The increase in the proportion of elderly people in the population is one of the most remarkable sociodemographic phenomena of the twenty-first century. The number of patients with diabetes is also increasing worldwide with this demographic change. Given these facts, consideration of the problems the general elderly population is facing in the management of diabetes is essential. In this review article, we focus on sarcopenia, which is the decrease in lower extremity muscle mass and muscle strength accompanying aging, describe the relationship between sarcopenia and diabetes, and highlight the specific factors through which diabetes contributes to loss of muscle strength. The quantitative methods for evaluating lower extremity muscle strength will also be described. These methods hold the key to assessing the effectiveness of exercise therapy and optimizing the assessment of the degree of autonomy in the activities of daily living. Exercise is one of the basic treatments for type 2 diabetes and may also prevent and improve sarcopenia. This review discusses the aspects common to the two health conditions and elucidates the effectiveness and necessity of exercise as a preventive measure against diabetes among the elderly.
Aged ; Aged, 80 and over ; Diabetes Mellitus, Type 2 ; physiopathology ; prevention & control ; Exercise Therapy ; Female ; Humans ; Leg ; physiopathology ; Male ; Muscle Strength ; physiology ; Muscle, Skeletal ; physiology ; Sarcopenia ; physiopathology ; prevention & control

Wearing transfemoral prosthesis is the only way to complete daily physical activity for amputees. Motion pattern recognition is important for the control of prosthesis, especially in the recognizing swing phase and stance phase. In this paper, it is reported that surface electromyography (sEMG) signal is used in swing and stance phase recognition. sEMG signal of related muscles was sampled by Infiniti of a Canadian company. The sEMG signal was then filtered by weighted filtering window and analyzed by height permitted window. The starting time of stance phase and swing phase is determined through analyzing special muscles. The sEMG signal of rectus femoris was used in stance phase recognition and sEMG signal of tibialis anterior is used in swing phase recognition. In a certain tolerating range, the double windows theory, including weighted filtering window and height permitted window, can reach a high accuracy rate. Through experiments, the real walking consciousness of the people was reflected by sEMG signal of related muscles. Using related muscles to recognize swing and stance phase is reachable. The theory used in this paper is useful for analyzing sEMG signal and actual prosthesis control.
Artificial Limbs ; Electromyography ; Humans ; Leg ; Muscle, Skeletal ; physiology ; Walking ; physiology

Despite the frequent use of the fibular free flap, there have been no reports of severe compartment syndrome of the donor leg that necessitated limb amputation. A 66-yr-old man had a fibular osseous free flap transfer from the left leg to the mandible that was complicated by postoperative compartment syndrome. An extensive chronic leg wound resulted, which was treated with multiple debridements and finally with below-knee amputation. Successful coverage of the below-knee amputation stump was accomplished with a nonisland pedicled foot fillet flap. Various foot fillet flaps may be used acutely as a free or an island pedicled flap, but dissection of the vascular pedicle may be difficult in a chronically inflamed wound because of inflammation and adhesions to surrounding tissue. The nonisland pedicled foot fillet flap may be considered as a useful option for treatment of a chronically inflamed stump wound after below-knee amputation.
Aged ; Amputation ; Compartment Syndromes/*diagnosis/etiology ; Drainage ; Free Tissue Flaps/*adverse effects ; Humans ; Knee Joint/physiology ; Leg/*surgery ; Male ; Postoperative Complications

INTRODUCTIONEarly debridement and coverage has long been regarded as the standard of care for open fractures of the lower limb, as infection is a serious complication. However, the best time for wound closure remains controversial. Negative-pressure wound therapy (NPWT) is thought to result in reduced flap infection and failure. To determine the effect of NPWT, we reviewed patients with open fractures of the lower limb and compared the rates of infection and flap failure in two time-based cohorts.

METHODSTwo cohorts of patients (periods 2003-2004 and 2008-2009) with Gustilo type IIIB open tibial fractures were recruited and their outcomes were compared. In the 2003-2004 cohort, wounds were dressed with occlusive dressing. In the 2008-2009 cohort, all patients underwent NPWT. Data was retrospectively analysed with regard to infection, failure, age, type of flap, comorbidities and defect size. The incidences of infection and flap failure were further analysed for any statistical difference between the different treatment protocols.

RESULTSIn the 2003-2004 cohort, 33% of patients developed infection and 11% had flap failure. However, in the 2008-2009 cohort, 10% of patients developed infection and 6% had flap failure. The difference in the incidence of infection was statistically significant between the two cohorts (p = 0.029).

CONCLUSIONPatients in the 2008-2009 cohort had better outcomes, and we are of the opinion that performing NPWT may have contributed to this result.

