Standard non‐invasive methods for diagnosing and selecting the best treatment for osteomyelitis in patients with multiple chronic conditions remain to be established. We aimed to evaluate the ability ...of quantitative 67Ga‐citrate single‐photon emission computed tomography (67Ga‐SPECT/CT) to determine the indication for either non‐surgical treatment or osteotomy in patients with lower‐limb osteomyelitis (LLOM) associated with diabetes mellitus and lower‐extremity ischemia, based on monitoring of inflammatory activity in bone tissue. This single‐centre prospective study conducted from January 2012 to July 2017 included 90 consecutive patients with suspected LLOM. Regions of interest were drawn on SPECT images during quantification of Ga accumulation. Subsequently, the inflammation‐to‐background ratio (IBR) was calculated by dividing the maximal accumulated lesion number by the mean number for the distal femur bone marrow of the unaffected side. Osteotomy was performed in 28 of 90 patients (31%). The osteotomy rate was higher for patients with IBR >8.4 (71.4%) than for those with IBR ≤8.4 (5.5%) (p < 0.001, sensitivity: 0.89, specificity: 0.84). In the multivariate Cox regression analysis, IBR >8.4 was an independent risk factor for osteotomy (hazard ratio HR: 19.0, 95% confident interval CI: 5.6–63.9, p < 0.001). Transcutaneous oxygen tension (TcPO2) was identified as an independent risk factor for lower‐limb amputation (HR: 0.96, 95% CI: 0.92–0.99, p = 0.01). The current results indicate that quantitative 67Ga‐SPECT/CT is useful for distinguishing patients with LLOM likely to require osteotomy.
Although the burden of traumatic lower limb amputation (TLLA) has been well described when it concerns the adult population, there is an evident scarcity in literature concerning this matter in the ...pediatric population. Our objective is to review the surgical burden and long-term outcome of lower limb amputation among pediatric trauma victims who have experienced lower extremity amputation as the result of an accident or injury. A PICO format was utilized. The population of interest includes only children and adolescents suffering TTLA. The generation of data to be reviewed was executed using MEDLINE and PUBMED. Altogether, all data that includes trauma in the pediatric population in the timeframe 1949-2019 was revised and yielded 13 observational studies. This systematic review includes statistical comparisons between the group of interest of this review and the adult population. Other comparisons include those between the different sources. Our outcomes include a consistent pattern. This consistency between different studies was opposed by certain contradictions. Disparity between the different reviewed studies was displayed in terms of the distribution of the most cited complications of TLLA among different sources and the frequency of additional surgery. The dichotomy in the results of the reviewed studies highlights a gap in the data relevant to TLLA in the pediatric population. In addition to the discrepancies in the available literature, the significant physio-anatomical differences between the pediatric and the adult populations which are relevant to TLLA highlight a requirement for further studies regarding TTLA in the pediatric age group.
Objective Attention can be paid to the biomechanical characteristics of running since the speed of running varies. The aim of the present study was to investigate the effects of increasing running ...speed on the three-dimensional kinematics of the lower limb joints in the stance phase. Methods The research was quasi-experimental. 27 volunteer subjects ran on a treadmill and the kinematic and kinetics data were collected through a three-dimensional system at three speed levels (2.5, 3.5, and 4.5) m/s. kinematics and kinetics data were recorded by 12 cameras (120 Hz) and force platform (150 Hz), respectively. The stance phase was derived according to the ground reaction Force value of the force platform. Hip, knee and ankle kinematics including peak of the absolute angles in three dimensions and three speeds were calculated for further analysis. Repeated measurement with Bonferroni post Hoc tests were employed to investigate the differences between the variables in three dimensions using SPSS software (P <0.05). Results The results showed that during increasing speed, significant differences were observed in frontal (2.5 & 3.5, 2.5 & 4.5 m/s) and sagittal (2.5 & 3.5. 2.5 & 4.5, 3.5 & 4.5 m/s) planes in hip as well as only in transverse (2.5 &4.5, 3.5 & 4.5 m/s) plane for knee. No significant differences were obvious in peak of ankle joints during increasing speed in all three planes. Conclusion The results of the present study showed that hip and knee joints are more susceptible to changes of kinematics behavior during running progressively. Ankle joint seems to be more stable during the progressive running situation. Coaches and athletes may also enhance their performance using the results of the present study.
OBJECTIVES: This study examines the recent national and regional incidence of lower limb amputations (LLAs) in Sweden and their annual changes.
