Genetic predictors of an unfavorable course of obliterating atherosclerosis of lower limb arteries

2021 ◽  
Vol 29 (2) ◽  
pp. 251-256
Author(s):  
Roman E. Kalinin ◽  
Igor A. Suchkov ◽  
Artem A. Chobanyan ◽  
Aleksandr A. Nikiforov ◽  
Evgenia I. Shumskaya
Keyword(s):  
Healthy Volunteers ◽  
Lower Limb ◽  
Young Patients ◽  
Lower Limbs ◽  
Control Group ◽  
Critical Ischemia ◽  
Genetic Predictors ◽  
Increased Risk ◽  
The Difference ◽  
Progressive Course

AIM: This study aimed to determine the influence of 250GA polymorphism in the LIPC gene and 1607insG in the MMP-1 gene on the course of obliterating atherosclerosis of lower limb arteries (OALLA). MATERIALS AND METHODS: Seventy-six individuals were included in this study. In the first group (n = 34), patients with an unfavorable (progressive) course of OALLA and developed critical ischemia of the lower limbs within 5 years from the onset of the disease were included. In the second group (n = 34), patients with a conventionally favorable (non-progressive) course but did not develop critical ischemia of the lower limbs within 5 years from the onset of the disease and did not have a progressive degree of chronic ischemia. In the control group, healthy volunteers (n = 8) without signs of atherosclerosis in all vascular pools were included. In all the patients, LIPC-250GA and MMP-1-1607insG were genotyped. The difference in the observed and expected frequencies was evaluated via a Pearson 2 test with correction for likelihood. RESULTS: Significant differences (p = 0.013) in the 250GA polymorphism of the LIPC gene were found between the observed and expected frequencies compared with those in patients with OALLA and healthy volunteers. The assessment of the first and second groups revealed differences in the observed and expected frequencies (р = 0.004). Heterozygous carriage (GA genotype) was associated with an increased risk of the development of the unfavorable course of OALLA (hazard ratio = 2.133 with 95% confidence interval = 1.2143.748). In the analysis of the 1607insG polymorphism of the MMP-1 gene, statistically insignificant data were obtained compared between the first and second groups (р = 0.128) and between the groups of patients with OALLA and healthy volunteers (р = 0.38). CONCLUSIONS: The heterozygous carrier of LIPC 250GA was associated with an increased risk of an unfavorable OALLA course. This research on this polymorphism could be applied to patients with the newly diagnosed atherosclerosis of the arteries of the lower extremities to determine the prognosis of the disease course, especially in young patients with early manifestation and individuals with a burdened hereditary history. The 1607insG polymorphism of the MMP-1 gene had no effect on the course of OALLA.

scholarly journals Motor disability in patients with multiple sclerosis: transcranial magnetic stimulation study

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Anssam Bassem Mohy ◽  
Aqeel Kareem Hatem ◽  
Hussein Ghani Kadoori ◽  
Farqad Bader Hamdan
Keyword(s):  
Transcranial Magnetic Stimulation ◽  
Lower Limb ◽  
Magnetic Stimulation ◽  
Motor Evoked Potential ◽  
Invasive Procedure ◽  
Single Pulse ◽  
Lower Limbs ◽  
Control Group ◽  
Conduction Time ◽  
Motor Disability

Abstract Background Transcranial magnetic stimulation (TMS) is a non-invasive procedure used in a small targeted region of the brain via electromagnetic induction and used diagnostically to measure the connection between the central nervous system (CNS) and skeletal muscle to evaluate the damage that occurs in MS. Objectives The study aims to investigate whether single-pulse TMS measures differ between patients with MS and healthy controls and to consider if these measures are associated with clinical disability. Patients and methods Single-pulse TMS was performed in 26 patients with MS who hand an Expanded Disability Status Scale (EDSS) score between 0 and 9.5 and in 26 normal subjects. Different TMS parameters from upper and lower limbs were investigated. Results TMS disclosed no difference in all MEP parameters between the right and left side of the upper and lower limbs in patients with MS and controls. In all patients, TMS parameters were different from the control group. Upper limb central motor conduction time (CMCT) was prolonged in MS patients with pyramidal signs. Upper and lower limb CMCT and CMCT-f wave (CMCT-f) were prolonged in patients with ataxia. Moreover, CMCT and CMCT-f were prolonged in MS patients with EDSS of 5–9.5 as compared to those with a score of 0–4.5. EDSS correlated with upper and lower limb cortical latency (CL), CMCT, and CMCT-f whereas motor evoked potential (MEP) amplitude not. Conclusion TMS yields objective data to evaluate clinical disability and its parameters correlated well with EDSS.

