Search Results (12)

Background: Peripheral vein thrombosis during pregnancy poses serious diagnostic challenges due to the intertwining of its clinical symptoms with normal pregnancy modifications. Methods: We analyzed and compared the paraclinical test results of singleton pregnant women and women in the first six weeks postpartum who presented with significant lower limb inequality. Results: Our data revealed three predictors of deep vein thrombosis (DVT): mean platelet volume (MPV), with a one-unit increase in MPV being associated with a 1.497-fold higher risk of thrombosis (p = 0.008); platelet distribution width (PDW), with a one-unit decrease in PDW increasing thrombosis risk (odds ratio (OR) = 1.17, p = 0.003); anemia, with its presence increasing the risk of thrombosis by 8.46 times (p = 0.003); and fibrinogen, with a one-unit increase in its level increasing DVT risk 1.003-fold. Conclusions: Significant lower limb inequality might be used as a predictor of DVT during puerperium. Full article

This study focuses on developing a control methodology for exoskeleton robots designed for lower limb rehabilitation, specifically addressing the needs of elderly individuals and pediatric therapy. The approach centers on implementing an affine state-feedback controller to effectively regulate and stabilize the knee-joint exoskeleton robot at a desired position. The robot’s dynamics are nonlinear, accounting for unknown parameters, solid and viscous frictions, and external disturbances. To ensure robust stabilization, the Lyapunov approach is utilized to derive a set of Linear Matrix Inequality (LMI) conditions, guaranteeing the stability of the position error. The derivation of these LMI conditions is grounded in a comprehensive theoretical framework that employs advanced mathematical tools, including the matrix inversion lemma, Young’s inequality, the Schur complement, the S-procedure, and specific congruence transformations. Simulation results are presented to validate the proposed LMI conditions, demonstrating the effectiveness of the control strategy in achieving robust and accurate positioning of the lower limb rehabilitation exoskeleton robotic system. Full article

Background: The purpose of this study was to assess specific rehabilitation methods’ effectiveness in early idiopathic scoliosis (IS) development, focusing on lower limb functional inequality’s role in scoliosis progression. Materials and Methods: This study comprised 812 patients aged 6–16 years at risk of developing idiopathic scoliosis (IS). The mean (SD) age was 10.66 (3.16) years. Patients were categorized into high- and medium-risk groups based on the angle of trunk rotation (ATR) size. Specific scoliosis physiotherapy was used, and the average follow-up period was 28.1 ± 14.5 months. Changes in ATR, Cobb angle, and functional length of the lower limbs pre- and post-treatment were statistically analyzed across three age groups (6–9, 10–12, and 13–16 years) and three scoliosis locations. Results: Significant effectiveness of early rehabilitation was observed in the high-risk group of children aged 6–9 years. In the medium-risk group, significant reductions in ATR were observed in both the 6–9 and 10–12 age groups across all three scoliosis locations. Additionally, there was a significant decrease in the Cobb angle in the thoracolumbar region and a significant reduction in lower limb inequality across all age groups and scoliosis locations. Conclusions: The early implementation of specific physiotherapy may enhance the efficacy of idiopathic scoliosis treatment by attenuating factors contributing to its progression. Full article

Background: Scoliosis is a structured rotatory deformity of the spine defined as >10° Cobb. Functional scoliosis (FS) is a curve < 10° Cobb, which is non-rotational and correctable. FS is often secondary to leg length inequality (LLI). To observe vertebral rotation (VR) in functional scoliosis due to LLI, one must demonstrate a correlation between LLI, sacral shelf inclination (SSI), and VR and discover a predictive value of LLI capable of inducing rotation. Methods: We studied 89 patients with dorso-lumbar or lumbar curves < 15° Cobb and radiographs of the spine and pelvis. We measured LLI, SSI, and VR. The patients were divided into VR and without rotation (WVR) groups. Statistical analysis was performed. Results: The mean LLI value was 6.5 ± 4.59 mm, and the mean SSI was 2.8 ± 2.53 mm. The mean value of LLI was 5.2 ± 4.87 mm in the WVR group and 7.4 ± 4.18 mm in the VR group. The mean SSI value for WVR was 1.4 ± 2.00 and that for VR was 3.9 ± 2.39. For each mm of LLI, it was possible to predict 0.12° of rotation. LLI ±5 mm increased the probability of rotation (R2.08 p < 0.0016), while this was ±2 mm for SSI (R2 0.22 p < 0.01). Each mm of LLI corresponded to 0.3 mm of SSI (R2 0.29, p < 0.01). Conclusions: FS secondary to LLI can cause VR, and 5 mm of LLI can cause SSI and rotation. Full article

