Search Results (4,663)

Background: Frail patients undergoing hip and knee revision surgery represent a major anesthetic challenge because of advanced age and multiple comorbidities. Continuous spinal anesthesia (CSA) with titrated low-dose levobupivacaine may offer a potentially useful alternative to general anesthesia or single-shot spinal anesthesia in this high-risk population. Methods: A retrospective review was conducted of ASA II-III patients who underwent complex hip and knee revision surgeries between February and October 2024 under CSA. The technique was performed using a 25-gauge spinal catheter with incremental boluses of 0.25% levobupivacaine (2.5 mg). Hemodynamic parameters, including mean arterial pressure (MAP), stroke volume index (SVI), and cardiac index (CI), were continuously monitored using the EV1000 hemodynamic monitoring system. Postoperative complications were recorded. Results: 37 high-risk patients were included in the study. Catheter placement was successful in all patients, with no conversions to general anesthesia. MAP decreased by a mean of 14.6% after boluses (p < 0.05); 9 patients (24.3%) experienced reductions ≥ 20%, but all remained >65 mmHg and responded to fluid therapy. CI and SVI decreased by 10.1% and 10.5%, respectively (p < 0.05), without clinical instability. No major complications (neurological injury, infection, post-dural puncture headache) were observed. Conclusions: In this retrospective single-center experience, CSA with titrated low-dose levobupivacaine was feasible and associated with stable hemodynamic profiles and a low rate of complications in frail patients undergoing complex lower-limb revision surgery. However, given the absence of a control group and the limited sample size, these findings should be interpreted cautiously. Further prospective comparative studies are needed to better define the role of CSA in high-risk orthopedic patients. Full article

Background: Podiatrists are crucial for managing lower limb pathologies, and effective appointment scheduling is vital for allocating adequate consultation time based on patient conditions. While occasional late patient arrivals may not significantly impact services, frequent lateness can disrupt patient flow and quality of care. This study explored the impact of patient lateness on podiatry practices worldwide, where no countries of origin were excluded. This study assessed current strategies to manage patient lateness, evaluated their effectiveness and reported recommendations for improvement. Methods: An international cross-sectional online survey was conducted between January and March 2024. Results: The survey, which garnered 201 responses from podiatrists, revealed that over 90% of podiatrists experienced disruptions in their clinic workflow due to late patients. Common reasons for lateness included traffic issues and difficulties with parking. SMS reminders emerged as the most effective tool for reducing tardiness. Over half (59.3%) of podiatrists implemented a 10-minute grace period before rescheduling late appointments, which effectively reduced lateness by 50%. However, some podiatrists refrained from rescheduling to avoid worsening patients' conditions or dealing with complaints. Additionally, many podiatrists reported a lack of managerial support in handling late patients. Conclusion: The frequency of late arrivals in podiatry is similar to other health professions and negatively impacts clinic workflow and staff morale. Enhanced managerial support is needed to better manage late patients, allowing podiatrists to concentrate on their clinical responsibilities. Full article

Background: Diabetic foot ulcers (DFUs) and lower extremity amputations are major contributors to morbidity and mortality in individuals with diabetes. Among patients undergoing active cancer treatment, the risks are compounded by immunosuppression, peripheral neuropathy, and vascular complications. Even minor foot infections or wounds in these patients can necessitate the suspension of cancer therapy, with potentially lifethreatening consequences. This study evaluated the impaqt of integrating symptom-focused patient education with coordinated podiatric care to reduce DFUs and amputations in this highrisk population with concurrent cancer and diabetes. Methods: A five-year retrospective review was conducted at a National Cancer Institute (NCl)designated comprehensive cancer center as part of the Novel Limb Preservation Initiative. The cohort included patients with Type II diabetes undergoing treatment for prostate, breast, colorectal, lymphoma, leukemia, thyroid, or lung cancers. Patients were assigned targeted educational modules based on self-reported diabetic foot symptoms. Podiatric care was individualized according to each patient's signs and symptoms, including routine diabetic foot examinations and close, timely monitoring when indicated. Results: The intervention yielded a DFU incidence of 2. 8% and an amputation rate of 0. 43%, both lower than national benchmarks. Enhanced patient engagement through diabetic foot symptom-focused education and earlier detection of foot complications-including diabetic foot ssues that may appear minor to laypersons-contributed to these improved outcomes. Conclusion: Integrating diabetic foot symptom-focused education with proactive podiatric monitoring significantly reduced DFUs and amputations in this high-risk population. This model, developed under the Novel Limb Preservation Initiative, offers a scalable strategy for broader implementation, particularly in high-risk communities, including Hispanic, African American, low socioeconomic, and rural populations across the United States. Full article