scholarly journals Lower-Limb Joint Coordination Pattern in Obese Subjects

2013 ◽  
Vol 2013 ◽  
pp. 1-9 ◽  
Author(s):  
Alberto Ranavolo ◽  
Lorenzo M. Donini ◽  
Silvia Mari ◽  
Mariano Serrao ◽  
Alessio Silvetti ◽  
...  
Keyword(s):  
Lower Limb ◽  
Control Group ◽  
Coordination Pattern ◽  
Obese People ◽  
Joint Coordination ◽  
Increased Risk ◽  
Risk Of Falls ◽  
Coupling Parameters ◽  
Obese Subjects ◽  
Time Distance

The coordinative pattern is an important feature of locomotion that has been studied in a number of pathologies. It has been observed that adaptive changes in coordination patterns are due to both external and internal constraints. Obesity is characterized by the presence of excess mass at pelvis and lower-limb areas, causing mechanical constraints that central nervous system could manage modifying the physiological interjoint coupling relationships. Since an altered coordination pattern may induce joint diseases and falls risk, the aim of this study was to analyze whether and how coordination during walking is affected by obesity. We evaluated interjoint coordination during walking in 25 obese subjects as well as in a control group. The time-distance parameters and joint kinematics were also measured. When compared with the control group, obese people displayed a substantial similarity in joint kinematic parameters and some differences in the time-distance and in the coupling parameters. Obese subjects revealed higher values in stride-to-stride intrasubjects variability in interjoint coupling parameters, whereas the coordinative mean pattern was unaltered. The increased variability in the coupling parameters is associated with an increased risk of falls and thus should be taken into account when designing treatments aimed at restoring a normal locomotion pattern.

Deficits in anticipatory inhibition of postural muscle activity associated with load release while standing in individuals with spastic diplegic cerebral palsy

2013 ◽  
Vol 109 (8) ◽  
pp. 1996-2006 ◽  
Author(s):  
Hidehito Tomita ◽  
Yoshiki Fukaya ◽  
Kenji Totsuka ◽  
Yuri Tsukahara
Keyword(s):  
Cerebral Palsy ◽  
Lower Limb ◽  
Muscle Activity ◽  
Erector Spinae ◽  
Lower Limbs ◽  
Control Group ◽  
Lower Limb Muscles ◽  
Limb Muscles ◽  
Postural Muscle ◽  
Load Release

This study aimed to determine whether individuals with spastic diplegic cerebral palsy (SDCP) have deficits in anticipatory inhibition of postural muscle activity. Nine individuals with SDCP (SDCP group, 3 female and 6 male, 13–24 yr of age) and nine age- and sex-matched individuals without disability (control group) participated in this study. Participants stood on a force platform, which was used to measure the position of the center of pressure (CoP), while holding a light or heavy load in front of their bodies. They then released the load by abducting both shoulders. Surface electromyograms were recorded from the rectus abdominis, erector spinae (ES), rectus femoris (RF), medial hamstring (MH), tibialis anterior (TA), and gastrocnemius (GcM) muscles. In the control group, anticipatory inhibition before load release and load-related modulation of the inhibition were observed in all the dorsal muscles recorded (ES, MH, and GcM). In the SDCP group, similar results were obtained in the trunk muscle (ES) but not in the lower limb muscles (MH and GcM), although individual differences were seen, especially in MH. Anticipatory activation of the ventral lower limb muscles (RF and TA) and load-related modulation of the activation were observed in both participant groups. CoP path length during load release was longer in the SDCP group than in the control group. The present findings suggest that individuals with SDCP exhibit deficits in anticipatory inhibition of postural muscles at the dorsal part of the lower limbs, which is likely to result in a larger disturbance of postural equilibrium.

scholarly journals Dysfunctional muscle activities and co-contraction in the lower-limb of lumbar disc herniation patients during walking

