Lower Limb Amputation Research Articles

Principal components analysis of postural sway in persons with unilateral lower limb amputation: A wearable sensor approach

Standing sway assessments can detect sensory imbalances which compromise postural control. Persons with lower limb amputation (LLA) often demonstrate impaired postural control, increasing fall risk. Here, principal features of postural sway were identified in persons with unilateral LLA using a single, commercially available wearable sensor. Sixty-one persons with LLA (n = 44 transtibial; n = 17 transfemoral) stood on a firm surface with eyes open/closed while wearing a single accelerometer mounted over the sacrum. Common parameters quantified spatiotemporal and spectral features of sway in anterior-posterior (AP) and mediolateral (ML) directions. Principal component (PC) dimensionality reduction was applied and loadings inspected to identify a reduced, non-redundant set among 14 original variables capturing 90 % variance. Six PCs described ≥ 90 % variance, with the first 3 explaining 75 %. With eyes open and closed, PC1 was loaded by variables characterizing trajectory planar size: area, jerk (i.e., sway smoothness), AP/ML RMS path distance, and AP/ML path range. With eyes open, PC2 was loaded by variables characterizing direction and spectral features: ellipse rotation, AP centroidal frequency, and ML jerk. With eyes closed, PC2 spectral loadings increased: ML centroidal frequency, ML frequency dispersion, and AP centroidal frequency. With eyes open, PC3 was loaded by ellipse rotation, jerk, ML velocity, ML centroidal frequency. With eyes closed, PC3 was loaded by ellipse rotation, ML centroidal frequency, ML frequency dispersion, and AP path velocity, characterizing off-axis error/corrections. RMS of path distance, ellipse rotation, centroidal frequency, frequency dispersion, path velocity, and jerk are a concise parameter set, derived from an accelerometer, to capture principal sway features in persons with LLA during standing balance with visual perturbations.

The impact of walking on the perception of multichannel electrotactile stimulation in individuals with lower-limb amputation and able-bodied participants

BackgroundOne of the drawbacks of lower-limb prostheses is that they do not provide explicit somatosensory feedback to their users. Electrotactile stimulation is an attractive technology to restore such feedback because it enables compact solutions with multiple stimulation points. This allows stimulating a larger skin area to provide more information concurrently and modulate parameters spatially as well as in amplitude. However, for effective use, electrotactile stimulation needs to be calibrated and it would be convenient to perform this procedure while the subject is seated. However, amplitude and spatial perception can be affected by motion and/or physical coupling between the residual limb and the socket. In the present study, we therefore evaluated and compared the psychometric properties of multichannel electrotactile stimulation applied to the thigh/residual limb during sitting versus walking.MethodsThe comprehensive assessment included the measurement of the sensation and discomfort thresholds (ST & DT), just noticeable difference (JND), number of distinct intervals (NDI), two-point discrimination threshold (2PD), and spatial discrimination performance (SD). The experiment involved 11 able-bodied participants (4 females and 7 males; 29.2 ± 3.8 years), 3 participants with transtibial amputation, and 3 participants with transfemoral amputation.ResultsIn able-bodied participants, the results were consistent for all the measured parameters, and they indicated that both amplitude and spatial perception became worse during walking. More specifically, ST and DT increased significantly during walking vs. sitting (2.90 ± 0.82 mA vs. 2.00 ± 0.52 mA; p < 0.001 for ST and 7.74 ± 0.84 mA vs. 7.21 ± 1.30 mA; p < 0.05 for DT) and likewise for the JND (22.47 ± 12.21% vs. 11.82 ± 5.07%; p < 0.01), while the NDI became lower (6.46 ± 3.47 vs. 11.27 ± 5.18 intervals; p < 0.01). Regarding spatial perception, 2PD was higher during walking (69.78 ± 17.66 mm vs. 57.85 ± 14.87 mm; p < 0.001), while the performance of SD was significantly lower (56.70 ± 10.02% vs. 64.55 ± 9.44%; p < 0.01). For participants with lower-limb amputation, the ST, DT, and performance in the SD assessment followed the trends observed in the able-bodied population. The results for 2PD and JND were however different and subject-specific.ConclusionThe conducted evaluation demonstrates that electrotactile feedback should be calibrated in the conditions in which it will be used (e.g., during walking). The calibration during sitting, while more convenient, might lead to an overly optimistic (or in some cases pessimistic) estimate of sensitivity. In addition, the results underline that calibration is particularly important in people affected by lower-limb loss to capture the substantial variability in the conditions of the residual limb and prosthesis setup. These insights are important for the implementation of artificial sensory feedback in lower-limb prosthetics applications.

