Evaluation of surgical results in lower limb atherosclerotic ischemia comparing men and women]

Multicenter studies involved 1449 male and 131 female patients operated for the atherosclerotic ischemia of the lower limbs. About 50% of all limbs were in the III or IV stage of ischemia (according to Fontaine's classification) before surgery. Atherosclerotic lesions involved mainly aortoiliac segment in the majority of patients. Early results of surgery were similar in both men and women. An improvement during a 5-year follow up period was noted more frequently in women than in men--86% and 68.5% of limbs respectively. Late result of lumbar sympathectomy was similar in both groups. Limb amputation and mortality rates were similar in both groups in the early postoperative period and during a 5-year follow up as well.     

Neoplastic diseases of the hematopoietic system and ischemia of the lower limbs]

The possible interaction between hematopoietic neoplasms and ischemia of the lower limbs in patients with both pathologies was subjected to analysis. Anaemia, polycythemia, thrombocythemia, increased leucocytosis in the peripheral blood, and hyperuricemia exerted unfavourable effect on the blood flow through the arteries of the lower limbs. In some cases effective cytostatic treatment diminished the ischemia of the lower limbs. Interactions between various drugs used in the chronic treatment of both pathologies in the same patient was also examined.     

Mass, center of mass, and moment of inertia estimates for infant limb segments.

To quantify limb dynamics, accurate estimates are needed of anthropometric inertia parameters (mass, center-of-mass location, and moments of inertia). These estimates, however, are not available for human infants; therefore, the movement dynamics of infants have not been studied extensively. Here, regression equations for the masses, center-of-mass locations, and transverse moments of inertia of upper and lower limb segments (upper arm, forearm, and hand; thigh, leg, and foot) of 0.04 to 1.50 yr old infants are provided. A mathematical model of the human body was used to determine the anthropometric inertia parameters for upper limbs in 44 infants and for lower limbs in 70 infants. Stepwise linear regressions were used to fit the distributions of the anthropometric inertia parameters. The regression equations accounted for significant amounts of the variance (64-98%), and the R2-values compared favorably when our equations were cross-validated. Consequently, these regression equations can provide, for infants of similar ages, reasonable estimates of upper and lower limb anthropometric inertia parameters, suitable for equations of motion in the analysis of limb dynamics in human infants.     

Impact clinique et thérapeutique de l’acquisition corps entier en TEP/TDM au 18F-FDG chez les patients suivis pour mélanome malin

ObjectiveTo assess the added benefit of scanning lower limbs in addition to usual whole-body PET/CT scan in patients with no known or suspected primary or metastatic melanoma involving the lower limbs.Materials and methodsThis is a retrospective study of 133 consecutive patients (189 FDG PET/CT) who underwent FDG PET/CT for staging of melanoma at different time points in the course of disease from October 2005 to July 2009 at Brest University Hospital. Reports of whole-body PET/CT scans including lower limbs were reviewed. PET/CT abnormalities on the lower extremities were tabulated by location and correlated with pathology, other imaging studies and at least a 6-month clinical follow-up.ResultsAmong the 189 consecutive PET/CT scans performed in 133 patients, 34 scans in 29 patients highlighted abnormal FDG uptakes considered as equivocal or suggestive of malignancy on lower limbs. In 29 cases, uptakes were located both on lower limbs and on the rest of the body (lung, liver, mediastinal and sub-diaphragmatic lymph nodes, adrenal glands, bone) corresponding to disseminated disease. In five cases, PET/CT uptakes were located only on lower limbs; each pathological uptake corresponded to benign lesions. Lower limbs findings never impacted clinical and therapeutic decision.ConclusionLower limbs additional PET/CT acquisition appears to offer poor additional benefit with no unexpected solitary lesion detected and routine skull base to upper thigh images may be sufficient for this subset of patients.     

Neural coupling between upper and lower limbs during recumbent stepping.