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Wei Wang ◽  
Hui Wei ◽  
Runxiu Shi ◽  
Leitong Lin ◽  
Lechi Zhang ◽  
...  
Keyword(s):  
Lumbar Disc Herniation ◽  
Disc Herniation ◽  
Lower Limb ◽  
Gait Cycle ◽  
Lumbar Disc ◽  
Lower Limbs ◽  
Heel Strike ◽  
Control Group ◽  
Double Support ◽  
Support Phase

AbstractThis study aimed to investigate lower-limb muscle activities in gait phases and co-contraction of one gait cycle in patients with lumbar disc herniation (LDH). This study enrolled 17 LDH patients and 17 sex- and age-matched healthy individuals. Bilateral muscle activities of the rectus femoris (RF), biceps femoris long head (BL), tibialis anterior (TA), and lateral gastrocnemius (LG) during walking were recorded. The gait cycle was divided into four phases by the heel strike and top off according to the kinematics tracks. Root mean square (RMS), mean frequency (MF), and co-contraction of surface electromyography signals were calculated. The LDH patients showed enhanced BL RMS during the single support phase (SS), second double support phase, and swing phase (SW) as well as decreased MF of RF during SS and of TA and LG during SW (p < 0.05). The co-contraction of the TA-LG was increased in LDH patients than in the control group (p < 0.05). Positive correlations were observed between TA-LG co-contraction (affected side, r = 0.557, p = 0.020; contralateral side, r = 0.627, p = 0.007) and the Oswestry disability index scores in LDH patients. LDH patients have increased BL firing rate and insufficient motor unit recruitment in specific phases in the lower limbs during walking. Dysfunction in LDH patients was associated with immoderate intermuscular co-contraction of the TA-LG during walking.

scholarly journals Combined Endovascular Treatment of Acute Coronary Syndrome with Bioresorbable Scaffolds and Angioplasty in Patient with Critical Lower Limb Ischemia – Hybrid Treatment in Multidisciplinary Hospital

2019 ◽  
Vol 14 (6) ◽  
pp. 901-907
Author(s):  
A. I. Zagorulko ◽  
R. V. Kolosov ◽  
A. V. Sidelnikov ◽  
Yu. V. Korzheva ◽  
A. G. Koledinsky
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Arteries ◽  
Lower Limb ◽  
Hybrid Methods ◽  
Lower Limbs ◽  
Limb Amputation ◽  
Critical Ischemia ◽  
Long Term Outcome ◽  
Coronary Syndrome ◽  
Hybrid Treatment

The key to successful treatment in patients with acute coronary syndrome is maximally early revascularization of the coronary arteries. Treatment of multifocal atherosclerosis with lesions of the coronary and peripheral arteries requires coordinated work of the multidisciplinary team of doctors. Critical ischemia of the lower limbs requires urgent revascularization in order to prevent limb amputation. However, it is not always possible to perform revascularization using specialists of the same profile – endovascular or surgical. The use of hybrid methods of treatment (surgical and endovascular) allows to significantly improve the prognosis in saving the limb. The article presents a clinical observation of successful multistep treatment of a patient with acute coronary syndrome in combination with critical ischemia of the lower limb. The first stage was performed by multiple stenting of the coronary arteries with bioabsorptive scaffolds; the second stage was the hybrid treatment – femoral-tibial bypass with simultaneous recanalization and angioplasty of the lower leg arteries with good postoperative and long-term outcome.

scholarly journals Acute myocardial infarctation in patients with critical ischemia underwent lower limb revascularization

2013 ◽  
Vol 12 (4) ◽  
pp. 284-288
Author(s):  
Esdras Marques Lins ◽  
Jose Wellington Barros ◽  
Fernanda Appolonio ◽  
Eduardo Anacleto ◽  
Eduardo Cavalcanti Lima
Keyword(s):  
Myocardial Infarction ◽  
Lower Limb ◽  
Troponin I ◽  
Lower Limbs ◽  
Elevated Blood ◽  
Peripheral Artery ◽  
Conventional Surgery ◽  
Critical Ischemia ◽  
Infrainguinal Bypass ◽  
Peripheral Artery Occlusive Disease

