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Journal of Biomechanics Jun 2024For some individuals with severe socket-related problems, prosthesis osseointegration directly connects a prosthesis to the residual limb creating a bone-anchored limb...
For some individuals with severe socket-related problems, prosthesis osseointegration directly connects a prosthesis to the residual limb creating a bone-anchored limb (BAL). We compared dynamic gait stability and between-limb stability symmetry, as measured by the Margin of Stability (MoS) and the Normalized Symmetry Index (NSI), for people with unilateral transfemoral amputation before and one-year after BAL implantation. The MoS provides a mechanical construct to assess dynamic gait stability and infer center of mass and limb control by relating the center of mass and velocity to the base of support. Before and one-year after BAL implantation, 19 participants walked overground at self-selected speeds. We quantified dynamic gait stability anteriorly and laterally at foot strike and at the minimum lateral MoS value. After implantation, we observed decreased lateral MoS at foot strike for the amputated (MoS mean(SD) %height; pre: 6.6(2.3), post: 5.9(1.3), d = 0.45) and intact limb (pre: 6.2(1.2), post: 5.8(1.0), d = 0.38) and increased between-limb MoS symmetry at foot strike (NSI mean(SD) %; anterior-pre: 10.3(7.3), post: 8.4(3.6), d = 0.23; lateral-pre: 18.8(12.4), post: 12.4(4.9), d = 0.47) and at minimum lateral stability (pre: 28.1(18.1), post: 19.2(6.8), d = 0.50). Center of mass control using a BAL resulted in dynamic gait stability more similar between limbs and may have reduced the adoption of functional asymmetries. We suggest that improved between-limb MoS symmetry after BAL implantation is likely due to subtle changes in individual limb MoS values at self-selected walking speeds resulting in an overall positive impact on fall risk through improved center of mass and prosthetic limb control.
PubMed: 38941842
DOI: 10.1016/j.jbiomech.2024.112208 -
ASAIO Journal (American Society For... Jul 2024Although current studies support the use of prophylactic distal perfusion catheters (DPCs) to decrease limb ischemia in patients on venoarterial extracorporeal membrane...
Although current studies support the use of prophylactic distal perfusion catheters (DPCs) to decrease limb ischemia in patients on venoarterial extracorporeal membrane oxygenation (VA ECMO), methods for monitoring limb ischemia differ between studies. We evaluated the safety of a selective rather than prophylactic DPC strategy at a single center with a well-established protocol for limb ischemia monitoring. Distal perfusion catheters were placed selectively if there was evidence of hypoperfusion at any point until decannulation. All patients were followed daily by vascular surgery with continuous regional saturation monitoring. Of 188 patients supported with VA ECMO, there were no significant differences in baseline characteristics between patients with upfront, delayed, and no DPC. Thirty day mortality was highest in patients with an upfront DPC (56% in the upfront DPC group, 19% in the delayed DPC group, and 22% in the no-DPC group, p < 0.001). The incidence of major bleeding, fasciotomy, and amputation in the entire cohort was 3.7%, 3.7%, and 0%, respectively. With strict adherence to a protocol for limb ischemia monitoring, a selective rather than prophylactic DPC strategy is safe and may obviate the risks of an additional arterial catheter.
PubMed: 38941597
DOI: 10.1097/MAT.0000000000002264 -
Medicine Jun 2024Diabetic foot (DF) ulcer is one of the common complications of diabetic patients, with high incidence and amputation rate, which seriously affects the quality of life... (Observational Study)
Observational Study
Diabetic foot (DF) ulcer is one of the common complications of diabetic patients, with high incidence and amputation rate, which seriously affects the quality of life and health of patients. Therefore, how to effectively prevent and treat DF ulcers and reduce amputation rate has become an urgent problem in the medical field. As a comprehensive nursing model for patients with DF ulcers, comprehensive nursing intervention is designed to improve the therapeutic effect and prognosis and reduce the rate of amputation. Convenient sampling method was used to select 360 patients with DF who received routine care for DF ulcers from July 2013 to July 2023 for retrospective cohort analysis. According to the existence of exposure factors (comprehensive nursing intervention), 180 cases were divided into observation group and comparison group. The basic demographic data, amputation rate, severity of foot ulcer, neuropathy and vascular disease, and blood glucose control were compared between the 2 groups. The data was analyzed using SPSS26.0. Harman single factor test was used to check whether there was common method bias in the study data. Descriptive analysis, Spearman rank correlation analysis and multiple linear regression analysis were used to analyze the current situation of amputation rate of DF patients and the influence of comprehensive nursing intervention on the amputation rate of DF patients. The amputation rate was 2.8% in the Observation group compared to 8.3% in the Comparison group. The amputation rate of the observation group was generally higher in the age group, and the amputation rate of the observation group was higher in the middle school education level and below and the economic status of <5000 yuan. The difference was statistically significant (P < .05). Age (odds ratio [OR] = 1.96; 95% confidence interval [CI]: 0.88-4.38), education level (OR = 1.30; 95% CI: 1.69-6.46), economic status (OR = 2.28; 95% CI: 1.69-10.85) was an independent risk factor for amputation rate (P < .05). Comprehensive nursing interventions have played a positive role in reducing the rate of amputation in patients with DF.
