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1.
JAMA ; 324(18): 1869-1877, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33170241

RESUMO

Importance: Medicare recently concluded a national voluntary payment demonstration, Bundled Payments for Care Improvement (BPCI) model 3, in which skilled nursing facilities (SNFs) assumed accountability for patients' Medicare spending for 90 days from initial SNF admission. There is little evidence on outcomes associated with this novel payment model. Objective: To evaluate the association of BPCI model 3 with spending, health care utilization, and patient outcomes for Medicare beneficiaries undergoing lower extremity joint replacement (LEJR). Design, Setting, and Participants: Observational difference-in-difference analysis using Medicare claims from 2013-2017 to evaluate the association of BPCI model 3 with outcomes for 80 648 patients undergoing LEJR. The preintervention period was from January 2013 through September 2013, which was 9 months prior to enrollment of the first BPCI cohort. The postintervention period extended from 3 months post-BPCI enrollment for each SNF through December 2017. BPCI SNFs were matched with control SNFs using propensity score matching on 2013 SNF characteristics. Exposures: Admission to a BPCI model 3-participating SNF. Main Outcomes and Measures: The primary outcome was institutional spending, a combination of postacute care and hospital Medicare-allowed payments. Additional outcomes included other categories of spending, changes in case mix, admission volume, home health use, length of stay, and hospital use within 90 days of SNF admission. Results: There were 448 BPCI SNFs with 18 870 LEJR episodes among 16 837 patients (mean [SD] age, 77.5 [9.4] years; 12 173 [72.3%] women) matched with 1958 control SNFs with 72 005 LEJR episodes among 63 811 patients (mean [SD] age, 77.6 [9.4] years; 46 072 [72.2%] women) in the preintervention and postintervention periods. Seventy-nine percent of matched BPCI SNFs were for-profit facilities, 85% were located in an urban area, and 85% were part of a larger corporate chain. There were no systematic changes in patient case mix or episode volume between BPCI-participating SNFs and controls during the program. Institutional spending decreased from $17 956 to $15 746 in BPCI SNFs and from $17 765 to $16 563 in matched controls, a differential decrease of 5.6% (-$1008 [95% CI, -$1603 to -$414]; P < .001). This decrease was related to a decline in SNF days per beneficiary (from 26.2 to 21.3 days in BPCI SNFs and from 26.3 to 23.4 days in matched controls; differential change, -2.0 days [95% CI, -2.9 to -1.1]). There was no significant change in mortality or 90-day readmissions. Conclusions and Relevance: Among Medicare patients undergoing lower extremity joint replacement from 2013-2017, the BPCI model 3 was significantly associated with a decrease in mean institutional spending on episodes initiated by admission to SNFs. Further research is needed to assess bundled payments in other clinical contexts.


Assuntos
Artroplastia de Substituição/economia , Medicare/economia , Mecanismo de Reembolso , Instituições de Cuidados Especializados de Enfermagem/economia , Idoso , Idoso de 80 Anos ou mais , Feminino , Idoso Fragilizado , Humanos , Extremidade Inferior , Masculino , Pessoa de Meia-Idade , Cuidados Semi-Intensivos/economia , Estados Unidos
2.
Bone Joint J ; 102-B(11): 1469-1474, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33135454

RESUMO

AIMS: To describe a new objective classification for open fractures of the lower limb and to correlate the classification with patient-centred outcomes. METHODS: The proposed classification was investigated within a cohort of adults with open fractures of the lower limb who were recruited as part of two large clinical trials within the UK Major Trauma Network. The classification was correlated with patient-reported Disability Rating Index (DRI) and EuroQol five-dimension questionnaire (EQ-5D) health-related quality of life in the year after injury, and with deep infection at 30 days, according to the Centers for Disease Control and Prevention definition of a deep surgical site infection. RESULTS: A total of 748 participants were included in the analysis. Of these, 288 (38.5%) had a simple open fracture and 460 (61.5%) had a complex fracture as defined by the new classification system. At 12 months, the mean DRI in the simple fracture group was 32.5 (SD 26.8) versus 43.9 (SD 26.1) in the complex fracture group (odds ratio (OR) 8.19; 95% confidence interval (CI) 3.69 to 12.69). At 12 months the mean health-related quality of life (EQ-5D utility) in the simple fracture group was 0.59 (SD 0.29) versus 0.56 (SD 0.32) in the complex fracture group (OR -0.03; 95% CI -0.09 to 0.02). The differences in the rate of deep infection at 30 days was not statistically significant. CONCLUSION: The Orthopaedic Trauma Society open fracture classification is based upon objective descriptors of the injury and correlates with patient-centred outcomes in a large cohort of open fractures of the lower limb. Cite this article: Bone Joint J 2020;102-B(11):1469-1474.