Human squat motion is commonly analyzed using inverse dynamics, where joint moments are computed from experimentally measured kinematics. Such analyses typically assume that the observed motion is mechanically feasible and do not explicitly account for limitations of joint moment capacity. In this study, a computational framework is proposed for the load-constrained reconstruction of squat motion that integrates kinematic motion generation with a mechanical model of moment-limited joints. The human body is represented as a multi-segment system consisting of feet, shanks, thighs, pelvis, and torso. Joint behavior is modeled using nonlinear rotational springs with bounded moment capacity, allowing elastic response followed by allowing bounded moment response and redistribution of mechanical demand as critical moment levels are approached. A reference squat trajectory is first generated kinematically, after which a constrained optimization problem is solved at each motion frame to obtain a mechanically admissible posture under external loading. The objective function combines trajectory tracking with joint energy contributions, while gravitational loading from a barbell applied at the shoulders introduces external work. The formulation enables automatic correction of the reference motion when joint moment limits are exceeded, resulting in mechanically admissible squat postures. Numerical examples illustrate the evolution of pelvis trajectory, torso inclination, lower-limb segment angles, and reconstructed body configurations throughout the squat cycle. The results confirm that joint moment capacity directly influences the reconstructed motion and leads to load-dependent adaptation of squat posture. Full article

Background and Clinical Significance: Conventional hard sockets are reported to result in skin breakdown for almost half of transtibial prosthesis users. Adjustable sockets have been developed to better accommodate residual limb shape and volume changes. They have demonstrated optimal skin health in prospective adult clinical studies. Case Presentation: We present the case of a 57-year-old male with a transtibial amputation who enrolled in a research study at the University of Pennsylvania. In the year before enrollment, he experienced frequent, near-constant skin breakdown of the distal residual limb at the anterior tibia due to limb volume fluctuations and excessive pressure from a conventional hard socket and was frequently unable to use his socket due to skin breakdown. The subject was fit with an adjustable, immediate fit transtibial prosthesis (iFIT Prosthetics^®). After a two-week home trial, he rated the adjustable prosthesis 62 out of 70 on an adapted Prosthetic Evaluation Questionnaire, compared with a score of 20 for his conventional prosthesis. Due to improved comfort, he discontinued the use of his conventional device. The subject was followed for over one year and wore the adjustable prosthesis exclusively without a recurrence of skin breakdown. Residual limb volume changes commonly lead to poor socket fit and skin irritation in conventionally fabricated hard sockets, often progressing to skin breakdown. In individuals with diabetes, wound healing can be prolonged and functionally limiting. In this case, an adjustable prosthesis successfully eliminated anterior tibial skin breakdown in a subject predisposed to this injury when using conventional hard sockets. Conclusions: Adjustable sockets can prevent skin breakdown in individuals with transtibial limb loss. Full article

