Pretibial Skin Research Articles

Erratum: Histopathological Evidence of Thyroid Dermopathy and its Correlation with Thyroid-Associated Orbitopathy in Patients with Graves’ Disease having Normally Appearing Pretibial Skin: A Case-Control Study

Erratum: Histopathological Evidence of Thyroid Dermopathy and its Correlation with Thyroid-Associated Orbitopathy in Patients with Graves’ Disease having Normally Appearing Pretibial Skin: A Case-Control Study

Modified medial gastrocnemius myocutaneous flap with extended anterior, inferior and/or posterior boundaries: Anatomical observation and report of a clinical series of 33 flaps

IntroductionReports on medial gastrocnemius myocutaneous (MGM) flaps with extended inferior and posterior boundaries are rare, and information about the MGM flaps with extended anterior boundaries is unavailable. Thus, this study aimed to investigate the vascular anatomical basis and clinical reliability of the modified MGM flap with extended anterior, inferior and/or posterior boundaries. MethodsFive fresh lower limb specimens from patients with recurrent tumours in the thigh were immediately irrigated and perfused. The stripped integuments were radiographed. The pretibial skin was equally divided into nine zones. The reconstruction outcomes of the modified MGM flaps were documented in 33 patients. ResultsTrue anastomotic connections existed among the branches of the saphenous artery, the perforator from the inferior medial genicular artery and 3–5 (mean, 4.5) perforators from the posterior tibial artery in the upper two-thirds of the leg. A total of 33 modified MGM flaps were applied. The anterior margins of 26 modified flaps with extended anterior boundaries exceeded the medial edge of the tibia by 1.0–4.5 cm (mean, 2.1 cm). Fourteen modified MGM flaps were used to repair the defects involving the lower third leg, whose distal edges were located in the seventh (n = 8) or eighth (n = 6) zone. A 1–169-month (median, 9 months) follow-up was conducted for 33 patients. Of the 33 flaps, 29 (87.9 %) survived completely, partial necrosis occurred in four flaps with extended anterior (n = 2) or inferior (n = 2) boundaries. ConclusionsMultiple source vessels are the vascular anatomical basis of the modified MGM flap with extended anterior, posterior and/or inferior boundaries. The modification of the MGM flap is feasible and reliable, broadening the applicable scope of the flap. The modified MGM flap can be applied to repair more distal, wider and larger-area defects with a simpler design and procedure.

Cutaneous Ossifying Amyloidoma

Amyloidoma, otherwise known as tumoral amyloidosis, is a localized deposition of amyloid (AL-type or AA type) without systemic amyloidosis. It is the rarest form of tissue amyloid deposition, and up to 7% of amyloidomas develop systemic amyloidosis.Cutaneous AL-type amyloidoma is considered by many authors as an unusual variant of primary cutaneous marginal zone lymphoma. Although cutaneous amyloidoma can form calcifications, ossification is extremely unusual, with only 1 case previously published to date.We report the case of a 75-year-old woman with voluminous and strikingly ossifying AL-type amyloidoma in the left pretibial skin. Her medical history included excision of hepatic hydatidic cysts 25 years prior and diffuse large B-cell lymphoma of the left parotid gland 8 years prior treated with chemotherapy and radiotherapy with complete response. After the diagnosis of amyloidoma, an extension study with cervical, chest, abdominal, and pelvic TC was performed, with no additional lesions found. Serum and protein electrophoresis revealed elevations in kappa light chain and IgA immunoglobulin levels but did not reveal monoclonal bands. In situ hybridization for immunoglobulin light chains showed monotypic kappa expression in plasma cells infiltrating the amyloidoma.Extensive ossification in amyloidomas can make diagnosis difficult; therefore, we describe an interesting case of this histopathologically peculiar amyloidoma.