This article is concerned with the adaptive-event-triggered filtering problem as it relates to a class of nonlinear discrete-time systems characterized by interval Type-2 fuzzy models. The system under investigation is susceptible to Markovian switching and deception attacks. It is proposed to implement an improved event-triggering mechanism to reduce the unnecessary signal transmissions on the communication channel and formulate the extended dissipativity specification to quantify the transient dynamics of filtering errors. By resorting to the linear matrix inequality approach and using the information on upper and lower membership functions, stochastic analysis establishes sufficient conditions for the existence of the desired filter, ensuring the mean-squared stability and extended dissipativity of the augmented filtering system. Further, an optimization-based algorithm (PSO) is proposed for computing filter gains at an optimal level of performance. The developed scheme was finally tested through experimental numerical illustrations based on a single-link robot arm and a lower limbs system. Full article

Osseous deformities in children arise due to progressive angular growth or complete physeal arrest. Clinical and radiological alignment measurements help to provide an impression of the deformity, which can be corrected using guided growth techniques. However, little is known about timing and techniques for the upper extremity. Treatment options for deformity correction include monitoring of the deformity, (hemi-)epiphysiodesis, physeal bar resection, and correction osteotomy. Treatment is dependent on the extent and location of the deformity, physeal involvement, presence of a physeal bar, patient age, and predicted length inequality at skeletal maturity. An accurate estimation of the projected limb or bone length inequality is crucial for optimal timing of the intervention. The Paley multiplier method remains the most accurate and simple method for calculating limb growth. While the multiplier method is accurate for calculating growth prior to the growth spurt, measuring peak height velocity (PHV) is superior to chronological age after the onset of the growth spurt. PHV is closely related to skeletal age in children. The Sauvegrain method of skeletal age assessment using elbow radiographs is possibly a simpler and more reliable method than the method by Greulich and Pyle using hand radiographs. PHV-derived multipliers need to be developed for the Sauvegrain method for a more accurate calculation of limb growth during the growth spurt. This paper provides a review of the current literature on the clinical and radiological evaluation of normal upper extremity alignment and aims to provide state-of-the-art directions on deformity evaluation, treatment options, and optimal timing of these options during growth. Full article

Background: Peripheral arterial disease (PAD) and acute limb ischemia (ALI) pose an increasing strain on health care systems. The objective of this study was to describe the German health care landscape and to assess hospital utilization with respect to PAD and ALI. Methods: Secondary data analysis of diagnosis-related group statistics data (2009–2018) provided by the German Federal Statistical Office. Inclusion of cases encoded by the International Classification of Diseases (ICD-10) codes for PAD and arterial embolism or thrombosis. Construction of line diagrams and choropleth maps to assess temporal trends and regional distributions. Results: A total of 2,589,511 cases (median age 72 years, 63% male) were included, of which 2,110,925 underwent surgical or interventional therapy. Overall amputation rate was 17%, with the highest rates of minor (28%) and major amputations (15%) in patients with tissue loss. In-hospital mortality (overall 4.1%) increased in accordance to Fontaine stages and was the highest in patients suffering arterial embolism or thrombosis (10%). Between 2009 and 2018, the annual number of PAD cases with tissue loss (Fontaine stage IV) increased from 97,092 to 111,268, whereby associated hospital utilization decreased from 2.2 million to 2.0 million hospital days. Hospital incidence and hospital utilization showed a clustering with the highest numbers in eastern Germany, while major amputation rate and mortality were highest in northern parts of Germany. Conclusions: Increased use of endovascular techniques was observed, while hospital utilization to treat PAD with tissue loss has decreased. This is despite an increased hospital incidence. Addressing socioeconomic inequalities and a more homogeneous distribution of dedicated vascular units might be advantageous in reducing the burden of disease associated with PAD and ALI. Full article

Background: Slipped capital femoral epiphysis is due to proximal femur physis failure in adolescent patients. Early iatrogenic closure of proximal growth cartilage in children with significant residual growth potential causes complications such as coxa breva, coxa vara, and lower limb length inequalities. The Free-Gliding SCFE Screw System is a self-extending cannulated screw used in Slipped Capital Femoral Epiphysis (SCFE) fixation and femoral neck fractures. Materials and Method: We conducted a retrospective study on 16 patients. All patients under 11 years old were treated by telescopic cannulated screws fixation. The youngest patient was 7 years old. Results: Out of the 22 operated hips, 2 screws have failed, thus resulting in a lack of telescoping of the screw. We discovered an average lengthening of approximately 10 mm at 24 months postoperative check-up in 20 hips in which lengthening took place. According to the Notzli method, none of the patients had an alpha angle value greater than 48 degrees. Conclusion: Fixation with telescopic screw for SCFE in patients less than 11 years old, with mild to moderate slippage, allows the continuous growth and remodeling of the proximal femur, thus avoiding deformities such as coxa breva, coxa vara, FAI, AVN, limb length discrepancies and also allows good range of motion. Full article

