Submitted by Angela Maria de Oliveira (amolivei@uepg.br) on 2018-11-30T15:19:09Z No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Divonei Gibala.pdf: 716715 bytes, checksum: 62013137c73366e29317e7a5788692e3 (MD5) / Made available in DSpace on 2018-11-30T15:19:09Z (GMT). No. of bitstreams: 2 license_rdf: 811 bytes, checksum: e39d27027a6cc9cb039ad269a5db8e34 (MD5) Divonei Gibala.pdf: 716715 bytes, checksum: 62013137c73366e29317e7a5788692e3 (MD5) Previous issue date: 2018-08-14 / Introdução: atualmente sabe-se que a ulceração do pé diabético é uma das principais complicações do diabetes, pois apresenta importância médica, social e econômica. Diversos fatores interferem na correta cicatrização dessas feridas, sendo um deles o estresse oxidativo. Diante dessa situação buscam-se medidas que atuem nessas vias, tendo o selênio como componente importante na defesa antioxidativa do organismo. Objetivo: analisar a evolução do processo cicatricial da úlcera no pé diabético após a suplementação com selênio. Métodos: Ensaio clínico, aberto, não-randomizado, com 19 pacientes com feridas diabéticas do ambultatório de feridas do HURCG. Foi realizada suplementação com selênio 100mcg por 60 dias e realizado biópsia cutânea antes e depois da suplementação com selênio. Avaliou-se histomorfologicamente essas lesões. Resultados: Houve predominância do sexo masculino e da faixa etária de 60 anos. Após o uso de selênio, a congestão vascular, tecido de granulação e fibrose diminuíram, não havendo diferenças estatísticas nos demais parâmetros (neutrófilos, edema e monomorfonucleares). As bordas das úlceras apresentaram hiperqueratose e acantose, as quais não sofreram influência do selênio. Conclusão: a suplementação com selênio apresentou melhora no quadro de congestão, além de diminuir componentes inflamatórios, como a formação de tecido de granulação e a fibrose. / Introduction: It is now known that diabetic foot ulceration is one of the main complications of diabetes, because it is of medical, social and economic importance. Several factors interfere in the correct healing of these wounds, one of them being oxidative stress. In view of this situation, measures are sought that act in these pathways, with selenium as an important component in the antioxidative defense of the organism. Objective: to analyze the evolution of the cicatricial process of the ulcer in the diabetic foot after the supplementation with selenium. Methods: An open, non-randomized clinical trial of 19 patients with diabetic wounds from the HURCG wound ambiance. Selenium supplementation was 100mcg for 60 days and skin biopsy was performed before and after selenium supplementation. These lesions were histomorphologically evaluated. Results: There was a predominance of males and 60-year-olds. After the use of selenium, vascular congestion, granulation tissue and fibrosis decreased, and there were no statistical differences in the other parameters (neutrophils, edema and monomorphonuclear cells). The edges of the ulcers presented hyperkeratosis and acanthosis, which were not influenced by selenium. Conclusion: supplementation with selenium improved congestion and decreased inflammatory components, such as granulation tissue formation and fibrosis.

Chronic diabetic foot ulcers, venous leg ulcers and pressure ulcers affect a large subset of the United State population yet they remain a challenge for physicians to treat. There are many different types of products on the market for the treatment of chronic wounds. Some use living cells but only two are FDA approved to heal chronic wounds. A new type of product recently garnered attention in the wound care market because it also contains living cells: hypothermically stored amniotic tissue products. Hypothermically stored amniotic tissue is unique because it maintains living cells and offers the benefits of containing signaling molecules and maintaining an intact extra cellular matrix. While there are other types of amniotic or placental tissue products in the wound care market, they are processed by dehydration or cryopreservation which limits their capacities for maintaining living cells. This thesis will explore the potential for hypothermically processed amniotic tissue products to treat chronic wounds.

