Search Results (26)

Diabetic Foot Ulcers (DFUs) are a significant health and economic burden, potentially leading to limb amputation, with a severe impact on a person’s quality of life. During active movements like gait, the monitoring of shear has been suggested as an important factor for effective prevention of DFUs. It is proposed that, in textiles, strain can be measured as a proxy for shear stress at the skin. This paper presents the conceptualisation and development of a novel strain-sensing approach that can be unobtrusively integrated within sock textiles and worn within the shoe. Working with close clinical and patient engagement, a sensor specification was identified, and 12 load-sensing approaches for the prevention of DFU were evaluated. A lead concept using a conductive adhesive was selected for further development. The method was developed using a Lycra sample, before being translated onto a knitted ‘sock’ substrate. The resultant strain sensor can be integrated within mass-produced textiles fabricated using industrial knitting machines. A case-study was used to demonstrate a proof-of-concept version of the strain sensor, which changes resistance with applied mechanical strain. A range of static and dynamic laboratory testing was used to assess the sensor’s performance, which demonstrated a resolution of 0.013 $\mathrm{\Omega }$ across a range of 0–430 $\mathrm{\Omega }$ and a range of interest of 0–20 $\mathrm{\Omega }$. In cyclic testing, the sensor exhibited a cyclic strain threshold of 6% and a sensitivity gradient of 0.3 ± 0.02, with a low dynamic drift of 0.039 to 0.045% of the total range. Overall, this work demonstrates a viable textile-based strain sensor capable of integration within worn knitted structures. It provides a promising first step towards developing a sock-based strain sensor for the prevention of DFU formation. Full article

Amniotic band syndrome is a constrictive phenomenon in fetal development that can provoke limb autoamputation, malformation, trunk division, and umbilical cord strangulation. The latter two complications will ultimately lead to fetal demise if left untreated. If detected early enough, select cases may benefit from prenatal resection of the amniotic bands, thus preventing amputation and fetal death. Yet, especially in the presence of complete chorioamniotic separation, these procedures are rare, technically difficult, and not without significant risk. Objectives: The purpose of this report is to present the surgical technique and outcome of a challenging percutaneous fetoscopic intervention in a human fetus with amniotic band constrictions of a fetal thigh, retroplacental hematoma, partial placental abruption, subtotal chorioamniotic separation, and multiple amniotic bands encircling the umbilical cord. Methods: Minimally invasive, fetoscopic surgery to salvage the fetal life and lower leg was performed at 22 + 2 weeks of gestation under general maternofetal anesthesia. Results: Total resection of all amniotic bands was achieved, notwithstanding the aforementioned challenges. No surgical complications were observed. Despite preterm delivery at 25 + 4 weeks of gestation, the postnatal experience for the infant was favorable and uncomplicated as it furthermore benefitted from neonatal intensive care. At almost three years of age, the child remains healthy and demonstrates normal function of the formerly constricted leg. Conclusions: Our case shows that the combination of tested percutaneous fetoscopic techniques, high-risk obstetrics, and modern neonatology can overcome multiple obstacles in order to save a fetal patient stuck in a near-hopeless situation. Full article

Background: Advances in prosthetic technology, especially microprocessor-controlled knees (MPKs), have helped enhance gait symmetry and reduce fall risks for individuals who have undergone transfemoral amputation. However, challenges remain in walking in constrained situations due to the limitations of passive prosthetic feet, lacking ankle mobility. This study investigates the benefits of SYNSYS^®, a new microprocessor-controlled knee–ankle–foot system (MPKA_NEW), designed to synergize knee and ankle movements. Methods: A randomized crossover trial was conducted on 12 male participants who had undergone transfemoral amputation who tested both the MPKA_NEW and their usual MPK prosthesis. Biomechanical parameters were evaluated using quantitative gait analysis in various walking conditions. Participants also completed self-reported questionnaires on their quality of life, locomotor abilities, and prosthesis satisfaction. Results: The MPKA_NEW showed a significant reduction in the risk of slipping and tripping compared to standard MPK prostheses, as evidenced by increased flat-foot time and minimum toe clearance during gait analysis. The MPKA_NEW also improved physical component scores in quality-of-life assessments (Short-Form 36 General Health Questionnaire), suggesting enhanced stability and reduced cognitive load during walking. Conclusions: The MPKA_NEW offers significant improvements in gait safety and quality of life for people who have undergone TFA, particularly in challenging conditions. Further studies are needed to assess the long-term benefits and adaptability across diverse amputee populations. Full article

