Lower Limb Research Articles

Clinical Reasoning: An Unusual Etiology of Lumbosacral Plexopathy in a Patient With HIV.

We present a compelling case of uncontrolled diabetes, who initially presented as diabetic lumbosacral radiculoplexus neuropathy (DLRPN), with radicular pain in the right lower limb (LL) followed by asymmetric weakness of both LLs (right greater than left) with wasting in the medial compartment of the right thigh and significant sensory loss in the bilateral sural and right saphenous nerve distribution. Electrophysiology was suggestive of right lumbosacral radiculoplexus neuropathy. Incidentally, the patient tested positive for HIV-1 at our tertiary care center. CSF analysis revealed markedly elevated protein levels (>400 mg/dL) with lymphocytosis, a red flag for DLRPN. This observation led to further workup. Nerve biopsy showed large collections of perivascular endoneurial and epineurial lymphoid inflammatory cells, which favored an alternative diagnosis. This case highlights the intricate interplay between HIV infection, diabetes, and neurologic manifestations, challenging the initial clinical suspicion of DLRPN. This study emphasizes the importance of considering atypical presentations of neuropathy, especially in the context of coexisting medical conditions, and emphasizes the significance of comprehensive diagnostic workup, including CSF studies and nerve biopsy, for an accurate diagnosis.

CLINICAL, EPIDEMIOLOGICAL, AND NOSOLOGICAL CHARACTERISTICS OF INJURED INDIVIDUALS WITH MASSIVE BLOOD LOSS

Severe mechanical trauma is one of the major medical and social issues in modern society, resulting in more than 5.8 million deaths worldwide each year. The leading potentially preventable cause of death in such cases is massive, uncontrolled blood loss. Objective: to study and analyze the clinical, epidemiological, and nosological characteristics of injuries, as well as age, sex, and peculiarities of traumagenesis, in order to enhance the effectiveness of emergency medical care for victims with traumatic blood loss, in accordance with the standards of evidence-based medicine. Results. The study found that trauma cases leading to massive blood loss occur more frequently in males (78.4% men vs. 21.6% women). The largest proportion of male victims are aged 21 to 30 years (21.8%). Most injuries resulted from domestic incidents (29.3%), road traffic accidents (21.2%), and criminal acts (19.2%). The most common injury types were stab wounds (40.1%) and direct blows (23.3%). In terms of injury localization, the upper limb was most commonly affected (21.9%), followed closely by the lower limb (21.6%). Individuals injured in hostilities predominantly sustained mine-blast injuries, often associated with multifactorial combined injuries. Conclusions: The clinical-epidemiological and nosological characteristics of victims with massive traumatic blood loss indicate distinct risk groups based on age, sex, type, and mechanism of injury. It has established that these clinical and epidemiological features significantly influence both the outcome of the traumatic process and the effectiveness of emergency medical care.

Single-port Thoracoscopic Laser Sympathicotomy for Primary Hyperhidrosis: A Safe and Minimally Invasive Approach With Favorable Short-term Outcomes

Objective: Thoracoscopic sympathicotomy is a well-established treatment for severe palmar hyperhidrosis. This study evaluates the safety and efficacy of a novel one-stage, bilateral, single-port laser sympathicotomy with minimal dissection. Methods: We retrospectively reviewed 73 patients with severe palmar hyperhidrosis who underwent this novel surgical technique between June 2023 and October 2023. Outcomes included complications, recurrent hyperhidrosis, and compensatory hyperhidrosis (CH). Hyperhidrosis severity was assessed using the hyperhidrosis disease severity score (HDSS). Results: The mean patient age was 21.3 ± 7.7 years, with a female predominance (52.1%). Sympathicotomy was performed at the T3 level only in 46 patients (63%), with the remaining undergoing sympathicotomy at both T3 and T4 levels. Median cauterization and operating times were 78 seconds and 8.7 minutes, respectively. No complications occurred. Two patients experienced recurrent hyperhidrosis during a median follow-up of 9 months, both were mild (HDSS grade 1). CH developed in 41 patients (56.2%), with all occurring within the first month postoperatively. The most common sites for CH were the back (51.2%), chest (43.9%), thigh (41.5%), abdomen (36.6%), and lower leg (36.6%). The majority of patients with CH (95.1%) reported mild (HDSS grade 1) or moderate (HDSS grade 2) hyperhidrosis. A higher body mass index was a significant risk factor for CH (odds ratio: 1.36, 95% CI: 1.12-1.71 for every 1 kg/m2 increase). Conclusions: This minimally invasive, single-port thoracoscopic laser sympathicotomy appears to be safe and effective for patients with palmar primary hyperhidrosis. Future studies should investigate long-term outcomes and refine the technique to minimize invasiveness even further.