Diabetic foot ulceration (DFU) is a known major complication of diabetes mellitus which contributes to lower extremities amputation. This study aimed to investigate the use of interventional devices either as a preventative or therapeutic strategy to improve clinical management of this pathology, as well as investigating the impaired function of endothelial progenitor cells in the diabetic condition. The first element targeted plantar callus formation among diabetic neuropathic (NRP) patients through the use of a SurroSenseRxTM biofeedback device. Reducing foot pressure with improved walking strategy in the 6 months study in diabetic neuropathy patients (n=20) appeared to minimise the size of non-ulcerative plantar callus (p < 0.05), potentially reducing future ulcer recurrence. The 2nd study focused on the use of a GekoTM electrical stimulation device to enhance DFU healing in 24 patients. Wounds were characterised as being neuroischaemic (NRI) or neuropathic (NRP) based on standard parameters adopted in the Manchester diabetes clinic. The device was worn by 11 intervention subjects and compared to 13 controls without any electrical stimulus. Results suggested healing and wound closure have potentially increased in participants with electrical stimulation. In addition, Neuropathy Disability Score (NDS) was improved among intervention patients compared to control (p < 0.0001). The 3rd, in vitro and mechanistic study focuses on the outgrowth of endothelial cells (OECs), abnormal angiogenic responses and inflammatory microenvironment which could contribute to impaired wound healing in diabetic patients. OECs were isolated from diabetic patients and healthy controls (HCs), characterised by immunohistochemistry and Polymerase Chain Reaction (PCR). The functions of the three OEC groups from NRI, NRP diabetic patients and healthy controls respectively were compared using in vitro proliferation, transwell migration and wound healing scratch assays, together with matrigel tube formation assays. Scratch assays showed 100% closure in HCs over 24 hours, while 86.6% closure was apparent in NRI vs 38.1% in NRP. Seahorse mitochondrial stress test was conducted and demonstrated mitochondrial dysfunction in NRP vs NRI vs HCs (p < 0.05). Western blot analysis showed a lack of ERK phosphorylation by NRP OECs and an up-regulation of plasma inflammatory cytokines (TNFa and IL-6) in diabetic samples vs HC (p < 0.0001), while the angiogenic factors ang-2, FGF-2, VEGF-D, HGF and IL-8, and nitric oxide bioavailability were all significantly reduced in diabetic samples vs HC (p < 0.05). The functional defects of the diabetic OECs were partially restored through glycomimetic (synthesis compounds for endothelial damage protection) treatment (p < 0.05). In summary, this study has highlighted areas worthy of future development both in terms of preventative and therapeutic strategies. With improvements in digital technology and the need to empower patients to take responsibility of their health and well-being as well as greater understanding of the cellular and molecular biological repair processes that may be exploited, there may be potentials to reduce the risk of future ulceration among patients using these novel approaches in the future.

