RESUMEN
INTRODUCTION: Wound management has become one of the ten physical therapy (PT) certification specialty areas. With this advanced clinical designation opportunity, more PT specialists and residencies with integumentary and wound management expertise will be needed for the educational and practice training of future specialists. PURPOSE: The purpose of this study was to characterize wound management practice by licensed physical therapists in Texas. METHODS: A Qualtrics survey was distributed to 19,159 licensed physical therapists. The questionnaire contained 23 questions that inquired into the subject's professional background, clinical experience, and opinions of wound care practice. RESULTS: The response rate was 9.6% (n = 1,839) and 1,643 respondents indicated that they were currently practicing. Although 69.1% of active physical therapists (n = 1,136) stated that they had practiced wound care at some point of their career, most of them do not practice wound care anymore and their reasons were discussed. Of those active physical therapists, 41.3% (n = 679) of them reported wound care was being practiced in their facilities, but only 18.3% (n = 311) directly practiced wound care. The respondents felt that the prevalence of wound management physical therapists practice over the last five years has been decreasing. CONCLUSION: The current prevalence of wound management practice is low and a decreasing trend of PT practice in wound care was observed in Texas. A limitation of this study is the low response rate. Future studies across different regions of the country are warranted.
Asunto(s)
Fisioterapeutas , Especialidad de Fisioterapia , Humanos , Texas , Fisioterapeutas/educación , Prevalencia , Encuestas y Cuestionarios , Escolaridad , Especialidad de Fisioterapia/educaciónRESUMEN
Background and objective: Xenotransplantation of porcine islets to human recipients has been investigated as a potential cure for type 1 diabetes. However, the porcine islets have poor insulin secretion capacity compared with human islets. The objective of this study was to evaluate the effect of photobiomodulation therapy (PBMT) in insulin secretion on isolated porcine islets. Methods: Eight pancreata were harvested from crossbred market porcine and the islets were isolated from the pancreas. The isolated islets were treated with PBMT (wavelength: 633 nm and dosages: 0.0, 15.6, and 31.3 J/cm2) followed by 30-min incubation in low (3.0 mM) or high (16.7 mM) glucose. The relative percentage differences on insulin secretion between three dosages were compared in low and high glucose, respectively. Results: Insulin secretion was higher in samples exposed to 15.6 J/cm2 PBMT in low glucose (p < 0.05), but not in high glucose. When evaluating sex differences, male islets had higher insulin secretion by 15.6 J/cm2 PBMT in low glucose compared with females (p < 0.05). No significant differences were seen in high glucose. When compared within the control groups (0.0 J/cm2 PBMT), the relative changes on insulin secretion in high glucose was significantly higher on male islets (p < 0.05), but not on female islets. Conclusions: PBMT may increase insulin secretion on isolated porcine islets in basal condition, but it may not improve islets' glucose responsiveness to secrete insulin. Male porcine islets may respond to PBMT and glucose stimuli better than female islets on insulin secretion.
Asunto(s)
Trasplante de Islotes Pancreáticos , Islotes Pancreáticos , Terapia por Luz de Baja Intensidad , Animales , Femenino , Glucosa/metabolismo , Glucosa/farmacología , Secreción de Insulina , Islotes Pancreáticos/metabolismo , Masculino , PorcinosRESUMEN
[Purpose] The purpose of this report is to describe the PT evaluation, prehab interventions, and outcomes of a patient pursuing reverse total shoulder replacement (rTSR) for pain reduction and functional gains. [Participant and Methods] A 62-year-old male self-referred to PT two months before his right rTSR. His chief complaints were right shoulder pain, stiffness, and functional impairment due to rotator cuff tendon tears and shoulder arthritis. He demonstrated poor posture, limited ROM, decreased strength, and diminished function. The PT prehab program consisted of an initial encounter followed by six treatment sessions across approximately one month. [Results] On the last visit, the patient's pain had meaningfully decreased along with improved posture, AROM, and muscle strength producing a clinically significant improvement in function resulting in the postponing of his rTSR. On a three months follow-up, the patient had maintained or improved in his test and measures and functional outcomes. He expressed satisfaction with the prehab outcomes and that he had indefinitely postponed his rTSR. [Conclusion] PT prehab program improved pre-operative measures on pain, posture, joint mobility, muscle strength, and function on a patient who had been scheduled for rTSR surgery. PT prehab program may delay the need for rTSR surgery.