Background: Diabetic foot ulcers are a common complication of diabetes mellitus, often leading to progressive sensory deficits, impaired vascularization, and a predisposition to ulceration and gangrene. Untreated ulcers may cause recurrent infections that endanger a patient’s life. Amputation of part of the limb up to a well-vascularized level is one of the treatments employed for untreated ulcers. Objectives: Laboratory data were analyzed with the aim of identifying risk factors related to surgical amputation treatment of diabetic foot. We believe it is useful to identify risk factors that can be altered from a reversible condition in the clinical decision-making of treatment, thus manifesting themselves in a timely manner to provide the patient with an alternative to surgical amputation of the lower limb. Methods: Our retrospective study was conducted by the Department of Orthopedics and Traumatology at the Fondazione Policlinico Universitario Agostino Gemelli IRCCS in Rome. We recruited 200 patients who underwent lower limb amputation for diabetic foot between 2017 and 2021 and had blood tests both 30 days and within 5 days before the first surgery. Results: This case–control study revealed a significant negative correlation between hemoglobin (Hb) levels and the occurrence of leg amputations. In contrast, C-reactive protein (CRP) levels, the neutrophil-to-lymphocyte ratio (NLR), and the platelet-to-lymphocyte ratio (PLR) showed significant positive correlations with leg amputations. A 3-year follow-up of the cases also revealed a significative positive correlation between age, white blood cells (WBC) count, NLR, PLR, and death at 3 years. Conclusions: Our findings suggested that lower Hb levels and elevated CRP, NLR, and PLR levels in patients with diabetic foot disease may be associated with a higher risk of lower-limb amputation. Unexpectedly, this study also demonstrated that elderly age, WBC, CRP, NLR and PLR levels may be associated with a negative prognosis for these patients. These findings highlighted the importance of monitoring these laboratory values in diabetic patients to identify individuals at higher risk of leg amputations and implement appropriate interventions to prevent or minimize the occurrence of this severe complication. Full article

People of all ages can contract pneumonia, and it can cause mild to severe disease and even death. In addition to being a major cause of death for elderly people and those with prior medical conditions such as diabetes, it isthe world’s biggest infectious cause of death for children. Diabetes mellitus is a metabolic condition with a high glucose level and is a leading cause of lower limb amputation, heart attacks, strokes, blindness, and renal failure. Hyperglycemia is known to impair neutrophil activity, damage antioxidant status, and weaken the humoral immune system. Therefore, diabetic patients are more susceptible to pneumonia than people without diabetes and linked fatalities. The absence of quick, precise, simple, and affordable ways to identify the etiologic agents of community-acquired pneumonia has made diagnostic studies’ usefulness contentious. Improvements in biological markers and molecular testing techniques have significantly increased the ability to diagnose pneumonia and other related respiratory infections. Identifying the risk factors for developing severe pneumonia and early testing in diabetic patients might lead to a significant decrease in the mortality of diabetic patients with pneumonia. In this regard, various risk factors, traditional testing techniques, and pathomechanisms are discussed in this review. Further, biomarkers and next-generation sequencing are briefly summarized. Finding biomarkers with the ability to distinguish between bacterial and viral pneumonia could be crucial because identifying the precise pathogen would stop the unnecessary use of antibiotics and effectively save the patient’s life. Full article

