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  1 / 2308 MEDLINE  
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PMID:28113632
Autor:Dumas R; Branemark R; Frossard L
Título:Gait Analysis of Transfemoral Amputees: Errors in Inverse Dynamics Are Substantial and Depend on Prosthetic Design.
Fuente:IEEE Trans Neural Syst Rehabil Eng; 25(6):679-685, 2017 Jun.
ISSN:1558-0210
País de publicación:United States
Idioma:eng
Resumen:Quantitative assessments of prostheses performances rely more and more frequently on gait analysis focusing on prosthetic knee joint forces and moments computed by inverse dynamics. However, this method is prone to errors, as demonstrated in comparison with direct measurements of these forces and moments. The magnitude of errors reported in the literature seems to vary depending on prosthetic components. Therefore, the purposes of this study were (A) to quantify and compare the magnitude of errors in knee joint forces and moments obtained with inverse dynamics and direct measurements on ten participants with transfemoral amputation during walking and (B) to investigate if these errors can be characterised for different prosthetic knees. Knee joint forces and moments computed by inverse dynamics presented substantial errors, especially during the swing phase of gait. Indeed, the median errors in percentage of the moment magnitude were 4% and 26% in extension/flexion, 6% and 19% in adduction/abduction as well as 14% and 27% in internal/external rotation during stance and swing phase, respectively. Moreover, errors varied depending on the prosthetic limb fitted with mechanical or microprocessor-controlled knees. This study confirmed that inverse dynamics should be used cautiously while performing gait analysis of amputees. Alternatively, direct measurements of joint forces and moments could be relevant for mechanical characterising of components and alignments of prosthetic limbs.
Tipo de publicación:CLINICAL TRIAL; JOURNAL ARTICLE


  2 / 2308 MEDLINE  
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PMID:28993523
Autor:Tropea P; Mazzoni A; Micera S; Corbo M
Dirección:From The BioRobotics Institute (P.T., A.M., S.M.), Scuola Superiore Sant'Anna, Pisa, Italy; Department of Neurorehabilitation Sciences (P.T., M.C.), Casa Cura Policlinico, Milan, Italy; and Translational Neural Engineering Laboratory, Center for Neuroprosthetics (S.M.), Swiss Federal Institute of Te
Título:Giuliano Vanghetti and the innovation of "cineplastic operations".
Fuente:Neurology; 89(15):1627-1632, 2017 Oct 10.
ISSN:1526-632X
País de publicación:United States
Idioma:eng
Resumen:OBJECTIVE: Developing functional artificial limbs for amputees has been a centuries-old challenge in medicine. We review the mechanical and neurologic principles of "cineplastic operations" and "plastic motors" used to restore movements in prostheses, with special attention to the work of Giuliano Vanghetti. METHODS: We evaluated original publications describing cineplastic operations, biographic information, writings, drawings, and unpublished letters from the Vanghetti library, preserved in Empoli, Italy, and performed a bibliographic search and comparison for similar procedures in the literature. RESULTS: Vanghetti's method for cineplastic operations differs from similar previous methods, being the first aimed at exploiting natural movements of the remnant muscles to activate the mechanical prosthesis, and the first to do so by directly connecting the prosthesis to the residual muscles and tendons. This represented a frame-changing innovation for that time and paved the way for current neuroprosthetic approaches. The first description of the method was published in 1898 and human studies started in 1900. The results of these studies were presented in 1905 and published in 1906 in . A German surgeon, Ferdinand Sauerbruch, often acknowledged as the inventor of the method, published his first results in 1915. CONCLUSIONS: Vanghetti was the first to accurately perform and describe cineplastic operations for patients following an upper arm amputation. He considered the neurologic implications of the problem and, perhaps in an effort to provide more appropriate proprioceptive feedback, he intuitively applied the prostheses so that they were functionally activated by the muscles of the proximal stump.
Tipo de publicación:HISTORICAL ARTICLE; JOURNAL ARTICLE; REVIEW
Nombre personal como asunto:Vanghetti G


