Clinical Applications of Artificial Neural Networks
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In this study, the results analyzed by ANN model were more precise and rigorous than those by our previous study The patients often reports a gradual onset of inferior heel pain that worsens with the first steps in the morning or after a long-term standing. After movements are made, the pain tends to subside but worsens again by the end of the day.
Various management strategies have been developed to treat plantar fasciitis. Nonsurgical treatment is the mainstay.
ESWT is a lithotripsy technology that target shock waves to the plantar fascia area. The shock wave can be generated through three approaches: electrohydraulic, electromagnetic, and piezoelectric The mechanism of analgesia in ESWT is still not clear. Some theories have been put forward to explain it. Some scholars believe that shock wave energy that concentrated on unit area is described by energy flux density, shows the shock wave stream which is reflected perpendicularly to the source of production.
Pressure waves of ESWT pass through fluids and soft tissues, such as superficial fascia, tendons, ligaments, and pose their effects on areas of impedance changes. Sometimes at cellular level, they mechanically promote microcirculation and relieve the pain. Of these effects, the strongest one is the transient damage to neuronal cell membrane or the increase of pain nociceptors Another scholars think that ESWT can press powerful shock waves on local soft tissues to intensely stimulate nerve ends and inhibit the action of the pain factors.
When the pain receptors are continuously and intensely stimulated, the sensitivity and compliance of pain nerve ends reduce. The formation of heel spur is a continuous biological process. The plantar fascia is a critical structure arising from the medial process of the calcaneal tuberosity and inserting into the digits of the foot. Heel spur consists of mature lamellar bone and demonstrates degeneration and fibro-cartilaginous proliferation, even ossification in the condition of plantar fasciitis 32 , 33 , At present, the relationship between the plantar calcaneal spurs and the plantar fasciitis pain stills remains elusive.
McMillan compared the clinical characteristics of asymptomatic and symptomatic subcalcaneal spur groups, finding a strong association between chronic heel pain and heel bone spurs Researchers have also found that the degree of pain and the length of spurs are positively correlated the longer the length of spurs, the severer the pain 36 , Furthermore, the direction and length of subcalcaneal spurs can affect the occurrence and prognosis of plantar fasciitis So we hold the view that attention should be paid to calcaneal spurs in the diagnosis and treatment of plantar fasciitis.
In our study, we found that the prevalence of calcaneal spurs in X-ray significantly affected the efficacy of ESWT. Some other studies also showed that ESWT had a significant effect on symptomatic heel spurs without any irreversible side effect Cosentino found that ESWT could relieve plantar heel pain symptoms and modify the structre of heel spurs ultrasonographically and radiographically The mechanism may be that ESWT can break sclerotic bones by producing microfissures and bony fragments High BMI is also a risk factor in the onset of plantar fasciitis, which is contradictory and misleading.
Some theories can explain. The diffusion of shockwaves follows the physical laws in the reflection and absorption of the acoustic waves, which are affected by the characteristics of the medium and the diversity in density, and the impedance of the skin, fat, muscle and bone. Adipose tissues, presenting an acoustic impedance close to that of water, allow acoustic waves to pass and reach their underlying tissues 41 , Some biological theories can also be put forward to explain the result of this study.
Adipose tissues are rich in stem cells.
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ADSCs adipose-derived stem cells could be isolated using automatic centrifuge for cell isolation specialized in cells from adipose tissue enhancing the bio-stimulating effects of the ESWT therapy This study is innovative in the following aspects. Our previous publications show that ESWT is an effective and safe tool in the treatment of chronic plantar fasciitis and should be an alternative to surgery Second, it finds that high VAS score symptomatized by severer pain on taking first steps in the morning, edema, and heel spur significantly affected the outcome of the treatment In this study, we conducted a more reasonable and accurate statistical analysis to guarantee the comprehensiveness by ANN model.
And the follow-up is longer than before. There are some limitations in our study.
First, the small sample size is adequate to evaluate the variables for ANN model at least 5 times than the number of factors , but as a data mining study, the sample size should be broadened to explore and verify its effectiveness. Second, we did not identify all possibly significant variables to predict the efficacy of ESWT.
Future studies using ANN model should contain more input factors such as the interval, impulses per second and so on and other detailed result data. Third, the time of follow-up was relatively short. Lacking long-term follow-ups, its predictive factors for long-term efficacy remain unknown.
Higher VAS symptomatized by short-duration severer pain on taking first steps in the morning or plantar fascia spur are important prognostic factors for the efficacy of ESWT. These parameters analyzed by a predictive model can help the decision-making for the application of ESWT. Thomas, J.
Clinical applications of artificial neural networks
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