Adult ; Aged ; Cohort Studies ; Debridement ; methods ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; adverse effects ; methods ; Fractures, Open ; diagnosis ; surgery ; Graft Rejection ; Humans ; Injury Severity Score ; Leg Injuries ; diagnosis ; surgery ; Male ; Middle Aged ; Negative-Pressure Wound Therapy ; Radiography ; Retrospective Studies ; Surgical Flaps ; blood supply ; Surgical Wound Infection ; diagnosis ; surgery ; Tibial Fractures ; diagnostic imaging ; surgery ; Treatment Outcome ; Wound Healing ; physiology ; Young Adult

DLUT4060 piezoelectric multi-component force platforms and DVM8820 three-dimensional infrared image capture system were used to test the sit-to-walk (STW) movements of 11 healthy elderly (72. 6 +/- 12. 2 years old) and 11 healthy young (19. 7 +/-1. 3 years old) individuals. Firstly, we studied the effects of seat-heights on the ground reaction forces, the velocity of the center of mass, and action time duration. Then we discussed the movement strategies and falling risks of the persons in the two age groups respectively. Finally, we decided the best seat height for the two age groups. It was found that the best seat heights for both the two age groups were 100% popliteal height. This height may make the subject get the greatest biomechanical advantages and the lowest falling risks. The popliteal height must be concerned when designing and fixing up the public activity area facilities and daily life of the elderly. To some extent, it can reduce the falling risk of the elderly.
Accidental Falls ; prevention & control ; Aged ; Aged, 80 and over ; Ankle Joint ; physiology ; Buttocks ; physiology ; Hip Joint ; physiology ; Humans ; Interior Design and Furnishings ; Knee Joint ; physiology ; Leg ; anatomy & histology ; physiology ; Male ; Middle Aged ; Movement ; physiology ; Posture ; Weight-Bearing ; physiology ; Young Adult

OBJECTIVETo evaluate the hemodynamic response to passive leg raising (PLR) indicates fluid responsiveness in patients with septic shock.

METHODSTwenty patients with septic shock, considered for fluid challenge (FC), were enrolled in the study from June 2009 to May 2010. Hemodynamic changes were determined by pulse-contour derived cardiac index at baseline, before and after PLR, return to baseline for 10 min, before and after fluid challenge (250 ml saline for 10 min). An increase of SV after fluid challenge (FC-ΔSV) ≥ 10% were defined responders.

RESULTSTwenty patients with septic shock were included in the study. PLR and fluid challenge were performed 46 instances, among which 15 instances were defined as response group. SV and pulse pressure induced by PLR (PLR-ΔSV and PLR-ΔPP) were increased significantly in response group [(76 ± 19) ml vs. (65 ± 18) ml, (73 ± 20) mmHg vs. (62 ± 20) mmHg (1 mmHg = 0.133 kPa), P < 0.05], while in nonresponse group there were no significant change. PLR-ΔSV and PLR-ΔPP were correlated with FC-ΔSV (r = 0.51, P = 0.001; r = 0.45, P = 0.006), central venous pressure (CVP) were unrelated with FC-ΔSV. Area under curve (AUC) for PLR-ΔSV, PLR-ΔPP and stroke volume variation (SVV) were 0.846, 0.791 and 0.708. PLR-ΔSV ≥ 12.5% predicted fluid responsiveness with sensitivity of 80% and specificity of 93.5%. PLR-ΔPP ≥ 9.5% predicted fluid responsiveness with sensitivity of 73.3% and specificity of 83.9%.

CONCLUSIONSPLR-ΔSV and PLR-ΔPP can predict fluid responsiveness in patients with septic shock. PLR-ΔSV and PLR-ΔPP have a greater ability in predicting volume responsiveness than CVP and SVV.

Adult ; Aged ; Aged, 80 and over ; Female ; Hemodynamics ; physiology ; Humans ; Leg ; Male ; Middle Aged ; Posture ; Sensitivity and Specificity ; Shock, Septic ; physiopathology

The corticospinal tract (CST) is the most important motor pathway in the human brain. Detailed knowledge of CST somatotopy is important in terms of rehabilitative management and invasive procedures for patients with brain injuries. In this study, I conducted a review of nine previous studies of the somatotopical location and arrangement at the brainstem in the human brain. The results of this review indicated that the hand and leg somatotopies of the CST are arranged medio-laterally in the mid to lateral portion of the cerebral peduncle, ventromedial-dorsolaterally in the pontine basis, and medio-laterally in the medullary pyramid. However, few diffusion tensor imaging (DTI) studies have been conducted on this topic, and only nine have been reported: midbrain (2 studies), pons (4 studies), and medulla (1 study). Therefore, further DTI studies should be conducted in order to expand the literature on this topic. In particular, research on midbrain and medulla should be encouraged.
Brain Stem/*anatomy & histology ; Diffusion Tensor Imaging ; Hand/innervation ; Humans ; Leg/innervation ; Medulla Oblongata/anatomy & histology ; Pons/anatomy & histology ; Pyramidal Tracts/*anatomy & histology/physiology ; Tegmentum Mesencephali/anatomy & histology