RESUMEN
OBJECTIVE: To investigate how wound care instruction is currently delivered within entry-level doctor of physical therapy (DPT) educational curricula. METHODS: An electronic survey was distributed to 226 DPT programs in the US. The questionnaire contained 27 questions about the characteristics of the wound care instruction as well as the credentials, clinical experience, and teaching experience of the instructors. Descriptive statistics were analyzed for each questionnaire item response. MAIN RESULTS: The response rate was 22.1% (n = 50). The majority of respondents reported 10 to 29 contact hours of wound care instruction throughout the curriculum. More than half of the programs reported that their students completed a wound care observation in clinical settings. Forty-four percent of programs stated that their students had the opportunity to participate in a clinical rotation focused solely on wound care. All respondents reported that their wound care instructors were physical therapists. Of those instructors, most were seasoned clinicians, and 46% held a wound care-related certification. CONCLUSIONS: Current entry-level DPT curricula provide physical therapy students with adequate contact hours in wound care and the opportunity for clinical experiences. The instructors are seasoned physical therapists, and nearly half of them hold advanced certification in the content area. Further studies are warranted to investigate how physical therapists practice in wound management in various clinical settings.
Asunto(s)
Competencia Clínica , Curriculum , Fisioterapeutas/educación , Especialidad de Fisioterapia/educación , Heridas y Lesiones/rehabilitación , Adulto , Femenino , Humanos , Masculino , Cuidados de la Piel/métodos , Estudiantes del Área de la Salud , Encuestas y Cuestionarios , Estados Unidos , Adulto JovenRESUMEN
PURPOSE: This case report presents evidence-based physical therapy assessments and interventions for a patient with unilateral vestibular hypofunction (UVH). UVH is the result of peripheral vestibular dysfunction in the inner ear. Case Description : The patient was a 48-year-old male with symptoms of dizziness, cephalalgia, and cervicalgia. The examination and treatment were focused on impaired cervical proprioception, which is a vital component of balance training in addition to visual, vestibular, and somatosensory re-education for patients with dizziness. Toward the end of the physical therapy episode of care, the patient was medically diagnosed with Chiari malformation, a congenital cerebellar tonsillar herniation. Outcomes : The patient made significant strides on the Dizziness Handicap Inventory, Ten Meter Walk Test, Single Leg Stance, Balance Error Scoring System, Fukuda Stepping Test, Cervical Joint Position Error Sense Test, Convergence Distance, Global Rate of Change, and cervical range of motion assessments. The patient did not demonstrate comparable improvements on the Dynamic Visual Acuity Test. Conclusion : This case report demonstrates a physical therapy program for a patient with peripheral UVH-related symptoms. This approach may also be applicable for patients with the central cause of dizziness such as Chiari malformation. Future directions for research and clinical practice are also suggested in this report.
Asunto(s)
Síndrome de Budd-Chiari/terapia , Cefalea/terapia , Dolor de Cuello/terapia , Modalidades de Fisioterapia , Trastornos Somatosensoriales/terapia , Vértigo/terapia , Humanos , Masculino , Persona de Mediana Edad , Examen Físico , Equilibrio Postural/fisiologíaRESUMEN
When working with isolated islet preparations, measuring the volume of tissue is not a trivial matter. Islets come in a large range of sizes and are often contaminated with exocrine tissue. Many factors complicate the procedure, and yet knowledge of the islet volume is essential for predicting the success of an islet transplant or comparing experimental groups in the laboratory. In 1990, Ricordi presented the islet equivalency (IEQ), defined as one IEQ equaling a single spherical islet of 150 µm in diameter. The method for estimating IEQ was developed by visualizing islets in a microscope, estimating their diameter in 50 µm categories and calculating a total volume for the preparation. Shortly after its introduction, the IEQ was adopted as the standard method for islet volume measurements. It has helped to advance research in the field by providing a useful tool improving the reproducibility of islet research and eventually the success of clinical islet transplants. However, the accuracy of the IEQ method has been questioned for years and many alternatives have been proposed, but none have been able to replace the widespread use of the IEQ. This article reviews the history of the IEQ, and discusses the benefits and failings of the measurement. A thorough evaluation of alternatives for estimating islet volume is provided along with the steps needed to uniformly move to an improved method of islet volume estimation. The lessons learned from islet researchers may serve as a guide for other fields of regenerative medicine as cell clusters become a more attractive therapeutic option.