The purpose of this study was to examine associations between lower-limb mechanical strength, phase-oriented composite strength indices, generalized neuromuscular activation, and maximal soccer ball kicking speed in trained athletes. Twenty-five male soccer players (age: 20.64 ± 2.50 years; height: 179.28 ± 4.27 cm; body mass: 75.80 ± 9.41 kg) participated in this cross-sectional study. Isometric ankle and knee joint torques were assessed using an isokinetic dynamometer, and joint-specific and phase-oriented cross-joint composite indices were computed to represent integrated strength capacity across the kinetic chain. Neuromuscular activation was evaluated via surface electromyography during a standardized squat jump task. Ball-kicking speed was measured using Doppler radar during maximal instep kicks. Associations were analyzed using Pearson correlation coefficients (p ≤ 0.05) with false discovery rate correction for multiple comparisons. In unadjusted analyses, moderate positive correlations were observed for several ankle torque variables and composite ankle strength indices, while swing-phase composite measures demonstrated moderate correlations (r = 0.43–0.55). Knee strength indices and sEMG variables showed no significant relationships. However, none of the variables remained statistically significant after FDR correction, suggesting limited independent explanatory value of isolated isometric strength and non-task-specific neuromuscular activation assessed during a standardized squat jump for maximal kicking performance. Full article

Monosex culture has been shown to enhance farming productivity in several decapod crustaceans, and it has also been suggested that this approach holds high potential for the sustainable aquaculture of the Chinese mitten crab, Eriocheir sinensis. Pronounced sexual dimorphism in E. sinensis facilitates the implementation of a monosex culture. This study aimed to compare the growth, gonadal development, culture performance, and economic outcomes of two monosex culture modes, i.e., an all-female culture and an all-male culture, as well as a mixed-sex culture (males: females = 1:1) during an 8-month growth period in earthen ponds. The results showed that: (1) Throughout the grow-out period, the average body weight in both monosex culture treatments was consistently higher than in the mixed-sex treatment, with a significantly greater body weight in the all-female and all-male treatments than that of males and females in the mixed-sex treatment being detected during mid-June and October, respectively (p < 0.05). (2) The percentages of both sexes that had finished puberty molting were mostly similar between the monosex and mixed-sex treatments between July 20th to October 10th, although the all-female treatment had a significantly lower puberty molting percentage than the mixed-sex treatment on August 10th (p < 0.05). Gonadosomatic index (GSI) values were similar between the monosex and mixed-sex treatments for both males and females (p > 0.05). (3) At harvest period, the final body weight in the all-male treatment was significantly higher than that of the mixed-sex treatment (p < 0.05). In contrast, the all-female treatment exhibited a significantly higher survival rate and a lower limb injury rate compared with the mixed-sex treatment (p < 0.05). As a result, the yield of the all-male and all-female treatments exceeded that of the males and females in the mixed-sex treatment by 24% and 13%, respectively. Additionally, the mixed-sex treatment also had a significantly higher feed conversion ratio (p < 0.05). Finally, the monosex treatments had a higher proportion of large crabs (males ≥ 200 g, females ≥ 175 g) and a lower proportion of small crabs (males ≤ 150 g, females ≤ 100 g) compared to the mixed-sex treatment. (4) In terms of economic benefits, net profit and return on investment (ROI) were highest under the all-female treatment, while the mixed-sex treatment recorded the lowest total return, net profit, and ROI (p < 0.05). In conclusion, an all-female culture is recommended for the grow-out culture period of E. sinensis, as it led to a higher survival rate, produced larger-sized crabs and generated greater overall economic benefit. Full article

Lower-limb strength is a health and performance indicator in adolescents, although its assessment often fails to account for the influence of sex and biological development. This study aimed to analyze the associations between anthropometric parameters, maturational status, and physical activity levels with jumping performance in adolescents. A cross-sectional study was conducted with male and female adolescents (mean age: 13.60 ± 1.50 years). Anthropometric variables, maturational status, and physical activity levels were assessed. Performance was measured using the Countermovement Jump (CMJ) and Standing Broad Jump (SBJ). In males, jumping performance was significantly associated with height (p = 0.002), lower-limb length (p < 0.001), and muscle mass (p < 0.001). However, fat mass emerged as a substantial factor, exhibiting a large effect size on performance (p < 0.001). Maturational status in males showed significant differences, with late maturers performing lower than on-time and early maturers (p < 0.023). In females, structural anthropometry and maturation showed limited-to-no significant associations with performance, except for a negative association with fat mass (p < 0.035) and a positive association between muscle mass and CMJ (p < 0.020). Active adolescents of both sexes performed significantly better than inactive ones in both CMJ and SBJ (p < 0.011). In conclusion, jumping performance in adolescents is characterized by marked sexual dimorphism. In males, greater height, lower-limb length, lower fat mass, and early maturation are positively associated with superior performance. Conversely, in females, these factors exhibit limited influence on jump outcomes. Full article

