| Diabetes mellitus is a group of metabolic diseases characterized by abnormally elevated blood sugar,which seriously threatens people’s health.With the global aging and the changes in people’s lifestyles,the incidence of diabetes is increasing year by year,and the initial age of onset tends to be younger.Statistics from the International Diabetes Federation(IDF)show that in 2017,the number of people with diabetes worldwide was425 million,and the number will continue to rise to 700 million by 2045.The incidence of diabetic complications has also increased with the increase in the incidence of diabetes.Among them,diabetic peripheral neuropathy(DPN)is one of the most common complications in patients with diabetes.In the early stage,its clinical manifestations are relatively insidious,with various manifestations.Mild limb pain,numbness,paresthesia,and intermittent claudication are more common.In severe cases,lower limb ischemic gangrene may occur,and there is even a high risk of amputation.Statistics show that the amputation rate of DPN patients is 10-20 times higher than that of non-diabetic patients.Every 30 seconds,a patient undergoes surgical amputation of the whole,or part of,the lower limb due to concurrent DPN.While DPN seriously interferes with the physical and mental health of patients,the high cost of treatment and rehabilitation care also causes huge economic pressure on patients.Therefore,it is particularly important to identify,diagnose and prevent DPN in the early or even ultra-early stage.The early onset of DPN is relatively insidious,and the disease is often in an irreversible stage when obvious clinical symptoms appear.At present,the detection methods and diagnostic standards for DPN are not yet perfect.30%-40% of DPN patients diagnosed by neurological examination are asymptomatic,and peripheral sensation loss is often slow and asymptomatic but increases the risk of foot ulcers and amputations.Studies have shown that more than 50% of mild to moderate patients are miss diagnosed.There are many clinical screening methods for DPN,including ankle reflex,knee reflex,temperature sense test,128 Hz tuning fork vibration test,monofilament test,nerve electrophysiological test,and neuromorphological test.The above-mentioned auxiliary tests have different focuses.Different,the clinician needs to choose the application reasonably,and at the same time,the patient screening and serious assessment scale should be given.Due to the lack of understanding of the disease and the relatively insufficient self-examination of patients,this has brought many difficulties to clinical diagnosis and treatment.How to diagnose and evaluate DPN in the early stage of its occurrence and development has become a worldwide problem that needs to be solved urgently.Faced with the bottleneck of early clinical diagnosis of DPN,we notice that although neuropathy is the most important pathological change in DPN,it does not mean that DPN is a purely neurological disease.Studies in recent years have shown that the foot lesions caused by DPN can involve various soft tissues such as the plantar epidermis,plantar fat connective tissue,and plantar blood vessels.Corresponding pathological changes may have occurred in the underlying soft tissues,such as epidermis,adipose connective tissue and blood vessels.Therefore,the study of DPN with the plantar soft tissue as the key point provides a new idea for exploring the new mechanism of DPN disease and seeking the early diagnosis method of DPN.Biomimicry is a science that learns from nature,simulates nature,imitates the phenomenon of human life,and realizes the concept and development model of bionic development of the invented equipment,tools and technology.It is an effective shortcut to solving the major economic and social problems faced by mankind.The research content of modern bionics is no longer limited to simulated organisms,but also focuses on the exploration of some phenomena that occur in human life;the research involves bionic attempts to utilize all information useful to human beings,especially taking human life as a life model,the same as biological model.This is the same as the bionic simulation.Focusing on the behavioral process of traditional Chinese and Western medicine to diagnose diseases by looking,smelling,asking,cutting,or seeing,touching,percussion,and auscultation,it provides us with a precious bionic model,and uses medical equipment to simulate the physical examination behavior of doctors,to explore the parameter changes of the multi-physics coupling of the soft tissue of the foot in the early DPN,which suggests that we can use the integration of bionic thinking and clinical thinking to explore the bottleneck problem in the diagnosis and identification of diseases in the ultra-early stage.This paper focuses on the soft tissues of the foot;simulates the preventive medicine concept of "preventive treatment" of traditional Chinese medicine and the four diagnostics of vision,touch,percussion and auscultation