Asunto(s)
Islotes Pancreáticos/anatomía & histología , Adenosina Trifosfato/análisis , Adenosina Trifosfato/metabolismo , Animales , Humanos , Islotes Pancreáticos/metabolismo , Islotes Pancreáticos/ultraestructura , Trasplante de Islotes Pancreáticos/métodos , Microscopía/métodos , Tamaño de los Órganos , Consumo de OxígenoRESUMEN
In a variety of mammalian species, small islets secrete more insulin per volume than large islets. This difference may be due to diffusional limitations of large islets, or inherent differences in the insulin production pathways. The purpose of this study was to identify possible differences in the early phase of glucose-stimulated insulin biosynthesis between large and small islets. Isolated small and large rat islets were challenged with 30 minutes of high glucose. The expression of insulin gene transcription factors (MafA, NeuroD/ Beta2, and PDX-1), preproinsulin mRNA, proinsulin and insulin were compared between large and small islets. Under basal (low glucose) conditions, MafA and NeuroD had higher mRNA levels and greater protein amounts in large islets compared to small when normalized to GAPDH levels. 30 minutes of high glucose stimulation failed to alter the mRNA or subsequent protein levels of either gene. However, 30 minutes of high glucose suppressed activated PDX-1 protein levels in both small and large islets. High glucose stimulation did not statistically alter the preproinsulin mRNA (insulin 1 and insulin 2) levels. At the translational level, high glucose increased the proinsulin levels, and large islets showed a higher proinsulin content per cell than small islets. Insulin content per cell was not significantly different between small and large islets under basal or high glucose levels. The results fail to explain the higher level of insulin secretion noted in small versus large islets and may suggest that possible differences lie downstream in the secretory pathway rather than insulin biosynthesis.
Asunto(s)
Diabetes Mellitus Experimental/metabolismo , Insulina/biosíntesis , Islotes Pancreáticos/metabolismo , Animales , Transporte Biológico , Diabetes Mellitus Experimental/patología , Islotes Pancreáticos/patología , Masculino , Ratas , Ratas Sprague-DawleyRESUMEN
Human islets come in a variety of sizes and shapes, and the total volume of islets used for research or clinical transplants must be estimated in a manner that is simple and valid. Islet equivalent (IEQ) measurements are the standard estimate of islet volume. We published a new method (the Kansas method) for estimating rat islet volume using cell numbers that was reliable and valid. Here we modified the method for human islets. We measured the dimensions of isolated human islets showing that they are not spherical and became less so in larger islets, with an average smallest/largest diameter ratio of 0.73 in large islets and 0.85 in small islets. Human islets were individually loaded into 96-well plates, dissociated into single cells, and the total cell number per islet determined with computer-assisted cytometry. Based on the counted cell number per islet, a regression model was created to convert islet diameter to cell number with a high R(2) value (0.99). Separate regression equations for male and female donors or young and old donors were not significantly different than the pooled data and did not improve the regression values. There was an inverse correlation between the cell number per IEQ and islet size. The Kansas method was validated with ATP/cell and cell viability data. Compared to the actual cell count, conventional IEQ measurements overestimated tissue volume of large islets by nearly double. Examples of differences in results obtained from the same data sets normalized to IEQ or the Kansas method included viability and insulin secretion concentrations. The implications of the error associated with the current IEQ method of volume estimation are discussed.