Background/Objectives: Chronic limb-threatening ischaemia (CLTI) is a significant life and limb-threatening condition. Two recent seminal trials, BEST-CLI and BASIL-2, have provided seemingly conflicting results concerning the optimal treatment modality for patients with CLTI. We sought to investigate the outcomes of patient undergoing infrainguinal bypass at two centres in Aotearoa New Zealand. Methods: A cross-sectional retrospective review of all patients who underwent infrainguinal bypass grafting for CLTI at Auckland City Hospital and Waikato Hospital between January 2020 and December 2021 was performed. The primary outcome was a composite of death, above-ankle amputation, and major limb reintervention. The secondary outcome was minor limb reintervention. Kaplan–Meier survival analysis was performed to determine time to the primary and secondary endpoints. Demographic factors were examined using the log-rank test to examine the effect on the outcome. Results: One hundred and nineteen patients who underwent infrainguinal bypass for CLTI in the study period were identified. Of these, 93 patients had a bypass with ipsilateral or contralateral GSV. The median follow-up time was 1.85 years. The most common indication for surgery was tissue loss (69%, n = 63), with the most common distal bypass target being the below-knee popliteal artery (45%, n = 41). The primary composite outcome occurred in 42.8% of the cohort (n = 39). Death was the most common component of the primary outcome (26%, n = 24). Male sex (HR 0.48, 95% CI 0.26–0.88, p = 0.018) and statin use (HR 0.49, 95% CI 0.24–0.98, p = 0.044) were independent predictors of protection from the composite outcome on multivariate analysis. Dialysis dependence (HR 3.32, 95% CI 1.23–8.99, p = 0.018) was an independent predictor for patients meeting the composite outcome. Conclusions: This study’s results are consistent with the published outcomes of BEST-CLI. The patient cohorts examined, anatomical disease patterns, and conduit use may explain some of the differences observed between this study, BEST-CLI and BASIL-2. Further work is required to define the specific patient populations who will benefit most from an open surgical or endovascular first approach to the management of CLTI. Full article

Background. Assessing the patient’s perceived body image is essential to measure the impact of lower limb amputation on quality of life and psychological well-being. Objective. The aim of this study was to develop a Spanish version of the Amputee Body Image Scale (ABIS-E) for Spanish-speaking lower limb amputees. Methods. A cross-sectional study was conducted including amputee patients in Madrid, Spain. Clinical outcomes of body image (Amputee Body Image Scale, ABIS), health-related quality of life (EuroQol-5D-5L), depression and anxiety (Hospital Anxiety and Depression Scale, HADS), pain (Brief Pain Inventory-Short Form, BPI-SF), and functional capacity (Prosthesis Evaluation Questionnaire, PEQ) were collected. Results. Seventy-three participants were assessed. Excellent test–retest reliability (ICC = 0.847) and good internal consistency (Cronbach’s alpha = 0.753) were obtained. Factor analyses extracted three factors. Convergent validity with Pearson’s and Spearman’s correlation coefficients were calculated for depression and anxiety questionnaires (HADS) (values between 0.57 and 0.67), functional capacity (PEQ) (values between −0.35 and 0.71), and quality of life (EQ-5D-5L) (values between −0.37 and 0.61). Conclusions. The ABIS-E is a reliable and valid instrument to measure body image in the Spanish population with lower limb amputation, potentially useful in primary care to identify psychosocial problems. Full article

Musculoskeletal diseases affect over 100 million people globally and are a leading cause of severe, prolonged pain, and disability. Recognized as a clinical emergency, prompt and accurate diagnosis of musculoskeletal disorders is crucial, as delayed identification poses the risk of amputation for patients, and in severe cases, can result in life-threatening conditions such as bone cancer. In this paper, a hybrid model HRD (Human-Resnet50-Densenet121) based on deep learning and human participation is proposed to efficiently identify disease features by classifying X-ray images. Feasibility testing of the model was conducted using the MURA dataset, with metrics such as accuracy, recall rate, F1-score, ROC curve, Cohen’s kappa, and AUC values employed for evaluation. Experimental results indicate that, in terms of model accuracy, the hybrid model constructed through a combination strategy surpassed the accuracy of any individual model by more than 4%. The model achieved a peak accuracy of 88.81%, a maximum recall rate of 94%, and the highest F1-score value of 87%, all surpassing those of any single model. The hybrid model demonstrates excellent generalization performance and classification accuracy. Full article