in the physical examination of Western medicine;and uses in vivo,non-invasive and quantitative modern imaging technology to obtain Multiphysics-related parameters of the soft tissue of the foot,and biomimetic identification of healthy volunteers and patients with mild DPN using machine learning methods.The biomimetic identification research of DPN based on multi-physics coupling carried out in this paper is to reveal the new mechanism of DPN biomechanics and pathology,to provide new ideas and data support for the early evaluation and diagnosis of DPN,and to transform traditional human disease identification methods into quantitative and automated methods.The direction of development plays an important role in promoting.The research content and the main conclusions of this paper are as follows:(1)Research on mechanical modulus field of plantar soft tissue.In this paper,8 soft tissues of the sole of the foot were selected as the test objects,and the in vivo,non-invasive,quantitative thickness and Young’s modulus were measured by ultrasonic B-scan and Shear Wave Elastography(SWE).The analysis found that gender and age had significant effects on plantar soft tissue thickness and Young’s modulus in healthy subjects.For different genders,the overall thickness of the plantar soft tissue,the thickness of the large cavity layer and the Young’s modulus were greater in males than in females.For different ages,except for individual soft tissues,with the increase of age,the overall thickness of the plantar soft tissue and the thickness of the large cavity layer gradually became thinner,and the Young’s modulus gradually increased.This paper also explored the differences in plantar soft tissue between healthy subjects and patients with mild DPN.The analysis found that only the soft tissue thickness of the soft tissue under the first metatarsal and the soft tissue under the second metatarsal was lower in the DPN patients than in healthy volunteers.Most of the plantar soft tissue Young’s modulus of DPN patients is higher than that of healthy subjects,which also indicates that for mild DPN patients,the plantar soft tissue has already appeared in the early stage before most of the plantar soft tissue morphological parameters are abnormal.The mechanical properties parameters are abnormal.(2)Study on the vascular flow field of the foot.In this paper,6 main blood supply arteries of the foot were selected,and the dynamic parameters,such as blood flow velocity and blood flow of arterial blood vessels,were measured by color Doppler ultrasound in vivo,non-invasively and quantitatively.There were no statistically significant differences in the hemodynamic parameters of the foot-related blood vessels in the DPN patients between gender and age;the differences in the foot hemodynamic parameters between healthy subjects and patients with mild DPN were compared and analyzed.The results of the study show that for patients with mild DPN,in the absence of obvious abnormalities in the blood flow velocity and blood flow of the lower extremity arteries,the small blood vessels have early abnormal hemodynamic parameters,including blood flow velocity and blood flow increase.(3)Research on the temperature field of DPN foot epidermis.In this paper,the infrared thermal imager was used to measure the epidermal temperature of the six main blood supply arteries of the foot in vivo,non-invasively and quantitatively.There was no statistically significant difference;the differences in the epidermal temperature of the plantar related blood vessels between healthy subjects and DPN patients were compared and analyzed.The results showed that for mild DPN patients,the epidermal temperature corresponding to the lower extremity arteries did not suggest In the case of obvious abnormality,the epidermal temperature corresponding to the small blood vessels has been abnormal in the early stage,which is manifested as an increase in the epidermal temperature of small blood vessels.(4)Research on DPN bionic identification based on neural network learning.Based on the measured multi-physics parameters of the soft tissues of the foot,this paper uses six machine learning methods,including BP neural network,decision tree,self-organizing competitive neural network,learning vector quantization,probabilistic neural network and extreme learning machine,to evaluate healthy subjects and Bionic identification was performed in patients with mild DPN.The results of the study show that the correct identification rate of healthy subjects and patient identification of the extreme learning machine are between 95%-100% and 90.0%-100.0%,respectively,and the overall correct identification rate is between 92.5%-100.0%,the extreme learning machine has high recognition accuracy and good recognition stability for healthy subjects and mild DPN patients,and can be used as a machine learning model for identifying healthy subjects and mild DPN patients in clinical application. |
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