Asunto(s)
Trasplante de Islotes Pancreáticos/métodos , Islotes Pancreáticos/metabolismo , Adulto , Femenino , Humanos , Insulina/metabolismo , Secreción de Insulina , Islotes Pancreáticos/citología , Masculino , Persona de Mediana EdadRESUMEN
For the past 30 years, data have suggested that unique islet populations exist, based on morphology and glucose sensitivity. Yet little has been done to determine the mechanism of these functional differences. The purpose of this study was to determine whether human islets were comprised functionally unique populations, and to elucidate a possible mechanism. Islets or pancreatic sections from 29 human donors were analyzed. Islets were isolated and measured for insulin secretion, cell composition and organization, insulin and glucagon granule density and insulin content. Insulin secretion was significantly greater in small compared with large islets. In sectioned human pancreata, ß-cells comprised a higher proportion of the total endocrine cells in small islets (63%) than large islets (39%). A higher percentage of ß-cells in small islets contacted blood vessels (44%) compared with large islets (31%). Total insulin content of isolated human islets was significantly greater in the small (1323 ± 512 µIU/IE) compared with large islets (126 ± 48 µIU/IE). There was less immunostaining for insulin in the large islets from human pancreatic sections, especially in the core of the islet, compared with small islets. The results suggest that differences in insulin secretion between large and small islets may be due to a higher percentage of ß-cells in small islets with more ß-cells in contact with blood vessels and a higher concentration of insulin/ß-cell in small islets.
Asunto(s)
Células Secretoras de Insulina/metabolismo , Células Secretoras de Insulina/ultraestructura , Insulina/metabolismo , Islotes Pancreáticos/ultraestructura , Regulación hacia Arriba , Adulto , Recuento de Células , Femenino , Glucagón/metabolismo , Células Secretoras de Glucagón/metabolismo , Células Secretoras de Glucagón/ultraestructura , Humanos , Hiperglucemia/metabolismo , Inmunohistoquímica , Secreción de Insulina , Islotes Pancreáticos/irrigación sanguínea , Islotes Pancreáticos/crecimiento & desarrollo , Islotes Pancreáticos/metabolismo , Masculino , Microscopía Electrónica de Transmisión , Persona de Mediana Edad , Proinsulina/metabolismo , Vesículas Secretoras/metabolismo , Vesículas Secretoras/ultraestructura , Somatostatina , Células Secretoras de Somatostatina/metabolismo , Células Secretoras de Somatostatina/ultraestructura , Bancos de TejidosRESUMEN
Isolated islets can provide a source of tissue for research, transplantation, and drug discovery to develop therapies for diabetes. Empirical modeling of islet diffusion barriers demonstrated that only the outermost layers of cells were exposed to glucose and sufficient oxygen levels, resulting in core cell death. Islets under a diameter of 100 µm exhibited a lower diffusion barrier, superior survival rates, and improved functional properties. Utilizing these observations, we engineered optimal islets by dispersing them into single cells and reaggregating them over several days in a micromold. These custom-designed micromolds contained conical-shaped recesses that enhanced reaggregation of cells into a defined geometry. The engineered islets, or Kanslets, were all under 100 µm in diameter, and had the same general cellular composition as native islets. Kanslets continued to produce new insulin molecules and had microvilli on the islet surface, much like native islets. The engineered islets had a statistically higher viability (percent of live cells), and increased glucose diffusion compared to native islets. In addition, they remained responsive to varying glucose levels by secreting insulin. When transplanted into diabetic rats, engineered islets performed reduced random blood glucose to normal levels within 48 h. Optimally, engineering islets may be a suitable alternative to utilizing native, isolated islet tissue for a variety of applications. Reaggregating tissue in an optimized manner using our engineered micromold approach has immense impact for three-dimensional tissue production and its subsequent use in research, drug discovery, and the clinic.