Introduction. Globally, over 230 million people have peripheral artery disease, often undiagnosed, leading to chronic limb-threatening ischemia. Revascularization is vital for preventing amputation and improving quality of life. While specific questionnaires for severe ischemia are lacking, the SF-36 questionnaire is widely used to assess quality of life, with variations like SF-12 and SF-8 for larger cohorts. Objectives. Our aim was to assess how different lower limb revascularization methods affect the postoperative quality of life in patients with chronic limb-threatening ischemia. Methods. This study was conducted at the St. Pantelimon Emergency Hospital of Bucharest, Romania. It included 166 adult patients with chronic limb-threatening ischemia who were monitored for 12 months. Quality of life was assessed using the SF-36 questionnaire. The patients were categorized into two groups: 112 underwent conventional surgery, and 54 had hybrid procedures. Data analysis involved t-tests, Mann-Whitney U tests and assessment of data reliability. Results. In the Conventional Surgery group, the average age was 70.5 years, predominantly male, with similar risk factors as the second group. The Hybrid Surgery group had an average age of 73 and exhibited more extensive distal arterial lesions, higher rates of ulcer/gangrene, and a higher occurrence of postoperative minor amputations. The SF-36 questionnaire showed low data reliability for the General Health and Social Functioning domains. Additionally, the Hybrid Surgery group had poorer preoperative perception in the Body Pain category. However, significant postoperative improvements in quality of life were observed in all domains for both groups with similar results. Conclusions. Revascularization improves the quality of life for patients with chronic limb-threatening ischemia, including those that also require minor amputations. SF-36 has good assessment for most QoL aspects, but reliability declines in severe ischemia. Full article

Myxofibrosarcoma (MFS) is a malignant soft tissue sarcoma (STS) that originates in the body’s connective tissues. It is characterized by the presence of myxoid (gel-like) and fibrous components and typically affects patients after the fifth decade of life. Considering the ongoing trend of increasing lifespans across many nations, MFS is likely to become the most common musculoskeletal sarcoma in the future. Although MFS patients have a lower risk of developing distant metastases compared with other STS cases, MFS is characterized by a high frequency of local recurrence. Notably, in 40–60% of the patients where the tumor recurs, it does so multiple times. Consequently, patients may undergo multiple local surgeries, removing the risk of potential amputation. Furthermore, because the tumor relapses generally have a higher grade, they exhibit a decreased response to radio and chemotherapy and an increased tendency to form metastases. Thus, a better understanding of MFS is required, and improved therapeutic options must be developed. Historically, preclinical models for other types of tumors have been instrumental in obtaining a better understanding of tumor development and in testing new therapeutic approaches. However, few MFS models are currently available. In this review, we will describe the MFS models available and will provide insights into the advantages and constraints of each model. Full article

Prosthetics and orthotics research, studies, and technologies have been evolving through the years. According to World Health Organization (WHO) data, it is estimated that, globally, 35–40 million people require prosthetics and orthotics usage in daily life. Prosthetics and orthotics demand is increasing due to certain factors. One of the factors is vascular-related disease, which leads to amputation. Prosthetic usage can increase an amputee’s quality of life. Therefore, studies of the ergonomic design of prosthetics are important. The ergonomic factor in design delivers prosthetic products that are comfortable for daily use. One way to incorporate the ergonomic design of prosthetics is by studying the human walking gait. This paper presents a multiclassification of human walking gait based on electromyography (EMG) signals using a machine learning method. An EMG sensor was attached to the bicep femoris longus and gastrocnemius lateral head to acquire the EMG signal. The experiment was conducted by volunteers during normal walking activity at various speeds and the movements were segmented as initial contact, which was labeled as initial gait; loading response to the terminal stance, which was labeled as mid-gait; and pre-swing to terminal swing, which was labeled as final gait. The EMG signal was then characterized using an artificial neural network (ANN) and compared to six training accuracy methods, i.e., the Levenberg–Marquardt backpropagation training algorithm, quasi-Newton training method, Bayesian regulation backpropagation training method, gradient descent backpropagation, gradient descent with adaptive learning rate backpropagation, and one-step secant backpropagation. The machine learning study performed well in the classification of three classes of human walking gait with an overall accuracy (training, testing, and validation) of 96% for Levenberg–Marquardt backpropagation. The gait data will be used to explore the design of lower limb prosthetics in future research. Full article