A pretibial skin lesion in a patient with type 1 diabetes mellitus

A 17-years-old woman with type 1 diabetes mellitus known since the age of 9 was admitted in the high-dependency unit for diabetic ketoacidosis. She had a history of poor glycemic control and many previous hospitalizations. Two years earlier, she reported the appearance of a red-brown, telangiectatic and hyperpigmented patch, localized in the pretibial skin of her left leg (Fig. 1). The lesion was well-circumscribed with erythema at the periphery. Two months before a spontaneous ulceration appeared in the middle of the lesion, apparently without any trauma.

Histopathological Evidence of Thyroid Dermopathy and its Correlation with Thyroid-Associated Orbitopathy in Patients with Graves' Disease having Normally Appearing Pretibial Skin: A Case-Control Study.

Objective:Thyroid dermopathy (TD), reportedly encountered in less than 5% of patients with Graves’ disease (GD), is supposed to coexist only with thyroid-associated orbitopathy (TAO). However, clinically inapparent TD, detected non-invasively by thermal imaging or ultrasonography, seems to be present in a larger proportion of GD. Histopathological examination (HPE), though considered as gold standard for detecting TD, has not been performed widely to identify subclinical TD in GD.Materials and Methods:In this single-centre, cross-sectional, case-control study, 50 patients with GD (cases) and normal appearing pretibial skin were compared with 45 age- and sex-matched individuals (39 healthy volunteers, 3 with toxic multinodular goitre and 3 with solitary toxic nodule) (control). All patients were evaluated clinically for presence of TAO. Punch biopsy specimens were obtained from the pretibial skin in all 95 participants. Tissue sections were examined under light microscopy for mucin deposition, splitting of collagen fibrils and perivascular lymphocytic infiltration.Results:Sixty per cent of patients with GD demonstrated at least one of the above three histological features, while 52% had any combination of two features and 46% harboured all the three features. Mucin deposition, splitting of collagen fibrils and lymphocytic infiltration were found overall in 52%, 54% and 52% of GD, respectively; 4.4–11.1% of controls also had some evidence of TD on HPE. Subclinical TD was not related to age, duration of disease and TAO in our study.Conclusions:TD, particularly in its subclinical form, Seems to be widely prevalent in GD (46–60%) and exists even in absence of TAO. HPE, though more sensitive than the various non-invasive tests, is not specific (ranges from 89% to 95%) for TD. However, HPE can accurately diagnose TD in appropriate clinical background.

Pre tibial myxedema associated with hypothyroid Hashimioto’s thyroiditis

Pretibial myxedema (PTM) is an infiltrative dermopathy due to accumulation of glycosaminoglycans in the dermis and sub cutis. It is commonly associated with Grave’s disease. However, it is infrequently associated with Hashimoto’s thyroiditis and primary hypothyroidism. It often presents as an asymptomatic diffuse non pitting edema, nodule or plaque involving both pretibial areas. Pretibial myxedema may undergo partial or complete remission and is primarily a cosmetic concern for the patient. Apart from treatment of the primary thyroid abnormality, topical or intralesional steroids remain the mainstay of treatment. We report a case of a 72-year-old lady who presented with non pitting edema on both legs. Her thyroid function tests were suggestive of hypothyroidism and thyroid auto antibody profile, ultrasonography and fine needle aspiration cytology favored Hashimoto’s thyroiditis. Histopathology of the pretibial skin was in consistent with pretibial myxedema. A paradox of pretibial myxedema in a patient with Hashimoto’s thyroiditis is a rare clinical entity.

Ophthalmic manifestations of thyroid disease and the association of serum levels of T3, T4 and TSH with thyroid eye disease