Chan Chak Ming. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (leaves 178-202). / Abstracts in English and Chinese. / Abstract --- p.i / Abstract in Chinese 摘耍 --- p.iii / Acknowledgements --- p.v / Table of contents --- p.vi / List of tables --- p.xii / List of figures --- p.xiii / Abbreviations --- p.xvi / Chapter Chapter 1: --- Introduction --- p.1 / Chapter 1.1 --- Definition of diabetes mellitus --- p.1 / Chapter 1.2 --- Classification of diabetes mellitus --- p.4 / Chapter 1.2.1 --- Type 1 diabetes --- p.4 / Chapter 1.2.2 --- Type 2 diabetes --- p.5 / Chapter 1.2.3 --- Other forms of diabetes --- p.9 / Chapter 1.3 --- Complications of diabetes mellitus --- p.11 / Chapter 1.4 --- Current treatment of diabetes mellitus --- p.12 / Chapter 1.4.1 --- Type 1 diabetes --- p.12 / Chapter 1.4.2 --- Type 2 diabetes --- p.13 / Chapter 1.4.2.1 --- Diet and exercise --- p.13 / Chapter 1.4.2.2 --- Medication --- p.13 / Chapter 1.5 --- The use of herbal medicines in diabetes treatment --- p.18 / Chapter 1.6 --- "Hypothesis, objectives and design of the project" --- p.22 / Chapter Chapter 2: --- Preparation and authentication of traditional Chinese medicines --- p.23 / Chapter 2.1 --- Introduction --- p.23 / Chapter 2.1.1 --- Background information of the formulae --- p.23 / Chapter 2.1.2 --- Component herbs of formula1 --- p.26 / Chapter 2.2 --- Objectives --- p.29 / Chapter 2.3 --- Materials --- p.30 / Chapter 2.3.1 --- Raw herbal materials and formula 1 extract --- p.30 / Chapter 2.3.2 --- Thin layer chromatography --- p.35 / Chapter 2.3.3 --- High performance liquid chromatography determination of the sugar content of the herbal extracts --- p.38 / Chapter 2.4 --- Methods --- p.41 / Chapter 2.4.1 --- Thin layer chromatography of the component herbs --- p.41 / Chapter 2.4.2 --- Raw herbal materials water extraction --- p.46 / Chapter 2.4.3 --- High performance liquid chromatography determination of the sugar content of the herbal extracts --- p.46 / Chapter 2.5 --- Results --- p.49 / Chapter 2.5.1 --- Thin layer chromatography of the component herbs --- p.49 / Chapter 2.5.2 --- Raw herbal materials water extraction --- p.56 / Chapter 2.5.3 --- High performance liquid chromatography determination of the sugar content of the herbal extracts --- p.57 / Chapter 2.6 --- Discussion --- p.62 / Chapter Chapter 3: --- The anti-diabetic effects of formula 1 and its component herbs in vitro --- p.67 / Chapter 3.1 --- Introduction --- p.67 / Chapter 3.1.1 --- Glycaemic control in type 2 diabetes --- p.67 / Chapter 3.1.2 --- Type 2 diabetes and peripheral tissues --- p.70 / Chapter 3.1.3 --- Type 2 diabetes and liver --- p.73 / Chapter 3.1.4 --- Type 2 diabetes and intestinal glucose absorption --- p.76 / Chapter 3.2 --- Objectives --- p.79 / Chapter 3.3 --- Materials --- p.80 / Chapter 3.3.1 --- Cell lines --- p.80 / Chapter 3.3.2 --- "Cell culture media, buffers, reagents and culture wares" --- p.81 / Chapter 3.3.3 --- "Chemicals, media and reagents for 3T3-L1 differentiation" --- p.83 / Chapter 3.3.4 --- Chemicals and reagents for 3T3-L1 and Hs68 2-deoxy-D- glucose (2-DG) uptake assay --- p.84 / Chapter 3.3.5 --- Chemicals and buffers for H4IIE glucose production assay and phosphoenolpyruvate carboxykinase (PEPCK) assay --- p.85 / Chapter 3.3.6 --- "Animal, buffers and reagents for preparation and glucose uptake assay of brush border membrane vesicles (BBMV)" --- p.87 / Chapter 3.3.7 --- Reagents for bicinchoninic acid (BCA) protein assay --- p.88 / Chapter 3.4 --- Methods --- p.89 / Chapter 3.4.1 --- Cell culture --- p.89 / Chapter 3.4.2 --- Studies on glucose uptake in 3T3-L1 adipocytes and Hs68 fibroblasts --- p.90 / Chapter 