Outcomes of external versus internal fixation for traumatic lower limb fractures in low- and middle-income countries

AimsLower limb fractures are common in low- and middle-income countries (LMICs) and represent a significant burden to the existing orthopaedic surgical infrastructure. In high income country (HIC) settings, internal fixation is the standard of care due to its superior outcomes. In LMICs, external fixation is often the surgical treatment of choice due to limited supplies, cost considerations, and its perceived lower complication rate. The aim of this systematic review protocol is identifying differences in rates of infection, nonunion, and malunion of extra-articular femoral and tibial shaft fractures in LMICs treated with either internal or external fixation.MethodsThis systematic review protocol describes a broad search of multiple databases to identify eligible papers. Studies must be published after 2000, include at least five patients, patients must be aged > 16 years or treated as skeletally mature, and the paper must describe a fracture of interest and at least one of our primary outcomes of interest. We did not place restrictions on language or journal. All abstracts and full texts will be screened and extracted by two independent reviewers. Risk of bias and quality of evidence will be analyzed using standardized appraisal tools. A random-effects meta-analysis followed by a subgroup analysis will be performed, given the anticipated heterogeneity among studies, if sufficient data are available.ConclusionThe lack of easily accessible LMIC outcome data, combined with international clinical guidelines that are often developed by HIC surgeons for use in HIC environments, makes the clinical decision-making process infinitely more difficult for surgeons in LMICs. This protocol will guide research on surgical management, outcomes, and complications of lower limb shaft fractures in LMICs, and can help guide policy development for better surgical intervention delivery and improve global surgical care.Cite this article: Bone Jt Open 2024;5(11):1020–1026.

PERCEPÇÃO CORPORAL E EQUILÍBRIO DINÂMICO DE PACIENTES AMPUTADOS POR MEIO DE TÉCNICAS DE ENFAIXAMENTO DOS COTOS

Amputation, often caused by trauma, tumors or complications from vascular diseases such as diabetes mellitus, can lead to a series of emotional reactions in patients, including depression, imbalance and disorganization of the body's schema. Objectives: To evaluate amputee patients who use stump bandaging in terms of body perception and balance. Analyze the evolution of patients in relation to sensitivity, balance and body perception; identify the benefits or harms it may present and compare body perception with and without the aid of bandaging. Methods: Field research will be carried out, observational and descriptive, quantitative, longitudinal, exploratory and descriptive. with a sample of 10 amputee participants who answered a questionnaire about balance and body perception, which will be administered together with a professor from the institution. Results: Binding had a positive impact on the balance of amputee patients, with average scores of 21.9 points with bandaging, compared to 16.8 points without bandaging. Regarding functionality, patients with transfemoral amputation demonstrated greater ease in placing the prosthesis compared to patients with transtibial amputation. Conclusion: Berg Balance Scale has been shown to be effective in the results and qualification of functionality in patients with lower limb amputation. However, it is essential to highlight that the topic still requires further studies.