Introduction: Thyroid-associated orbitopathy (TAO) frequently termed Graves ophthalmopathy is part of an autoimmune process that can affect the orbital and periorbital tissue, the thyroid gland and rarely the pretibial skin or digits (thyroid acropachy). Material and Methods: This is a Retrospective study conducted in the Department of Endocrinology, Sapthagiri Institute of Medical Scinences and Research center, Banglore . The patients included in the study their demographic data was recorded along with the serum levels of T3, T4, TSH at the time of diagnosis and examination. All the patients detailed ocular examination was carried out with the help of torch light, and slit lamp for anterior segment evaluation, direct ophthalmoscopy for posterior segment evaluation, indirect ophthalmoscopy whenever necessary. Result: A total of 60 patients were examined. Of the 60 cases, male predominent was noted. The highest incidence of thyroid orbitopathy, the patients were arbitrarily divided into four groups and least one less than 20 years of age group. Among 60 patients, 11 (18.3%) were hypothyroid, 46 (76.6%) were hyperthyroid, and 3 (5%) patients were euthyroid. The frequency of different symptoms among the study group. Most of the patients came with complaint itching of (31.6%). The second most common symptom was foreign body sensation (23.3%). Conclusion: We recommend to ophthalmologists to be aware of TED clinical signs and suspect it even if the patients have a normal thyroid function. The assessment for these patients should be based on orbital images, serum T3, free T4, TSH, TRAbs, and interdisciplinary management with the endocrinologist.

Acute progressive stroke with middle cerebral artery occlusion caused by idiopathic hypereosinophilic syndrome: a case report

BackgroundIdiopathic hypereosinophilic syndrome (IHES) is associated with various organ system dysfunctions. Neurologic abnormalities have been previously noted in this syndrome. Cerebral infarction secondary to occlusion of large cerebral artery is rarely reported. Here we described a patient with IHES presented progressive multiple cerebral infarctions caused by bilateral middle cerebral artery occlusion.Case presentationA 55-year-old Chinese woman presented to our hospital with acute onset of right limbs weakness and slurred speech. Laboratory tests showed a significant eosinophilia of 5.29 × 109/L (normal, < 0.5), 49.9% of leukocytes. Brain magnetic resonance imaging (MRI) revealed multiple acute cerebral ischemic lesions. Magnetic resonance angiography (MRA) demonstrated stenosis in horizontal segment of right middle cerebral artery. A pretibial skin biopsy revealed eosinophilic infiltration around the capillaries in deep dermis and adipose tissue. The patient was given oral dual anti platelet agents and intravenous methylprednisolone. However, one week later, the patient presented significant neurological deterioration with right-sided hemiparesis and totally motor aphasia. Brain MRI and computed tomography perfusion (CTP) demonstrated new acute cerebral ischemia in left hemisphere. Digital subtraction angiography (DSA) revealed left middle cerebral artery completely occluded. The patient received a high-dose of intravenous methylprednisolone 500 mg per day and the eosinophil count quickly fell to normal within 2 days. She was transferred to a rehabilitation center and her neurological symptoms improved with modified Ranking Scale from 4 to 2.ConclusionsIHES is one of the rare causes of acute ischemic stroke with large cerebral artery occlusion. An early high-dose of corticosteroids therapy should be considered in cases of IHES patients. Our case study is benefit to clinical diagnosis and treatment of cerebral infarction with IHES.

A case report and differential diagnosis of pruritic pretibial skin lesions

Pretibial pruritic papular dermatitis (PPPD) is a clinical entity first described in 2006. The etiology is uncertain; however, gentle chronic rubbing is likely to be the reason for the skin reaction. Pretibial pruritic lesions may reflect many different systemic diseases and dermatoses. We present a 61-year-old patient with a 2-year history of pruritic pretibial xerosis, keratotic erythematous to brownish papules, and excoriations. Differential diagnosis excluded papular mucinosis, myxoedema, stasis dermatitis, lichen simplex chronicus, prurigo nodularis, lichen amyloidosis, and lichen planus. Regarding clinical-histological correlation, we confirmed a diagnosis of PPPD.

Pretibial skin lesions in a patient with HIV infection

Pretibial skin lesions in a patient with HIV infection

Role of Lung Ultrasound in Adjusting Ultrafiltration Volume in Hemodialysis Patients

