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1

The influence of ambient temperature on foot temperature in patients with diabetic foot ulceration

Foltyński P., Mrozikiewicz-Rakowska B., Ładyżyński P., Wójcicki J. M., Karnafel W.

Biocybernetics and Biomedical Engineering

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2014

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Vol. 34, no. 3

178--183

EN

Background: Patients with diabetic neuropathy exhibit a higher foot temperature than those without neuropathy and they are at risk for foot ulceration. Ambient temperature and foot ulceration additionally influence foot temperature in such patients. The aim of the study was to assess the influence of ambient temperature on foot temperature in patients with an ulcer on one of the feet. Methods: Miniature temperature data loggers were used for the monitoring of foot skin and ambient temperature. Twenty patients with diabetic neuropathy and ten healthy subjects were monitored for about 24 h each. Results: The temperature of the foot with an ulcer correlates significantly with ambient temperature, with the slope of the regression line of 0.09. The temperature of the non-ulcerated foot also correlates significantly with ambient temperature, with the slope of 0.31, however the correlation coefficient and the slope are significantly higher than in the case of the foot with an ulcer. The difference of temperature of the foot with an ulcer and temperature of the foot without an ulcer correlates well with ambient temperature with the slope of _0.219. The temperatures of left and right feet were studied as a function of ambient temperature in healthy individuals and there were no statistically significant differences between correlation coefficients and slopes. Conclusions: It is apparent that ambient temperature influences foot temperature even during foot ulceration. Thus ambient temperature should be taken into consideration in any application when foot temperatures are important, especially in the prediction of diabetic foot ulceration.

2

Monitoring of sweat secretion from eccrine sweat glands using electric conductivity method

Foltyński P., Ładyżyński P., Wójcicki J. M.

Biocybernetics and Biomedical Engineering

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2012

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Vol. 32, no. 4

47-57

EN

Sweat secretion from a single sweat gland can be monitored by using microtube or by visual observation of the skin region using a microscope or video recorder. Another method described in the present paper is based on perfusion with ultra-low conductive water of a small region of the skin with only one sweat pore. Sweat secreted from a gland is reach in ions comparing to perfusion fluid and therefore increases conductivity of the perfusion fluid. Conductivity of the perfusion fluid is measured on inlet and outlet of the measurement probe and the difference is amplified and sampled by an analog-to-digital converter controlled by developed software on PC. The goal of the present paper is to present an improved system of single sweat glands monitoring.

3

Continuous monitoring of feet temperature using a data logger with wireless communication

Foltyński P., Ładyżyński P., Wójcicki J. M., Brandl M., Grabner J., Migalska-Musiał K., Molik M., Sabalińska S., Ciechanowska A.

Biocybernetics and Biomedical Engineering

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2012

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Vol. 32, no. 4

59-64

EN

The aim of the present study was to verify a system for continuous monitoring of feet temperature. The temperature measurement system developed in cooperation of the Center for Biomedical Technology (Krems, Austria) and Digilog Inc. (Perg, Austria) company was used for monitoring of the skin temperature on foot. The temperature monitoring devices are wirelessly controlled and they could be encapsulated in order to achieve waterproofing and facilitate disinfection with liquid disinfectant. The skin temperature measurements were performed every 1 or 5 minutes. Two healthy subjects were monitored for 7-9 days. The preliminary system application showed its usefulness in continuous temperature monitoring of feet.

4

Preventive systems for the late complications of diabetes

Ładyżyński P., Wójcicki J. M., Foltyński P.

Biocybernetics and Biomedical Engineering

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2011

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Vol. 31, no. 2

3-21

EN

Aim of this work is to review and characterize methods and systems that are used to prevent onset and to slow down the progression of the late complications of diabetes. Two groups of methods and systems that might be used to prevent or to slow down the progression of the late complications of diabetes are characterized in this paper. Each of these two groups serves a different purpose. The first group is composed of the systems that facilitate a maintenance of strict metabolic control in diabetic patients, i.e. the systems which are used for monitoring and treatment of diabetes. The second group contains systems that are aimed at screening/monitoring or treatment of the risk factors or the early signs of the late complications. Obesity increases risk of diabetes and its complications. Thus, body mass monitoring and control systems are examples of the tools that belong to this group. Other examples include the diabetic retinopathy telescreening systems and the systems for monitoring of the diabetic foot syndrome.