Objectives: The aim of this study was to assess the differences in diagnostic delay and disease progression in people with ALS (PALS) based on site of onset. Methods: A retrospective analysis of prospectively collected data was performed, including all PALS seen in the ALS clinic in the Hadassah Medical Center between January 2009 and March 2022. PALS were divided to three groups based on site of onset (upper limb onset—ULO, lower limb onset—LLO, or bulbar onset—BO). A linear mixed-effects model was constructed with the following variables: diagnostic delay, site of onset, age of onset and time since the initial visit. The model was applied to the ALSFRS-R total score and the bulbar and motor subscales. Results: Data from 1255 visits of 281 PALS were included in the study. PALS with LLO had longer diagnostic delays than PALS in the BO group. Slower decline of total ALSFRS-R score was observed in younger PALS, and in PALS with LLO when compared with PALS with BO or ULO. The slower decline of ALSFRS-R in PALS with LLO was due to a slower decline in the motor subscale. Longer diagnostic delays were associated with lower total ALSFRS-R scores at the initial visit and with slower rates of decline. Conclusions: Comparison among PALS with ULO, LLO and BO revealed differences in the diagnostic delay and in the rate of functional decline, suggesting that differentiating between ULO and LLO ALS may be useful in the stratification of PALS in clinical trials. Full article

This study investigated interlimb asymmetries in lower limb performance using both vertical and horizontal jump tests in elite young basketball players. Specifically, it aimed to determine whether (1) unilateral jump performance and (2) the magnitude of interlimb asymmetry differed across maturity groups, whether (3) limb dominance influences performance, and whether (4) asymmetry direction is consistent across tests. One hundred elite male basketball players (U13 to U19) were categorised into three maturational stages: Pre-PHV (n = 19), Circa-PHV (n = 29), and Post-PHV (n = 52). Each athlete performed the following unilateral tests with both the dominant and non-dominant leg: single-leg hop, triple hop for distance, 6 m timed hop, single-leg countermovement jump (SL-CMJ), and single-leg drop jump (SL-DJ) from a 30 cm box. The Bilateral Strength Asymmetry (BSA) index was computed for each test. All tests showed significant differences between Pre-PHV and Circa-PHV groups (p < 0.001), whereas only the 6 m timed hop differed between Circa-PHV and Post-PHV (p < 0.01). BSA did not differ significantly across maturation stages in any test, except for the single-leg hop. Agreement in asymmetry direction between test pairs was slight to fair (kappa ≤ 0.29). BSA values remained largely stable across maturational stages, suggesting that interlimb asymmetries are established before PHV, likely during childhood. Limb dominance did not affect jump performance, and asymmetry direction varied between tests, confirming they are not interchangeable. Full article