  3 / 2308 MEDLINE  
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PMID:28339333
Autor:Batsford S; Ryan CG; Martin DJ
Dirección:a School of Health and Social Care , Teesside University , Middlesbrough , UK.
Título:Non-pharmacological conservative therapy for phantom limb pain: A systematic review of randomized controlled trials.
Fuente:Physiother Theory Pract; 33(3):173-183, 2017 Mar.
ISSN:1532-5040
País de publicación:England
Idioma:eng
Resumen:The aim of this manuscript was to investigate the effectiveness of conservative therapy for phantom limb pain (PLP). In this systematic review, CINAHL, AMED, the Cochrane database of systematic reviews, PEDro, psychology and behavioral sciences collection, and MEDLINE were systematically searched for appropriate randomized controlled trials (RCTs). Selected papers were assessed for risk of bias, and evidence was graded using the GRADE approach. Twelve RCTs met initial inclusion/exclusion criteria, of which five were of sufficient quality for final inclusion. There is conflicting evidence from two RCTs for the effectiveness of electromagnetic shielding limb liners on pain in the short term. There is limited evidence supporting the effectiveness of both hypnosis in the short term and graded motor imagery (GMI) in the short-to-medium term. Additionally, there is limited evidence that a single session of mirror therapy has no immediate effect on PLP. Limb liner discomfort was the only adverse effect identified. This review identifies a range of conservative therapies, many of which demonstrate preliminary evidence of potential with respect to clinically worthwhile effects above control interventions and few, if any, adverse effects. However, there is a paucity of high-quality evidence upon which to make any firm clinical conclusions.
Tipo de publicación:JOURNAL ARTICLE; REVIEW


  4 / 2308 MEDLINE  
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PMID:28641140
Autor:Abdelhafez MM; Shaw J; Sutter D; Schnider J; Banz Y; Jenni H; Voegelin E; Constantinescu MA; Rieben R
Dirección:Department of Clinical Research, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland. Electronic address: mai.abdelhafez@dkf.unibe.ch.
Título:Effect of C1-INH on ischemia/reperfusion injury in a porcine limb ex vivo perfusion model.
Fuente:Mol Immunol; 88:116-124, 2017 Aug.
ISSN:1872-9142
País de publicación:England
Idioma:eng
Resumen:Revascularization of an amputated limb within 4-6h is essential to avoid extensive ischemia/reperfusion (I/R) injury leading to vascular leakage, edema and tissue necrosis. I/R injury is a pathological inflammatory condition that occurs during reperfusion of an organ or tissue after prolonged ischemia. It is characterized by a complex crosstalk between endothelial cell activation and the activation of plasma cascades. Vasculoprotective pharmacological intervention to prevent I/R injury might be an option to prolong the time window between limb amputation and successful replantation. We used C1-easterase inhibitor (C1-INH) in this study because of its known inhibitory effects on the activation of the complement, coagulation and kinin cascades. Forelimbs of 8 large white pigs were amputated, subjected to ischemia, and then reperfused with autologous whole blood. All limbs were exposed to 9h of cold ischemia at 4°C. After 2h of cold ischemia the limbs were either perfused with of C1-INH (1U/ml in hydroxyethyl starch, n=8) or hydroxyethyl starch alone (n=7). After completion of the 9-h ischemia period, all limbs were ex vivo perfused with heparinized autologous whole blood for 12h using a pediatric heart lung machine to simulate in vivo revascularization. Our results show that I/R injury in the control group led to a significant elevation of tissue deposition of IgG and IgM, complement C3b/c, C5b-9 and MBL. Also, activation of the kinin system was significantly increased, namely bradykinin in plasma, and expression of bradykinin receptors 1 and 2 in tissue. In addition, markers for endothelial integrity like expression of CD31, VE-cadherin and heparan sulfate proteoglycans were decreased in reperfused tissue. Limb I/R injury also led to activation of the coagulation cascade with a significant elevation of fibrin and thrombin deposition and increased fibrinogen-like protein-2 expression. C1-INH treated limbs showed much less activation of plasma cascades and better protection of endothelial integrity compared to the reperfused control limbs. In conclusion, the use of the cytoprotective drug C1-INH significantly reduced I/R injury by protecting the vascular endothelium as well as the muscle tissue from deposition of immunoglobulins, complement and fibrin.
Tipo de publicación:JOURNAL ARTICLE
Nombre de substancia:0 (Complement C1 Inhibitor Protein); 0 (Complement Membrane Attack Complex); 0 (Hydroxyethyl Starch Derivatives); 0 (Immunoglobulin G); 0 (Immunoglobulin M); 0 (Receptors, Bradykinin); 80295-43-8 (Complement C3b); 9001-31-4 (Fibrin); 9001-32-5 (Fibrinogen); EC 3.4.21.5 (Thrombin); S8TIM42R2W (Bradykinin)