5

Comparison of the wound area assessment methods in the diabetic foot syndrome

Molik M., Foltyński P., Ładyżyński P., Tarwacka J., Migalska-Musiał K., Ciechanowska A., Sabalińska S., Młynarczuk M., Wójcicki J. M., Krzymień J., Karnafel W.

Biocybernetics and Biomedical Engineering

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2010

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Vol. 30, no. 4

3-15

EN

The paper presents results of comparison of the wound area assessment methods in the diabetic foot syndrome (DFS). Wound size is a basic parameter that is used to evaluate efficacy of the applied treatment. Four measurement methods were used: the rulers, the planimetric Visitrak (Smith & Nephew, England), the Silhouette (Aranz Medical, New Zealand) applying lasers, digital photography and planimetry as well as the patient's module of TeleDiaFoS telecare system with the foot scanning capabilities. Study group consisted of 18 DFS patients. Nineteen wounds were successfully measured with all 4 methods. The results of the Visitrak and the Silhouette can be used interehangeably (r = 0.994, slope = 1.01, intercept = 0.154 cm2). For the other systems strong linear relationships exist that can be used to convert the wound area measured with one method to the corresponding value of another method. The correlation coefficients higher than 0.985 were obtained in ease of 3 systems: Visitrak, Silhouette and TeleDiaFoS. The TeleDiaFoS system can provide a physician with the patient-self-taken wound images that can be used for reliable assessment of the wound healing process during home tele-monitoring of the DFS patients.

6

In memoriam of Prof. M. Nałęcz

Wójcicki J. M., Weryński A.

Biocybernetics and Biomedical Engineering

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2009

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Vol. 29, no. 2

5-8

EN

On February 6, 2009 Professor Maciej Nałęcz the Editor-in-Chief of the journal of Biocybernetics and Biomedical Engineering passed away suddenly. He was a pioneer in the field of biomedical engineering, a leader who had made a real progress in this discipline.

7

Modern application of membrane technique in therapeutic and diagnostic medical systems

Ciechanowska A., Sabalińska S., Gutowska M., Wójcicki J. M.

Biocybernetics and Biomedical Engineering

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2008

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Vol. 28, no. 2

21-33

EN

This study presents actually available membrane systems devoted to therapeutic and diagnostic applications. In particular LDL apheresis systems including new Two Stage Membrane System with Recirculation (TSMS) and the microdialysis technique are discussed. Application of the membrane systems to therapeutic purposes with utilization of methods improving the selectivity of LDL cholesterol removal cause decrease of albumin losses. Application of quasi-continuous monitoring using microdialysis technique during intensive treatment provided in some cases a completely new quality data, which may be helpful in the profound understanding of the pathophysiology of the specified diseases.

8

Microdialysis technique in monitoring of the patient's metabolic state

Wójcicki J. M., Ciechanowska A., Sabalińska S., Gutowska M.

Biocybernetics and Biomedical Engineering

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2007

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Vol. 27, no. 1-2

53-64

EN

Frequent daily monitoring of the blood glucose level is not an adequately efficient method to maintain long-term normoglycemia and especially to prevent hypoglycemia in many diabetic patients. Continuous glucose measurement systems are currently being developed. The minimally invasive methods are mainly connected with measurements in the interstitial fluid (ISF). With the electroenzymaitic sensor implanted, the ISF glucose continuously reacts with the sensor’s enzyme, and the resulting current is proportional to the glucose concentration. Another possibility can be application of the microdialysis technique (MDS) - technique to monitor the biochemistry of the extracellular space in living tissue. The aim of the study was to review systems for continuous glucose measurements using the microdialysis technique and to present preliminary results of an application of this technique to monitoring of the patient’s metabolic state in ketoacidosis. The first prototype of a system for continuous glucose measurements,was designed and developed in Ulm. Currently, a few similar systems with application of the microdialysis are being developed and tested. The most interesting of them are Accu Chek (Roche Diagnostics), GlucoDay (Menarini) and Gluc-Online (Roche/Disetronic). The MDS technique can be applied, for example, to characterize the patient’s metabolic state in ketoacidosis during application of the standard treatment by measurements of the biochemical parameters, like glucose, lactate and glycerol, in the interstitial fluid. This study was performed by the authors in cooperation with the Clinic of Gastroeneterology and Metabolic Diseases, Medical University in Warsaw. The first presented results indicate that, after the initial hydration, the glycemia, glycerol and lactate levels correlated in a very different way with the reference measurements from blood. No distinct delays between the measurements performed in the studied compartments were observed. It can be stated that the analysis of the courses of the biochemical compounds, involved in the glucose metabolism, in the interstitial and in the blood compartments may be helpful to better understand the pathophysiology of the diabetic ketoacidosis, and consequently, its application can lead to an improvement of the current standard treatment.