Topics: Humans; Diabetic Foot; Male; Female; Quality of Life; Retrospective Studies; Middle Aged; Amputation, Surgical; Prognosis; Aged; Adult
PubMed: 38941405
DOI: 10.1097/MD.0000000000038674 -
Chemistry & Biodiversity Jun 2024Delayed healing of chronic wounds results in amputation and mortality rates in serious cases. The present study examines the merged wound-restorative efficacy of...
Delayed healing of chronic wounds results in amputation and mortality rates in serious cases. The present study examines the merged wound-restorative efficacy of injectable bone marrow-derived mesenchymal stem cells (BMMSCs) and topical Callyspongia sp. extract in immunocompromised rats. HR-LC-MS analysis of Callyspongia sp. extract tentatively identified twenty-nine compounds (1-29) and highlighted its richness in fatty acids and terpenoids, known for their wound regenerating efficacies. The wound closure was greatly prominent in the BMMSCs/Callyspongia sp. group in contrast to the control group (p < 0.001). The RT-PCR gene expression emphasized these results by attenuating the oxidative, inflammatory, and immunity markers, further confirmed by histopathological findings. Additionally, in silico modeling was particularly targeting matrix metalloproteinase-9 (MMP9), a key player in wound healing processes. Computational analysis revealed that compounds 18 and 19 potentially modulate MMP9 activity. The combination of BMMSCs and topical Callyspongia sp. extract holds a promise for regenerative therapy constituting a drastic advance in the wound cure of immunocompromised patients, eventually further safety assessments and clinical trials are required.
PubMed: 38941178
DOI: 10.1002/cbdv.202400682 -
European Journal of Trauma and... Jun 2024The objective was to analyze the treatment and complications of the patients after a major amputation of the upper and lower extremities. Risk factors and predictors of...
Risk factors and predictors of prolonged hospital stay in the clinical course of major amputations of the upper and lower extremity a retrospective analysis of a level 1-trauma center.
PURPOSE
The objective was to analyze the treatment and complications of the patients after a major amputation of the upper and lower extremities. Risk factors and predictors of a prolonged hospital stay should be outlined.
METHODS
This is a retrospective study of a national Level-1 Trauma center in Germany. In a 10-year period, patients were identified by major amputations in the upper and lower extremities. The medical reports were considered and the results were split into four main groups with analysis on basic-, clinical data, the course on intensive care unit and the outcome. A recovery index was established. The patients' degree of recovery was summed up. Statistical analysis was performed.
RESULTS
81 patients were included. A total of 39 (48.1%) major amputations were carried out on the lower leg and 34 (42.0%) involved the thigh. There were two instances (2.5%) of hip joint disarticulation. 6 major amputations were done on the upper extremities (n = 3 on the upper arm, n = 3 on the forearm). 13.83 ± 17.10 days elapsed between hospital admission and major amputation. The average length of hospital stay was 38.49 ± 26,75 days with 5.06 ± 11.27 days on intensive care unit. Most of the patients were discharged home followed by rehabilitation. A significant correlation was found between the hospital length of stay and the increasing number of operations performed (p = 0.001). The correlation between the hospital length of stay and the CRP level after amputation was significant (p = 0.003).
CONCLUSIONS
Major amputations in trauma patients lead to a prolonged stay in hospital due to severe diseases and complications. Especially infections and surgical revisions cause such lengthenings.
PubMed: 38940948
DOI: 10.1007/s00068-024-02587-8 -
Advances in Wound Care Jun 2024Objective This prospective cohort study aimed to determine the relationship between serum vitamin C, D and zinc on foot wound healing and compare time to healing in...