Current status and progress in research on dressing management for diabetic foot ulcer.

Diabetic foot ulcer (DFU) is a major complication of diabetes and is associated with a high risk of lower limb amputation and mortality. During their lifetime, 19%-34% of patients with diabetes can develop DFU. It is estimated that 61% of DFU become infected and 15% of those with DFU require amputation. Furthermore, developing a DFU increases the risk of mortality by 50%-68% at 5 years, higher than some cancers. Current standard management of DFU includes surgical debridement, the use of topical dressings and wound decompression, vascular assessment, and glycemic control. Among these methods, local treatment with dressings builds a protective physical barrier, maintains a moist environment, and drains the exudate from DFU wounds. This review summarizes the development, pathophysiology, and healing mechanisms of DFU. The latest research progress and the main application of dressings in laboratory and clinical stage are also summarized. The dressings discussed in this review include traditional dressings (gauze, oil yarn, traditional Chinese medicine, and others), basic dressings (hydrogel, hydrocolloid, sponge, foam, film agents, and others), bacteriostatic dressings, composite dressings (collagen, nanomaterials, chitosan dressings, and others), bioactive dressings (scaffold dressings with stem cells, decellularized wound matrix, autologous platelet enrichment plasma, and others), and dressings that use modern technology (3D bioprinting, photothermal effects, bioelectric dressings, microneedle dressings, smart bandages, orthopedic prosthetics and regenerative medicine). The dressing management challenges and limitations are also summarized. The purpose of this review is to help readers understand the pathogenesis and healing mechanism of DFU, help physicians select dressings correctly, provide an updated overview of the potential of biomaterials and devices and their application in DFU management, and provide ideas for further exploration and development of dressings. Proper use of dressings can promote DFU healing, reduce the cost of treating DFU, and reduce patient pain.

Assessing Socket Fit Effects on Pressure and Shear at a Transtibial Residuum/Socket Interface.

Fluctuations in residuum volume during daily activities are known to occur in lower-limb amputees. This can cause frequent changes to fit, which cannot be accommodated by commonly-used prosthetic sockets. The real-time effects, if any, of these minor socket fit changes on interface biomechanics have not been studied extensively. Amputees commonly use different layers of socks to accommodate frequent volume fluctuations, enabling adjustment of socket fit. We, thus, altered socket fit levels via addition/removal of sock layers to a transtibial amputee who habitually-donned two-sock layers to mimic relatively looser and tighter socket fits. Interface pressure and shear sensors were placed at known prominent load-bearing sites of the transtibial residuum/socket interface, i.e., patellar tendon (PT), popliteal fossa (PF), and anterior-distal (AD) end, to measure real-time biomechanical interactions during standing and level walking. Although socket fit level was only slightly modified, changes in interface pressure and shear across anatomical sites were still observed. Tighter fit corresponds to notable pressure reduction at AD during early stance and pressure increase at PT during terminal stance due to the residuum being pushed up. Shear-to-pressure ratios were used to assess comfort, while pressure- and shear-time integrals were used to assess tissue health. We observed more notable changes at tissue sites (e.g., AD and PF). Combined evaluation of pressure and shear, including shear-to-pressure ratio and time integrals, may offer insight for residuum care.

ADP-Fuse: A novel two-layer machine learning predictor to identify antidiabetic peptides and diabetes types using multiview information