Foot Progression Angle in Relation to Spatiotemporal Parameters of Gait in Children with Cerebral Palsy

OBJECTIVE: This study assessed the difference in the foot progression angle and measure spatiotemporal parameters of gait of children with diplegic cerebral palsy and to examine the relation among foot progression angle of right and left lower limb and spatiotemporal parameters of gait. DESIGN: Cross-sectional and Correlation study. SUBJECTS: Sixty children with spastic diplegia, aged 5 to 8 years. The participants were categorized into 3 age groups of equivalent number: group A (5 to 6 years), group B (6 to 7 years), as well as group C (7 to 8 years). METHODS: Foot progression angle and spatiotemporal parameters of the gait for both feet were evaluated utilizing a dynamic footprint. RESULTS: a moderate negative significant correlation was noted among left FPA and right step length, and right stride length. There was moderate positive significant correlation among left FPA and cadence . A weak non-significant correlation was observed among right and left FPA and gait parameters among three groups. CONCLUSION: foot progression angle assessment and spatiotemporal measurements and the correlation among them can give objective and quantitative data that could be utilized in rehabilitation and clinical evaluations to identify functional deficiencies.

Potential effects of peripheral neuropathy on brain function in patients with type 2 diabetes mellitus

BackgroundThe mechanisms associated between diabetic peripheral neuropathy (DPN) and various brain function abnormalities in patients remains unclear. This study attempted to indirectly evaluate the effect of DPN on brain function in patients with type 2 diabetes mellitus (T2DM) by characterizing the resting-state functional connectivity (FC) of the lower limb sensorimotor cortex (LSM).MethodsForty-four T2DM patients with diabetic peripheral neuropathy (DPN), 39 T2DM patients without diabetic peripheral neuropathy (ND), and 43 healthy controls (HCs) underwent a neuropsychological assessment and resting-state functional magnetic resonance imaging examinations to examine the differences in FC between the LSM and the whole brain. The relationships of FC with clinical/cognitive variables were examined.ResultsIn comparison with the HCs group, the ND group showed reduced FC of the LSM with the right lateral occipitotemporal cortex (LOTC) and increased FC with the medial superior frontal gyrus (SFGmed), while the DPN group showed reduced FC of the LSM with the right cerebellar lobule VI, the right LOTC, the rostral prefrontal cortex (rPFC), and the anterior cingulate gyrus (ACC). Moreover, in comparison with the ND group, the DPN group showed reduced FC of the LSM with the ACC, SFGmed, and rPFC. In the DPN group, the FC between the LSM and right cerebellar lobule VI was significantly correlated with fasting blood glucose levels (r = -0.490, p = 0.001), and that between the LSM and ACC was significantly correlated with the Montreal Cognitive Assessment score (r = 0.479, p = 0.001).ConclusionsPatients with T2DM may show abnormal motion-related visual perceptual function before the appearance of DPN. Importantly, DPN can influence the brain regions that maintain motion and motor control, and this effect is not limited to motor function, which may be the central neuropathological basis for diabetic peripheral neuropathy.

Corticosteroid Effect in Acute Spinal Cord Injury in the Rural Area

Spinal cord injuries (SCI) are devastating traumatic events in the lives of patients, often resulting in severe and/or permanent neurologic disabilities. Nearly half a million people are living permanently disabled in the United States due to traumatic SCI and 12,000–15,000 patients per year incur new injuries. A 78-year-old male patient came to the emergency room with a history of falling from a height with a pelvic position below exposed to trees 30 hours before admission, found weakness in the lower limbs, unable to urinate since yesterday. On radiologic examination, a burst fracture was found in the collumna of the 1st lumbar vertebra. The patient could not be examined for MRI due to limitations and unavailability of equipment at the hospital. The patient was given high dose of Methylprednisolone treatment for 3 days and there was no motoric improvement in the patient. Acute spinal cord injury is a very dangerous disease because it can cause patients both psychological and non psychological disorders. In areas that are left behind and do not have very good facilities and medical personnel to carry out this treatment. There is no treatment option other than using corticosteroids. However, the effect of corticosteroids still needs to be further developed and researched.