Chronic fluid over-hydration is common in dialysis patients. It is associated with mortality and cardiovascular events. Optimal methods for adjusting fluid volume status and ideal dry weight remain uncertain. The purpose of this study was to evaluate the usefulness of ultrasound in quantifying body water. In 35 hemodialysis patients, we performed ultrasound of the chest, pre-tibial skin tissue thickness (TT), heart and inferior vena cava (IVC) before and after dialysis. We compared B-line scores of lungs, IVC diameters and cardiac functions in pre-dialysis and post-dialysis groups. We then estimated the correlations between ultrasound parameters and ultrafiltration volumes. Ultrafiltration parameters were adjusted prospectively for subsequent dialysis. As a result, both extravascular and intravascular water decreased during ultrafiltration. The median numbers of B-line scores (10 [0–42] vs. 4 [0–30]; p < 0.001); mitral valve blood flow velocities E (0.83 ± 0.23 m/s vs. 0.70 ± 0.20 m/s; p < 0.001), A (0.93 ± 0.28 vs. 0.89 ± 0.23 m/s; p < 0.001) and E/e' (12.47 ± 4.92 vs. 10.37 ± 4.0; p < 0.001); IVC diameters at end-expiration (17.51 ± 3.33 mm vs. 14.26 ± 3.45 mm; p < 0.001); and right pre-tibial TT (2.86 ± 1.36 mm vs. 2.43 ± 1.24 mm; p < 0.001) decreased during dialysis. Ultrafiltration volume was most associated with B-line score (adjusting for age and sex) (β = –3.340; p = 0.003). In addition, the B-line score after dialysis was significantly associated with left ventricular ejection fraction (r = –0.393; p = 0.019) and TT (r = –0.447; p = 0.007). Ultrafiltration volume was prospectively increased then if the B-line score was >6 in the previous dialysis. All patients tolerated the protocol well without any symptoms. Ultrafiltration volume was most associated with lung water, reflected by variation in B-line score. It was not associated with cardiac function, IVC diameter, IVC collapse rate or TT. Lung ultrasound is a useful imaging tool for dialysis patients.

Influence of wheelchair user interface and personal characteristics on static and dynamic pretibial skin pressures in elite wheelchair racers, a pilot study

Context/objective: To examine personal (athletic classification, age, sex, body mass index, duration of disability, tactile sensation of lower extremities) and wheelchair (kneeling plate angle) factors associated with increased pretibial skin pressures in elite wheelchair racers.Design: Cross-sectional study.Setting: University-based laboratory in Champaign, USA.Participants: A convenience sample of elite wheelchair races with traumatic spinal cord injury and spinal disease were recruited for participation.Interventions: Interface pressure mapping was used to examine athletes’ average and peak pretibial skin pressures in their own racing wheelchairs during static and dynamic (propulsive) conditions on a dynamometer.Outcome measures: The study examined associations between personal and wheelchair factors and pressure, differences in pressure between static and dynamic conditions, and the influence of athletic classification (T53 vs. T54) on kneeling plate angle preference and skin pressure magnitudes.Results: Increased kneeling plate angle was moderately associated with dynamic pressures. T53 athletes utilized more vertical kneeling angles and experienced larger average and peak pressures during propulsion. Duration of disability was negatively associated with all measures of pressure. Overall, mean dynamic peak pressure was significantly greater than mean static peak pressure.Conclusion: This pilot study represents a first step in understanding the influence of user interface on potentially injurious skin pressures in wheelchair racers. Vertical kneeling plate configurations were associated with increased pressures while increased years with disability was associated with lower pretibial pressures. In addition, T53 athletes with less trunk function may be at a greater risk for experiencing larger interface pressures than T54 athletes.

Increases of capillary blood pressure in the supine position in persons with cervical spinal cord injuries