  5 / 2308 MEDLINE  
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PMID:28249981
Autor:Chimutengwende-Gordon M; Pendegrass C; Blunn G
Dirección:Centre for Biomedical Engineering, Institute of Orthopaedics and Musculoskeletal Science, Division of Surgery and Interventional Science, University College London, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
Título:The effect of a porous titanium alloy flange with hydroxyapatite, silver and fibronectin coatings on soft-tissue integration of intraosseous transcutaneous amputation prostheses.
Fuente:Bone Joint J; 99-B(3):393-400, 2017 Mar.
ISSN:2049-4408
País de publicación:England
Idioma:eng
Resumen:AIMS: The Intraosseous Transcutaneous Amputation Prosthesis (ITAP) may improve quality of life for amputees by avoiding soft-tissue complications associated with socket prostheses and by improving sensory feedback and function. It relies on the formation of a seal between the soft tissues and the implant and currently has a flange with drilled holes to promote dermal attachment. Despite this, infection remains a significant risk. This study explored alternative strategies to enhance soft-tissue integration. MATERIALS AND METHODS: The effect of ITAP pins with a fully porous titanium alloy flange with interconnected pores on soft-tissue integration was investigated. The flanges were coated with fibronectin-functionalised hydroxyapatite and silver coatings, which have been shown to have an antibacterial effect, while also promoting viable fibroblast growth The ITAP pins were implanted along the length of ovine tibias, and histological assessment was undertaken four weeks post-operatively. RESULTS: The porous titanium alloy flange reduced epithelial downgrowth and increased soft-tissue integration compared with the current drilled flange. The addition of coatings did not enhance these effects. CONCLUSION: These results indicate that a fully porous titanium alloy flange has the potential to increase the soft-tissue seal around ITAP and reduce susceptibility to infection compared with the current design. Cite this article: 2017;99-B:393-400.
Tipo de publicación:JOURNAL ARTICLE
Nombre de substancia:0 (Alloys); 0 (Coated Materials, Biocompatible); 0 (Fibronectins); 3M4G523W1G (Silver); 91D9GV0Z28 (Durapatite); D1JT611TNE (Titanium)


  6 / 2308 MEDLINE  
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PMID:28164748
Autor:McGrath MP; Gao J; Tang J; Laszczak P; Jiang L; Bader D; Moser D; Zahedi S
Dirección:1 Faculty of Engineering and the Environment, University of Southampton, Southampton, UK.
Título:Development of a residuum/socket interface simulator for lower limb prosthetics.
Fuente:Proc Inst Mech Eng H; 231(3):235-242, 2017 Mar.
ISSN:2041-3033
País de publicación:England
Idioma:eng
Resumen:Mechanical coupling at the interface between lower limb residua and prosthetic sockets plays an important role in assessing socket fitting and tissue health. However, most research lab-based lower limb prosthetic simulators to-date have implemented a rigid socket coupling. This study describes the fabrication and implementation of a lower limb residuum/socket interface simulator, designed to reproduce the forces and moments present during the key loading phases of amputee walking. An artificial residuum made with model bones encased in silicone was used, mimicking the compliant mechanical loading of a real residuum/socket interface. A 6-degree-of-freedom load cell measured the overall kinetics, having previously been incorporated into an amputee's prosthesis to collect reference data. The developed simulator was compared to a setup where a rigid pylon replaced the artificial residuum. A maximum uniaxial load of 850 N was applied, comparable to the peak vertical ground reaction force component during amputee walking. Load cell outputs from both pylon and residuum setups were compared. During weight acceptance, when including the artificial residuum, compression decreased by 10%, while during push off, sagittal bending and anterior-posterior shear showed a 25% increase and 34% decrease, respectively. Such notable difference by including a compliant residuum further highlighted the need for such an interface simulator. Subsequently, the simulator was adjusted to produce key load cell outputs briefly aligning with those from amputee walking. Force sensing resistors were deployed at load bearing anatomic locations on the residuum/socket interface to measure pressures and were compared to those cited in the literature for similar locations. The development of such a novel simulator provides an objective adjunct, using commonly available mechanical test machines. It could potentially be used to provide further insight into socket design, fit and the complex load transfer mechanics at the residuum/socket interface, as well as to evaluate the structural performance of prostheses.
Tipo de publicación:JOURNAL ARTICLE