9

Application of telemedicine technique in screening for diabetic retinopathy

Ładyżyński P., Wójcicki J. M., Chihara K.

Biocybernetics and Biomedical Engineering

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2007

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Vol. 27, no. 1-2

253-263

EN

Diabetic retinopathy is one of the most serious long-term microvascular complications of diabetes. It is a sight-threatening, chronic ocular disorder, which is currently the most common cause of blindness in people of working age in western societies. Slit lamp biomicroscopy and seven-field stereoscopic 30o fundus photography (with dilated pupil) represent the current gold standard techniques for detecting diabetic retinopathy. These methods are too expensive for widespread use in the screening process, even in the most developed countries. At present, retinopathy is usually detected by the direct ophthalmoscopic examination. Simple wide angle color fundus photography is another much more accurate and widely used method. The introduction of digital imaging cameras made the application of the telemedicine technique possible. First feasibility studies concerning application of the telemedicine technique in screening for diabetic retinopathy were reported in the late 1990s. These early systems used mobile fundus cameras or e-mail messages for transmission of digital fundus photographs between distant locations in a store–and–forward mode. Then, more advanced systems followed, which either based on proprietary software solutions or on the latest advances of the internet technology. One of such systems has been developed in co-operation between NAIST and IBBE PAS. The developed DRWeb system consists of the image acquisition station, the database and communication server and the image grading station. Two modes of operation are possible: telediagnosis – when all the mentioned above stages are conducted independently, one after another and teleconsultation – when real time interaction between the physician and the expert is possible. The system is supplemented by an algorithm ensuring that the quality of the transmitted digital images is good enough for a successful making of the diagnosis.

10

BIAL - Registration and Monitoring System for Patients with chronic lymphocitic leukemia

Ładyżyński P., Migalska-Musiał K., Foltyński P., Kawiak J., Hus I., Sieklucka M., Roliński J., Dmoszyńska A., Wójcicki J.M.

Biocybernetics and Biomedical Engineering

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2005

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Vol. 25, no. 3

57-63

EN

B-cell chronic lymphocitic leukemia (B-CLL) is the most common type of leukemia in adults. The aim of the work was to design and implement a computer registration and monitoring system for patients with B-CLL. The developed BIAL system comprises modules allowing for registration of the data related to patient's identification, patient's general state (e.g. objective examination, phenotype, etc.), laboratory examinations (biochemical, immunological and cytogenetical), applied treatment (chemo- and/or immunotherapy) and evaluation of immunotherapy on an animal model. Selected biochemical and immunological parameters can be presented on charts, to facilitate evaluation of patient's state, the course and outcome of the treatment. The BIAL system was preliminary verified basing on the data registration of 8 B-CLL patients treated with chemo- or immunotherapy in the Clinic of Hematooncology and Bone Marrow Transplantation MU in Lublin. It was found to be comprehensive yet easy to learn and use. The system should facilitate the current treatment of the B-CLL patients and should make a foundation for the future multi-patients data analysis leading to elaboration of the criteria for selection of the optimal treatment regimen for patients with B-CLL.

11

A system for monitoring of sweat secretion from four sweat glands

Foltyński P., Ładyżyński P., Musiał K., Wójcicki J. M., Togawa T.

Biocybernetics and Biomedical Engineering

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2004

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Vol. 24, no. 1

39-48

EN

A method providing monitoring of activity of a single sweat gland by measurement of electric conductivity of perfusion solution has been developed recently. The aim of this project was to design and develop a mesurement system employing the electric conductivity method, which could simultaneously monitor the sweat secretion from four sweat glands. The measurement chamber was developed to use in the measurement system. In vivo measurements using developed system were carried out. Detailed measurement procedure has been presented. The results proved proper operation of the designed system.