Diabetes mellitus has become a major public health concern associated with high mortality and reduced life expectancy and can cause blindness, heart attacks, kidney failure, lower limb amputations, and strokes. A new generation of antidiabetic peptides (ADPs) that act on β-cells or T-cells to regulate insulin production is being developed to alleviate the effects of diabetes. However, the lack of effective peptide-mining tools has hampered the discovery of these promising drugs. Hence, novel computational tools need to be developed urgently. In this study, we present ADP-Fuse, a novel two-layer prediction framework capable of accurately identifying ADPs or non-ADPs and categorizing them into type 1 and type 2 ADPs. First, we comprehensively evaluated 22 peptide sequence-derived features coupled with eight notable machine learning algorithms. Subsequently, the most suitable feature descriptors and classifiers for both layers were identified. The output of these single-feature models, embedded with multiview information, was trained with an appropriate classifier to provide the final prediction. Comprehensive cross-validation and independent tests substantiate that ADP-Fuse surpasses single-feature models and the feature fusion approach for the prediction of ADPs and their types. In addition, the SHapley Additive exPlanation method was used to elucidate the contributions of individual features to the prediction of ADPs and their types. Finally, a user-friendly web server for ADP-Fuse was developed and made publicly accessible (https://balalab-skku.org/ADP-Fuse), enabling the swift screening and identification of novel ADPs and their types. This framework is expected to contribute significantly to antidiabetic peptide identification.

Clinical Outcomes in Elderly Atrial Fibrillation Patients at Increased Bleeding Risk Treated with Very-Low-Dose versus Regular-Dose Non-Vitamin K Antagonist Oral Anticoagulants: a Nationwide Cohort Study.

The ELDERCARE-AF trial showed that edoxaban at a very-low-dosage (VLD) of 15mg/day was more effective than a placebo at preventing stroke/systemic embolism without significantly increasing the risk of serious bleeding. We aimed to compare the effectiveness and safety for VLD non-vitamin K antagonist oral anticoagulants (NOACs) (edoxaban 15mg once daily, dabigatran 110 or 150 once daily, apixaban 2.5mg once daily, or rivaroxaban 10mg (without the diagnosis of chronic kidney disease) or less than 10mg once daily) versus regular-dosage (RD) NOACs (edoxaban 60/30mg once daily or other labeling-dosage NOACs) among a real-world cohort of elderly AF population similar to the ELDERCARE-AF cohort. In this nationwide retrospective cohort study from Taiwan National Health Insurance Research Database (NHIRD), we identified a total of 7294 and 4151 consecutive AF patients aged 80 years or older with a CHADS2 score≥2 who met the enrollment criteria (generally similar to ELDERCARE-AF) taking VLD and RD NOACs from June 1, 2012, to December 31, 2019, respectively. Propensity-score stabilized weighting (PSSW) was used to balance covariates across study groups. Patients were followed up from the first date of prescription for NOACs until the first occurrence of any study outcome, death, or until the end date of the study period (December 31, 2020). After PSSW, VLD NOAC was associated with a comparable risk of ischemic stroke/systemic embolism and major bleeding but a higher risk of major adverse limb events (MALEs) requiring lower limb revascularization or amputation (Hazard ratio [HR]:1.54, 95% confidential interval [CI]:1.09-2.18; p=0.014), venous thrombosis (HR:3.75,95%CI:1.56-8.97; p=0.003), and all-cause mortality (HR:1.21,95%CI:1.15-1.29; p<0.001) compared to RD NOACs. VLD NOACs showed worse outcomes in most net clinical benefits (NCOs). The main result was consistent based on on-treatment analysis or accounting for death as a competing risk. In general, the advantage of NCOs for the RD NOACs over VLD NOACs persisted in most high-risk subgroups, consistent with the main analysis (P for interaction>0.05). Use of VLD NOACs was associated with a greater risk of arterial and venous thrombosis, death as well as the composite outcomes, when compared to that of RD NOAC in high-risk elderly AF patients at increased bleeding risk. Thromboprophylaxis with RD NOAC is still preferable over VLD NOAC for the majority of elderly AF patients at increased bleeding risk.

Determinants of Inadequate Empiric Antimicrobial Therapy in ICU Sepsis Patients in Al-Madinah Al-Munawwarah, Saudi Arabia: A Comparison of Artificial Neural Network and Regression Analysis.