3.4.2.1 --- Differentiation of 3T3-L1 cells --- p.90 / Chapter 3.4.2.2 --- Oil red O staining of the 3T3-L1 cells --- p.90 / Chapter 3.4.2.3 --- 2-DG uptake assay of 3T3-L1 adipocytes and Hs68 fibroblasts --- p.91 / Chapter 3.4.3 --- Studies on gluconeogenesis in H4IIE hepatoma cells --- p.93 / Chapter 3.4.3.1 --- Glucose production assay --- p.93 / Chapter 3.4.3.2 --- PEPCK assay --- p.94 / Chapter 3.4.4 --- Studies on BBMV glucose uptake --- p.95 / Chapter 3.4.4.1 --- Preparation of BBMV --- p.95 / Chapter 3.4.4.2 --- Preparation of the chloroform extract of the herbal water extract --- p.96 / Chapter 3.4.4.3 --- Glucose uptake assay of BBMV --- p.97 / Chapter 3.4.5 --- BCA (Bicinchoninic acid) protein assay --- p.99 / Chapter 3.4.6 --- Statistical analysis --- p.100 / Chapter 3.5 --- Results --- p.101 / Chapter 3.5.1 --- Glucose uptake assay in 3T3-L1 adipocytes and Hs68 fibroblasts --- p.101 / Chapter 3.5.2 --- Glucose production and PEPCK assay in H4IIE hepatoma cells --- p.108 / Chapter 3.5.3 --- Glucose uptake assay in BBMV --- p.113 / Chapter 3.6 --- Discussion --- p.119 / Chapter 3.6.1 --- Glucose uptake in 3T3-L1 adipocytes and Hs68 fibroblasts --- p.119 / Chapter 3.6.2 --- Glucose production and PEPCK activity in H4IIE hepatoma cells --- p.123 / Chapter 3.6.3 --- Glucose absorption in BBMV --- p.125 / Chapter 3.6.4 --- Conclusion --- p.128 / Chapter Chapter 4: --- The anti-diabetic effects of formula 1 and Rhizoma Smilacis Chinensis in vivo --- p.131 / Chapter 4.1 --- Introduction --- p.131 / Chapter 4.1.1 --- Diabetic animal models --- p.131 / Chapter 4.1.2 --- Neonatal streptozotocin-induced diabetic rat model --- p.133 / Chapter 4.2 --- Objective --- p.136 / Chapter 4.3 --- Materials --- p.137 / Chapter 4.3.1 --- Animals --- p.137 / Chapter 4.3.2 --- Chemicals and reagent kit --- p.137 / Chapter 4.4 --- Methods --- p.139 / Chapter 4.4.1 --- Induction of diabetes in rats --- p.139 / Chapter 4.4.2 --- Oral glucose tolerance test --- p.139 / Chapter 4.4.3 --- Basal glycaemia test --- p.141 / Chapter 4.4.4 --- Plasma glucose level determination --- p.142 / Chapter 4.4.5 --- Statistical analysis --- p.142 / Chapter 4.5 --- Results --- p.143 / Chapter 4.5.1 --- Oral glucose tolerance test --- p.143 / Chapter 4.5.2 --- Basal glycaemia test --- p.147 / Chapter 4.6 --- Discussion --- p.151 / Chapter Chapter 5: --- The effects of the TCM treatment on glucose homeostasis in diabetic foot ulcer patients --- p.155 / Chapter 5.1 --- Introduction --- p.155 / Chapter 5.2 --- Objective --- p.156 / Chapter 5.3 --- Materials --- p.157 / Chapter 5.3.1 --- Study subjects --- p.157 / Chapter 5.3.2 --- Blood sample --- p.158 / Chapter 5.3.3 --- Chemicals and reagents for erythrocyte glucose uptake assay --- p.158 / Chapter 5.4 --- Methods --- p.160 / Chapter 5.4.1 --- Preparation of blood sample --- p.160 / Chapter 5.4.2 --- Zero-trans influx of 3-OMG uptake in erythrocytes --- p.160 / Chapter 5.4.3 --- Statistical analysis --- p.161 / Chapter 5.5 --- Results --- p.162 / Chapter 5.6 --- Discussion --- p.166 / Chapter Chapter 6: --- General discussion and conclusion --- p.168 / Chapter 6.1 --- Overview of the project and analysis of research findings --- p.168 / Chapter 6.2 --- Limitations of the study --- p.173 / Chapter 6.3 --- Future directions --- p.174 / Chapter 6.4 --- Conclusion --- p.177 / Chapter Chapter 7: --- References --- p.177 / Appendices --- p.203 / Appendix I The determination of the sugar contents in the herbal water extracts by high performance liquid chromatography --- p.203 / Appendix II Basal glycaemia test of formula 1 (822mg/kg) on nO-STZ rats --- p.206