12

Tissue insulin sensitivity measurements in men. Quality factors and performance determinants for successful clamp experiments. Design and development of the TISS system and its clinical verifications

Wójcicki J. M., Ładyżyński P., Foltyński P., Mikulicz H., Blachowicz J.

Biocybernetics and Biomedical Engineering

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2002

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Vol. 22, no. 2-3

129-144

EN

Insulin sensitivity (IS) is one of the important diagnostic parameters used in treatments of diabetes, hypertension and other diseases as well as during evaluation of new drug therapies. Euglycaemic glucose clamp is the most accurate method of the IS measurement. Effectiveness of this procedure depends on accuracy of the tissue glucose utilization measurements (GU) and proper realization of the insulin infusion. Application of the accurate glucose control algorithm, sampling site, sampling frequency, duration of the procedure are also very important factors. Possible technical realization includes manual, semi-automatic and automatic modes. Recently the computerized semi-automatic system realizing this type of measurement has been designed and developed in the IBBE PAS. A developed system consist of control unit, infusion unit, glycaemia measurement unit and printer. Endogenous glucose secretion is suppressed by insulin infusion, which is determined according to individual patients parameters. The newest version of the measurement procedure allows to realize euglycaemic or normoglycaemic clamp studies. TISS system is inexpensive and easily operated by one person from middle medical staff. Till now GU measurements using TISS system were performed on over 200 patients in 4 Polish clinical centers. Developed and clinically tested TISS system seems to provide satisfying quality of the GU measurement in men.

13

Pharmacodynamics based close-Ioop system for vasoactive drugs administration

Blachowicz J., Wójcicki J.M., Ładyżyński P., Słomka K., Opolski G.

Biocybernetics and Biomedical Engineering

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1999

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Vol. 19, no. 2

23-35

EN

This paper presents a newly designed and developed drug delivery system (NitroCom) that incorporates an original rule-based control algorithm implemented in easy to use hardware design. NitroCom as a mobile bedside device is dedicated for vasoactive drug administration for support of the patients with myocardial infarction therapy. NitroCom is a fulIy automatic system for the delivery of folIowing drugs: nitroglicerin, dobutamine or dopamine. Arterial blood pressure and heart rate as feedback control parameters were used. NitroCom is able to reach a predefined arterial pressure in a reasonable time and maintain it within narrow ranges. Preliminary clinical applications (2 patients) have indicated that NitroCom is characterised by high accuracy of the measurements of the control parameters and high accuracy of the drug infusion. Developed system leads to improvement of the medical staff work by: easy handling, graphic visualisation of the current state of therapy, clear signalIing of the alarm states and storage of the alI data during infusion.

PL

W pracy przedstawiono nowe, łatwe w obsłudze, urządzenie do podawania leków (NitroCom), w którym zastosowano oryginalny progowy algorytm sterowania. NitroCom, jako ruchome, przyłóżkowe urządzenie dawkujące leki wazoaktywne, jest przeznaczony do wspomagania prowadzenia terapii pacjentów z zawałem serca. NitroCom jest w pełni zautomatyzowanym systemem do podawania: nitrogliceryny, dobutaminy lub dopaminy. Jako parametry kontrolne, w pętli sprzężenia zwrotnego, przyjęto ciśnienie tętnicze krwi i częstość rytmu serca. NitroCom pozwala osiągnąć wymagane wartości ciśnienia krwi i tętna w odpowiednim czasie oraz utrzymać je w założonym zakresie. NitroCom szybko i poprawnie reaguje w warunkach, kiedy dochodzi do utraty stabilności podczas osiągania pożądanych wartości parametrów kontrolnych. Wstępne zastosowania kliniczne (2 pacjentów) wykazały, że NitroCom charakteryzuje się dużą dokładnością pomiarową parametrów kontrolnych oraz dużą dokładnością infuzji leku. Ponadto, umożliwia on poprawę warunkow pracy personelu medycznego przez: ułatwienie prowadzenia wlewów leku, graficzne przedstawienie bieżącego stanu prowadzonej terapii, jednoznaczną sygnalizację stanów alarmowych oraz zapamiętywanie wszystkich danych pomiarowych podczas realizacji infuzji.