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A proposal for an in vitro setup to test microbubbles combined with ultrasound as an improvement of the current therapy for patients with infected diabetic foot ulcers

Karremans, S.N. and Kock, B.C.M. and Kormelink, I.M. and Ribbens, V.J. (2020) A proposal for an in vitro setup to test microbubbles combined with ultrasound as an improvement of the current therapy for patients with infected diabetic foot ulcers.

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Abstract:Purpose: Type II Diabetes Mellitus patients have a high chance of developing diabetic foot ulcers. The current treatment appears to be insufficiently effective due to the formation of biofilms. Microbubbles may offer a solution because of their mechanical effects when exposed to ultrasound. The aim is to determine the best method to use bubbles for improvement of the treatment of diabetic foot ulcers. Methods: This research report consists of three main parts: findings of a systematic review, bubble models and an in vitro setup. Based on a systematic review the potentiality of microbubbles, nanobubbles and nanodroplets as an improvement of diabetic foot ulcer treatment is evaluated. One bubble type will be chosen as the most promising option, whereafter the rest of the research focuses on this bubble type. A mathematical energy model is made to strengthen the concept of the bubble as a way to penetrate or destruct a biofilm. The Bubblesim model is used to hypothesize which ultrasound settings should be used for a maximum antibiofilm effect with the bubble type. Finally, a proposed in vitro setup is described to contribute to the clinical translation of the antibiofilm treatment. Results: Microbubbles are the most promising option as application for diabetic foot ulcer treatment when fast clinical implementation is taken into account. Ultrasound mediated microbubble destruction appears to have mechanical and biological effects on bacteria in the biofilm expressed as changed biofilm and bacterial morphology, decreased bacterial viability and changed biofilm-associated gene expression. The addition of antibiotics results in an even stronger antibiofilm and antibacterial effect. The proposed ultrasound setting are fres=3.25MHz and pulse amplitude=0.2 MPa for SonoVue and fres=6.05MHz and pulse amplitude=0.9 MPa for Luminity. Conclusion: The strongest antibiofilm effect results from treatment with microbubbles exposed to ultrasound in combination with antibiotics. This offers prospects for improving the treatment of diabetic foot ulcers. A next step of translation to the clinic can be made through experiments with the proposed in vitro setup.
Item Type:Essay (Bachelor)
Faculty:TNW: Science and Technology
Subject:44 medicine, 50 technical science in general
Programme:Technical Medicine BSc (50033)
Link to this item:http://purl.utwente.nl/essays/81701
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