Assuntos
Fraturas Expostas/classificação , Extremidade Inferior/lesões , Adulto , Avaliação da Deficiência , Feminino , Fraturas Expostas/etiologia , Fraturas Expostas/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Ortopedia , Avaliação de Resultados da Assistência ao Paciente , Qualidade de Vida , Sociedades Médicas , Infecção da Ferida Cirúrgica
3.
JAMA ; 324(17): 1765-1776, 2020 Nov 03.
Artigo em Inglês | MEDLINE | ID: mdl-33141212

RESUMO

Importance: Incidence rates for lower extremity deep vein thrombosis (DVT) range from 88 to 112 per 100 000 person-years and increase with age. Rates of recurrent VTE range from 20% to 36% during the 10 years after an initial event. Observations: PubMed and Cochrane databases were searched for English-language studies published from January 2015 through June 2020 for randomized clinical trials, meta-analyses, systematic reviews, and observational studies. Risk factors for venous thromboembolism (VTE), such as older age, malignancy (cumulative incidence of 7.4% after a median of 19 months), inflammatory disorders (VTE risk is 4.7% in patients with rheumatoid arthritis and 2.5% in those without), and inherited thrombophilia (factor V Leiden carriers with a 10-year cumulative incidence of 10.9%), are associated with higher risk of VTE. Patients with signs or symptoms of lower extremity DVT, such as swelling (71%) or a cramping or pulling discomfort in the thigh or calf (53%), should undergo assessment of pretest probability followed by D-dimer testing and imaging with venous ultrasonography. A normal D-dimer level (ie, D-dimer <500 ng/mL) excludes acute VTE when combined with a low pretest probability (ie, Wells DVT score ≤1). In patients with a high pretest probability, the negative predictive value of a D-dimer less than 500 ng/mL is 92%. Consequently, D-dimer cannot be used to exclude DVT without an assessment of pretest probability. Postthrombotic syndrome, defined as persistent symptoms, signs of chronic venous insufficiency, or both, occurs in 25% to 50% of patients 3 to 6 months after DVT diagnosis. Catheter-directed fibrinolysis with or without mechanical thrombectomy is appropriate in those with iliofemoral obstruction, severe symptoms, and a low risk of bleeding. The efficacy of direct oral anticoagulants-rivaroxaban, apixaban, dabigatran, and edoxaban-is noninferior to warfarin (absolute rate of recurrent VTE or VTE-related death, 2.0% vs 2.2%). Major bleeding occurs in 1.1% of patients treated with direct oral anticoagulants vs 1.8% treated with warfarin. Conclusions and Relevance: Greater recognition of VTE risk factors and advances in anticoagulation have facilitated the clinical evaluation and treatment of patients with DVT. Direct oral anticoagulants are noninferior to warfarin with regard to efficacy and are associated with lower rates of bleeding, but costs limit use for some patients.


Assuntos
Extremidade Inferior/irrigação sanguínea , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/terapia , Fatores Etários , Biomarcadores/sangue , Inibidores do Fator Xa/efeitos adversos , Inibidores do Fator Xa/uso terapêutico , Produtos de Degradação da Fibrina e do Fibrinogênio/análise , Humanos , Estilo de Vida , Ilustração Médica , Síndrome Pós-Trombótica/etiologia , Valor Preditivo dos Testes , Fatores de Risco , Fatores Sexuais , Avaliação de Sintomas , Trombectomia/métodos , Trombofilia/complicações , Trombofilia/genética , Ultrassonografia , Filtros de Veia Cava , Tromboembolia Venosa/sangue , Tromboembolia Venosa/etiologia , Varfarina/uso terapêutico
4.
Wiad Lek ; 73(9 cz. 2): 1990-1994, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33148846