BACKGROUND: Atherosclerosis is the main cause of peripheral artery occlusive disease (PAOD) of the lower limbs. Patients with PAOD often also have obstructive atherosclerosis in other arterial sites, mainly the coronary arteries. This means that patients who undergo infrainguinal bypass to treat critical ischemia have a higher risk of AMI. There are, however, few reports in the literature that have assessed this risk properly. OBJECTIVE: The aim of this study was to determine the incidence of acute myocardial infarction in patients who underwent infrainguinal bypass to treat critical ischemia of the lower limbs caused by PAOD. MATERIAL AND METHODS: A total of 64 patients who underwent 82 infrainguinal bypass operations, from February 2011 to July 2012 were studied. All patients had electrocardiograms and troponin I blood assays during the postoperative period (within 72 hours). RESULTS: There were abnormal ECG findings and elevated blood troponin I levels suggestive of AMI in five (6%) of the 82 operations performed. All five had conventional surgery. The incidence of AMI as a proportion of the 52 conventional surgery cases was 9.6%. Two patients died. CONCLUSION: There was a 6% AMI incidence among patients who underwent infrainguinal bypass due to PAOD. Considering only cases operated using conventional surgery, the incidence of AMI was 9.6%.

scholarly journals Association between walking and strength of lower limbs after chronic stroke

2020 ◽  
Vol 27 (3) ◽  
pp. 131-138
Author(s):  
Brenno Belchior Cordeiro Silva ◽  
Iza de Faria-Fortini ◽  
Pollyana Helena Vieira Costa ◽  
Camila Torriani-Pasin ◽  
Janaine Cunha Polese
Keyword(s):  
Muscle Strength ◽  
Lower Limb ◽  
Walking Speed ◽  
Chronic Stroke ◽  
Community Dwelling ◽  
Lower Limbs ◽  
Average Strength ◽  
Paretic Side ◽  
The Difference ◽  
Muscle Groups

Certain muscle groups strength directly influence walking speed (WS), and the lower strength of the paretic side is significantly associated with lower WS of individuals after stroke. Studies that have investigated the association between the average of lower limb strength and the WS in individuals are scarce. Therefore, it is important to determine whether the strength could explain walking performance due to some muscle weakness could be compensated by the strength of others, mainly because all muscles act in group, not isolated. Objective: To investigate the association between WS and lower limbs muscle strength, and to identify whether an individual muscle group or the average strength of lower limb would best predict WS and walking speed reserve (WSR) in individuals with stroke. Methods: Sixty-four community-dwelling individuals with chronic stroke have their maximum isometric strength (hip flexors/extensors/abductors, knee flexors/extensors, and ankle dorsiflexors/plantarflexors) and self-selected and fast WS (10m walk test) measured. WSR was considered as the difference between the fast and self-selected speed. Results: Average strength of the paretic limb accounted for 19% and 20% of the variance in self-selected and fast WS, respectively. Plantarflexor strength of the paretic, knee and hip flexors of the non-paretic side explained alone 27% of the WSR scores and plantarflexor strength of the paretic side alone explained 15%.Conclusion: Average muscle strength of the paretic side contributed to self-selected and fast WS. Plantarflexor strength of the paretic side, knee and hip flexors of the non-paretic side contributed with the WSR of chronic stroke individuals.

scholarly journals Treatment of critical limb ischemia in patients with multilevel arterial lesions

2018 ◽  
Vol 22 (3) ◽  
pp. 474-478
Author(s):  
V. Shaprynskyi ◽  
Y. Gupalo ◽  
O. Shved ◽  
O. Nabolotnyi ◽  
D. Shapovalov
Keyword(s):  
Atherosclerotic Lesion ◽  
Lower Extremities ◽  
Main Group ◽  
Lower Limbs ◽  
Control Group ◽  
Critical Ischemia ◽  
Optimal Method ◽  
Surgical Interventions ◽  
Limb Preservation ◽  
Arterial Lesions