Phellodendri amurensis Cortex is the dried bark of the cork tree (Phellodendron amurense Rupr.) from the Rutaceae family, and possesses traditional efficacy in clearing heat, drying dampness, purging fire, relieving steaming sensations, detoxifying, and healing sores. Clinically, it is commonly used for treating symptoms such as damp-heat diarrhea and dysentery, jaundice with reddish urine, leukorrhea with vaginal itching, painful and difficult urination due to heat strangury, flaccidity and weakness of the lower limbs, bone-steaming and consumptive fever, night sweats and seminal emission, sores, ulcers, swellings, and toxins, eczema, damp sores, and urinary tract infections. Modern pharmacological studies have further revealed its diverse bioactivities, including antioxidant, antibacterial, anti-inflammatory, immunosuppressive, and anticancer effects. To provide an updated and comprehensive review of the research into Phellodendri amurensis Cortex, this study conducted a thorough literature search and analysis based on databases such as SciFinder, Web of Science, and China National Knowledge Infrastructure. The review integrates information on the plant’s botanical characteristics, geographical distribution, traditional applications, chemical components, quality control methods, and pharmacological effects to present a current and holistic overview of its research status. To date, approximately 170 compounds have been isolated and identified from Phellodendri amurensis Cortex, primarily including alkaloids, phenolics, terpenoids, sterols, lignans, flavonoids, and others. Among these, alkaloids exhibit significant antioxidant and anti-inflammatory activities and demonstrate potential pharmacological value in antibacterial, anticancer, hypoglycemic, and multi-organ protective effects. Although substantial foundational research exists, the mechanisms of action and quality control of Phellodendri amurensis Cortex require further in-depth exploration. Future efforts should focus on clarifying its pharmacodynamic material basis, uncovering new targets and pathways, and improving analytical methods for component analysis and quality control to advance the scientific development and rational utilization of this medicinal material. Full article

Background: Intravascular lithotripsy (IVL) has emerged as a novel vessel preparation device for patients with peripheral artery disease undergoing angioplasty. The IVL catheter includes an integrated balloon, which emits high pressure and transient sonic waves. The release of shockwaves results in cracking of intimal and medial calcium within the vessel wall improving lumen patency. Objectives: The aim of this prospective observational cohort study is to evaluate the morphological and imaging changes in atherosclerotic plaque in patients with PAD undergoing IVL as a vessel preparation technique, followed by angioplasty with drug-coated balloon (DCB) or stent placement if required. Secondary endpoint is to evaluate the efficacy of IVL in the perfusion of the lower extremities, by calculating the ankle–brachial index (ABI) and toe–brachial index (TBI) post-angioplasty, as well as adverse events within 30 days. Methods: Consecutive adult (≥18 years of age) patients with symptomatic femoropopliteal artery disease selected to undergo IVL will be included in the study. Computed tomography angiography (CTA) of the lower limbs will be performed pre- and postoperatively. Intraoperatively, an intravascular ultrasound (IVUS) will be used before and immediately post-angioplasty, for real-time evaluation of the morphological and quantitative changes in the atherosclerotic plaque. All participants will be clinically re-evaluated in 30 days postoperatively and a color Duplex ultrasound of the lower extremity arteries will be performed. The perfusion of the peripheral arteries will be assessed using ABI and TBI post-procedurally. Outcomes: The primary outcome is the quantitative assessment of changes in plaque morphology and volume within the index target lesion, based on pre- and post-procedural computed tomography angiography using TeraRecon™ (Durham, NC, USA) plaque analysis module, reflecting plaque modification and redistribution, in the context of IVL-based vessel preparation. Secondary outcomes include improvement of peripheral arterial perfusion and freedom from clinically driven target lesion revascularization (CD-TLR) and major adverse events. Full article

Humanoid upper-limb robots are an important direction in biomimetic robotics, and inverse kinematics is a key technique for achieving human-like coordinated operation. However, existing inverse kinematics methods for bimanual trajectory tracking often suffer from high computational complexity and limited synchronization performance. To address this, this paper proposes an error-adaptive competition-based inverse kinematics (EAC-IK) approach for bimanual trajectory tracking of humanoid upper-limb robots. First, a unified modeling framework for the absolute tracking errors and synchronization errors of the two arms is established, and the end-effector task constraints are reformulated into a low-dimensional representation, thereby reducing the computational complexity of the original high-dimensional task mapping. Second, to enhance the coordination capability of bimanual operations, an error-adaptive competition mechanism is developed to regulate the weighting coefficients of the two arms online according to their error states. In addition, a virtual second-order command shaper is introduced at the joint level to reconstruct joint trajectories and suppress oscillations induced by input noise and the error-adaptive competition mechanism. Simulation and experimental results on a hyper-redundant humanoid upper-limb robot demonstrate that, compared with the zeroing neural-network-based inverse kinematics method, the proposed method achieves lower tracking and synchronization errors, as well as higher computational efficiency. In the circular trajectory-tracking experiment, the left-arm position and orientation tracking errors decrease from $1.60\times {10}^{-3}\mathrm{m}$ and $4.72\times {10}^{-3}\mathrm{rad}$ to $0.70\times {10}^{-3}\mathrm{m}$ and $0.95\times {10}^{-3}\mathrm{rad}$, respectively, while the synchronization error decreases from $1.96\times {10}^{-3}$ to $1.30\times {10}^{-3}$. In addition, the average algorithm runtime decreases from $0.82\mathrm{ms}$ to $0.63\mathrm{ms}$. Full article