RESUMO

OBJECTIVE: The aim: To evaluate the effectiveness of the appointment of α- lipoic acid for correcting electroneuromyographyс indicators polyneuropathy of the lower extremities in patients with hemoblastosis. PATIENTS AND METHODS: Materials and methods: The study included 77 patients from hematology department of Poltava Regional Hospital, who were divided into 3 groups according to the underlying disease: Group 1 - patients with chronic myeloid leukemia (CML) (n = 26 ) groups and 2 - patients with chronic lymphocytic leukemia (CLL) (n = 27 ), group 3 - patients with multiple myeloma (MM) ( n = 24 ). For the examined patients were taken electroneuromyographyc researches of distal lower extremities by measuring the following parameters: the amplitude of the M-response from short extensors nerves of the fingers ( MEDB) and abductor of the big toe ( MAH) and the rate of excitation the spread of short extensors nerve of the fingers ( VEDB), thumb abductor ( VAH), superficial shallow ( VSF) and calf ( VC) nerves on both sides (sin/dex ) before and after administration of α- lipoic acid. RESULTS: Results: ENMG examination of the peripheral nerves of the lower extremities in patients with CML and CLL revealed a slight decrease in M-responses at normal values of the rate of conduction of excitation through sensory and motor fibers. In patients with MM, multiple lesions of peripheral nerve fibers of the lower extremities were detected, which is represented by a decrease in the M-response and the rate of excitation through sensory fibers and indicates deeper lesions, namely the axial cylinder, which requires longer treatment. The difference in the dynamics of the studied indicators indicates a different degree of PNP. Administration of α-lipoic acid increased the M-response rate and the rate of excitation of motor fibers in all groups of patients. The rate of excitation through sensory fibers was improved in patients with CLL and MM. Following the use of α-lipoic acid in the complex treatment of patients with MM ENMG, the signs of peripheral nerve fiber damage in the lower extremities were worse due to the severe initial condition, but reached a medium level. The positive effect of α-lipoic acid can be caused by a decrease in oxidative stress and endothelial dysfunction in nerve vessels, and, as a consequence, an improvement in the trophism and functional state of nerve fibers. CONCLUSION: Conclusions: ENMG signs of defeat of PNP of the lower extremities are more expressed at MM. The appointment of α-lipoic acid in the complex treatment of PNP in patients with chronic hemoblastosis improves the functional state of the peripheral nerve fibers of the lower extremities and may be a component of pathogenetic therapy.


Assuntos
Polineuropatias , Ácido Tióctico , Eletromiografia , Humanos , Extremidade Inferior , Fibras Nervosas , Polineuropatias/tratamento farmacológico , Ácido Tióctico/uso terapêutico
5.
Mymensingh Med J ; 29(4): 969-976, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33116104

RESUMO

Growth and stature of individuals depend upon various factors like environment, race, and inheritance etc. India has different ethnic groups, which are unique in their genetic and socio economic status. Therefore, present study is formulated to estimate the stature by four anthropometric measurements of the inferior extremity in the Western Indian population (rural and urban population in and around Jodhpur district) during July 2014-June 2016 and to compare with other regions of India with respect to body proportion used for stature estimation equations. Measurements of lower limb length and tibial length on both side, and in both genders of 504 individuals were done. Stature estimation equations were developed by single and multiple predictor models and compared with previous researches. Four subgroups were also made according to the stature to see the hypothesis that body proportions will vary in short, medium and tall individuals. A positive correlation (Pearson's) was observed between stature and all the four measurements of inferior extremity. The strongest correlations observed were between lower limb length and stature for all groups (combined r=0.991; males r=0.971; females r=0.967). The highest estimation accuracy (R²=0.992, SEE=0.718) was observed in male during height estimation done by measurements of left side as suggested by low SEE value. Strong correlation in between stature and other body proportions was observed in taller group of individuals either male or female. Significant difference in all the regions was observed, when compared with previous research and suggests that western Indians are peculiar in their body proportions. It was also detected that body proportion may vary according to the stature.


Assuntos
Estatura , Antropologia Forense , Grupo com Ancestrais do Continente Asiático , Feminino , Humanos , Índia/epidemiologia , Extremidade Inferior , Masculino
6.
Stud Health Technol Inform ; 273: 91-96, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-33087596

RESUMO

A lower-extremity exoskeleton can facilitate the lower limbs' rehabilitation by providing additional structural support and strength. This article discusses the design and implementation of a functional prototype of lower extremity brace actuation and its wireless communication control system. The design provides supportive torque and increases the range of motion after complications reducing muscular strength. The control system prototype facilitates elevating a leg, gradually followed by standing and slow walking. The main control modalities are based on an Artificial Neural Network (ANN). The prototype's functionality was tested by time-angle graphs. The final prototype demonstrates the potential application of the ANN in the control system of exoskeletons for joint impairment therapy.