In the management of sepsis, providing adequate empiric antimicrobial therapy is one of the most important pillars of sepsis management. Therefore, it is important to evaluate the adequacy of empiric antimicrobial therapy (EAMT) in sepsis patients admitted to intensive care units (ICU) and to identify the determinants of inadequate EAMT. The aim of this study was to evaluate the adequacy of empiric antimicrobial therapy in patients admitted to the ICU with sepsis or septic shock, and the determinants of inadequate EAMT. The data of patients admitted to the ICU units due to sepsis or septic shock in two tertiary healthcare facilities in Al-Madinah Al-Munawwarah were retrospectively reviewed. The current study used logistic regression analysis and artificial neural network (ANN) analysis to identify determinants of inadequate empiric antimicrobial therapy, and evaluated the performance of these two approaches in predicting the inadequacy of EAMT. The findings of this study showed that fifty-three per cent of patients received inadequate EAMT. Determinants for inadequate EAMT were APACHE II score, multidrug-resistance organism (MDRO) infections, surgical history (lower limb amputation), and comorbidity (coronary artery disease). ANN performed as well as or better than logistic regression in predicating inadequate EAMT, as the receiver operating characteristic area under the curve (ROC-AUC) of the ANN model was higher when compared with the logistic regression model (LRM): 0.895 vs. 0.854. In addition, the ANN model performed better than LRM in predicting inadequate EAMT in terms of classification accuracy. In addition, ANN analysis revealed that the most important determinants of EAMT adequacy were the APACHE II score and MDRO. In conclusion, more than half of the patients received inadequate EAMT. Determinants of inadequate EAMT were APACHE II score, MDRO infections, comorbidity, and surgical history. This provides valuable inputs to improve the prescription of empiric antimicrobials in Saudi Arabia going forward. In addition, our study demonstrated the potential utility of applying artificial neural network analysis in the prediction of outcomes in healthcare research.

Automatic Diabetic Foot Ulcer Recognition Using Multi-Level Thermographic Image Data.

Lower extremity diabetic foot ulcers (DFUs) are a severe consequence of diabetes mellitus (DM). It has been estimated that people with diabetes have a 15% to 25% lifetime risk of acquiring DFUs which leads to the risk of lower limb amputations up to 85% due to poor diagnosis and treatment. Diabetic foot develops planter ulcers where thermography is used to detect the changes in the planter temperature. In this study, publicly available thermographic image data including both control group and diabetic group patients are used. Thermograms at image level as well as patch level are utilized for DFU detection. For DFU recognition, several machine-learning-based classification approaches are employed with hand-crafted features. Moreover, a couple of convolutional neural network models including ResNet50 and DenseNet121 are evaluated for DFU recognition. Finally, a CNN-based custom-developed model is proposed for the recognition task. The results are produced using image-level data, patch-level data, and image-patch combination data. The proposed CNN-based model outperformed the utilized models as well as the state-of-the-art models in terms of the AUC and accuracy. Moreover, the recognition accuracy for both the machine-learning and deep-learning approaches was higher for the image-level thermogram data in comparison to the patch-level or combination of image-patch thermograms.

Analysis of systemic risk factors between diabetic/vascular patients having primary lower limb amputations and re-amputations.

Background: Patients with diabetes mellitus (DM) are known to be predisposed to many complications in the lower extremities such as neuropathy, peripheral artery disease (PAD) and infection. Diabetic foot ulcers are complications of diabetes that can lead to lower extremity amputations, re-amputations and high mortality rates.Purpose: The aim of this study is to evaluate the risk factors associated with higher re-amputation rates in diabetic foot disease.Research Design: This is a mono-centric retrospective comparative study.Study Sample: the study included 136 patients, with a total of 193 procedures (111 primary amputations and 82 re-amputations) between 2011 and 2021.Data Analysis: The t-student test and Spearman correlation were used to look for mean differences and any relevant association, respectively. Multivariate logistic regression analysis was computed to look for independent variables.Results: Twenty-two (27%) and 60 (50%) of those who had major and minor amputations, respectively, had a re-amputation (p= 0.006). Besides diabetes (89%), the commonest risk factor associated with amputation was hypertension (86.7%), be it for primary amputation or re-amputation, followed by peripheral (PAD) and coronary artery diseases. Only three risk factors showed independent correlation with re-amputation; chronic kidney disease (r = 15%,p= 0.03), smoking (r = 15%,p= 0.03), and simultaneous presence of DM + PAD (r = 13.7%,p= 0.05).Conclusions: Factors that were significantly correlated with increased re-amputation rates have a clear pathologic pathway that affects vascularity and wound healing. Further studies should be aimed at developing a clear scoring system that can be used to stratify patient for re-amputation risk, and to better predict the results according to the severity of diabetes.