(1) Background: Creutzfeldt–Jakob disease (CJD) is a progressive neurodegenerative disorder, characterized by cognitive decline, and motor and psychiatric symptoms; it primarily affects the central nervous system; however, peripheral nervous system involvement has rarely been described, particularly as an atypical presentation. (2) Methods: A 78-year-old Caucasian man, a retired farmer with no family history of neurological disease, presented with diarrhea followed by progressive lower limb weakness, which eventually evolved into encephalopathy and generalized areflexia. An initial diagnosis of inflammatory neuropathy was considered; the diagnostic assessment included blood and cerebrospinal fluid testing, a CT whole body scan, brain MRI, neuropsychological testing, electroencephalography, a nerve conduction study and electromyography. (3) Results: Neurophysiological studies demonstrated an acute asymmetrical sensorimotor, predominantly axonal polyneuropathy, initially suggestive of an axonal form of inflammatory polyradiculoneuritis. This pattern was confirmed on follow-up neurophysiological assessment performed three weeks later. Unexpectedly, the diagnostic course ultimately led to a diagnosis of sporadic Creutzfeldt–Jakob disease, confirmed by post-mortem neuropathological examination. Based on these findings, we conducted a literature review to summarize the current evidence on CJD-related neuropathy. (4) Conclusions: Our case emphasizes the importance of maintaining clinical suspicion for CJD even in patients presenting with progressive lower limb weakness and suggests that peripheral neuropathy may be concomitant or even precede the CNS manifestations. Careful consideration is required to avoid misdiagnosis of inflammatory neuropathy in the context of neurodegenerative diseases such as CJD. Full article

Background: Upper limb functional performance depends on the interaction of strength, mobility, and neuromuscular control, while inter-limb asymmetries may increase injury risk. However, comprehensive analyses integrating these factors remain limited. This study aimed to evaluate sex differences and identify functional phenotypes in young adults using a multidimensional assessment approach. Methods: Forty-six healthy young adults (23 women, 23 men) underwent a comprehensive battery of upper limb assessments, including anthropometric measurements, maximal handgrip strength, isometric elbow flexion and extension torque, postural stability via the Fall Risk Index (FRI), and functional reach using the Upper Quarter Y-Balance Test (YBT-UQ). Inter-limb symmetry was calculated using the Limb Symmetry Index (LSI). K-means clustering was applied to standardized variables to identify latent functional phenotypes. Results: Men demonstrated significantly greater body mass, height, limb length, and absolute strength (p < 0.01), while functional performance (YBT-UQ composite scores) and inter-limb symmetry were similar between sexes. Strength asymmetry was most prevalent for elbow flexion and handgrip strength (up to 89%), whereas stability asymmetry was less frequent (≈54%). Three functional clusters were identified: Cluster 1—high strength and moderate stability, Cluster 2—lower anthropometry and strength, Cluster 3—high strength but reduced stability and increased asymmetry. Despite phenotypic differences, composite functional performance was comparable across clusters. Conclusions: Upper limb function reflects the interaction of morphological and neuromuscular factors rather than strength alone. Observed asymmetries should be interpreted within a functional context, as moderate asymmetries may represent normal variation in motor control, while larger asymmetries may indicate potential functional imbalance; however, due to the cross-sectional design of this study, no causal inferences regarding injury risk can be made. Functional phenotyping provides a framework for individualized training, screening, and rehabilitation strategies. Full article