Aims
The standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of ...phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.
Methods
The MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest.
Results
Three studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184).
Conclusion
Rotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.
Cite this article:
Bone Jt Open
2023;4(11):817–824.
•Prosthetics are the mainstay in surgery after resection of extremity bone tumors.•For these patients gait parameters deteriorated compared to healthy individuals.•Further refinement of surgical ...techniques is required.•New rehabilitation strategies and follow-up programming are needed.
Prosthetic reconstructive procedures have become the mainstay in contemporary surgical treatment following resection of extremity bone neoplasms. Given that these patients are of young age most of the time, achievement of robust functional outcomes is of paramount importance. The aim of this study is to assess the impact of this procedure on the gait parameters of cancer patients compared to healthy individuals. The Medline, Scopus and Cochrane databases were systematically searched until January 2022 for eligible studies. Gait parameters measured by gait analysis after prosthetic reconstruction were the outcomes of interest. Eight cohort studies were included in our analysis. From these, seven studied prosthetic reconstruction of the knee (distal femur or proximal tibia) and only one exclusively studied prostetic reconstructions of the proximal femur. Compared to healthy individuals a significant decrease was evident in gait velocity (-0.16 m/sec, 95 %CI: −0.23 to −0.09, p-value < 0.001), in stride length (-6.07 %height, 95 %CI: −9,36 to −2.78, p-value < 0.001), in cadence (-3.96 stride/min, 95 %CI: −5.41 to −2.51, p-value < 0.001) and significant increase in cycle time (0.10 s, 95 %CI: 0.03 to 0.17, p-value = 0.005). Prosthetic reconstruction following lower limb tumor resection significantly affects the gait of patients. This knowledge can be utilized for further refinement of surgical techniques, rehabilitation strategies and follow-up programming.
Hemiplegia affects a significant portion of the human population. It is a condition that causes motor impairment and severely reduces the patient’s quality of life. This paper presents an automatic ...system for identifying the hemiplegia type (right or left part of the body is affected). The proposed system utilizes the data taken from patients and healthy subjects using the accelerometer sensor from the RehaGait mobile gait analysis system. The collected data undergo a pre-processing procedure followed by a feature extraction stage. The extracted features are then sent to a neural network trained by the Levenberg-Marquardt backpropagation (LM-BP) algorithm. The experimental part of this research involved creating a custom-created dataset containing entries taken from ten healthy and twenty non-healthy subjects. The data were taken from seven different sensors placed in specific areas of the subjects’ bodies. These sensors can capture a three-dimensional (3D) signal using the accelerometer, magnetometer, and gyroscope device types. The proposed system used the signals taken from the accelerometers, which were split into 2-sec windows. The proposed system achieved a classification accuracy of 95.12% and was compared with fourteen commonly used machine learning approaches.
Hemiplegia is a condition caused by brain injury and affects a significant percentage of the population. The effect of patients suffering from this condition is a varying degree of weakness, ...spasticity, and motor impairment to the left or right side of the body. This paper proposes an automatic feature selection and construction method based on grammatical evolution (GE) for radial basis function (RBF) networks that can classify the hemiplegia type between patients and healthy individuals. The proposed algorithm is tested in a dataset containing entries from the accelerometer sensors of the RehaGait mobile gait analysis system, which are placed in various patients’ body parts. The collected data were split into 2-second windows and underwent a manual pre-processing and feature extraction stage. Then, the extracted data are presented as input to the proposed GE-based method to create new, more efficient features, which are then introduced as input to an RBF network. The paper’s experimental part involved testing the proposed method with four classification methods: RBF network, multi-layer perceptron (MLP) trained with the Broyden–Fletcher–Goldfarb–Shanno (BFGS) training algorithm, support vector machine (SVM), and a GE-based parallel tool for data classification (GenClass). The test results revealed that the proposed solution had the highest classification accuracy (90.07%) compared to the other four methods.
This work illustrates the case of cilioretinal artery occlusion (CilRAO) combined with central retinal vein occlusion (CRVO) in a young patient that resolved spontaneously. A 17-year-old male with an ...unremarkable medical history presented with acute painless loss of vision unilaterally. Upon ophthalmologic examination, retinal hemorrhages in all four quadrants and edema extending from the optic disc to the macula were reported. Using optical coherence technology (OCT) imaging and fundus fluorescein angiography (FFA), combined CilRAO/CRVO was diagnosed. The full medical evaluation was unremarkable. Within the next month, the patient had regained full visual acuity (VA) in the affected eye, and the retinal findings resolved without intervention. Combined CilRAO/CRVO is a common vascular pathology in young, otherwise healthy patients. It is commonly considered a hemodynamic block in the capillary bed, hence its hopeful prognosis. Nonetheless, several risk factors have been proposed that need to be eliminated. Despite the initial alarming symptoms, young patients with CilRAO/CRVO should be monitored closely, and intervention should be resorted to when necessary.