Asunto(s)
Islotes Pancreáticos/citología , Ingeniería de Tejidos , Andamios del Tejido/química , Animales , Glucemia/metabolismo , Agregación Celular , Difusión , Islotes Pancreáticos/ultraestructura , Trasplante de Islotes Pancreáticos , Tamaño de los Órganos , Proinsulina/metabolismo , Ratas , Supervivencia TisularRESUMEN
Islet equivalent (IE), the standard estimate of isolated islet volume, is an essential measure to determine the amount of transplanted islet tissue in the clinic and is used in research laboratories to normalize results, yet it is based on the false assumption that all islets are spherical. Here, we developed and tested a new easy-to-use method to quantify islet volume with greater accuracy. Isolated rat islets were dissociated into single cells, and the total cell number per islet was determined by using computer-assisted cytometry. Based on the cell number per islet, we created a regression model to convert islet diameter to cell number with a high R2 value (0.8) and good validity and reliability with the same model applicable to young and old rats and males or females. Conventional IE measurements overestimated the tissue volume of islets. To compare results obtained using IE or our new method, we compared Glut2 protein levels determined by Western Blot and proinsulin content via ELISA between small (diameter≤100 µm) and large (diameter≥200 µm) islets. When normalized by IE, large islets showed significantly lower Glut2 level and proinsulin content. However, when normalized by cell number, large and small islets had no difference in Glut2 levels, but large islets contained more proinsulin. In conclusion, normalizing islet volume by IE overestimated the tissue volume, which may lead to erroneous results. Normalizing by cell number is a more accurate method to quantify tissue amounts used in islet transplantation and research.
Asunto(s)
Recuento de Células , Tamaño de la Célula , Trasplante de Islotes Pancreáticos , Islotes Pancreáticos/citología , Animales , ADN/análisis , Femenino , Transportador de Glucosa de Tipo 2/análisis , Humanos , Islotes Pancreáticos/química , Masculino , Proinsulina/análisis , Ratas , Ratas Sprague-Dawley , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadRESUMEN
Exercise appears to improve glycemic control for people with type 1 diabetes (T1D). However, the mechanism responsible for this improvement is unknown. We hypothesized that exercise has a direct effect on the insulin-producing islets. Eight-week-old mice were divided into four groups: sedentary diabetic, exercised diabetic, sedentary control, and exercised control. The exercised groups participated in voluntary wheel running for 6 weeks. When compared to the control groups, the islet density, islet diameter, and ß-cell proportion per islet were significantly lower in both sedentary and exercised diabetic groups and these alterations were not improved with exercise. The total insulin content and insulin secretion were significantly lower in sedentary diabetics compared to controls. Exercise significantly improved insulin content and insulin secretion in islets in basal conditions. Thus, some improvements in exercise-induced glycemic control in T1D mice may be due to enhancement of insulin content and secretion in islets.
Asunto(s)
Diabetes Mellitus Tipo 1/metabolismo , Insulina/metabolismo , Islotes Pancreáticos/citología , Condicionamiento Físico Animal , Animales , Glucemia/metabolismo , Diabetes Mellitus Experimental/patología , Secreción de Insulina , Masculino , Ratones , Microscopía Fluorescente/métodos , Páncreas/patología , Carrera , Factores de TiempoRESUMEN
NADH-cytochrome b5 oxidoreductase (Ncb5or) is an endoplasmic reticulum (ER)-associated redox enzyme involved in fatty acid metabolism, and phenotypic abnormalities of Ncb5or(-/-) mice include diabetes and lipoatrophy. These mice are lean and insulin-sensitive but become hyperglycemic at age 7 weeks as a result of ß-cell dysfunction and loss. Here we examine early cellular and molecular events associated with manifestations of ß-cell defects in Ncb5or(-/-) mice. We observe lower islet ß-cell content in pancreata at age 4 weeks and prominent ER distention in ß-cells by age 5 weeks. Ultrastructural changes progress rapidly in severity from age 5 to 6 weeks, and their frequency rises from 10% of ß-cells at 5 weeks to 33% at 6 weeks. These changes correlate temporally with the onset of diabetes. ER stress responses and lipid load in Ncb5or(-/-) ß-cells were assessed with isolated islets from mice at age 5 weeks. Expression levels of the stress marker protein Grp78/BiP and of phosphorylated eIF2α protein were found to be reduced, although their transcript levels did not decline. This pattern stands in contrast to the canonical unfolded protein response. Ncb5or(-/-) ß-cells also accumulated higher intracellular levels of palmitate and other free fatty acids and exhibited greater reactive oxygen species production than wild-type cells. An alloxan-susceptible genetic background was found to confer accelerated onset of diabetes in Ncb5or(-/-) mice. These findings provide the first direct evidence that manifestations of diabetes in lean Ncb5or(-/-) mice involve saturated free fatty acid overload of ß-cells and ER and oxidative stress responses.