The extreme manifestation of atherosclerotic lesion of the arteries of the lower extremities is the critical ischemia of the lower extremities. The number of high amputations in such patients ranges from 120 to 500 per 1 million population in the general population annually. In order to achieve the best results in the patency of the arterial bed in the near and distant periods, revascularization of the arteries of the proximal and distal blood flow is necessary. The aim of the work was to evaluate the possibilities and effectiveness of endovascular, open and hybrid arterial interventions on the lower extremities, particularly in patients with multilevel arterial disease, by conducting a retrospective analysis of treatment of critical ischemia. The results of the preoperative ultrasound duplex scan (UDS) of the arteries of 212 patients with critical ischemia of the lower limbs (CILL) shoved, that in 78 (36.8%) were multilevel arterial lesions (MLAL). Patients were divided into two groups. The first (main group) consisted of 50 patients (64%), who have been restored to the open-end and endovascular methods of MLAL, or only endovascular. The second (control) group included 28 patients (36%) — with restoration of permeability of the proximal segment without intervention on the arteries of the distal. Installed, during the period of 16 months, postoperative observation of 78 patients with MLAL, the primary frontal area of the femoral reconstruction in the main group was 92%, and limb preservation - 96%. In the control group, the permeability of the reconstruction zone was 75%, limb preservation — 82%. Thus, it has been established that the most optimal method of recovery of inflow and outflow pathways is one-time hybrid surgical interventions performed in 88% of these patients, which allow to achieve more effectively the recurrence of ischemia and maintain limb.

scholarly journals A study of the efficacy of external fixation in healing large, deep and unstable diabetic foot wounds

2019 ◽  
Vol 6 (3) ◽  
pp. 669
Author(s):  
Byomokesh Patro ◽  
Pankaj Surana ◽  
Kailash Chandra Mahapatra
Keyword(s):  
External Fixation ◽  
External Fixator ◽  
Lower Limb ◽  
Diabetic Foot ◽  
Foot Ulcer ◽  
Diabetic Foot Ulcer ◽  
Working Environment ◽  
Lower Limbs ◽  
Control Group ◽  
Study Group

Background: Infection of a diabetic foot wound heralds a poor outcome, early diagnosis and treatments are important. The aim of the study was to study the efficacy of external fixation in healing large, deep and unstable diabetic foot wounds.Methods: 50 patients with diabetic foot ulcer considered for the present study. Out of this 50 cases 25 are selected for external fixations (study group), after fulfilling the inclusion criteria and rest 25 cases are managed by posterior slab support. After reducing the infective load, the external fixator was applied as per application of external fixator procedure. The fixator is kept for 4 to 6 weeks. Daily dressings are done with advance dressing materials. Posterior slab group 25 patients are included having large, deep ulcers and unstable joints, to which posterior slabs were supported after proper and extensive debridement of wound under SA/LA.Results: DFU predominantly affects right lower limb than left lower limb. Both lower limbs affected in 4% cases. Because of different working environment males are more vulnerable to foot ulcerations. Out of 50 cases 48 (96%) of DFU are unilateral and 32 no of cases (64%) are predominantly occurs in right lower limb (Table 2). Out of 50 cases 38 no. of patient are males and 12 no. of patient are females. External fixator in exposed joint decreases the wounds in 52 days where as by posterior slab support 59 days. The mean surfaces are of the wound after therapy in study group is 75 cm2 and in control group it was 78 cm2.Conclusions: Large ulcers and exposed joints due to diabetic foot can be managed by external fixator for better prognosis than posterior slab method.

scholarly journals Intramedullary glioblastoma multiforme in young patients: A case report and brief review

2021 ◽  
Vol 0 ◽  
pp. 1-5
Author(s):  
Pedro Lukas do Rêgo Aquino ◽  
Erlan Pércio Lopes Rufino ◽  
Assíria Maria Santana Santos ◽  
Luana Cristina Rodrigues de Oliveira Costa ◽  
Camila Flach Weinmann ◽  
...  
Keyword(s):  
Glioblastoma Multiforme ◽  
Lower Limb ◽  
Patient Survival ◽  
Current Knowledge ◽  
Young Patients ◽  
Rare Condition ◽  
Lower Limbs ◽  
Age Group ◽  
Young Population ◽  
Intramedullary Lesion

Cervical glioblastoma multiforme (GBM) is rare, and its early diagnosis and management is crucial to patient survival. In the young population, it’s even more difficult to diagnose. The main challenges in GBM therapy are associated with the location of the disease and its complex and heterogeneous biology. Here, we present a case of a 35-year-old female patient admitted due to complain of pain in her right lower limb. She reported the evolution of the condition for dysesthesia in upper limbs and lower limbs 4 weeks ago. MRI showed an intramedullary lesion extending from C2 to C5. The patient was managed surgically. The purpose of this report is to document this rare condition, especially in the young age group, and reveal the current knowledge regarding intramedullary GBM.

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