DESIGN: Observational study using Swedish national ...register data.
METHODS: We identified all initial amputations in Sweden from 2008 to 2017 in individuals 18 years or older using the national inpatient register. The amputations were categorized into three levels: High proximal (through or above the knee joint), low proximal (through the tibia to through the ankle joint), and partial foot amputations. To examine the national and regional incidence and annual changes, the age-, sex- and region-specific population count each year was used as the denominator and Poisson regression or negative binomial regression models were used to estimate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) adjusted for age and sex.
RESULTS: The national annual incidence of LLAs was 22.1 per 100,000 inhabitants, with a higher incidence in men (24.2) than in women (20.0). The incidence of LLAs (all levels combined) declined during the study period, with an IRR of 0.984 per year (95% CI, 0.973-0.994). This was mainly due to a decrease in high proximal amputations (0.985, 95% CI 0.974-0.995) and low proximal amputations (0.973, 95% CI 0.962-0.984). No change in the incidence of partial foot amputations was observed (0.994, 95% CI 0.974-1.014). Such declines in LLA incidence (all levels combined) were observed in 9 out of 21 regions. Compared to the national average and with adjustment for age, sex, diabetes and artery disease, the regional IRR varied from 0.85-1.36 for all LLAs, from 0.67-1.61 for high proximal amputations, from 0.50-1.51 for low proximal amputations and from 0.13-3.68 for partial foot amputations.
CONCLUSIONS: The incidence of LLAs has decreased in Sweden. However, regional variations in incidence, time trends, and amputation levels warrant more research.
Bancroftian filariasis is caused by the filarial parasite Wuchereria Bancrofti and is transmitted by Culexmosquitoes. It is found in tropical and subtropical countries. Traditionally, peripheral ...blood smears identify this condition by finding microfilaria. Inadvertently found adult worms and microfilaria in fine needle aspiration cytology (FNAC). The disease may be missed in the absence of eosinophilia in a CBC or peripheral blood smear. One must be aware of this possibility. Chronic inflammation and lymphedema lead to lymphatic damage, swelling and elephantiasis of the legs, arms, scrotum, breasts, and vulva. A 29-year-old male patient presented with chief complaints of pain and swelling over the right lower limb for one and a half years. It was reported to be filariasis during laboratory investigations.
Human walking movement is realized by bilateral lower limb height coupling. The unilateral lower limb dysfunction imposes great limitations on the patient's normal activities. This paper addressed ...the rehabilitation training needs of patients with unilateral lower extremity disabilities, which utilized the normal motor function of the healthy limb to guide the affected lower limb for coordinated movement. The lower limb exoskeleton (LLE) facilitated coordinated movement in five gait modes by utilizing the multi-sensor fusion information (MSFI) set. The paper aimed to tackle the crucial challenges related to intention recognition, trajectory following, and motion control of LLEs during rehabilitation training tasks. A novel MSFI set for LLE, based on a combination of low-cost sensors, was proposed in this paper to enhance the accuracy of attitude estimates. To further improve the accuracy and timeliness of the model, a spatiotemporally embedded convolutional long-short memory deep learning network (TSLSTM) was introduced. Additionally, a double closed-loop (DCL) controller was designed to address poor human-machine synergy issues. Experimental tests, including trajectory following and stable walking experiments, were conducted to validate and evaluate the proposed model. The results offered valuable insights for addressing intent recognition and enhancing human-machine collaboration for LLEs.
In physiotherapy, there is still a lack of practical measurement options to track the progress of therapy or rehabilitation following injuries to the lower limbs objectively and reproducibly yet ...simply and with minimal effort and time. We aim at filling this gap with the design of an IMU (inertial measurement unit) system with only one sensor placed on the tibia edge. In our study, the IMU system evaluated a set of 10 motion tests by a score value for each test and stored them in a database for a more reliable longitudinal assessment of the progress. The sensor analyzed the different motion patterns and obtained characteristic physiological parameters, such as angle ranges, and spatial and angular displacements, such as knee valgus under load. The scores represent the patient’s coordination, stability, strength and speed. To validate the IMU system, these scores were compared to corresponding values from a simultaneously recorded marker-based 3D video motion analysis of the measurements from five healthy volunteers. Score differences between the two systems were almost always within 1–3 degrees for angle measurements. Timing-related measurements were nearly completely identical. The tests on the valgus stability of the knee showed equally small deviations but should nevertheless be repeated with patients, because the healthy subjects showed no signs of instability.