Objective This prospective cohort study aimed to determine the relationship between serum vitamin C, D and zinc on foot wound healing and compare time to healing in individuals who are deficient versus those who have adequate levels. Approach One hundred adults with foot wounds were recruited from Blacktown high risk foot service with a follow up period of 12 months. Serum vitamin C, D and zinc as well as routine baseline blood testing was undertaken. Wounds were measured using a three-dimensional wound camera and classified using the WIfI system at regular intervals. Results Vitamin C deficiency was present in 75% of participants, 50% had vitamin D deficiency and 38% had zinc deficiency. Diabetes was present in 91% of participants, and 50% had history of a previous amputation. Wound chronicity (p=.03) and toe pressures (p=.04) were predictive of wound healing. Serum vitamin C, D and zinc were not associated with significant differences in wound healing, or time to wound healing. Innovation Deficiencies in vitamin C, D and zinc were highly prevalent in patients participants with active foot ulceration. Wound chronicity was predictive of healing outcomes, highlighting the importance of rapid access to best practice care. Conclusion This cohort had high deficiency rates of vitamin C, D and zinc consistent with previous literature, however there was not a relationship between these deficiencies and wound healing, or time to heal. Large randomised controlled trials are required to comprehensively determine if adequate levels of these nutrients improve wound healing outcomes.
PubMed: 38940723
DOI: 10.1089/wound.2024.0063 -
JACC. Advances Nov 2023The prevalence and degree of lower extremity artery disease in hemodialysis (HD) patients is higher than in the general population. However, the pathological features...
BACKGROUND
The prevalence and degree of lower extremity artery disease in hemodialysis (HD) patients is higher than in the general population. However, the pathological features have not yet been evaluated.
OBJECTIVES
The aim of the study was: 1) to compare lesion characteristics of lower extremity artery disease in HD vs non-HD patients; and 2) to determine factors associated with severe medial calcification.
METHODS
Seventy-seven lower limb arteries were assessed from 36 patients (median age 77 years; 23 men; 21 HD and 15 non-HD) who underwent autopsy or lower limb amputation. Arteries were serially cut at 3- to 4-mm intervals creating 2,319 histological sections. Morphometric analysis and calcification measurements were performed using ZEN software. Calcification with a circumferential angle (arc) ≥180° was defined as severe calcification. Multivariable logistic regression was used to identify risk factors for severe medial calcification.
RESULTS
The degree of the medial calcification arc was significantly higher in the HD group compared to the non-HD group ( < 0.0001). In the multivariable analysis, HD was associated with severe medial calcification in below-the-knee lesions (OR: 17.1; = 0.02). The degree of intimal calcification in above-the-knee lesions was also significantly higher in HD patients with a higher prevalence of advanced atherosclerotic plaque ( = 0.02). The prevalence of severe bone formation was more common in the HD patients ( = 0.01).
CONCLUSIONS
Hemodialysis patients demonstrated a higher degree of medial and intimal calcification compared with non-HD patients. The difference was more prominent in the medial calcification of below-the-knee lesions.
PubMed: 38938733
DOI: 10.1016/j.jacadv.2023.100656 -
BMC Musculoskeletal Disorders Jun 2024Coronavirus disease 2019 (COVID-19) has resulted in substantial morbidity and mortality globally. The National Database of Health Insurance Claims and Specific Health...
BACKGROUND
Coronavirus disease 2019 (COVID-19) has resulted in substantial morbidity and mortality globally. The National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) covers 99.9% of health insurance claim receipts by general practitioners. The purpose of this study is to investigate the nationwide number of inpatient orthopedic surgeries in Japan during the effect of state of emergency (SoE) due to COVID-19.
METHOD
The NDB has been publicly available since 2014. We retrospectively reviewed the NDB from April 2019 to March 2022. We gathered the monthly number of all inpatient orthopedic surgeries. We also classified orthopedic surgeries into the following 11 categories by using K-codes, Japanese original surgery classification: fracture, arthroplasty, spine, arthroscopy, hardware removal, hand, infection/amputation, ligament/tendon, tumor, joint, and others. By using the average number from April to December 2019 as the reference period, we investigated the increase or decrease orthopedic surgeries during the pandemic period.
RESULTS
The NDB showed that the average number of total inpatient orthopedic surgeries during the reference period was 115,343 per month. In May 2020, monthly inpatient orthopedic surgeries decreased by 29.6% to 81,169 surgeries, accounting for 70.3% of the reference period. The second SoE in 2021 saw no change, while the third and fourth SoEs showed slight decreases compared to the reference period. Hardware removal and tumor surgeries in May 2020 decreased to 45.3% and 45.5%, respectively, while fracture surgeries had relatively small decreases.