Background: The effect of Leg-Length Discrepancy (LLD) on dynamic gait parameters has been extensively discussed. Podobarography is the study of foot-to-ground pressure distribution. It has been used to test plantar footprint deviations that could reveal pathology. Purpose: The aim of this study is to determine the effects of simulated LLD on dynamic gait parameters measured with a pressure platform in healthy subjects. Methods: Thirty-seven healthy subjects participated in observational cross-sectional research. A procedure was performed to capture the dynamic parameters of each participant under five different simulated LLD conditions. Support time, mean pressure, and peak pressure measures were registered on three trials for each foot and LLD level per session. An analysis of variance (ANOVA) test for repeated measures was performed to check for differences between the different simulated LLD levels. Results: The stance time of the short leg had no significant changes. The stance time of the long leg increased by 3.51% (p < 0.001), mean pressure of the short leg increased by 1.23% (p = 0.005), and decreased by 5.89% in the long leg (p < 0.001). Peak pressure of the short leg decreased by 2.58% (p = 0.031) and the long leg decreased by 12.11% (p < 0.001). Conclusions: This study demonstrates that increasing LLD causes an asymmetrical foot-loading pattern, with decreased mean and peak pressure on the longer limb, and consequently an overload on the short side. Furthermore, an increasing LLD causes increased stance time on the long leg. Full article

The number of precarious workers is increasing globally, and precarious employment is becoming a public concern in terms of workers’ health. However, sufficient research on precarious employment and its impact on musculoskeletal pain (MSP) is lacking. This study aimed to investigate the relationship between precarious employment and the risk of MSP among Korean wage workers. After merging the data from the 4th and 5th Korean Working Conditions Surveys, 59,644 wage workers were analyzed. The control group comprised full-time permanent workers, and precarious employment was defined as workers involved in temporary or daily employment, or part-time workers. The outcome variable was the summed number of MSP in three anatomical sites (back, neck and upper limb, lower limb). Zero-inflated negative binomial analyses were selected to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) between precarious employment and MSP. In adjusted models with age, sex, educational level, income level, weekly working hours, and occupation, precarious employment was significantly associated with an increased risk of both MSP (OR 1.66 95% CI 1.56–1.77) and work-related MSP (OR 1.18 95% CI 1.11–1.25). Given the job insecurity and health inequity associated with precarious employment, special attention on precarious workers’ health is needed. Full article

Background: Migrant workers (MWs) generally perform dangerous jobs and have reduced access to occupational health (OH) care, therefore being prone to developing occupational diseases (OD). The aim of the work is to describe a case series of MWs and report on related outcomes for OH professionals. Methods: A case series of 724 MWs, sent from January 2001 to June 2013 to a public OH unit for OD or fitness-for-work (FFW) evaluation, was entered in a dedicated database and elaborated for descriptive statistics with Microsoft Excel. Results: MWs were mostly (75%) men, with a mean age of 40. They came mainly from Morocco, Senegal, Albania, Romania, and Pakistan. Main sectors of employment were manufacturing, metal industry, services, construction. OD were found in 210 cases, main diagnoses being: Lumbar disc and upper limb musculoskeletal disorders (51%), contact dermatitis (15%), allergic asthma (8%), noise-induced hearing loss (7%), tumors (3%), psychiatric disorders (2%). Moreover, 136 FFW judgements were formulated, with some limitations/restrictions expressed. Finally, a relevant prevalence of some chronic non-occupational diseases was found. Conclusions: MWs in Italy may suffer from OH inequalities. Qualified public OH professionals and occupational physicians in workplaces should have a proactive role to concretely meet MWs’ health needs. Full article

Responsible Innovation in Health (RIH) represents an emerging Science, Technology and Innovation (STI) approach that could support not only the Sustainable Development Goal (SDG) “Good health and well-being” but also other SDGs. Since few studies have conceptualized the relationships between RIH and the SDGs, our goal was to inductively develop a framework to identify knowledge gaps and areas for further reflections. Our exploratory study involved: (1) performing a web-based horizon scanning to identify health innovations with responsibility features; and (2) illustrating through empirical examples how RIH addresses the SDGs. A total of 105 innovations were identified: up to 43% were developed by non-profit organizations, universities or volunteers; 46.7% originated from the United States; and 64.5% targeted countries in Africa, Central and South America and South Asia. These innovations addressed health problems such as newborn care (15.5%), reduced mobility and limb amputation (14.5%), infectious diseases (10.9%), pregnancy and delivery care (9.1%) and proper access to care and drugs (7.3%). Several of these innovations were aligned with SDG10-Reduced inequalities (87%), SDG17-Partnerships for the goals (54%), SDG1-No poverty (15%) and SDG4-Quality education (11%). A smaller number of them addressed sustainable economic development goals such as SDG11-Sustainable cities and communities (9%) and SDG9-Industry and innovation (6%), and environmental sustainability goals such as SDG7-Affordable and clean energy (7%) and SDG6-Clean water and sanitation (5%). Three examples show how RIH combines entrepreneurship and innovation in novel ways to address the determinants of health, thereby contributing to SDG5 (Gender), SDG10 (Inequalities), SDG4 (Education) and SDG8 (Decent work), and indirectly supporting SDG7 (Clean energy) and SDG13 (Climate action). Further research should examine how alternative business models, social enterprises and social finance may support the STI approach behind RIH. Full article