During gait rehabilitation, therapists or robotic devices often supply physical assistance to a patient's lower limbs to aid stepping. The expensive equipment and intensive manual labor required for these therapies limit their availability to patients. One alternative solution is to design devices where patients could use their upper limbs to provide physical assistance to their lower limbs (i.e., self-assistance). To explore potential neural effects of coupling upper and lower limbs, we investigated neuromuscular recruitment during self-driven and externally driven lower limb motion. Healthy subjects exercised on a recumbent stepper using different combinations of upper and lower limb exertions. The recumbent stepper mechanically coupled the upper and lower limbs, allowing users to drive the stepping motion with upper and/or lower limbs. We instructed subjects to step with 1) active upper and lower limbs at an easy resistance level (active arms and legs); 2) active upper limbs and relaxed lower limbs at easy, medium, and hard resistance levels (self-driven); and 3) relaxed upper and lower limbs while another person drove the stepping motion (externally driven). We recorded surface electromyography (EMG) from six lower limb muscles. Self-driven EMG amplitudes were always higher than externally driven EMG amplitudes (P < 0.05). As resistance and upper limb exertion increased, self-driven EMG amplitudes also increased. EMG bursts during self-driven and active arms and legs stepping occurred at similar times. These results indicate that active upper limb movement increases neuromuscular activation of the lower limbs during cyclic stepping motions. Neurologically impaired humans that actively engage their upper limbs during gait rehabilitation may increase neuromuscular activation and enhance activity-dependent plasticity.     

四肢骨折矫形术后患者慢性手术后疼痛的发生率及其危险因素分析

目的:研究四肢骨折矫形术后患者慢性手术后疼痛的发生率及其危险因素。方法:以2014年12月-2017年10月于我院接受四肢骨折矫形术患者300例为研究对象,于术后6个月分析慢性手术后疼痛的发生率。收集所有患者年龄、性别、体重、术前疼痛程度、二次手术、麻醉方式、术后镇痛、术后引流、合并骨质疏松、骨折类型以及骨折部位等资料,并采用单因素以及多因素Logistic回归分析术后疼痛的危险因素。结果:术后6个月内有96名患者术后发生慢性手术后疼痛,发生率为32.00%(96/300)。单因素分析结果显示:慢性手术后疼痛患者与术前疼痛程度、是否二次手术、麻醉方式、术后有无镇痛、是否合并骨质疏松、骨折类型、骨折部位有关(P0.05),与患者的性别、年龄、体重、术后是否引流无关(P0.05)。多因素Logistic回归分析结果显示:术前重度疼痛、二次手术、麻醉方式为非全麻、术后无镇痛、合并骨质疏松、开放性骨折以及下肢骨折均是四肢骨折矫形术后发生慢性手术后疼痛的独立危险因素(P0.05)。结论:四肢骨折矫形术后患者慢性手术后疼痛的发生率较高,术前重度疼痛、二次手术、麻醉方式为非全麻、术后无镇痛、合并骨质疏松、开放性骨折以及下肢骨折均增加了慢性手术后疼痛的发生风险,临床应根据危险因素给予针对性的干预措施。     

A mathematical programming approach for gene selection and tissue classification

MOTIVATION: Extracting useful information from expression levels of thousands of genes generated with microarray technology needs a variety of analytical techniques. Mathematical programming approaches for classification analysis outperform parametric methods when the data depart from assumptions underlying these methods. Therefore, a mathematical programming approach is developed for gene selection and tissue classification using gene expression profiles. RESULTS: A new mixed integer programming model is formulated for this purpose. The mixed integer programming model simultaneously selects genes and constructs a classification model to classify two groups of tissue samples as accurately as possible. Very encouraging results were obtained with two data sets from the literature as examples. These results show that the mathematical programming approach can rival or outperform traditional classification methods.     

Electrophysiological Follow-Up of Patients with Chronic Peripheral Neuropathy Induced by Occupational Intoxication with n-Hexane

The aim of this study is to characterize and dynamically monitor the progress of peripheral neuropathy induced by n-hexane by electromyography and nerve conduction velocity (NCV-EMG). Twenty-five patients with n-hexane poisoning from an electronic company were investigated in the year 2009. The occupational history of these workers was collected, and toxic substance exposure was identified. Neurologic inspection and regular NCV-EMG inspection were performed for all patients upon hospital admission and after 3, 6, and 12 months of treatment. NCV-EMG results shown that patients with n-hexane poisoning have simultaneous damage on motor and sensory nerves, of which sensory nerve damage was more severe. Motor nerves of the lower limbs were severe damaged than those of the upper limbs; whereas injury of sensory nerve in the upper limbs was more severe than that of the lower limbs. After treatment, clinical signs and symptoms of the patients were significantly improved. NCV-EMG result showed a delayed worsening at 3 months then gradually recovered after 12 months. Recovery of the motor nerve was better compared with sensory nerve, with upper limbs faster than that of the lower limbs.     