  7 / 2308 MEDLINE  
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PMID:28179478
Autor:Cirstea CM; Choi IY; Lee P; Peng H; Kaufman CL; Frey SH
Dirección:Department of Physical Medicine and Rehabilitation, University of Missouri, Columbia, Missouri; cirsteac@health.missouri.edu.
Título:Magnetic resonance spectroscopy of current hand amputees reveals evidence for neuronal-level changes in former sensorimotor cortex.
Fuente:J Neurophysiol; 117(4):1821-1830, 2017 Apr 01.
ISSN:1522-1598
País de publicación:United States
Idioma:eng
Resumen:Deafferentation is accompanied by large-scale functional reorganization of maps in the primary sensory and motor areas of the hemisphere contralateral to injury. Animal models of deafferentation suggest a variety of cellular-level changes including depression of neuronal metabolism and even neuronal death. Whether similar neuronal changes contribute to patterns of reorganization within the contralateral sensorimotor cortex of chronic human amputees is uncertain. We used functional MRI-guided proton magnetic resonance spectroscopy to test the hypothesis that unilateral deafferentation is associated with lower levels of -acetylaspartate (NAA, a putative marker of neuronal integrity) in the sensorimotor hand territory located contralateral to the missing hand in chronic amputees ( 19) compared with the analogous hand territory of age- and sex-matched healthy controls ( 28). We also tested whether former amputees [i.e., recipients of replanted ( 3) or transplanted ( 2) hands] exhibit NAA levels that are indistinguishable from controls, possible evidence for reversal of the effects of deafferentation. As predicted, relative to controls, current amputees exhibited lower levels of NAA that were negatively and significantly correlated with the time after amputation. Contrary to our prediction, NAA levels in both replanted and transplanted patients fell within the range of the current amputees. We suggest that lower levels of NAA in current amputees reflects altered neuronal integrity consequent to chronic deafferentation. Thus local changes in NAA levels may provide a means of assessing neuroplastic changes in deafferented cortex. Results from former amputees suggest that these changes may not be readily reversible through reafferentation. This study is the first to use functional magnetic resonance-guided magnetic resonance spectroscopy to examine neurochemical mechanisms underlying functional reorganization in the primary somatosensory and motor cortices consequent to upper extremity amputation and its potential reversal through hand replantation or transplantation. We provide evidence for selective alteration of cortical neuronal integrity associated with amputation-related deafferentation that may not be reversible.
Tipo de publicación:JOURNAL ARTICLE
Nombre de substancia:30KYC7MIAI (Aspartic Acid); 997-55-7 (N-acetylaspartate)


  8 / 2308 MEDLINE  
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PMID:28280002
Autor:Zayed MA; Wei X; Park KM; Belaygorod L; Naim U; Harvey J; Yin L; Blumer K; Semenkovich CF
Dirección:Section of Vascular Surgery, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA; zayedm@wustl.edu.
Título:-Acetylcysteine accelerates amputation stump healing in the setting of diabetes.
Fuente:FASEB J; 31(6):2686-2695, 2017 Jun.
ISSN:1530-6860
País de publicación:United States
Idioma:eng
Resumen:Over 60% of lower extremity amputations are performed in patients with diabetes and peripheral arterial disease, and at least 25% require subsequent reamputation due to poor surgical site healing. The mechanisms underlying poor amputation stump healing in the setting of diabetes are not understood. -acetylcysteine (NAC) is known to promote endothelial cell function and angiogenesis and may have therapeutic benefits in the setting of diabetes. We tested the hypothesis that NAC alters the vascular milieu to improve healing of amputation stumps in diabetes using a novel murine hindlimb ischemia-amputation model. Amputation stump tissue perfusion and healing were evaluated in C57BL/6J adult mice with streptozotocin-induced diabetes. Compared with controls, mice treated with daily NAC demonstrated improved postamputation stump healing, perfusion, adductor muscle neovascularization, and decreased muscle fiber damage. Additionally, NAC stimulated HUVEC migration and proliferation in a phospholipase C ß-dependent fashion and decreased Gαq palmitoylation. Similarly, NAC treatment also decreased Gαq palmitoylation in ischemic and nonischemic hindlimbs In summary, we demonstrate that NAC accelerates healing of amputation stumps in the setting of diabetes and ischemia. The underlying mechanism appears to involve a previously unrecognized effect of NAC on Gαq palmitoylation and phospholipase C ß-mediated signaling in endothelial cells.-Zayed, M. A., Wei, X., Park, K., Belaygorod, L., Naim, U., Harvey, J., Yin, L., Blumer, K., Semenkovich, C. F. -acetylcysteine accelerates amputation stump healing in the setting of diabetes.
Tipo de publicación:JOURNAL ARTICLE
Nombre de substancia:0 (Reactive Oxygen Species); WYQ7N0BPYC (Acetylcysteine)