Submitted by Fabíola Silva (fabiola.silva@famerp.br) on 2017-02-24T19:38:53Z No. of bitstreams: 1 denilsonpereirajose_dissert.pdf: 1394022 bytes, checksum: 45ff80cb00c7924473059901b8f4ed4f (MD5) / Made available in DSpace on 2017-02-24T19:38:53Z (GMT). No. of bitstreams: 1 denilsonpereirajose_dissert.pdf: 1394022 bytes, checksum: 45ff80cb00c7924473059901b8f4ed4f (MD5) Previous issue date: 2014-10-13 / Introduction: Diabetes mellitus is a chronic disease evidenced by hyperglycemia and one of the main symptoms includes the diabetic foot, which can lead to amputation thereby decreasing the survival of patients with diabetes. Objective: Identify sociodemographic and clinical factors of patients with diabetes types one and two who were seen at the diabetic foot outpatient clinic at a University Hospital in São José do Rio Preto/SP. Methods: Descriptive study with a quantitative approach which the data was collected from 121(100%) electronic patient records with diabetes type 1 and 2 who were seen at the diabetic foot outpatient clinic at a University Hospital in São José do Rio Preto/SP from July 2010 to July 2012. Results: Of the 121 patients, 80(66,12%) were male,50(41,32%) were from São José do Rio Preto,46(38,02%) had incomplete primary education and, 86(71,07%) consensual marriage, with a mean age of 54,17 (DP=15,37) years old, since the age ranges from 21 to 84 years old.. As for the clinical characteristics, there is a majority of type 2 DM with 68(72,34%), showed presence of wounds 61(6,19%), 53(43,80%) of Wagner classification grade 0 (high risk, but no lesions). And yet the first degree of injury is directly related to type 2 diabetes and patients who have nephropathy, hypertension, neuropathy, dyslipidemia and related diseases, as well as having risk factors such as smoking and alcoholism. Conclusion: Greater investments are needed in health education strategies, strengthening planned investments by a multidisciplinary healthcare team. / Introdução: A diabetes mellitus (DM) é uma doença crônica, caracterizada pela hiperglicemia e uma das principais complicações é o pé diabético, que pode evoluir para amputações com isso diminuindo a sobrevida do paciente com diabetes. Objetivo: Identificar os fatores sóciodemográficos e clínicos dos pacientes com diagnóstico de diabetes tipo1 e 2 atendidos no ambulatório do pé diabético de um hospital de ensino de São José do Rio Preto/SP e associar estes fatores ao tipo de diabetes e classificação de Wagner. Casuística e Métodos: Pesquisa descritiva com abordagem quantitativa, cujos dados foram obtidos por meio de pesquisa de 121(100%) prontuários eletrônicos de pacientes com diagnóstico de diabetes tipo1 e 2 atendidos no ambulatório do pé diabético de um hospital de ensino de São José do Rio Preto/SP no período de julho de 2010 a julho de 2012. Resultados: Dos 121 pacientes, 80(66,12%) eram do gênero masculino,50(41,32%) eram de São José do Rio Preto,46(38,02%) tinham ensino fundamental incompleto,86(71,07%) apresentavam com conjugue, com idade média de 54,17 anos (DP=15,37), sendo que a faixa etária que variou de 21 a 84 anos. Quanto às características clinicas, verificou-se a predominância do DM do tipo 2 com 68(72,34%), apresentaram presença de feridas 61(56,19%),53(43,80%) a Classificação de Wagner de grau 0 (risco elevado, porém ausência de úlcera) e ainda de grau 1 apresentou associação com o diabetes tipo 2 e com pacientes que apresentava nefropatia, HAS, neuropatia, dislipidemia como doenças associadas, além de apresentar fatores de risco como tabagismo e alcoolismo. Conclusão: Faz-se necessário maiores investimentos em estratégias de educação em saúde, intensificando os programados por equipe multidisciplinar da área da saúde.