Outcomes Associated with Concomitant Lower-Limb Amputation in Persons with Major Upper-Limb Amputation: Results of a National Study

ABSTRACT Introduction The challenges faced by persons with amputations are amplified for those with multiple limb loss, compared with single limb loss. However, there is limited research describing the functional outcomes of mixed upper and lower limb loss or the long-term psychosocial and health-related quality of life (HRQoL) outcomes among this group. Materials and Methods A cross-sectional, national telephone survey of 808 US veterans with major upper-limb amputation (ULA) with and without concomitant lower-limb amputation (LLA) who received care at US Veterans Affairs Medical Centers between 2010 and 2015 was conducted. T-tests and χ2 tests identified any significant differences in characteristics and outcomes of groups with and without LLA. Linear regressions examined the association between amputation laterality and outcomes. Results In comparison to those with no LLA, respondents with concomitant LLA were slightly younger (60.0 vs. 63.7) and had similar mean time in years from initial amputation (31.5 vs. 31.4). Transfemoral was the most common level of LLA (67.7%), and there was no significant difference in the distribution of ULA levels between the 2 groups. Phantom pain was less common among those with concomitant LLA compared with ULA only (64.4% vs. 74.5%, P &lt; 0.05). No significant differences were found in prevalence of residual limb, neck, or back pain; measures of disability (QuickDASH); HRQoL; or need for activities of daily living help across the two groups. Conclusions In veterans with concomitant LLA and ULA, transfemoral amputation was the most common level of LLA. Those with concomitant LLA were less likely to report phantom limb pain. No statistically significant differences were found by group in need for ADL help, disability, or HRQoL. Clinical Relevance These results provide clinicians with a greater appreciation of the similarities and differences between the two groups in relation to amputation characteristics, pain, prosthesis utilization, prosthesis satisfaction, and functional outcomes.

DFU_VIRNet: A novel Visible-InfraRed CNN to improve diabetic foot ulcer classification and early detection of ulcer risk zones

Diabetic Foot Ulcer (DFU) is considered the most serious complication suffered by people living with Diabetes Mellitus (DM). The development of an advanced stage of DFU may lead to complete or partial lower limb amputation. In this paper a novel Deep Convolutional Neural Network (CNN) architecture, DFU_VIRNet, is proposed for automatic classification of abnormal skin (DFU) versus normal skin (healthy skin). Visible and infrared (thermography) images are used to train and validate the proposed CNN. Furthermore, a new method based on estimation maps is presented to detect risk zones with high probability of the patient developing DFU. To verify the generality of the proposed approach, the performance of DFU_VIRNet was evaluated using four recently published visible datasets and one visible-infrared dataset presented in this paper; for a total of five datasets, which contain samples of abnormal skin (DFU), normal skin (healthy skin), Ischaemia and Infection. The results showed that DFU_VIRNet outperformed the current state-of-the-art results with 0.9923 (AUC) and 0.9600 (F1-score) for DFU classification (PEDIS-classification), 0.9982 (AUC) and 0.9928 (F1-score) for Ischaemia classification, and 0.9121 (AUC) and 0.8363 (F1-score) for Infection classification. The high performance of DFU_VIRNet is attributed to a novel learning mechanism proposed in this work, which is referred as GAP-2D-DLSA-IMG substructure and is used to significantly avoid overfitting and increase the perceptual field of DFU_VIRNet.

Transfemoral amputees adapt their gait during cross-slope walking with specific upper-lower limb coordination

BackgroundUnilateral lower limb amputees have asymmetrical gaits, particularly on irregular surfaces and slopes. It is unclear how coordination between arms and legs can adapt during cross-slope walking. Research questionHow do transfemoral amputees (TFAs) adapt their upper-lower limb coordination on cross-slope surfaces? MethodsTwenty TFA and 20 healthy adults (Ctrl) performed a three-dimensional gait analysis in 2 walking conditions: level ground and cross-slope with prosthesis uphill. Sagittal joint angles and velocities of hips and shoulders were calculated. Continuous relative phases (CRP) were computed between the shoulder and the hip of the opposite side. The closer to 0 the CRP is, the more coordinated the joints are. Curve analysis were conducted using SPM. ResultsThe mean CRP between the downhill shoulder and the uphill hip was higher in TFA compared to Ctrl (p = 0.02), with a walking conditions effect (p = 0.005). TFA showed significant differences about the end of the stance phase (p = 0.01) between level ground and cross-slope, while Ctrl showed a significant difference (p = 0.008) between these walking conditions at the end of the swing phase. In CRP between the uphill shoulder and the downhill hip, SnPM analysis showed intergroup differences during the stance phase (p < 0.05), but not in the comparison between walking conditions in TFA and Ctrl groups. SignificanceTFA showed an asymmetrical coordination in level ground walking compared to Ctrl. Walking on cross-slope led to upper-lower limb coordination adaptations: this condition impacted the CRP between downhill shoulder and uphill hip in both groups. The management of the prosthetic limb, positioned uphill, induced a reorganization of the coordination with the upper limb of the amputated side. Identifying upper-lower limb coordination adaptations on cross-slope surfaces will help to achieve rehabilitation goals for effective walking in urban environments.