BackgroundCervical spinal cord injuries (CSCI) subjects have hypotension and most of physicians have believed that capillary pressure in CSCI would be decreased and easily formed pressure ulcers. Systemic blood pressure (BP) decreases are mainly caused by attenuated total peripheral resistance in CSCI. However, BP in capillary was not measured in CSCI. We hypothesized that the measurement of peripheral pressure such as arteriole pressure and capillary pressure could be a simple and efficient means of expecting to occur with lasting tissue damage for CSCI. The purpose of the present study was to investigate capillary BP in CSCI.MethodsEleven male CSCI individuals with a lesion between C6 and C7 (ASIA A, age, 32.5 +/− 2.8 y) and 13 healthy subjects (age, 40.1 +/− 3.5 y) participated in the present study. Measurements were performed in the supine position with the legs at heart level. To measure capillary BP, a pressure transducer with probe of Laser Tissue Blood Flowmeter was attached to the pretibial skin and the probe was gradually and continually compressed for five seconds until the output signal of the flowmetry showed constant values. When the output of the velocimeter showed constant values, the pressure of the probe compression should mean the Capillary BP. Because the termination of capillary blood flow demonstrated constant signals of velocimeter and at the time the compression pressure should be the capillary pressure. Simultaneously, systolic and diastolic BP was non‐invasively measured during the measurement on the contralateral arm of the blood flow measuring leg.ResultsA significant lower MBP was observed in CSCI (76.7 +/−3.9 mm Hg) than in healthy subjects (91.0 +/− 4.0 mm Hg). Capillary BP in CSCI (55.7 +/− 2.0 mm Hg) was significantly greater than in control subjects (45.9 +/− 2.3 mm Hg).ConclusionWe demonstrated here that transection of sympathetic nervous system from medulla to peripheral nerves in CSCI resulted in the increase of capillary pressure. We suggested that the cervical spinal transection diminished tonic impulses of sympathetic nerves to resistant vessels in CSCI.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Keystone-Designed Perforator Island Flaps for the Coverage of Traumatic Pretibial Defects in Patients With Comorbidities.

Reconstruction of pretibial skin and soft-tissue defects remains a challenge because this area has less underlying tissues and limited tissue mobility. Here, we present a retrospective review of our experience with pretibial reconstruction using the keystone-designed perforator island flap (KDPIF) in patients with comorbidities. All defects resulted from nononcological causes. We describe the expanding versatility of KDPIF reconstruction for pretibial defects and suggest a simple algorithmic approach. The medical records of 9 patients who underwent reconstruction with a KDPIF to cover a pretibial defect between May 2016 and June 2017 were reviewed. Clinical and operative data were collected. All 9 KDPIFs fully survived. The defect size varied from 3 × 2 cm2 to 8 × 6 cm2. The flap size varied from 5 × 3 to 20 × 10 cm2. The mean operative time was 90.4 minutes (range = 37-127 minutes). No postoperative complications occurred. The cosmetic results were favorable, and all patients were satisfied with the final outcomes. Thus, the KDPIF is a good reconstruction modality with few complications and provides an alternative to free flaps for pretibial defect reconstruction in patients with comorbidities.

Skin surface brachytherapy: A survey of contemporary practice patterns

PurposeThe aim of this study was to define current patterns of care among radiation oncologists who use skin surface brachytherapy for the treatment of cutaneous squamous cell carcinoma (cSCC) and basal cell carcinoma (BCC) in academic and community settings. Methods and MaterialsA 30-question electronic survey was administered to clinician members of the American Brachytherapy Society. The respondents were asked to provide details regarding their clinical practice and their approach to skin surface brachytherapy. ResultsA total of 16 surveys were returned. Among the respondents, aggregate experience varied from 8 to 1800 cases. Most preferred brachytherapy over external beam radiation because of shorter treatment course, conformality of treatment for irregular or curved targets, and shallow dose deposition. Of the total, 60% of respondents routinely estimated lesion depth via ultrasound before initiating treatment. Treatment margin on gross disease varied widely (range, 3–15 mm; median, 5 mm). Hypofractionation was the preferred dose schedule. Prescribed doses ranged from 30 Gy in five fractions to 64 Gy in 32 fractions (EQD2, 40 Gy–65 Gy). There was a tendency to increase the number of fractions for larger targets, although some used the same fractionation regardless of anatomic location or lesion size. There was no consensus on dosimetric constraints, and some respondents reported cases of severe toxicity, particularly when treating the pretibial skin. ConclusionsThis pattern of care study suggests that skin brachytherapy can be a convenient and safe tool for treatment of BCC and cSCC. Prospective trials and the development of expert consensus guidelines would be beneficial for optimizing skin surface brachytherapy and reducing practice variation.