Impact of strength training on the prevention of orthopedic injuries in sports: a literature review.

Introduction: The perception of physical activity has evolved, influenced by urbanization, media, and public health initiatives. While regular physical activity offers health benefits, musculoskeletal injuries in athletes remain a concern, often going unnoticed due to subtle symptoms. Preventing these injuries is crucial, with strength training (ST) emerging as a strategy to enhance stability and reduce injury risk. Purpose of the Study: This review examines the impact of strength training on preventing orthopedic injuries in athletes, focusing on mechanisms like muscle strengthening, joint stabilization, improved endurance, and correcting imbalances. It evaluates research on ST's effectiveness in preventing knee, ankle, hip, back, and upper limb injuries. Methodology: A comprehensive search of databases, including PubMed, Scopus, and Google Scholar, was conducted using keywords such as "strength training," "orthopedic injury prevention," "musculoskeletal stability," "injury risk reduction," and "sports injuries." Results: Strength training plays a key role in preventing sports injuries by enhancing muscle strength, joint stability, and endurance, addressing musculoskeletal weaknesses and imbalances. Studies show ST significantly reduces knee, ankle, hip, and back injuries. For instance, knee injuries are prevented by strengthening the hip abductors and quadriceps, while ankle injuries are mitigated by improving core and lower limb strength. ST also prevents injuries in "overhead sports" by enhancing shoulder stability. Keywords: strength training, orthopedic injury prevention, musculoskeletal stability, sports injuries, injury risk reduction.

Thermopixelgraphy: a new method for analyzing the skin temperature of the lower limbs through infrared thermography

Thermopixelgraphy: a new method for analyzing the skin temperature of the lower limbs through infrared thermography

Segmental phase angles as predictors of functional recovery and activities of daily living in patients after stroke

AbstractBackgroundThis study investigated the association between segmental phase angles and functional outcomes in patients after stroke, hypothesizing that increased segmental phase angle correlates with improved functional status.MethodsA retrospective cohort study of 1012 patients after stroke was conducted. Whole body and segmental phase angles were measured using bioelectrical impedance analysis within 3 days of admission. Our exposure of interest was segmental phase angle measured via a multifrequency bioelectrical impedance analyzer and calculated as phase angle = arctangent (Xc/R) × (180/π), where R is the resistance of the right half of the body and Xc is the reactance measured at 50 kHz. The primary outcomes were the motor subscale of the functional independence measure (FIM) at discharge and FIM change between admission and discharge. Secondary outcomes included FIM scores for specific activities. Multiple linear regression analysis was performed to assess associations.ResultsPhase angles of the healthy upper and lower limbs demonstrated stronger associations with discharge FIM motor scores (β = 0.175 and β = 0.105, respectively) and FIM motor gain (β = 0.242 and β = 0.092, respectively) compared with whole body or paretic limb phase angles. Upper limb phase angles were more closely related to grooming and toileting abilities, whereas lower limb phase angles were associated with both toileting and locomotion at discharge.ConclusionSegmental phase angles, particularly those of the nonparetic limbs, are promising predictors of functional outcomes in patients after stroke. Assessing segmental phase angles may guide targeted interventions and rehabilitation strategies for improving specific activities of daily living.

Progress and development trends of lower limb exoskeleton rehabilitation robots

Abstract. Currently, as the aging population intensifies, many elderly people are trapped by lower limb dysfunctions caused by diseases such as stroke sequelae, spinal cord injuries, and bone injuries. Research on lower limb exoskeleton robots has made progress both domestically and internationally. Foreign lower limb exoskeleton robot technology is very mature and widely applied; although starting later, domestic development in this field has been rapid. This paper studies the key technologies of lower limb exoskeleton robots from several aspects: the degrees of freedom in human lower limb movement, the cyclic movement of human gait, structural design, driving methods, and interactive control. With the continuous advancement of technology, lower limb exoskeleton robots will become more intelligent and focus more on personalized services and wearing comfort in future development, aiming to bring more convenience and help to disabled individuals, rehabilitation patients, and groups with special needs.