Le diabète sucré est un problème majeur de santé publique. L’une de ses principales complications est l’ulcère du pied (UPD) à l’origine d’infections et de nombreuses amputations. Ces plaies sont majoritairement polymicrobiennes. La principale bactérie isolée est Staphylococcus aureus (SA) qui pose d’importants problèmes en thérapie courante. Bactérie commensale notamment des fosses nasales, elle est un vrai pathogène au niveau des UPD. La compréhension du passage du commensalisme à la pathogénicité reste peu connue. Or récemment une souche colonisante de SA présentant un faible potentiel de virulence, et isolée sur un UPD a été identifiée. Cette souche présente un phage (ROSA-like) inséré dans son génome dont la stabilité a été démontrée. Ce phage est responsable de la faible virulence de cet isolat. Ce travail de doctorat a permis : i) de mettre en évidence l’implication du phage ROSA-like dans la dérégulation des mécanismes d’acquisition du fer, mécanismes essentiels pour la survie du SA ainsi que dans le métabolisme global de cette souche. Ces résultats ont confirmé le rôle clé du phage dans la baisse de la virulence du SA colonisant ; ii) à partir d’un modèle in vitro d’infections chroniques mimant les conditions rencontrées dans les UPD, d’étudier le comportement de souches cliniques de SA (colonisantes/infectantes) en fonction des différentes conditions environnementales : hyperglycémie, anaérobie, antibiotiques (linézolide et vancomycine). Les résultats ont montré qu’une exposition prolongée (plus de 24 semaines) à ces conditions de stress notamment aux antibiotiques, réduisait la virulence des souches de SA ; iii) d’évaluer la virulence des SA en présence d’autres bactéries qui l’entourent, élément essentiel du polymicrobisme de l’UPD. Ce travail s’est particulièrement intéressé aux interactions existant entre SA et Helcococcus kunzii, bactérie fréquemment isolée en association avec le SA dans les UPD. Il a montré pour la première fois une baisse de la pathogénicité des souches de SA par une bactérie commensale non virulente. / Diabetes mellitus is a global problem. One of the main complications is diabetic foot ulcer (DFU) which can evolve towards infection and induces lower limb amputations. Those wounds are mostly polymicrobial and Staphylococcus aureus (SA), the most prevalent pathogen isolated in this situation causes numerous therapeutic problems. This bacterium, known to be a commensal organism present notably in nasal cavity, is a real pathogen in DFU. However the comprehension between the commensalism and the pathogenicity of SA remains still unknown. Recently, a colonizing SA strain with very low virulence potential was discovered in DFU. This strain possesses a phage named Rosa-like responsible of its low virulence.This work helped us: i) to highlight the involvement of the Rosa-like phage in the disregulation of iron uptake mechanisms, the main source for SA survival and its global metabolism. The obtained results confirm the key role of the phage in the decrease of the colonizing SA strain virulence; ii) to study the behaviour of clinical SA strains (colonizing/infecting) using an in vitro chronic infection model miming different environmental conditions encountered in DFU: hyperglycemia, anaerobic condition, antibiotics (linezolid and vancomycin). Results showed that prolonged exposure (up to 24 weeks) to those stress conditions notably antibiotics reduced SA strains virulence; iii) to evaluate SA virulence in presence of other bacteria present in DFU. Particularly, in this work a focus was performed in the interaction between SA and Helcococcus kunzii, gram positive bacteria frequently isolated with SA in DFU. It was shown for the first time a decrease of SA pathogenicity by a commensal non virulent bacterium.