Increasing anthropogenic pressures often jeopardize ecosystem integrity and policy-relevant conservation management in protected areas. To harmonize nature conservation with human well-being, EU ...Biodiversity Strategy to 2020 suggests Mapping and Assessment of Ecosystems and their Services (MAES) as the key concept for environmental planning and management in EU Member States. Applying this procedure is challenging due to its data-demanding and multidisciplinary nature, resulting in the ecoystem services (ES) approach being scarcely used in protected areas management. Increased data availability under EU biodiversity-related inventories and monitoring projects, as well as theoretical and empirical research advances developed during the last decade, should be put into practice to guide Member States towards local management frameworks and scenario building under the ongoing changes in the EU socio-economic environment. This study aims at filling this gap by embodying into the MAES operational framework a scenario-based approach and demonstrates this in a challenging case study of a Natura 2000 site, Lake Stymfalia, in Greece. The present management strategy, an ecological-friendly management practice, a water-efficient management practice and a non-environmentally friendly option (e.g. ecosystem destruction) are examined for current and future water demand under current and future climatic scenarios. The proposed methodological framework for ES operationalization is based on the available data (derived by EU Directives and/or modelling), expert judgment and stakeholder involvement. Therefore, this work applies and tests the importance of the MAES approach as a management and coordination platform.
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•The MAES approach is applicable in high complexity and data-scarce conditions.•Ecosystem services valuation is crucial for effective protected area management.•MAES studies support coordination for management actions in protected areas.
Robotic and Exoskeleton Assisted Gait Training (REAGT) has become the mainstream gait training module. Studies are investigating the psychosocial effects of REAGT mostly as secondary outcomes. Our ...systematic review and meta-analysis aims to investigate the effects of REAGT in MS patients' mental health and fatigue.
We searched the electronic databases (Scopus, PubMed, Pedro, Cochrane Trials, Dare) for RCT studies fulfilling our inclusion criteria. A meta-analysis of available assessment tools was conducted calculating the summary mean differences in two different timepoints, before and after the intervention using random-effects models.
The systematic search of the electronic databases identified 302 studies. Seven RCT studies were considered eligible for data extraction and meta-analysis, according to our eligibility criteria. We were able to obtain adequate data to proceed with a quantitative synthesis for QoL SF36-MC (Mental Component), QoL SF-36 mental and psychosocial subscales, Multiple Sclerosis Quality of Life-54-Mental Health Composite (MSQoL-54-MHC), Patient's Health Questionnaire (PHQ-9) and Fatigue Severity Scale (FSS).
Overall, REAGT seems to have a positive effect to Quality of Life, especially in MS patients' perspective of General and Mental Health and a slight positive effect in depression as measured by PHQ-9.Implications for rehabilitationMultiple Sclerosis (MS) decreases physical and non-physical aspects of patients' quality of life perspective.Rehabilitation strategy must take into consideration the non-physical effects of a training intervention.Robotic and Exoskeleton Gait Training has a positive effect in MS patients' non-physical quality of life and a slight positive effect in depression.
We present models that utilize smart contracts and interledger mechanisms to provide decentralized authorization for constrained IoT devices. The models involve different tradeoffs in terms of cost, ...delay, complexity, and privacy, while exploiting key advantages of smart contracts and multiple blockchains that communicate with interledger mechanisms. These include immutably recording hashes of authorization information and policies in smart contracts, resilience through the execution of smart contract code on all blockchain nodes, and cryptographically linking transactions and IoT events recorded on different blockchains using hash-lock and time-lock mechanisms. In the case of two ledgers, an authorization and a payment ledger, the authorization ledger can be a private Ethereum network or a permissioned ledger such as Hyperledger Fabric. For decentralized authorization where a subset of m-out-of-n authorization servers are required, we present two policies for selecting the m servers. The first policy can utilize statistics of the authorization servers such as transaction cost and response time. The second policy selects the first m servers that respond. The proposed models are evaluated on the public Ethereum testnets Rinkeby and Ropsten, and for different implementations on the Hyperledger Fabric permissioned ledger, in terms of execution cost (gas), delay, and reduction of data that needs to be sent to the constrained IoT devices.
AimsThe standard of surgical treatment for lower limb neoplasms had been characterized by highly interventional techniques, leading to severe kinetic impairment of the patients and incidences of ...phantom pain. Rotationplasty had arisen as a potent limb salvage treatment option for young cancer patients with lower limb bone tumours, but its impact on the gait through comparative studies still remains unclear several years after the introduction of the procedure. The aim of this study is to assess the effect of rotationplasty on gait parameters measured by gait analysis compared to healthy individuals.MethodsThe MEDLINE, Scopus, and Cochrane databases were systematically searched without time restriction until 10 January 2022 for eligible studies. Gait parameters measured by gait analysis were the outcomes of interest.ResultsThree studies were eligible for analyses. Compared to healthy individuals, rotationplasty significantly decreased gait velocity (-1.45 cm/sec; 95% confidence interval (CI) -1.98 to -0.93; p < 0.001), stride length (-1.20 cm; 95% CI -2.31 to -0.09; p < 0.001), cadence (-0.83 stride/min; 95% (CI -1.29 to -0.36; p < 0.001), and non-significantly increased cycle time (0.54 sec; 95% CI -0.42 to 1.51; p = 0.184).ConclusionRotationplasty is a valid option for the management of lower limb bone tumours in young cancer patients. Larger studies, with high patient accrual, refined surgical techniques, and well planned rehabilitation strategies, are required to further improve the reported outcomes of this procedure.
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