Asunto(s)
Citocromo-B(5) Reductasa/fisiología , Diabetes Mellitus Experimental/inducido químicamente , Diabetes Mellitus Experimental/patología , Retículo Endoplásmico/patología , Células Secretoras de Insulina/patología , Estrés Oxidativo , Aloxano , Animales , Western Blotting , Diabetes Mellitus Experimental/metabolismo , Retículo Endoplásmico/metabolismo , Chaperón BiP del Retículo Endoplásmico , Ácidos Grasos Insaturados/metabolismo , Femenino , Técnica del Anticuerpo Fluorescente , Proteínas de Choque Térmico/genética , Proteínas de Choque Térmico/metabolismo , Células Secretoras de Insulina/metabolismo , Islotes Pancreáticos , Masculino , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Mitocondrias/metabolismo , Mitocondrias/patología , Oxidación-Reducción , Palmitatos/metabolismo , Especies Reactivas de Oxígeno/metabolismo , Reacción en Cadena en Tiempo Real de la Polimerasa , Respuesta de Proteína DesplegadaRESUMEN
The existence of morphologically distinct populations of islets in the pancreas was described over 60 years ago. Unfortunately, little attention has been paid to possible functional differences between islet subpopulations until recently. We demonstrated that one population, the small islets, were superior to large islets in a number of functional aspects. However, that work did not determine whether these differences were inherent, or whether they arose because of the challenge of isolation procedures. Nor, were there data to explain the differences in insulin secretion. We utilized immunohistochemistry, immunofluorescence, ELISA, and transmission electron microscopy to compare the unique characteristics found in isolated rat islet populations in situ and after isolation. Insulin secretion of small isolated islets was significantly higher compared to large islets, which correlated with higher insulin content/area in small islets (in situ), a higher density of insulin secretory granules, and greater insulin content/volume in isolated islets. Specifically, the core b-cells of the large islets contained less insulin/cell with a lower insulin granule density than peripheral b-cells. When insulin secretion was normalized for total insulin content, large and small islets released the same percentage of total insulin. Small islets had a higher density of cells/area than large islets in vitro and in situ. The data provide a possible explanation for the inferior insulin secretion from large islets, as they have a lower total cell density and the b-cells of the core contain less insulin/cell.
Asunto(s)
Insulina/análisis , Islotes Pancreáticos/química , Islotes Pancreáticos/citología , Animales , Recuento de Células , Separación Celular , Tamaño de la Célula , Células Cultivadas , Inmunohistoquímica , Hibridación in Situ , Insulina/metabolismo , Secreción de Insulina , Islotes Pancreáticos/metabolismo , Masculino , Concentración Osmolar , Ratas , Ratas Sprague-Dawley , Distribución TisularRESUMEN
For people with type 1 diabetes and severe hypoglycemic unawareness, islet transplants offer hope for improving the quality of life. However, islet cell death occurs quickly during or after transplantation, requiring large quantities of islets per transplant. The purpose of this study was to determine whether poor function demonstrated in large islets was a result of diffusion barriers and if removing those barriers could improve function and transplantation outcomes. Islets were isolated from male DA rats and measured for cell viability, islet survival, glucose diffusion and insulin secretion. Modeling of diffusion barriers was completed using dynamic partial differential equations for a sphere. Core cell death occurred in 100% of the large islets (diameter >150 µm), resulting in poor survival within 7 days after isolation. In contrast, small islets (diameter <100 µm) exhibited good survival rates in culture (91%). Glucose diffusion into islets was tracked with 2-NBDG; 4.2 µm/min in small islets and 2.8 µm/min in large islets. 2-NBDG never permeated to the core cells of islets larger than 150 µm diameter. Reducing the diffusion barrier in large islets improved their immediate and long-term viability in culture. However, reduction of the diffusion barrier in large islets failed to improve their inferior in vitro insulin secretion compared to small islets, and did not return glucose control to diabetic animals following transplantation. Thus, diffusion barriers lead to low viability and poor survival for large islets, but are not solely responsible for the inferior insulin secretion or poor transplantation outcomes of large versus small islets.