Objective: This dissertation includes three projects that study care environments and apathy in dementia as well as measures of activity. Project 1 developed the Person-Environment Apathy Rating (PEAR) scale to measure environmental stimulation and apathy, and tested its psychometrics. Project 2 examined the association between care environments and apathy in persons with dementia. Project 3 tested the accuracy of ActiGraph and activPALTM activity monitors in measuring weight-bearing activities among persons with previous diabetic foot ulcers. Methods: The PEAR consists of environment (PEAR-Environment) and apathy (PEAR-Apathy) subscales. The validity and reliability of the PEAR was examined through video observation of 24 participants. Project 2 selected 40 participants with dementia in order to examine the association between apathy and environmental stimulation, ambiance, crowding, staff familiarity, and light and sound. Study procedures involved video observation and data extraction. Project 3 enrolled 31 participants to test the accuracy of ActiGraph and activPALTM in measuring number of steps taken and duration of walking, standing, sitting, and lying. Results: The PEAR-Environment subscale had significant but fair correlation with the Crowding Index (Ρ=.27, p<.01), suggesting fair validity. The PEAR-Apathy highly correlated with the Passivity in Dementia Scale (ρ=.81) and Neuropsychiatry Inventory (NPI)-Apathy subscale (ρ=.266), and moderately correlated with the NPI-Depression subscale (ρ=.46), indicating good convergent validity and moderate discriminate validity. The PEAR also demonstrated good internal consistency (Cronbach's Α= .84 -.85) and moderate to good inter-rater (Weighted Kappa=.47-.94) and intra-rater (Weighted Kappa=.47-.94) reliability. Project 2 revealed that stimulation clarity and strength were significantly associated with a low apathy level (p<.001). An increase of 1 point on stimulation clarity and strength corresponded to a decrease on apathy score of 1.3 and 1.9 points, respectively. Project 3 revealed that ActiGraph had widely varied accuracy in measuring duration of standing, walking, sitting, and lying (0-100%) and in measuring number of steps taken (43-81%). In contrast, activPALTM showed consistently high accuracy in measuring duration of standing, walking, sitting, and lying (97-100%) and in measuring number of steps of taken (91-99%). Discussion: The PEAR is a valid and reliable measure of care environment and apathy in long-term care residents with dementia. Care environments that contain clear and sufficiently strong environmental stimulation are significantly associated with lower apathy levels, providing a foundation for interventions targeting apathy. ActivPALTM is a valid tool to measure weight-bearing activity in persons with diabetes in order to examine the role of weight-bearing activity in foot ulceration. This monitor may also be useful as a supplemental measure for apathy in persons with dementia.

The object of the thesis is to analyze the potential of thermography in the early diagnosis of type 2 diabetic foot. The main advantages of thermography are that it is simple to use, non-invasive, contactless, non-irradiant, and fast. A robust acquisition protocol is proposed, as well as a dedicated image processing algorithm. The algorithm includes a pre-processing step, plus a segmentation and a rigid registration procedures. Various parameters are assessed: the mean and standard deviation of right and left feet plantar surfaces temperaure, as well as the percentage of pixels such that the absolute point to point temperature difference between right and left feet is greater than 2.2°C. A percentage greater than 1% indicates significative hyperthermia regions. A transversal clinical study is conducted on a population of 85 persons of type 2 diabetic foot. They are classified in one of these three groups: Low risk, Medium risk, and High risk. For the Low risk group, the mean temperature is close to 32°C. For the medium one, it goes down to 31°C, and increases for the High risk group to a value of 32°C. In the early stage of diabetic foot, i.e. from the Low risk group to Medium risk group, the plantar foot surface temperature is lowered by 1°C: if this result is confirmed by other clinical tests, this information can be useful for the early diagnosis of diabetic foot. Finally, 9 images out of the 85 show hyperthermia, mainly in the heel or toes regions. This hyperthermia indication may be of a substantial assistance in the early prevention of foot ulcer and can help in avoiding subsequent foot amputation.