This systematic review pooled evidence from randomised controlled trials (RCTs) on the effectiveness of dietary upregulators of nitric oxide (NO) in improving the walking and quality of life of patients with peripheral artery disease (PAD). RCTs examining the effect of dietary upregulators of NO in patients with PAD were included. The primary outcome was the maximum walking distance. Secondary outcomes were the initial claudication distance, the six-minute walking distance, quality of life, the ankle-brachial pressure index (ABI), adverse events and risk of mortality, revascularisation or amputation. Meta-analyses were performed using random effects models. The risk of bias was assessed using Cochrane’s ROB-2 tool. Leave-one-out and subgroup analyses were conducted to assess the effect of individual studies, the risk of bias and intervention type on pooled estimates. Thirty-four RCTs involving 3472 participants were included. Seven trials tested NO donors, nineteen tested antioxidants, three tested NO synthase inducers and five tested enhancers of NO availability. Overall, the dietary supplements significantly improved the initial claudication (SMD 0.34; 95%CI 0.04, 0.64; p = 0.03) but not maximum walking (SMD 0.13; 95%CI −0.17, 0.43; p = 0.39) distances. Antioxidant supplements significantly increased both the maximum walking (SMD 0.36; 95%CI 0.14, 0.59; p = 0.001) and initial claudication (SMD 0.58; 95%CI 0.26, 0.90; p < 0.001) distances. The dietary interventions did not improve the physical function domain of the Short Form-36 (SMD −0.16; 95%CI −0.32, 0.00; p = 0.38), ABI or risk of adverse events, mortality, revascularisation or amputation. Dietary NO upregulators, especially antioxidants, appear to improve the initial claudication distance in patients with PAD. Larger high-quality RCTs are needed to fully examine the benefits and risks of these treatments. PROSPERO Registration: CRD42022256653. Full article

The design and fitting of prosthetic sockets can significantly affect the acceptance of an artificial limb by persons with lower limb amputations. Clinical fitting is typically an iterative process, which requires patients’ feedback and professional assessment. When feedback is unreliable due to the patient’s physical or psychological conditions, quantitative measures can support decision-making. Specifically, monitoring the skin temperature of the residual limb can provide valuable information regarding unwanted mechanical stresses and reduced vascularization, which can lead to inflammation, skin sores and ulcerations. Multiple 2D images to examine a real-life 3D limb can be cumbersome and might only offer a partial assessment of critical areas. To overcome these issues, we developed a workflow for integrating thermographic information on the 3D scan of a residual limb, with intrinsic reconstruction quality measures. Specifically, workflow allows us to calculate a 3D thermal map of the skin of the stump at rest and after walking, and summarize this information with a single 3D differential map. The workflow was tested on a person with transtibial amputation, with a reconstruction accuracy lower than 3 mm, which is adequate for socket adaptation. We expect the workflow to improve socket acceptance and patients’ quality of life. Full article

Quality control testing under acceptance sampling plans involves inspecting a representative sample of products or materials from a larger lot or batch to determine whether the lot meets predetermined quality standards. In this research, the modified Lindley distribution is used as a model for lifetime study. When a life test is amputated at a pre-appropriated time to decide on the admission or refusal of the submitted batches, the problems of the single, double, and multiple (three and four stages) acceptance sampling strategies are introduced. The optimal sample sizes are computed for single, double, and multiple acceptance sampling plans to ensure that the veritable mean life is greater than the prescribed mean life at the stipulated consumer’s risk. The operating characteristic functions are investigated at diverse quality levels. For single, double, and multiple acceptance sampling plans, the minimal ratios of the veritable mean life to the prescribed mean life at the established percent of the producer’s risk are obtained. To demonstrate the uses of single, double, and multiple, some numerical experiments are presented. Full article

Transcutaneous Electrical Nerve Stimulation (TENS) is a promising technique for eliciting referred tactile sensations in patients with limb amputation. Although several studies show the validity of this technique, its application in daily life and away from laboratories is limited by the need for more portable instrumentation that guarantees the necessary voltage and current requirements for proper sensory stimulation. This study proposes a low-cost, wearable high-voltage compliant current stimulator with four independent channels based on Components-Off-The-Shelf (COTS). This microcontroller-based system implements a voltage-current converter controllable through a digital-to-analog converter that delivers up to 25 mA to load up to 3.6 kΩ. The high-voltage compliance enables the system to adapt to variations in electrode-skin impedance, allowing it to stimulate loads over 10 kΩ with currents of 5 mA. The system was realized on a four-layer PCB (115.9 mm × 61 mm, 52 g). The functionality of the device was tested on resistive loads and on an equivalent skin-like RC circuit. Moreover, the possibility of implementing an amplitude modulation was demonstrated. Full article