Skin Surface Brachytherapy: A Survey of Contemporary Practice Patterns

The aim of this study was to define current patterns of care among radiation oncologists who utilize skin surface brachytherapy for the treatment of nonmelanoma skin cancers (NMSCs) in academic and community settings. A 30 question electronic survey was administered to clinician members of the American Brachytherapy Society. The respondents were asked to provide details regarding their clinical practice and their approach to skin surface brachytherapy. They were also asked to provide brachytherapy recommendations for several clinical scenarios. A total of 17 surveys were returned. Among the respondents, aggregate experience varied from 8 to 1800 cases. Most preferred brachytherapy over external beam radiation because of shorter treatment course, conformality of treatment for irregular or curved targets, and shallow dose deposition. Common reasons for avoiding brachytherapy included tumor depth over 3 mm, PNI and previous radiation therapy. Shielded applicators were the most common device used while a few respondents preferred electronic brachytherapy and custom molds. Sixty percent of the respondents routinely estimated lesion depth via ultrasound prior to initiating treatment. Treatment margin on gross disease varied widely (range 3 to 15mm, median 5mm). All but one respondent employed hypofractionation. Doses ranged from 35 to 42 Gy in 5 to 8 fractions (BED range 48 to 75 Gy, median 60 Gy). There was a tendency to increase the number of fractions for larger targets, although some used the same fractionation regardless of anatomic location or lesion size. There was no consensus on dosimetric constraints and nearly all respondents reported rare cases of severe toxicity, especially when treating the pretibial skin. This patterns of care study reveals wide variation in patient eligibility, dose/fractionation, margins, and dosimetric constraints among practitioners who use brachytherapy for the treatment of nonmelanoma skin cancers. Prospective trials and the development of practice guidelines would be beneficial for optimizing skin surface brachytherapy.

Prevalence and risk factors of thyroid-associated ophthalmopathy among Indians

Background: Thyroid-associated ophthalmopathy (TAO) is a part of an autoimmune process that can affect the orbital and periorbital tissue, the thyroid gland, and, rarely, the pretibial skin or digits. The aim of the present study was to determine the prevalence of TAO among Indian patients with thyroid dysfunction and the risk factors associated with TAO. Methods: A cross-sectional study of thyroid eye disease was conducted on patients with thyroid dysfunction visiting the outpatient department of a tertiary care centre. Demographic data, past medical history, family history, and life-style data were collected from all patients. An ophthalmologist interviewed the patients and noted the presence of symptoms and signs relevant to thyroid eye disease. Results: Out of a total of 100 patients, who were eligible for analysis, 80 were diagnosed with mild to moderate TAO and 20 were diagnosed with severe TAO. There were more male patients in patients with a severe course (50%) compared to those with a mild to moderate course (42.5%). More patients with a severe course were smokers compared to those with a mild to moderate course (chi-square test, p=0.021). More patients with a severe course had a higher clinical activity score (p=0.007). Conclusions: We have confirmed that smoking is the strongest risk factor for development of a severe course of TAO in Indian patients. Thus, it is important for patients with Graves' disease to refrain from smoking.

Pilot randomised controlled trial of protective socks against usual care to reduce skin tears in high risk people: ‘stopcuts’

Skin tears are traumatic injuries occurring mostly on the extremities due to shearing and friction forces that separate the epidermis and the dermis from underlying tissues. They are common in older adults - especially those who have taken long-term steroids - and are caused by falls, mobility aids and knocks from obstacles. Traumatic injuries are the second most common type of wounds in care homes and are the commonest reason for community nurse involvement. Pretibial skin tears can develop into leg ulcers, which require lengthy, expensive treatment. No effective prevention exists. We are trialling knee-length, protective socks that contain cut, tear and abrasion-resistant Kevlar fibres and cushioning layers. In this pilot parallel group, randomised controlled trial, 90 people at risk of skin-tear injury were recruited in Devon from care homes and the community and were randomised to wear the intervention socks or usual clothing for 4 months. The aim of the pilot was to inform the design of a definitive trial (that recruitment, randomisation, treatment and follow-up ran smoothly). 395 patients were approached and 90 were consented (54 in care homes and 36 community). Median age of participants was 85 years. 31 skin tear injuries occurred in 18 (20%) of the 90 participants over a period of 112 days. There were 21 injuries among 10 (21.74%) patients in the control group (n=46) and 10 injuries among 8 (18.18%) patients in the socks group (n=44). Only two in this group were definitely wearing their intervention socks at the time of their injury.