Epidemiology of Limb Amputations and Prosthetic Use During COVID-19 Pandemic in the Netherlands

ObjectiveTo evaluate the trends in the incidence of major limb amputations and the prevalence of Dutch prosthetic users at the national level in The Netherlands between 2012 and 2021 (during the COVID-19 pandemic). Local hospitals in The Netherlands reported a doubling of major lower limb amputations during COVID-19, information about a change in the incidence of major upper limb amputations was not reported. We could not confirm this remarkable increase in major lower limb amputations in our institution, nor did we observe a change in the incidence of major upper limb amputations. We hypothesize that the COVID-19 pandemic had no effect on the number of major limb amputations. DesignObservational retrospective study analyzing national open-access databases of health insurance claims. SettingThe Dutch national opensource database www.opendisdata.nl was used to retrieve the incidence of limb amputations in the period 2012-2021, stratified by the level of amputation and the cause of amputation. The results were verified using the www.gipdatabank.nl databank. This period included 4 intervals of nationwide COVID-19 lockdowns. Participants60,848 patients who underwent limb amputations at the upper or lower extremity in the Netherlands from 2012 to 2021 (N=60,848) were included in this study. InterventionNot applicable. Main Outcome MeasuresUpper- and lower-limb amputation and prosthetic use. ResultsData were retrieved for a total of 60,848 patients in the Netherlands, who underwent 68,180 amputations of the upper and lower extremities at any level from 2012 to 2021, including 22,095 major amputations of the lower extremities. The ongoing trend of stable numbers of major lower-limb amputations from 2012 to 2019 continued in 2020 and 2021. The verification of these data at the level of prosthetic users confirmed that the annual trends were unchanged. ConclusionThe reported increased numbers of major lower-limb amputations during the COVID-19 pandemic in the Netherlands could not be confirmed using nationwide epidemiologic data.

Magnitude of limb loss attributable to diabetes mellitus in a tertiary institution in Nigeria

Background: Diabetes mellitus (DM) and its complications, continues to pose enormous challenge to health and financial stability. Diabetes has remained a source of national and global economic burden. It has been observed lately that incidence of diabetic foot ulcer (DFU); one of the complications of DM, is on the increase and it is contributing hugely to financial loss, morbidity and mortality among diabetic patients. This is taking a great toll on affected individuals in terms of cost of treatment, deformities sustained, number of working/productive days lost while on admission and its attendant economic implications, and ultimately mortalities recorded. The aim was to determine the magnitude of limb loss or lower extremity amputation attributable to DM over a period of 12 months in tertiary institution and to assess the clinical profile of the patients.&#x0D; Method: This is a retrospective study of the records of all patients that were consecutively booked for lower limb amputation and operated upon in the last 12 months at UNIOSUN Teaching Hospital, Osogbo, South-Western Nigeria. Out of these total, cases of DFU were extracted to form another study group and then studied in detail.&#x0D; Results: Atotal of 38 patients had lower limb amputation from July 2021 to May 2022. Twenty three of the total number of amputations had DFU with a huge proportion of 60.5%, followed by road traffic accident with 28.9% (n=11) Of the 23 diabetic cases , females were 15 with M:F ratio of 1:1.9. Mean age was 63±11.18 years. Mean duration of DM was 8.06±5.64 years. 78.3% had no foot care education and Doppler USS confirmed atherosclerosis in 100% of the patients. The commonest bacteria isolated was Proteus 34.8%. Length of hospital stay ranged between 6 weeks to 16 weeks. Outcome of admission was largely successful with 95.7% discharged and 4.3% mortality. &#x0D; Conclusion: DFU contributes markedly to morbidity and mortality. Long duration of DM, presence of PAD and DPN as well as advancement in age and wound infection with proteus bacterial are observed to be risk factors associated with gangrenous DFU. However, larger studies are needed to establish these factors as predictors of amputation in patient with DFU. Outcome was majorly good as majority of the patients were discharged.