虚拟场景的下肢康复训练系统的设计与实现

大多数的脑卒中患者在下肢运动方面有障碍,给其生活带来了极大的不便,进行及时有效的康复训练是恢复下肢运动功能的关键。传统的下肢康复训练过程中重复性高,患者的参与度低和互动性差。为了解决该问题,本研究设计了一种基于虚拟场景的下肢康复训练系统。该系统实现了结合虚拟现实技术进行下肢康复训练和评估,采集和处理足底压力数据,控制虚拟场景中虚拟元素,显示训练的时间、得分和训练过程中足底压力的最大值、平均值。该系统由下位机硬件和上位机软件构成。硬件系统包括力传感模块和数据采集模块;软件系统是由虚拟场景模块和人机交互模块构成。基于SPSS软件的分析数据结果表明,系统不仅可以准确的采集足底脚掌与脚跟的压力值,而且组内相关系数均大于0.9,系统具有很好的可靠性。本研究的虚拟场景的趣味性很高,能有效地提高患者训练的积极性,并有利于医生制定针对性的康复计划。     

L’échographie doppler dans la prévention des amputations des membres inférieurs du diabétique en Côte d’Ivoire

ObjectiveThe aim of this study was to demonstrate the role of the Doppler ultrasound examination in the management of diabetic feet and particularly in the prevention of the diabetic's amputation.Patients and methodIt is about a retrospective study carried out over a 4-year period at Yopougon University Hospital (Abidjan, Côte d’Ivoire). It consisted in the analysis of the records of 78 patients hospitalized for diabetic foot and in whom was performed a Doppler ultrasound examination of the lower limbs vessels. The analysis of patients’ records helped to bring out the epidemiological, clinical, radiographic, biologic, therapeutic and evolutional elements.ResultsPatients’ mean age was 57.6 years. The sex ratio was 1.05. Adult diabetes accounted for 93.5% of cases and had been developing for 11.49 years on average. On the Doppler ultrasound scan of the lower limbs arterial anomalies of these limbs were found in 70 cases. They were associated with a venous anomaly in four cases. Arterial anomalies were represented by stenosis (34 cases), occlusions (10 cases), medialarterosclerosis (four cases), small arteries (six cases) and the associations of several elementary lesions (nine cases). In three cases, the arterial abnormality was not indicated. A medical treatment was instituted for all the patients. The outcome was favorable for 61 patients, 13 were amputated and four deaths were recorded.ConclusionColor Doppler ultrasound examination of lower limbs vessels helped to bring out a vascular anomaly in 89.7% of patients with diabetic foot whose treatment helped to keep the lower limb in 78.2%. We recommend the systematic request of this examination in the African diabetic with adult diabetes which has been developing for more than 10 years before the onset of diabetic foot.     

2型糖尿病周围血管病的危险因素分析

目的:探讨2型糖尿病周围血管病发病的风险因素。方法:随机选取342例2型糖尿病患者,其中279例2型糖尿病合并周围血管病,63例未合并周围血管病,对比分析两组的性别、年龄、BMI指数、病程、有无吸烟史、有无高血压病史、尿酸、胱抑素C、总胆红素、直接胆红素、间接胆红素、前白蛋白等。依据双下肢动脉狭窄程度将279例合并周围血管病患者分为4组:狭窄率50%(组1)、狭窄率50%至75%(组2)、狭窄率75%(组3)、下肢闭塞(组4),分析和比较不同狭窄程度组间上述各项基础资料及指标间差异,危险因素采用多元Logistic回归分析。结果:下肢动脉狭窄程度与胱抑素C为正相关关系(r=0.227,P0.05);下肢动脉狭窄程度与前白蛋白为负相关关系(r=-0.181,P0.05)。结论:胱抑素C为2型糖尿病周围血管病的危险因素,前白蛋白为2型糖尿病周围血管病的保护因素,临床可将二者用于糖尿病周围血管病患者的诊治监测指标。     