Microvascular responses to (hyper-)gravitational stress by short-arm human centrifuge: arteriolar vasoconstriction and venous pooling

We hypothesized that lower body microvessels are particularly challenged during exposure to gravity and hypergravity leading to failure of resistance vessels to withstand excessive transmural pressure during hypergravitation and gravitation-dependent microvascular blood pooling. Using a short-arm human centrifuge (SAHC), 12 subjects were exposed to +1Gz, +2Gz and +1Gz, all at foot level, for 4 min each. Laser Doppler imaging and near-infrared spectroscopy were used to measure skin perfusion and tissue haemoglobin concentrations, respectively. Pretibial skin perfusion decreased by 19% during +1Gz and remained at this level during +2Gz. In the dilated area, skin perfusion increased by 24 and 35% during +1Gz and +2Gz, respectively. In the upper arm, oxygenated haemoglobin (Hb) decreased, while deoxy Hb increased with little change in total Hb. In the calf muscle, O2Hb and deoxy Hb increased, resulting in total Hb increase by 7.5 ± 1.4 and 26.6 ± 2.6 µmol/L at +1Gz and +2Gz, respectively. The dynamics of Hb increase suggests a fast and a slow component. Despite transmural pressures well beyond the upper myogenic control limit, intact lower body resistance vessels withstand these pressures up to +2Gz, suggesting that myogenic control may contribute only little to increased vascular resistance. The fast component of increasing total Hb indicates microvascular blood pooling contributing to soft tissue capacitance. Future research will have to address possible alterations of these acute adaptations to gravity after deconditioning by exposure to micro-g.

Pilot randomised controlled trial of protective socks against usual care to reduce skin tears in high risk people "STOPCUTS": study protocol.

BackgroundSkin tears are traumatic injuries occurring mostly on the extremities due to shearing and friction forces that separate the epidermis and the dermis from underlying tissues. They are common and occur mostly in older adults and those taking medications that compromise skin integrity. Pretibial skin tears can develop into leg ulcers, which require lengthy, expensive treatment to heal. Traumatic injuries are the second most common type of wounds after pressure ulcers in care homes and are the commonest reason for older adults to require the attention of a community nurse. Common causes of skin tear injuries are bumping into furniture and other obstacles, using mobility aids, transfer to/from wheelchairs, getting in and out of bed and falls. No effective preventative measures currently exist but knee-length, protective socks are now available that contain impact-resistant Kevlar fibres (of the type used in stab-proof vests) and cushioning layers underneath.Methods/designIn this pilot parallel group, randomised controlled trial, 90 people at risk of skin-tear injury will be randomised with equal allocation to receive the intervention or usual care. They will be recruited from care homes and from the community via general practices and a research volunteer database. Pilot outcomes include recruitment, eligibility, attrition, ascertainment of injuries and completion of outcome measures. Acceptability of the intervention and of study participation will be explored using semi-structured interviews. The proposed primary outcome for the future definitive trial is skin tear-free days. Secondary outcomes are skin tear severity, health status, specific skin-tears quality of life, capability and fear of falling, measured at baseline and the end of the study and in the event of a skin tear.DiscussionThe results of this study will be used to inform the development and design of a future randomised controlled trial to assess the effectiveness and cost-effectiveness of a unique and innovative approach to skin tear prevention.Approval was granted by the NRES - Cornwall and Plymouth Research Ethics Committee (13/SW/013). Dissemination will include publication of quantitative and qualitative findings, and experience of public involvement in peer-reviewed journals.Trial registrationCurrent Controlled Trials: ISRCTN96565376