Assuntos
Exoesqueleto Energizado , Extremidade Inferior , Redes Neurais de Computação , Torque , Caminhada
7.
Medicine (Baltimore) ; 99(43): e22935, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120851

RESUMO

RATIONALE: Recent research shows that in-stent restenosis (ISR) occurs in half of the patients treated with stenting of femoral and popliteal artery for lower extremity arteriosclerotic occlusive disease (LEASO). Combined therapy is mainly used clinically to obtain better medium- and long-term treatment outcomes and reduce the occurrences of reintervention, among which, the combination of excimer laser ablation (ELA) and drug eluting balloon (DEB) is a new and effective choice. PATIENT CONCERNS: A 76-year-old male patient with ISR of right superficial femoral artery after stent implantation was reported. DIAGNOSIS: Rechecking angiography indicated severe occlusion of the right superficial femoral artery. The physical examination showed that bilateral femoral and popliteal arteries were accessible whereas right dorsalis and posterior tibial arteries are unaccessible. Ankleolus brachial index (ABI) was 0.92 for left and 0.58 for right. INTERVENTIONS: We performed the operation with ELA and drug balloon DEB on the right superficial femoral artery under local anesthesia and treated with oral antiplatelet drugs after operation. OUTCOMES: The combination treatment was very successful, and postoperative lower extremity arteriogram showed the blood flow was fluent and fast. No recurrence was discovered 3 months after the operation and he had no obvious symptom of claudication. LESSONS: The combination of ELA and DEB is useful and effective for ISR of peripheral vessel after stent implantation, and this surgical method is worthwhile but need further clinical research for safety confirmation.


Assuntos
Angioplastia com Balão a Laser/métodos , Arteriopatias Oclusivas/etiologia , Lasers de Excimer/normas , Stents/efeitos adversos , Administração Oral , Idoso , Angiografia/métodos , Terapia Combinada , Constrição Patológica/etiologia , Stents Farmacológicos/normas , Artéria Femoral/patologia , Artéria Femoral/cirurgia , Humanos , Extremidade Inferior/irrigação sanguínea , Extremidade Inferior/diagnóstico por imagem , Masculino , Inibidores da Agregação de Plaquetas/administração & dosagem , Inibidores da Agregação de Plaquetas/uso terapêutico , Resultado do Tratamento
8.
J Surg Orthop Adv ; 29(3): 129-134, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044151

RESUMO

Our purpose was to determine the rates of lower extremity nonunion and malunion over 17 years in South Carolina. Our hypothesis was that malunions and nonunions decreased over time due to improved access to trauma centers and improved orthopaedic surgical training. The South Carolina Department of Budget and Control Hospital Discharge Database was queried between 1998-2014 and yielded a total of 4,994 malunions and 16,454 nonunions. Malunions increased from 1.2% (1998) to 1.8% (2010); nonunions increased from 4.0% (1999) to 5.8% (2011). Older age and gender were predictive of malunion and nonunion. This study identified females as having a higher odds ratio for malunion or nonunion; higher nonunion rates in worker's compensation or government payer status; and older age as incurring greater risks for sustaining fractures or developing a malunion or nonunion. There was increased prevalence of nonunion and malunion despite improved access to trauma centers and trained orthopaedic trauma surgeons. (Journal of Surgical Orthopaedic Advances 29(3):129-134, 2020).


Assuntos
Fraturas Mal-Unidas , Fraturas não Consolidadas , Fraturas da Tíbia , Idoso , Feminino , Fraturas Mal-Unidas/epidemiologia , Fraturas não Consolidadas/epidemiologia , Humanos , Extremidade Inferior , South Carolina/epidemiologia
9.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 6127-6130, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019369

RESUMO

This paper covers the design and implementation of a proof of concept for a wireless system measuring pelvic floor muscle forces based on a dynamometer. The proposed device is the main component of a novel assessment tool intended for pelvic floor muscle rehabilitation in women suffering from urinary incontinence. The proposed system allows the physiotherapist to wirelessly monitor variation in pelvic floor muscle forces during assessment or training. Wireless communication is provided by a Bluetooth low energy transceiver and a corresponding interface designed for this purpose. Force measurements are sensed with strain gauge precision sensors operated in a Wheatstone bridge configuration. The designed module consumes 14 mW of power in operating mode. System design and experimental results are reported and discussed.


