Abstract-Orthotic insoles are commonly used in the treatment of the diabetic foot to prevent ulcerations. Choosing suitable insole material is vital for effective foot orthotic treatment. We examined seven types of orthotic materials. In consideration of the key requirements and end uses of orthotic insoles for the diabetic foot, including accommodation, cushioning, and control, we developed test methods for examining important physical properties, such as force reduction and compression properties, insole-skin friction, and shear properties, as well as thermal comfort properties of fabrication materials. A novel performance index that combines various material test results together was also proposed to quantify the overall performance of the insole materials. The investigation confirms that the insole-sock interface has a lower coefficient of friction and shearing stress than those of the insole-skin interface. It is also revealed that material brand and the corresponding density and cell volume, as well as thickness, are closely associated with the performance of moisture absorption and thermal comfort. On the basis of the proposed performance index, practitioners can better understand the properties and performance of various insole materials, thus prescribing suitable orthotic insoles for patients with diabetic foot.

BackgroundTurning during locomotion involves considerable changes of the body’s center of mass and reduced stability, as well as lower limb kinematics and kinetics. However, many previous studies have been carried out to evaluate the effectiveness and applications of orthotic insoles as well as different types of orthotic materials in various clinical symptoms, which are focused primarily on straight line walking. Hence, the influence of custom-made insoles with the use of advanced three-dimensional spacer fabrics on biomechanics parameters in terms of plantar pressure distribution and lower limb electromyography during turning movement was studied.MethodsTwelve subjects performed 180-degree turning at a speed 3.07-3.74 km/h for five successful trials under 3 insoles conditions: wearing traditional ethylene vinyl acetate insoles and two different spacer-fabricated insoles, with the plantar pressure and lower limb muscle activity collected simultaneously. Turning movement was broken down into 3 phases for analysis: Turning initiation, turn around and turn termination.ResultsThere was a statistically significance difference in plantar pressure between the traditional insoles and the insoles made of a spacer fabric as the top layer (p < 0.05). Compared to the traditional insoles, insoles made of a spacer fabric reduced the peak pressure (>12 %) and pressure–time integral (>13 %) in toes, metatarsal head 1 and metatarsal heads 2–3 at turning initiation; (>15 %) and (>17 %) in medial midfoot and medial heel at turn around. Insoles with spacer fabrics on the top and middle layer reduced both pressure parameters (>18 %) in toes and MTH 1 at turn termination. In terms of muscle activities, insoles with two-layer spacer fabrics could lower maximum muscle activities of vastus lateralis (>16 %; p < 0.05) at turn around.ConclusionsInsoles with different fabrications could offer various pressure offloading patterns across the plantar and muscle activity changes while turning. Insoles with a spacer fabric on the top tend to reduce plantar pressure loading at different regions during turn initiation and turn around phases, while two-layer spacer-fabricated insoles may contribute to reduced vastus lateralis muscle activation during turn around. More importantly, this study provides a new dimension in the potential use of the textile-fabricated insoles which may widen the range of insole materials selection in the design and development of insoles so as to enhance the effectiveness of orthotic treatment.

Background: Current data concerning the relationship between renal function and clinical outcome among stroke patients treated with intravenous thrombolytic therapy are conflicting. Our aim is to analyze whether the clinical outcome of Chinese ischemic stroke patients treated with thrombolytic therapy is affected by the presence of renal dysfunction. Methods: Chinese patients who received intravenous thrombolytic therapy for acute ischemic stroke were recruited. Renal dysfunction was defined as an estimated glomerular filtration rate (eGFR) <90 ml/min/1.73 m 2 . The primary outcome was independent function (modified Rankin Scale, mRS, 0-2) at 3 months, while secondary outcomes included early improvement of the National Institute of Health Stroke Scale (NIHSS) score of ≥ 4 points at 24 h, symptomatic intracerebral hemorrhage (ICH) within 36 h of treatment and 30-day mortality. Results: A total of 199 patients were recruited, of whom 51.3% had renal dysfunction. There were no significant differences in functional independence at 3 months, NIHSS improvement at 24 h postthrombolysis and 30-day mortality between patients with or without renal dysfunction. Multivariate analysis showed that eGFR as a continuous variable was not an independent risk factor for symptomatic ICH. Conclusion: Chinese ischemic stroke patients with renal dysfunction who received thrombolytic therapy had clinical outcomes similar to those without renal dysfunction.

Tandem stenting and antiplatelet resistance might contribute to the development of SAT after intracranial stenting in patients with symptomatic intracranial arterial stenosis.