  9 / 2308 MEDLINE  
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PMID:28195886
Autor:Mongon MLD; Ribera FC; de Souza AMA; Sposito AL; Belangero WD; Livani B
Dirección:*State Hospital of Sumare of the State University of Campinas, HES-UNICAMP †Paulo Sacramento Hospital, Jundiaí ‡The Department of Orthopedics and Traumatology Surgery of the State University of Campinas, UNICAMP, Maxsuelton Alves de Souza §The State University of Campinas, HC-UNICAMP, Campinas, SP, Brazil.
Título:Pedicled Sensate Composite Calcaneal Flap in Children With Congenital Tibial Pseudoarthrosis.
Fuente:J Pediatr Orthop; 37(4):e271-e276, 2017 Jun.
ISSN:1539-2570
País de publicación:United States
Idioma:eng
Resumen:BACKGROUND: The preservation and functionality of a limb affected by a malformation (such as congenital pseudoarthrosis of the tibia) or a severely mangled lower limb in children, despite modern reconstructive techniques, remains challenging, often eventually requiring amputation to achieve a better outcome. The classical Syme and Boyd procedures are functionally better than transtibial (TT) amputation, but are not feasible for congenital tibial pseudoarthrosis. TT amputation delivers an excellent, effective, and functional stump that usually leads, after prosthetization, to a functional gait. Unfortunately, in some situations, particularly when amputation is performed conventionally, the stump is also associated with complications. Future surgical revisions are often needed, particularly in children, because of stump overgrowth. METHODS: Between 2008 and 2010, three patients diagnosed with congenital pseudoarthrosis of the tibia associated with neurofibromatosis who were indicated for TT amputation with calcaneal flap after failure of all previous surgical reconstructive procedures were selected. The chosen method for osteosynthesis was an external fixator of Ilizarov. RESULTS: At 12 weeks of follow-up, the stump had healed in all three patients, and tibiocalcaneal fusion was achieved without complications. All patients were prosthetized and had an asymptomatic gait. After a minimum follow-up of 6 years, all three cases with the pedicled sensate composite calcaneal flap still had a strong, full weight-bearing surface and have adapted easily to the conventional prosthesis, providing a painless stump with excellent functionality. CONCLUSION: With a 0 rate of needed revisions, all 3 cases with the pedicled sensate composite calcaneal flap preserving the hind foot still have a strong, full weight-bearing surface and have easily adapted to the conventional prosthesis, providing a painless and excellent functional stump that could last a lifetime. LEVEL OF EVIDENCE: Level IV.
Tipo de publicación:JOURNAL ARTICLE


  10 / 2308 MEDLINE  
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PMID:28232236
Autor:Xu H; Greenland K; Bloswick D; Zhao J; Merryweather A
Dirección:School of Medical Imaging, Xuzhou Medical University, Xuzhou, China; Department of Mechanical Engineering, University of Utah, Salt Lake City, UT, USA. Electronic address: h_xu@xzmc.edu.cn.
Título:Vacuum level effects on gait characteristics for unilateral transtibial amputees with elevated vacuum suspension.
Fuente:Clin Biomech (Bristol, Avon); 43:95-101, 2017 Mar.
ISSN:1879-1271
País de publicación:England
Idioma:eng
Resumen:BACKGROUND: The elevated vacuum suspension system has demonstrated unique health benefits for amputees, but the effect of vacuum pressure values on gait characteristics is still unclear. The purpose of this study was to investigate the effects of elevated vacuum levels on temporal parameters, kinematics and kinetics for unilateral transtibial amputees. METHODS: Three-dimensional gait analysis was conducted in 9 unilateral transtibial amputees walking at a controlled speed with five vacuum levels ranging from 0 to 20inHg, and also in 9 able-bodied subjects walking at self-preferred speed. Repeated ANOVA and Dunnett's t-test were performed to determine the effect of vacuum level and limb for within subject and between groups. FINDINGS: The effect of vacuum level significantly affected peak hip external rotation and external knee adduction moment. Maximum braking and propulsive ground reaction forces generally increased for the residual limb and decreased for the intact limb with increasing vacuum. Additionally, the intact limb experienced an increased loading due to gait asymmetry for several variables. INTERPRETATION: There was no systematic vacuum level effect on gait. Higher vacuum levels, such as 15 and 20inHg, were more comfortable and provided some relief to the intact limb, but may also increase the risk of osteoarthritis of the residual limb due to the increased peak external hip and knee adduction moments. Very low vacuum should be avoided because of the negative effects on gait symmetry. A moderate vacuum level at 15inHg is suggested for unilateral transtibial amputees with elevated vacuum suspension.
Tipo de publicación:JOURNAL ARTICLE



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