Assuntos
Diafragma da Pelve , Incontinência Urinária , Feminino , Humanos , Extremidade Inferior
10.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4737-4740, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019049

RESUMO

Spinal cord injury (SCI) limits life expectancy and causes a restriction of patient's daily activities. In the last years, robotics exoskeletons have appeared as a promising rehabilitation and assistance tool for patients with motor limitations, as people that have suffered a SCI. The usability and clinical relevance of these robotics systems could be further enhanced by brain-machine interfaces (BMIs), as they can be used to foster patients' neuroplasticity. However, there are not many studies showing the use of BMIs to control exoskeletons with patients. In this work we show a case study where one SCI patient has used a BMI based on motor imagery (MI) in order to control a lower limb exoskeleton that assists their gait.


Assuntos
Interfaces Cérebro-Computador , Exoesqueleto Energizado , Traumatismos da Medula Espinal , Marcha , Humanos , Extremidade Inferior
11.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 4858-4862, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019078

RESUMO

This paper presents an algorithm that makes novel use of distance measurements alongside a constrained Kalman filter to accurately estimate pelvis, thigh, and shank kinematics for both legs during walking and other body movements using only three wearable inertial measurement units (IMUs). The distance measurement formulation also assumes hinge knee joint and constant body segment length, helping produce estimates that are near or in the constraint space for better estimator stability. Simulated experiments have shown that inter-IMU distance measurement is indeed a promising new source of information to improve the pose estimation of inertial motion capture systems under a reduced sensor count configuration. Furthermore, experiments show that performance improved dramatically for dynamic movements even at high noise levels (e.g., σdist = 0.2 m), and that acceptable performance for normal walking was achieved at σdist = 0.1 m. Nevertheless, further validation is recommended using actual distance measurement sensors.


Assuntos
Extremidade Inferior , Dispositivos Eletrônicos Vestíveis , Fenômenos Biomecânicos , Perna (Membro) , Caminhada
12.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5410-5415, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019204

RESUMO

Freezing of Gait is the most disabling gait disturbance in Parkinson's disease. For the past decade, there has been a growing interest in applying machine learning and deep learning models to wearable sensor data to detect Freezing of Gait episodes. In our study, we recruited sixty-seven Parkinson's disease patients who have been suffering from Freezing of Gait, and conducted two clinical assessments while the patients wore two wireless Inertial Measurement Units on their ankles. We converted the recorded time-series sensor data into continuous wavelet transform scalograms and trained a Convolutional Neural Network to detect the freezing episodes. The proposed model achieved a generalisation accuracy of 89.2% and a geometric mean of 88.8%.


Assuntos
Transtornos Neurológicos da Marcha , Doença de Parkinson , Dispositivos Eletrônicos Vestíveis , Marcha , Humanos , Extremidade Inferior , Redes Neurais de Computação , Doença de Parkinson/diagnóstico , Análise de Ondaletas
13.
Angiol Sosud Khir ; 26(3): 37-43, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33063750

RESUMO

Critical ischaemia of lower limbs is a cause of death and invalidity in the whole world. Stem cells and products of their secretion find wide application in treatment of vascular diseases, including critical ischaemia of the lower limbs. Erythropoietin promotes an increase in the angiogenic potential of stem cells. The authors examined the therapeutic potential of a biomedical cellular product (mesenchymal stem cells and products of their secretion) and mesenchymal stem cells with erythropoietin on the processes of restoration of vessels in the hind legs of Wistar male rats following induction of lower limb critical ischaemia. Mesenchymal stem cells were derived from the bone marrow of male Wistar rats. Critical ischaemia of hind legs was modulated by transaction of the femoral artery. The parameters of microcirculation in the foot were assessed with the help of laser Doppler flowmetry. In the blood serum and crural muscles by means of solid-phase enzyme immunoassay we examined the levels of cytokines, growth factors, and persistent metabolites of nitrogen oxide - nitrites. Muscles morphology and the number of blood vessels were assessed by the findings of histological examination. It was shown that the biomedical cellular product alone and in combination with erythropoietin stimulated angiogenesis. The results of Doppler flowmetry revealed restoration of the parameters of microcirculation in the lower limb by 35-75% of the baseline values. Besides, we observed a decrease of muscle necrosis, connective tissue proliferation, and an increase in the number of the vessels supplying the muscles in the experimental groups. It was also determined that the biomedical cellular product influenced the levels of cytokines in blood serum and crural muscles. Hence, the obtained findings proved the therapeutic potential of the biomedical cellular product in critical ischaemia of lower limbs.