Searching for biomarkers of heart failure in the mass spectra of blood plasma

We have developed a technique for analysing blood plasma using MALDI-MS with subsequent data analysis to identify significant and specific differences between heart failure (HF) patients and healthy individuals. A training dataset comprising 100 HF patients and 100 healthy individuals was used to search for biomarkers (m/z range 1000-10,000). EWP cartridges when used in tandem with microcon centrifugal filters were found to give the best results. A data management chain including event binning, background subtraction and feature extraction was developed to reduce the data, and statistical analysis was used to map feature intensities on to a common scale. Various mathematical approaches including a simple cumulative score, support vector machines (SVM) and genetic algorithms (GAs) were then used to combine the results from individual features and provide a robust classification algorithm. The SVM gave the most promising results (accuracy 95%, receiver operating characteristic (ROC) score of 0.997 using 18 selected features). Finally, a test dataset comprising a further 32 HF patients and 20 controls was used to verify that the 18 putative biomarkers and classification algorithms gave reliable predictions (accuracy 88.5%, ROC score 0.998).     

Automatic detection of gait events: a case study using inductive learning techniques

One of the problems which occurs in the development of a control system for functional electrical stimulation of the lower limbs is to detect accurately specific events within the gait cycle. We present a method for the classification of phases of the gait cycle using the artificial intelligence technique of inductive learning. Both the terminology of inductive learning and the algorithm used for the analyses are fully explained. Given a set of examples of sensor data from the gait events that are to be delected, the inductive learning algorithm is able to produce a decision tree (or set of rules) which classify the data using a minimum number of sensors. The nature of the redundancy of the sensor set is examined by progressively removing combinations of sensors and noting the effect on both the size of the decision trees produced and their classification accuracy on ‘unseen’ testing data. Since the algorithm is able to calculate which sensors are more important (informative), comparisons with the intuitive appreciation of sensor importance of five researchers in the fields were made, revealing that those sensors which appear intuitively most informative may, in fact, provide the least information. Comparison results with the standard statistical classification technique of linear discriminant analysis are also presented, showing the relative simplicity of the inductively derived rules together with their good classification accuracy. In addition to the control of FES, such techniques are also applicable to automatic gait analysis and the construction of expert systems for diagnosis of gait pathologies.     

表面肌电信号的下肢痉挛信号的特征分析与识别

脑卒中患者康复治疗中会引起下肢肌肉痉挛,这种现象给患者的康复训练过程带来极大的危害,因此能够在训练过程中识别痉挛并及时中断训练具有重要的实际意义。本研究通对下肢表面肌电信号的采集,采用基于形状的模版匹配法来识别痉挛信号,并以皮尔逊相关系数来分析表征下肢痉挛信号的相关性大小。分析结果表明,通过仿真验证了模版匹配法在个人痉挛信号识别中的准确性,显示了在泛用痉挛信号识别中的可行性。     

Dissecting aneurysm as a cause of acute non-traumatic ischemia of the lower limbs]

The results of the treatment the acute non-traumatic ischemia of the lower limbs caused by dissecting aneurysm are discussed. Out of 726 analysed patients 8 of them suffered from dissecting aneurysm, i.e. 1.1%. Dissecting aneurysm was more frequent in male patients. All patients with lower limbs ischemia caused by the dissecting aneurysm were operated. Vascular prosthesis was used in 6 cases, and restoration of arterial patency in 2 cases. Seven patients died during the early postoperative period and one was released home with proper blood flow.     

Results of surgical and conservative treatment for multi-level atheromatous arterial occlusion of the lower limb after five years]

After 5 years of observation, materials of 239 patients treated operatively and 96 patients treated conservatively because of multisegmental arterial occlusion of lower limbs were obtained within the framework of multi-central programme of investigation. The results of the treatment with these methods have been evaluated according to the site of the atheromatous changes and the degree of ischemia of lower limbs. It has been ascertained, that after operative therapy, the percentage of good results and the percentage of death in the case of occlusion comprising the aorto-ilio-femoral segment is higher than in the case of occlusion of femoro-popliteal and peripheral segments, whereas in the case of conservative therapy, the situation is reverse. The results of therapy (operative and conservative) of multilevel arterial occlusion, in all kinds of location, depend upon blood supply in the limbs. The results are best (the highest percentage of good results and without improvement, the least number of amputation and death) in the II period of disease and they become worse when the degree of ischemia increases. It appears that the operative therapy is less effective than the conservative therapy in the case of atheromatous multilevel changes manifesting clinically in the form of intermittent claudication, whereas in the case of the IV degree of ischemia, only the operation can save the limb or even the patient's life.     