Sex-Based Differences in Clinical Characteristics and Outcomes among Patients with Peripheral Artery Disease: A Retrospective Analysis.

Peripheral arterial disease (PAD) is a prevalent medical condition associated with high mortality and morbidity rates. Despite the high clinical burden, sex-based differences among PAD patients are not well defined yet, in contrast to other atherosclerotic diseases. This study aimed to describe sex-based differences in clinical characteristics and outcomes among hospitalized patients affected by PAD. This was a retrospective study evaluating all patients with a diagnosis of PAD admitted to the Emergency Department from 1 December 2013 to 31 December 2021. The primary endpoint of the study was the difference between male and female PAD patients in cumulative occurrence of Major Adverse Cardiovascular Events (MACEs) and Major Adverse Limb Events. A total of 1640 patients were enrolled. Among them, 1103 (67.3%) were males while females were significantly older (median age of 75 years vs. 71 years; p =< 0.001). Females underwent more angioplasty treatments for revascularization than men (29.8% vs. 25.6%; p = 0.04); males were treated with more amputations (19.9% vs. 15.3%; p = 0.012). A trend toward more MALEs and MACEs reported in the male group did not reach statistical significance (OR 1.27 [0.99-1.64]; p = 0.059) (OR 0.75 [0.50-1.11]; p = 0.153). However, despite lower extremity PAD severity seeming similar between the two sexes, among these patients males had a higher probability of undergoing lower limb amputations, of cardiovascular death and of myocardial infarction. Among hospitalized patients affected by PAD, even if there was not a sex-based significant difference in the incidence of MALEs and MACEs, adverse clinical outcomes were more common in males.

Mapping lines of non-extension in persons with lower limb amputation to aid comfort-driven prosthetic socket design.

This study aimed to develop a new technique to map the strain field for persons with lower-limb amputations to use for the design of comfortable prostheses. Using a DSLR camera with stenciled 2D markers, we demonstrated a technique to measure skin strain around the residual limb of persons with lower limb amputations. We used open-source software programs to reconstruct a series of cloud points derived from the pictures of the marked residual limb into 3D models, then calculated the minimum, maximum, and non-extension lines from directional strain fields. A DSLR camera was successful in capturing 2D markers. The maximum mean principal strain was 68% ± 14%, observed around the patella. The minimum compressive mean principal strain of -31% ± 4% was observed posteriorly in the popliteal region of the knee. Although lines of non-extension (LoNE) appear separate in different participants, they are anatomically located in regions that could be generalized for the design of prostheses. Marker locations extracted from the video of different poses can be compared to calculate strains from which the position of LoNE can be generated. The use of LoNE could be valuable in reducing discomfort at the socket interface and informing future socket design.

Is mirror therapy associated with progressive muscle relaxation more effective than mirror therapy alone in reducing phantom limb pain in patients with lower limb amputation?: Erratum.

Is mirror therapy associated with progressive muscle relaxation more effective than mirror therapy alone in reducing phantom limb pain in patients with lower limb amputation?: Erratum.

Association between statin-use and mobility and long-term survival after major lower limb amputation.