Assuntos
Isquemia , Doenças Vasculares Periféricas , Animais , Modelos Animais de Doenças , Humanos , Isquemia/tratamento farmacológico , Extremidade Inferior , Masculino , Ratos , Ratos Wistar
14.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3150-3153, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018673

RESUMO

The purpose of this study is to investigate the effect of changing the application points and directions of the soft actuator band of a wearable hip assist device on muscle force and joint kinematics during gait. Healthy adult participants walked under four conditions with varying band positions of a soft wearable hip assist device. The three-dimensional coordinates of markers and ground reaction force data were measured during gait. Lower limb muscle forces and joint angles were calculated using a musculoskeletal model. Our results showed that the position and running direction of the soft actuator band decreased the forces of the iliopsoas and hamstring muscles.


Assuntos
Marcha , Dispositivos Eletrônicos Vestíveis , Adulto , Fenômenos Biomecânicos , Humanos , Extremidade Inferior , Caminhada
15.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3281-3284, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018705

RESUMO

Lower limb prosthetic users exhibit gait deviations, which include asymmetrical stance time (ST), leading to secondary musculoskeletal problems. Biofeedback (BFB) systems have the potential to provide gait training to correct gait deviations. In this work, we describe a wearable BFB system that delivers vibrotactile feedback via two tactors (located at the anterior and posterior side of the residual limb of prosthetic users) to correct asymmetrical ST (%) using two strategies - single threshold feedback (SF) and bandwidth threshold feedback (BF). Validation of the system involved a sample of five lower limb amputees to examine the effectiveness of each strategy when compared to no feedback (NF) gait trials. Significant differences were found between no feedback and feedback trials. Although no significant differences were found between SF and BF, there are small but evident trends indicating that BF encourages ST (%) that is closest to the target with less error.


Assuntos
Amputados , Dispositivos Eletrônicos Vestíveis , Biorretroalimentação Psicológica , Marcha , Humanos , Extremidade Inferior
16.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3921-3926, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018858

RESUMO

In this study, we propose a method for estimating lower extremity strength from daily gait movement. Gait movement is affected by sex and gait environment. Therefore, we examined correlation coefficient between lower extremity strength and gait movement based on sex and environment and created models for estimating lower extremity strength. As a result, when only male or female data were used for model constructing, the correlation coefficient between estimates and actual measurements of lower extremity strength were approximately 0.7 and the precision had a mean absolute error of approximately 0.1 N/kg. The accuracy of the estimates was higher than that when sex was considered.


Assuntos
Apatia , Marcha , Feminino , Extremidade Inferior , Masculino
17.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 3969-3972, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018869

RESUMO

The assessment of lower limb oedema almost always involves measuring leg volume, and the gold-standard for this is the water displacement technique. As it is not very practical to use in a clinical routine, physicians prefer indirect methods such as anthropometric or bioimpedance measurements. In the case of "non-pitting" leg oedema, i.e. where the presence of oedema is not obvious, it may be challenging to estimate changes in leg volume using these methods separately. The combination of these two methods, however, gives interesting results, such as a new composite parameter that is much more robust and efficient than commonly used parameters.Clinical Relevance- This study demonstrates the benefit of using a composite anthropometric-impedimetric parameter to predict water displacement variations in the leg over the course of a day, rather than using parameters based solely on anthropometry or impedance. Our new parameter (C²-A²)/R0 showed a robust r² value of 61%, which is more than twice the r² values obtained using other simple or composite parameters.