CONCLUSION
According to NDB, approximately 1.3 million orthopedic inpatient surgeries were performed or claimed in a year in Japan. In May 2020, the first SoE period of the COVID-19 pandemic, the number of inpatient orthopedic surgeries in Japan decreased by 30%. Meanwhile, the decrease was relatively small during the SoE periods in 2021.
Topics: COVID-19; Humans; Japan; Orthopedic Procedures; Retrospective Studies; Pandemics; SARS-CoV-2; Inpatients; Databases, Factual; Hospitalization
PubMed: 38937813
DOI: 10.1186/s12891-024-07620-w -
Journal of Biomechanics Jun 2024One of the most significant developments in prosthetic knee technology has been the introduction of the Microprocessor-Controlled Prosthetic Knee (MPK). However, there...
One of the most significant developments in prosthetic knee technology has been the introduction of the Microprocessor-Controlled Prosthetic Knee (MPK). However, there is a lack of consensus over how different types of MPKs affect performance in different ambulation modes. In this study, we investigated the biomechanical differences in ramp and stair maneuvers when an individual with transfemoral amputation wears three commercial MPKs: the Össur Power Knee, the Össur Rheo Knee and the Ottobock C-Leg 4. The primary outcome variable for this study was the lower limb biological joint work, inclusive of the intact leg and prosthetic side hip. We hypothesized that (1) the Power Knee would result in lower biological work during ascent activities than the C-Leg and Rheo, both passive MPKs, and (2) the C-Leg and Rheo would result in lower biological work during descent activities than the Power Knee. During ramp ascent, the C-Leg was associated with lower biological joint work (p < 0.05) than the Power Knee. However, this relationship did not hold during stair ascent, where the Power Knee showed advantages for stair ascent with net reductions in biological joint work of 14.1% and 23.3% compared to the Rheo and C-leg, respectively. There were no significant differences in biological joint work between the knees during ramp and stair descent, indicating that choice of MPK may not be as important for descent activities. Our results demonstrate that differences are present between different types of MPKs during ascent activities which could prove useful in the prescription of these devices.
PubMed: 38936310
DOI: 10.1016/j.jbiomech.2024.112201 -
Computer Methods and Programs in... Jun 2024Lower-limb wearable devices can significantly improve the quality of life of subjects suffering from debilitating conditions, such as amputations, neurodegenerative...
BACKGROUND AND OBJECTIVES
Lower-limb wearable devices can significantly improve the quality of life of subjects suffering from debilitating conditions, such as amputations, neurodegenerative disorders, and stroke-related impairments. Current control approaches, limited to forward walking, fall short of replicating the complexity of human locomotion in complex environments, such as uneven terrains or crowded places. Here we propose a high-level controller based on two Support Vector Machines exploiting four surface electromyography (EMG) signals of the thigh muscles to detect the onset (Toe-off intention decoder) and the direction (Directional EMG decoder) of the upcoming step.
METHODS AND MATERIALS
We validated a preliminary version of the approach by acquiring EMG signals from ten healthy subjects, performing steps in four directions (forward, backward, right, and left), in three different settings (ground-level walking, stairs, and ramps), and in both steady-state and static conditions. Both the Toe-off intention and Directional EMG decoders have been tested with a 5-fold cross-validation repeated five times, using linear and radial-basis-function kernels, and by changing the classification output timing, from 200 ms before to 50 ms after the toe-off.
RESULTS
The Toe-off intention decoder reached a median accuracy of 83.34 % (interquartile range (IQR): 6.48) and specificity of 92.72 % (IQR: 3.62) in its radial-basis-function version, while the Directional EMG decoder's median accuracy ranged between 73.92 % (IQR: 5.8), 200 ms before the toe-off, to 92.91 % (IQR: 4.11), 50 ms after the toe-off, with the radial-basis-function kernel implementation. For both the Toe-off intention and Directional EMG decoders the radial-basis-function version achieved better performances than the linear one (Wilcoxon signed rank test, p < 0.05).
CONCLUSIONS AND SIGNIFICANCE
The combination of the two decoders proved to be a promising solution to detect the step initiation and classify its direction, paving the way for wearable devices with a broader range of movements and more degrees of freedom, ultimately promoting usability in uncontrolled settings and better reactions to external perturbations. Additionally, the encumbrance of the setup is limited to the thigh of the leg of interest, which simplifies the implementation in compact devices, concurrently limiting the sensors worn by the subject.
PubMed: 38936151
DOI: 10.1016/j.cmpb.2024.108305