Effects of immersive virtual reality stimulation and/or multicomponent physical exercise on cognitive and functional performance in hospitalized older patients with severe functional dependency: study protocol for a randomized clinical trial

BackgroundHospital-associated functional decline affects nearly one-third of the hospitalized older adults. The aim of this trial is to investigate the effect of a cognitive stimulation intervention provided via immersive virtual reality (IVR), with or without a multicomponent physical exercise intervention (ME) in hospitalized patients aged 75 or older with severe functional dependency at admission (Barthel Index < 60 points).MethodsThis clinical randomized controlled trial will be conducted in the Acute Geriatric Unit of a tertiary hospital in Spain. A total of 212 acute patients will be enrolled according to the following criteria: age ≥ 75, Barthel Index < 60, able to collaborate, expected length of stay ≥ 5 days, absence of clinical instability and severe dementia (Global Deterioration Scale 7) or other end-stage disease. Patients will be randomly assigned to a control group (CG) or any of the three intervention groups (IG): IVR, ME, or IVR + ME. The IVR group will watch ad-hoc videos showing Spanish regional landscapes and villages, approximately 4 min per day for three consecutive days. The ME group will undergo aerobic and strength exercise for progressive training of the upper and lower limbs. The IVR + ME group will do both cognitive and physical intervention. The primary outcomes will be cognitive and physical measures at discharge. Mood, quality of life, isometric strength, and acceptance of IVR will be also assessed.DiscussionThis project has the potential to enhance physical and psychological well-being of patients with severe functional dependency hospitalized for acute conditions, using technology. Virtual reality is expected to be favourably perceived by hospitalized older adults. This intervention represents a novelty in the geriatric patients’ care, comprising IVR and/or ME dispensed within the patient’s room, and including patients who are commonly excluded from research clinical trials.Trial registrationThis study was approved by the Navarra Clinical Research Ethics Committee on May 17th, 2023 (PI_2023/60). The trial is registered at ClinicalTrials.gov, registration number NCT06340282, 24th May 2024.

Focal classic intradural extramedullary ependymoma near the conus medullaris: A case report and literature review

Rationale: To enhance clinicians’ comprehension of conus medullaris region ependymomas and elevate their diagnostic accuracy. Patient concerns: A 26-year-old female patient had 10 months of low back pain and right lower limb pain. Diagnoses: Lumbar magnetic resonance imaging (MRI) scan revealed a circular abnormal signal in the spinal canal at the level of L2. Pathological examination confirmed classic ependymoma. Interventions: The patient underwent tumor resection surgery. Outcomes: Postoperatively, the patient’s right lower limb soreness improved, and no new neurological deficits were observed. Lessons: Focal classic intradural extramedullary ependymomas near the conus medullaris are rare. Close follow-up with MRI of the craniospinal axis is necessary. Hormonal factors may influence the development of ependymomas in this unusual location. The appearance of these tumors on MRI and contrast-enhanced MRI scans is variable.

Case report of varicose veins treatment in patient with a prosthetic mitral valve

This clinical case may be of interest in situations where a patient with varicose veins of the lower limbs and concomitant heart disease, who is on long-term anticoagulant therapy and is scheduled to undergo minor surgery, may present the possibility of endovenous laser ablation (EVLA) against the background of warfarin use. Patient, G., 68 years old, with rheumatic combined mitral valve disease (mitral valve replacement in 2019, permanent atrial fibrillation), also had varicose vein disease of the lower limbs. History included acute cerebrovascular accident (19.01.2023). Duplex Ultrasonography Screening (DUS) showed failure of the left great saphenous vein valve. Hypocoagulation was also observed in coagulogram and the risk of bleeding on HAS-BLED score was average. On Caprini score, the risk was very high. Endovenous laser ablation of the large saphenous vein on the left side was performed. During follow-up examinations, there were no signs of bleeding from puncture sites. The target trunk was obliterated in dynamics at DUS. Therefore, it is possible to carry out EVLA of a large subcutaneous vein while taking therapeutic doses of warfarin without switching to bridge therapy. Endovascular laser ablation allowed it to be done with less risk of bleeding and, against the background of taking warfarin, reduced the risk of thrombosis.

