperelastic models.
The measurements AR provided a mean Young’s Modulus of 1638 Pa (min 1035 – max 2019) using the Yeoh constitutive model, which is in line with previous ex-vivo measurements. However, while hoping to find a rest state under GA, the tongue unexpectedly appeared to be approximately 2 to 2.5 times stiffer under GA than AR. Explanations for this were sought by examining drugs administered during GA, blood flow, perfusion, and upper airway reflexes, but neither of these explanations could be confirmed.
•First large trial to evaluate effectiveness of MI by trained podiatrists on improving adherence to wearing orthopedic shoes in clinical practice.•Short- and longer-term adherence was objectively ...assessed.•A single-session MI-consultation did not contribute to improving adherence.
To evaluate the effectiveness of motivational interviewing (MI) performed by MI-trained podiatrists in improving adherence to wearing orthopedic shoes in comparison to usual care in people with diabetes at low-to-high risk of ulceration.
People with diabetes with loss of protective sensation and/or peripheral artery disease, and with orthopedic shoes prescription were allocated to receive one MI-consultation by a podiatrist randomized to MI training (n = 53) or usual care only (n = 68). Adherence was measured as the percentage of steps taken while wearing orthopedic shoes, determined using an insole temperature microsensor and wrist-worn activity tracker during one week at 3 and 6 months.
The proportion of participants ≥80 % adherent to wearing their orthopedic shoes was higher in the control group than in the MI-intervention group at 3 months (30.9 % versus 15.1 %; p = 0.044), and not significantly different at 6 months (22.1 % versus 13.2 %; p = 0.210). Average adherence was also higher in the control group than the intervention group at both 3 months (60.9 % versus 50.9 %; p = 0.029) and 6 months (59.9 % versus 49.5 %; p = 0.025).
One podiatrist-led MI-consultation in its current form did not result in higher adherence to wearing orthopedic shoes in people with diabetes 3 and 6 months after inclusion.
Trial registration: Netherlands Trial Register NL7710 (available on the International Clinical Trials Registry Platform).
Oral cancer surgery has a negative influence on the quality of life (QOL). As a result of the complex physiology involved in oral functions, estimation of surgical effects on functionality remains ...difficult. We present a user-friendly biomechanical simulation of tongue surgery, including closure with suturing and scar formation, followed by an automated adaptation of a finite element (FE) model to the shape of the tongue. Different configurations of our FE model were evaluated and compared to a well-established FE model. We showed that the post-operative impairment as predicted by our model was qualitatively comparable to a patient case for five different tongue maneuvers.
The Standard Model describes the smallest building blocks of our universe, so-called quarks and leptons, and the forces that act on them. The building blocks can bundle into larger and heavier ...particles. These composite particles are called hadrons. One of the best-known hadrons is the proton. The Higgs boson, which was first detected in 2012, explains how the smallest building blocks get their mass. However, the Higgs mechanism only explains 1% of the mass of the proton. The other 99% arises from internal strong forces that are not yet well-understood. To better understand the 99%, it is important to study the production of hadrons in different processes, and to obtain information from as many different decay reactions as possible. Hadrons of the charmonia group, such as J/psi and the ground state eta_c, are highly suitable particles for this, and result in a relatively easy-to-interpret spectrum of narrow peaks that do not overlap. In this thesis the radiative decay of J/psi into a proton (p) and antiproton (pbar) is studied. The aim of this study was to gain a better understanding of the full spectrum of the proton-antiproton invariant mass, and especially to gain more insight into the poorly-understood properties of the intermediate resonance eta_c. In this study, a special multidimensional analysis, a so-called partial-wave analysis, was applied for the first time to the radiative decay from J/psi to eta_c. This study is based on data taken by the Beijing Spectrometer (BES) III, which has collected world's largest dataset of J/psi reactions.
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