Abtrakt (EN) In spite of the fact that the diabetic foot syndrome is not considered a marginal complication of the patients with diabetes mellitus any more, its prevalence and incidence is not decreasing. The fact that early diagnosis and treatment or even prevention of foot ulcers is associated with a decrease in healthcare costs and, more importantly, with reducing patients' suffering, applies also in this case. The dissertation work originated in the Diabetologic Center of the Medical department I., University Hospital and Medical Faculty in Pilsen, Charles University in Prague, which has been dealing with diagnostic and therapeutic procedures in patients with diabetic foot syndrome for over 20 years. The examinations for diagnosis of the main etiologic factors, i.e. peripheral neuropathy and impaired perfusion, belong to already routine ordinary procedures here. My task was to move the diagnostics of this complication to earlier stages, even before the development of the ulcers, through diagnosing an impairment in skin microcirculation. The aim of the work was to evaluate reactivity of the skin microcirculation in patients with diabetes mellitus using laser doppler flowmetry and to introduce a new method - iontophoresis. Skin microcirculation assessment has become a center of interest of many studies...

L'objectif de cette thèse est d'analyser l’utilité de la thermographie dans le cadre du diagnostic précoce du pied diabétique. Un protocole d'acquisition robuste des images thermiques est proposé, ainsi qu'un algorithme spécifique de traitement de ces images. Cet algorithme comporte une étape de prétraitement, suivie d'une segmentation et d’un recalage rigide. Différents paramètres sont ensuite évalués : la moyenne et l'écart type de la température de la voute plantaire de chacun des pieds droit et gauche, de même que le pourcentage des pixels pour lesquels la différence de température entre les pieds droit et gauche est supérieure à 2,2°C. Cela permet de mettre en évidence les régions en hyperthermie. Une étude clinique est menée sur une population de 85 personnes diabétiques. Ces patients sont classés sur critères médicaux dans trois groupes : risque faible, moyen ou élevé. Pour le groupe à faible risque, la température des pieds est proche de 32°C. Pour le groupe à risque moyen, elle descend à 31°C et remonte à 32°C pour le groupe risque élevé. Au stade précoce du pied diabétique, c'est-à-dire entre le risque faible et le risque moyen, la température de la surface plantaire diminue de 1°C : si ce résultat est confirmé par d'autres essais cliniques, cette information peut être utile pour le diagnostic précoce du pied diabétique. Enfin, 9 images sur les 85 étudiées révèlent une hyperthermie significative : cette indication d'hyperthermie peut être d'une aide considérable dans la prévention précoce de l'ulcère du pied et pourrait éviter des complications graves chez ces patients. / The object of the thesis is to analyze the potential of thermography in the early diagnosis of type 2 diabetic foot. The main advantages of thermography are that it is simple to use, non-invasive, contactless, non-irradiant, and fast. A robust acquisition protocol is proposed, as well as a dedicated image processing algorithm. The algorithm includes a pre-processing step, plus a segmentation and a rigid registration procedures. Various parameters are assessed: the mean and standard deviation of right and left feet plantar surfaces temperaure, as well as the percentage of pixels such that the absolute point to point temperature difference between right and left feet is greater than 2.2°C. A percentage greater than 1% indicates significative hyperthermia regions. A transversal clinical study is conducted on a population of 85 persons of type 2 diabetic foot. They are classified in one of these three groups: Low risk, Medium risk, and High risk. For the Low risk group, the mean temperature is close to 32°C. For the medium one, it goes down to 31°C, and increases for the High risk group to a value of 32°C. In the early stage of diabetic foot, i.e. from the Low risk group to Medium risk group, the plantar foot surface temperature is lowered by 1°C: if this result is confirmed by other clinical tests, this information can be useful for the early diagnosis of diabetic foot. Finally, 9 images out of the 85 show hyperthermia, mainly in the heel or toes regions. This hyperthermia indication may be of a substantial assistance in the early prevention of foot ulcer and can help in avoiding subsequent foot amputation.