Analytical models for FMS design optimization: A survey

This paper surveys the analytical methods that have been developed for optimizing the design of flexible manufacturing systems. A classification of the design issues into six groups is proposed first. The two main mathematical tools used for performance analysis are presented briefly. Then, the literature is analyzed critically according to the problem classification given. Suggestions for further work within each area are given throughout the paper and some general remarks concerning the whole field are finally made.     

间歇性充气加压疗法对下肢深静脉血栓患者血液流变学的影响

目的:观察间歇性充气加压疗法(intermittent pneumatic compression,IPC)对下肢深静脉血栓形成(deep vein thrombosis of lower limbs,DVT)患者的治疗效果,并从血液流变学方面探讨间歇性充气加压的作用机理.方法:2003年3月-2010年9月我科收治的243例下肢深静脉血栓患者,将其中42例IPC治疗病例定为B组实验组,145例单纯药物治疗病例中选取60例定为A组对照组.观察两组患者血液流变学指标和小腿肿胀消退情况的对比.结果:两组患者全血粘度、红细胞聚集指数、红细胞电泳时间、红细胞变形性,在治疗第1天较入院时无差异,组间无差异(P＞0.05),第3天较入院时有差异(P＜0.05),组间第3天有差异(P＜0.05),两组患者下肢肿胀度均明显消退,但B组肿胀消退速度明显快于对照组(P＜0.05).结论:间歇性充气加压治疗仪可有效改变血液流变学状态,改善血液高凝状态,有效缓解肢体肿胀症状,缩短住院时间.且不增加治疗难度,使用简单,治疗依从性好.     

Application of autologous bone marrow mononuclear cells in six patients with advanced chronic critical limb ischemia as a result of diabetes: our experience

Background aimsPrevious clinical studies have reported that the injection of bone marrow (BM)-derived mononuclear cells (MNC) results in improvement in symptoms and healing of ulcers in patients with critical limb ischemia (CLI) up to stage IV of Fontaine's classification. However, most patients with Fontaine stage IV CLI limbs had to undergo amputation even after stem cell therapy. We report on six patients, who had poorly controlled diabetes with extensive ulceration and gangrene of limbs because of Fontaine stage IV CLI and had been advised amputation elsewhere, who underwent injection of autologous BM MNC.MethodsIn all six patients, BM was aspirated and the isolated MNC from the BM were injected intralesionally at various sites of the ulcer and its surroundings after necessary debridement. The patients were followed up at regular intervals for at least 6 months.ResultsAt the end of the 6-month follow-up, the lower limb pain and ulcers had improved significantly in all patients. The mean toe–brachial index had increased from 0.26 to 0.36. One patient died a month after therapy because of causes unrelated to the procedure. Limb salvage was possible in the remaining five patients and they had a pain-free walking distance of 100 m within 6 months.ConclusionsLimb salvage was possible in all six diabetic patients with Fontaine stage IV CLI following autologous BM MNC injection. The procedure was safe without any adverse outcomes.     

Evaluation method for coalmining-based cities ecosystem based on attribute mathematical model with Huainan City as an example

Attributive recognition model of coalmining-based cities ecosystem classification is developed in terms of attributive mathematical theory. Based on the analysis of main causes of coalmining-based cities ecosystem, the city vitality, city structure strength, city resilience ability, service functions and health status are chosen as the criterion indicators of coalmining-based cities ecosystem classification; the attributive measurement functions are constructed to compute the attributive measurement of single indicator and multi-indicator; and the synthetic attributive measurement is calculated by the AHP; the health classification of cities ecosystem are recognized by the confidence criterion. An empirical analysis is made by the proposed model and method, the synthetic evaluation results are better than fuzzy comprehensive evaluation method which validates the proposed model feasible, effective and reliable in coalmining-based cities ecosystem classification. As attributive recognition theory can success fully resolve certain issues with a number of fuzzy attribution in comprehensive evaluation, its confidence criterion is established on the basis of the ordered evaluation sets, consequently it will make the evaluation results more reliable.