The Predictive Role of Inflammatory Biomarkers and Their Correlation with the Biochemical Profile in Patients with Vasculopathy Undergoing Surgery

Inflammation is involved in the pathomechanism of vascular diseases. Pro-inflammatory cytokines are important in perioperative monitoring. The aim of the study was the perioperative assessment of biochemical tests and inflammatory markers in patients with vasculopathy, focusing on the identification of subjects prone to complications. The study was performed between 2020 and 2023 at the Clinical County Hospital in Târgu Mureș on enrolled diabetic and non-diabetic patients with vasculopathy and lower limb surgery (amputation or necrectomy). Pre- and postoperative inflammatory markers, biochemical, and hematological tests (n = 62) were performed. Positive correlation was found between preoperative C-reactive protein (CRP) and interleukin-6 (IL-6) levels, and between preoperative triglyceridemia and glycemia/cholesterolemia. Positive correlation was present between pre- and postoperative values of IL-6, tumor necrosis factor-alfa (TNF-α), CRP, and fibrinogen. Preoperative TNF-α values positively correlated with malondialdehyde (MDA) levels, postoperative TNF-α values with transaminase enzymes. Diabetic patients presented higher IL-6 results compared to non-diabetic subjects. We can conclude that dynamic assessment of inflammatory markers is appropriate for monitoring perioperative course. Half of the subjects presented moderately increased preoperative IL-6 levels, and one quarter had critically high values, which might predict prolonged hospitalization. The assessment of oxidative stress, inflammatory markers and biochemical parameters enables the identification of patients prone to complications, so they can benefit from more complex management.

Combined Use of External Iliac Lymph Node Count and Bone Scintigraphy for PJI Diagnosis: A Prospective Study

Background: The reactive enlargement of external iliac lymph nodes and increased blood flow in the infected region are commonly observed in lower limb infections. We aimed to differentiate between aseptic loosening and periprosthetic joint infection (PJI) after joint replacement surgery by quantifying the number of enlarged external iliac lymph nodes and using bone scintigraphy to monitor blood flow. Methods: We recruited 124 patients undergoing revision surgery for aseptic loosening or PJI. All the patients underwent preoperative dual-energy computed tomography (DECT) imaging for external iliac lymph nodes and bone scintigraphy. The diagnostic value was evaluated using ROC curve analysis. Results: The number of enlarged external iliac lymph nodes was significantly higher in the PJI group than in the aseptic failure group (4.0 versus. 1.0, p value &lt; 0.001). The median affected/unaffected side ratio in the blood pool phase of ECT in the PJI group was 1.49, significantly higher than the aseptic failure group’s median ratio of 1.04 (p value &lt; 0.001). The AUC for diagnosing PJI using the number of enlarged lymph nodes alone was 0.91, and when using the bone scintigraphy blood pool phase alone, the AUC was 0.89. When both metrics were combined, the AUC increased to 0.95, which was higher than the AUCs for the ESR (AUC = 0.83), CRP (AUC = 0.76), and synovial fluid PMN% (AUC = 0.62). Conclusions: Combining the enlargement of the lymph node count with the bone scintigraphy blood pool phase is a promising approach for diagnosing PJI.

Comprehensive treatment of the patient with venous trophic ulcer

Improving the results of treatment for patients with varicose veins in the lower extremities, complicated by trophic ulcers, is an urgent task for modern medicine. A long-term, recurrent course of the disease leads to a reduction in working capacity and deterioration in quality of life, as well as permanent disability for patients, whose treatment causes special economic problems. At present, there are virtually no effective methods for conservative therapy, leading to prolonged unsuccessful treatment of such patients. This article presents the clinical case of a 63-year-old patient undergoing complex treatment for chronic lower limb venous insufficiency of class C6 according to the CEAP classification. Conclusion. An effective complex method for treating trophic ulcers in patients with chronic venous disease involves the correction of venous hemodynamic disorders (in this case, through radiofrequency ablation), as well as primary surgical treatment for the ulcerative defect, and simultaneous autodermaplasty with a perforated skin flap.