The aim of this study was to determine if there is an association between statin-use and prosthetic mobility and long-term survival in patients receiving rehabilitation after major amputation for lower limb arterial disease. A retrospective analysis of prospectively maintained data (2008-2020) from a centre for rehabilitation was performed. Patients were grouped by statin-use status and sub-grouped by the combination of statin and antithrombotic drugs (antiplatelets or anticoagulants). Outcomes were prosthetic mobility (SIGAM score, timed-up-go and 2-min walking distance) and long-term survival. Regression, Kaplan-Meier and Cox-proportional hazard analyses were performed to test associations adjusted to confounders. Of 771 patients, 499 (64.7%) were on a statin before amputation or prescribed a statin peri-operatively. Rate of statin-use was significantly lower among female (53.3%) compared to male (68.2%) patients, P < 0.001. Statin-use was associated with significantly better prosthetic independence (53.1% vs 44.1%, P = 0.017), timed-up-go (mean difference of 4 s, P = 0.04) and long-term survival HR 0.59 (0.48-0.72, P < 0.001). Significance persisted after adjusting for confounding factors and in subgroup analyses. The combination of statin with antiplatelet was associated with the most superior survival, HR 0.51 (0.40-0.65, P < 0.001). Sensitivity analysis (exclusion of non-users of prosthesis) showed that statin-use remained a significant indicator of longer survival, maximally when combined with antiplatelet use HR 0.52 (0.39-0.68, P < 0.001). Statin-use is associated with better mobility and long-term survival in rehabilitees after limb loss, particularly when used in combination with antiplatelets. Significantly lower rates of statin-use were observed in female patients. Further research is warranted on gender disparities in statin-use and causality in their association with improved mobility and survival.

Efficacy of Polyherbal Formulation (&lt;i&gt;Phalatrikadi Vati&lt;/i&gt;) in the Management of Type 2 Diabetes Mellitus through Metabolic Correction – A Clinical Study

Background: Diabetes mellitus is a prevalent metabolic disorder worldwide; its incidents have grown notably in recent years. Over the last 50 years, lifestyle changes have led to a dramatic increase in the prevalence of type 2 diabetes around the world. India has been projected as the diabetic capital of the world. Diabetes and its complications pose a major threat to future public health resources throughout the world and are the major cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation. In the southern part of India, the mortality rate due to diabetes mellitus is in fifth rank amongst the ten vital causes of death. Despite recent advances in knowledge, preventing and controlling diabetes remain a major challenge. So the present study has focused on the disease pathogenesis and its regulation through Polyherbal formulation (Phalatrikadi Vati). Objectives: To determine the efficacy of Polyherbal formulation in reducing the subjective complaints in Type 2 Diabetes Mellitus by metabolic corrections and thereby controlling the blood glucose level in the body. Methods: A single arm open labeled trial with 1 month in duration. Participants: 25 patients of Diabetes Mellitus Type 2 with diagnosed, high fasting blood sugar and postprandial blood sugar levels. 500mg tablet was given in twice a day after food. Results: A total of 30 patients enrolled in the study and 25 patients completed the treatment. Significant relief of 68% in polyuria, 56% in urine turbidity, 84% in polyphagia, and 76% in polydipsia seen. There was a highly significant reduction in FBS with a mean difference of 31.84 mg and PPBS with a mean difference of 63.92 mg. Conclusion: The polyherbal formulation is a safe intervention and can be expected to reduce the symptoms of Type 2 Diabetes Mellitus and blood sugar levels. Future studies with larger sample sizes, longer duration of intervention and follow up needed for more accurate and reliable results.

An eight-year analysis of participant characteristics at admission to inpatient prosthetic rehabilitation following a lower limb amputation: a Canadian perspective

Purpose To describe admission and discharge characteristics of participants admitted to prosthetic rehabilitation following a lower limb amputation and determine changes in participant characteristics including if the population has gotten older over time at admission. Methods A retrospective chart audit of consecutive admissions to an amputee rehabilitation program. Study criteria were transtibial level LLA and above and ≥ 18 years old. Admission characteristics included: age, Montreal Cognitive Assessment (MoCA), Functional Comorbidity Index (FCI) and days between amputation surgery and admission. Discharge characteristics included the L -Test of Functional Mobility (L-Test), 2-Minute Walk Test (2MWT), 6-Minute Walk Test (6MWT), and Activities-specific Balance Confidence (ABC) scale. Multivariable linear regression modelling quantified the association between participant characteristics and admission time. Results A total of 601 participants (62.3 ± 14.1 years) were included, 63 were (84.9 ± 3.7 years) aged 80 and over. FCI scores [β = 70.34, (95% CI: 20.93, 119.74), p = 0.005] and days between amputation surgery [β = −0.08, (95% CI: −0.13, −0.02), p = 0.011] were independently associated with admission time. Conclusion People with an LLA are presenting with a higher number of comorbidities at admission over time while being admitted faster from amputation surgery. Future research should investigate the impact of these changing characteristics on rehabilitation outcomes to better assist this population.