Objective. In this study an experimental set-up for measuring skin microvascular responses of the footsole to changes in externally applied pressure was analysed. Design. A clinical study. Skin microvascular blood flow was measured in healthy volunteers, during and after external mechanical pressure of different magnitudes. Background. During standing and walking the footsole is commonly exposed to high static and dynamic mechanical pressure, resulting in changes in the microcirculation of the footsole. In diabetic patients a disturbed interaction between externally applied pressure and skin microvascular response seems to be involved in the development of a foot ulcer. Methods. Eleven volunteers participated in the study. Static loads were applied to the heel part of the footsole with the person in a supine position. Contact pressure and skin blood flux, based on the laser Doppler technique, were simultaneously monitored. The pressure used was varied in five discrete steps between 10 and 160 kPa and applied during a period of 5 min each. The microcirculation was measured during as well as after pressure loading. Results. Pressures of 40 kPa and higher do stop the blood flow in the skin micro-circulation. Releasing the applied pressure resulted in a hyperaemic response. This response appears to increase in amplitude at increasing pressures up to 800% of the baseline laser Doppler fluxmetry level. Beyond a pressure level of 80 kPa the hyperaemic response seems not to be influenced by the pressure level. The time needed to achieve the maximal laser Doppler fluxmetry level decreased when the pressure was raised from 10 to 80 kPa, but increased again when higher pressures were applied (P = 0.051). An intra-individual variation of 11-50% was observed for the parameters describing the blood flux before, during, and after pressure application. Conclusion. Simultaneously measuring changes in contact pressure and laser Doppler flux of the footsole is a useful method to study the interaction of external mechanical pressure and skin microvascular reactions. Pressures above 40 kPa stop skin microvascular blood flow. Releasing the applied pressure results in a hyperaemic response, which increases when the applied pressure increases from 40 to 80 kPa. Higher pressures do not influence the amplitude in skin microvascular response, but result in a longer delay to maximal hyperaemia.
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The objective of this thesis is to make a first step towards prevention of the progression of chronic venous disease and the development of a first venous leg ulcer in chronic venous disease patients. The aim is to identify chronic venous disease patients at risk of developing more severe clinical stages, provide insight in the lifestyle related risk factors, and provide an overview of current chronic venous disease care in the Netherlands.
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Onder scheikundedocenten, chemiedidactici en lerarenopleiders is consensus over de centrale rol die het micro/macro concept zou moeten spelen in een nieuw te ontwerpen scheikundeprogramma voor havo en vwo. Bovendien kan worden geconcludeerd dat naast aandacht voor de plaats van het heen-en-weer denken in het te ontwikkelen lesmateriaal ook de wijze waarop scheikundedocenten in hun lessen dienen om te gaan met dit begrip belangrijk geacht wordt. Om ons een beeld te kunnen vormen van de didactische aspecten van het heen-en-weer denken is het van belang beter zicht te krijgen op de inzichten van scheikundedocenten in het gebruik van micro- en macro-scheikunde.
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