Benign Evolution of Complex Regional Pain Syndrome (CRPS) Type 1 in Patients Treated with Intravenous Neridronate: A Single-Center Real-Life Experience

Objective: To investigate the long-term effects of intravenous neridronate treatment in patients with complex regional pain syndrome type 1 (CRPS) in a real-life setting. Methods: We conducted a retrospective study on consecutive CRPS patients treated at our hospital from February 2018 to July 2023. All were treated within three months of the onset of CRPS symptoms. The Patient-Reported Outcomes Measurement Information System 29-Item Health Profile (PROMIS-29) version 2.1 was administered. The main outcome of interest was the evolution of the PROMIS-29 scores from baseline to the last follow-up visit. Patients were categorized as “complete responders” or “non-complete responders”. The association of clinical and demographic variables with a complete response was analyzed using chi-square tests and univariate logistic regression. Results: Thirty-six patients were included, with a median follow-up time of 4.8 years. A significant improvement was noted in the mean numerical pain rating scale (from 6.4 ± 1.9 to 3.1 ± 2.4, p &lt; 0.001), as well as across all PROMIS-29 domains. Physical function improved from 34.2 ± 4.9 to 49.2 ± 9.9, p &lt; 0.001; anxiety from 58.0 ± 6.7 to 49.6 ± 6.9, p &lt; 0.001; depression from 55.3 ± 6.3 to 47.7 ± 6.6, p &lt; 0.001; fatigue from 55.7 ± 7.7 to 50.9 ± 8.7, p &lt; 0.001; sleep disturbance from 53.8 ± 6.8 to 51.3 ± 6.6, p = 0.034; social roles and activities from 41.8 ± 5.2 to 51.8 ± 8.9, p &lt; 0.001; and pain interference from 64.1 ± 5.9 to 52.4 ± 9.9, p &lt; 0.001. The likelihood of achieving a complete response was associated with the male sex, foot or ankle injuries (compared to hand and wrist injuries), and a younger age. No association was found with the type of inciting event or with the body mass index. Conclusions: Our real-life data indicate that early treatment with neridronate leads to substantial benefits in patients affected by CRPS type 1. The strongest responses are seen in young patients, males, and those with lower limb involvement.

Risk assessment study on the impact of sitting posture on lumbar vibration injury based on finite element method and neural network

Different driving postures may alter the impact of vibrations on the lumbar spine. This study explores the influence of posture on the lumbar spine by analyzing the risk of intervertebral disc vibration injury. Initially, Python language was utilized to develop code to obtain 48 different postural three-dimensional finite element models of the human-chair system. Subsequently, these models underwent harmonic response analyses at frequencies of 5, 7, and 9 Hz, with the maximum Von Mises stress on the L4–L5 intervertebral disc used to calculate the risk factor. Finally, a neural network model was trained using the frequency and posture angles as input values and the risk factor as the output values, enabling prediction of intervertebral disc risk factors in more precise sitting postures. The findings reveal that the posture of the upper body plays a primary role in influencing the lumbar spine, with the thigh posture having a greater impact when the upper body is closer to a vertical position, while the influence of the lower leg posture is minimal. Across all three frequencies, the optimal angle for the upper body is 109°, 109°, 115°, and for the thighs, it is 90°, 90°, 100°. A higher risk factor is observed when the upper body is angled between 90° and 100°. Conversely, an upper body angle between 110° and 120° is deemed acceptable. Vibration at 9 Hz had the greatest impact on the risk of lumbar injury when the upper body is in or close to a vertical sitting position.