Assuntos
Perna (Membro) , Água , Antropometria , Edema/diagnóstico , Humanos , Extremidade Inferior , Análise Espectral
18.
Khirurgiia (Mosk) ; (9): 69-74, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030004

RESUMO

Critical limb ischemia, especially in the absence of autologous vein, prosthetic and native vascular infections are isolated diseases for which there currently doesn't have best surgical treatment. Vascular allografts may be the treatment of choice for these patients. In this analysis, we tried to reflect the directions of development of vascular allotransplantation, global trends related to indications for their use, methods of conservation, degradation and endothelial dysfunction. At the present time there doesn't have meta-analyzes on the efficiency of using arterial allografts or other options for implantation (synthetic graft, xenografts) for critical limb ischemia and graft and native infections. Now it is wrong to recommend using them always. Further studies of their performance are necessary. In addition, development of graft control techniques is also needed when rejection develops. Currently, there are no special diagnostic markers, the assessment of which could save patients with immune-mediated dilatation and dysfunction of allografts.


Assuntos
Artérias , Procedimentos Cirúrgicos Reconstrutivos , Aloenxertos , Humanos , Extremidade Inferior , Transplante Homólogo
19.
Khirurgiia (Mosk) ; (9): 80-84, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33030006

RESUMO

Two-stage surgical treatment of a patient with type I acute aortic dissection and lower limb malperfusion is reported in the manuscript. Frozen elephant trunk procedure was applied. A 49-year-old man was hospitalized with a diagnosis of «Debakey type I acute aortic dissection¼ in 7 hours after manifestation of the disease. At admission, paleness and numbness of both lower limbs with a violation of active movements were observed in addition to pain syndrome. Chest CT revealed false lumen thrombosis within the distal aorta followed by stenosis of aortic bifurcation up to 80% and stenosis of the right common iliac artery up to 80%. Considering critical lower limb ischemia, axillo-bifemoral bypass surgery was performed at the first stage. A day later, the patient underwent replacement of ascending aorta, aortic arch and descending thoracic aorta. E-vita Open Plus № 24 hybrid prosthesis and frozen elephant trunk procedure under hypothermia 25o C with bilateral antegrade cerebral perfusion were used. CPB time was 285 min, aortic cross-clamping time - 180 min, circulatory arrest - 135 min. Postoperative period was uneventful, ICU-stay - 5 days. The patient was discharged after 20 days. Control CT confirmed false lumen thrombosis throughout the stent-graft. Follow-up survey after 1 year revealed no complaints.


Assuntos
Aneurisma Dissecante , Implante de Prótese Vascular , Extremidade Inferior/cirurgia , Aorta Torácica , Humanos , Masculino , Pessoa de Meia-Idade , Stents
20.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 45(9): 1082-1088, 2020.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33051422

RESUMO

OBJECTIVES: To explore the most suitable insertion site for neonatal placement of peripherally inserted central venous catheter (PICC) according to the evidence-based ACE Star model. METHODS: This study was carried out according to the evidence-based ACE Star model in 5 steps, including discovery research, evidence summary, guidelines translation, practice integration, and outcome evaluation. Based on the results of Meta-analysis, relevant guidelines, expert recommendations, clinical experience of nurses, and characteristics of neonates, the final recommendation was formed. A total of 87 neonates in a tertiary neonatal intensive care unit in Hunan Province were integrated into practice of PICC to evaluate the incidence of catheter-related complications and one-attempt success rate of puncture. RESULTS: The results of Meta-analysis showed that the incidence of complications of PICC in neonates via lower limb veins was significantly lower than that of upper limb veins (OR=0.83, 95% CI 0.75 to 0.92, P<0.05). The final result of guideline translation was that PICC should be performed first through lower limb veins if the lower limb vein before PICC catheterization was not damaged.The results of integrated practice showed that the incidence of complications of PICC via lower extremity vein was 17.24%. Compared with the left lower limb catheterization, the incidence of complications and the incidence of catheter blockage of the right lower limb catheterization were significantly lower (both P<0.05). Compared with femoral vein catheterization, one-attempt success rate of puncture via the saphenous vein catheterization was higher and the incidence of complications, the incidence of catheter blockage, and the incidence of infection were lower, with significant difference (all P<0.05). CONCLUSIONS: Saphenous vein in right lower limb could be the most suitable insertion site for neonatal PICC.


Assuntos
Cateterismo Venoso Central , Cateterismo Periférico , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Veia Femoral , Humanos , Incidência , Recém-Nascido , Extremidade Inferior
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