OBJECTIVE: To analyze and compare different methods for assessment of the limbs joints function and to discuss the rationality of the methods. METHODS: Eight hundred and six cases were collected from the Fujian Minzhong Forensic Appraisal Center from 2007 to 2010. These cases included injuries of large limbs joints with or without peripheral nerve injury. The loss of joint function was calculated according to the simple joint mobility method or the table method introduced in the book "Forensic Clinical Judicial Authentication Practice". The results of disability evaluation with different methods were analyzed and compared between different joints and injury patterns. RESULTS: In 642 cases of simple joint injuries without peripheral nerve injury, the results of disability evaluation based on simple joint mobility were the same as that based on the table. In 118 cases of joint injuries with peripheral nerve injury, all of them could be classified as disability, 33 cases (28.00%) had higher degree based on the table method than based on the simple joint mobility method. While 21 cases (17.80%) did not be evaluated as disabled based on the simple joint mobility method. CONCLUSION The evaluation for loss of limb function would be easier, more scientific and reasonable by the direct table method than the simple joint mobility method.
Accidents, Traffic ; Adult ; Arm Injuries/physiopathology* ; Disability Evaluation ; Extremities ; Female ; Forensic Medicine/methods* ; Humans ; Joints/physiopathology* ; Leg Injuries/physiopathology* ; Male ; Peripheral Nerve Injuries/physiopathology* ; Range of Motion, Articular/physiology* ; Trauma Severity Indices

As there are a number of ankle arteries and some of them can not be blocked completely under higher pressure from the external inflate cuff, we can not accurately identify the starting point of the pulse wave, so the errors of lower limb systolic blood pressure measurement take place and affect the accuracy of ankle-brachial index in diagnosing vascular disease. In this paper, we constructed delay vectors from the data we already collected from lower limb pulse wave and formed an embedding matrix; thus solving the problem of inadequate sensor dimensions. We extracted a single arterial pulse wave through the blind signal separation on the basis of embedding matrix, and we identified the lower limb systolic blood pressure corresponding to the starting point. Simulation and clinical experiments show the method can be used to separate the wave signals of ankle artery which contains information of systolic blood pressure. It improves the accuracy of lower limb systolic blood pressure measurement and hence provides accurate data for the clinical diagnosis of arterial disease.
Algorithms ; Ankle ; blood supply ; Blood Pressure ; Blood Pressure Determination ; methods ; Brachial Artery ; physiology ; Humans ; Leg ; blood supply ; Pulsatile Flow ; physiology ; Signal Processing, Computer-Assisted

BACKGROUND: There are no reports of the pressure changes across the foot after extraarticular subtalar arthrodesis for a planovalgus foot deformity in cerebral palsy. This paper reviews our results of extraarticular subtalar arthrodesis using a cannulated screw and cancellous bone graft. METHODS: Fifty planovalgus feet in 30 patients with spastic diplegia were included. The mean age at the time of surgery was 9 years, and the mean follow-up period was 3 years. The radiographic, gait, and dynamic foot pressure changes after surgery were investigated. RESULTS: All patients showed union and no recurrence of the deformity. Correction of the abduction of the forefoot, subluxation of the talonavicular joint, and the hindfoot valgus was confirmed radiographically. However, the calcaneal pitch was not improved significantly after surgery. Peak dorsiflexion of the ankle during the stance phase was increased after surgery, and the peak plantarflexion at push off was decreased. The peak ankle plantar flexion moment and power were also decreased. Postoperative elevation of the medial longitudinal arch was expressed as a decreased relative vertical impulse of the medial midfoot and an increased relative vertical impulse (RVI) of the lateral midfoot. However, the lower than normal RVI of the 1st and 2nd metatarsal head after surgery suggested uncorrected forefoot supination. The anteroposterior and lateral paths of the center of pressure were improved postoperatively. CONCLUSIONS: Our experience suggests that the index operation reliably corrects the hindfoot valgus in patients with spastic diplegia. Although the operation corrects the plantar flexion of the talus, it does not necessarily correct the plantarflexed calcaneus and forefoot supination. However, these findings are short-term and longer term observations will be needed.
Adolescent ; Arthrodesis/*methods ; Bone Screws ; Bone Transplantation ; Cerebral Palsy/*complications ; Child ; Child, Preschool ; Female ; Flatfoot/etiology/radiography/*surgery ; Foot/radiography ; Foot Deformities, Acquired/etiology/*surgery ; Humans ; Leg ; Male ; Muscle Spasticity/complications ; Muscle, Skeletal/surgery ; Postoperative Complications ; Subtalar Joint/radiography/surgery ; Walking/physiology