Effectiveness of Somatic Balance Restoration Therapy to Alleviate Pain of Musculoskeletal System

Chronic pain and general physical discomfort are common symptoms among those seeking medical or physiotherapy treatment, as it relates to disorders found in the Human Musculoskeletal System (HMS). Since this system is highly complex and large in scale, clinical pain research has been confounded by many complex factors. The goal of our research is to overcome these obstacles by applying multidisciplinary approaches including systems engineering, traditional oriental techniques, conventional medicine and related sciences. To pursue such an integrated approach this paper examines the therapist-guided exercise for restoring human musculoskeletal balance called the Somatic Balance Restoration Therapy (SBRT). The SBRT is a simple but effective self-exercise therapy with minimal assistance by a trained therapist. This therapy is analyzed by a mechanical engineering method by modeling the human body as a multi-body subject to a static equilibrium condition. In addition, the wording has been rewritten in functional anatomical terms, enabling smooth communication between specialists of three different disciplines: therapy, conventional medicine and systems engineering. Examples will be given to demonstrate an integrated and systematic approach for identifying and remedying malfunctions within the HMS.

Recent advances of medical polyhydroxyalkanoates in musculoskeletal system

Infection and rejection in musculoskeletal trauma often pose challenges for natural healing,prompting the exploration of biomimetic organ and tissue transplantation as a common alternative solution.Polyhydroxyalkanoates(PHAs)are a large family of biopolyesters synthesised in microorganism,demonstrating excellent biocompatibility and controllable biodegradability for tissue remodelling and drug delivery.With different monomer-combination and polymer-types,multi-mechanical properties of PHAs making them have great application prospects in medical devices with stretching,compression,twist in long time,especially in musculoskeletal tissue engineering.This review systematically summarises the applications of PHAs in multiple tissues repair and drug release,encompassing areas such as bone,cartilage,joint,skin,tendons,ligament,cardiovascular tissue,and nervous tissue.It also discusses challenges encountered in their application,including high production costs,potential cytotoxicity,and uncontrollable particle size distribution.In conclusion,PHAs offer a compelling avenue for musculoskeletal system applications,striking a balance between biocompatibility and mechanical performance.However,addressing challenges in their production and application requires further research to unleash their full potential in tackling the complexities of musculoskeletal regeneration.

Acute Lymphoblastic Leukemia Presenting as Systemic Juvenile Idiopathic Arthritis: Experience from Bangladesh

Background: Acute lymphoblastic leukemia (ALL), the most common paediatric malignancy, is a heterogeneous hematologic disease. ALL patients may present with isolated and persistent osteo-articular complaints, lower incidence of hepatomegaly, splenomegaly or lymphadenopathy without clear laboratory features, and misdiagnosed as systemic juvenile idiopathic arthritis (sJIA). Methods: This was a single center cross sectional study over a period of 4 years. Clinic laboratory profiles of 39 ALL children were compared with 39 age and sex-matched sJIA cases. Result: Among 39 ALL patients 89.7% were initially misdiagnosed as sJIA upon clinical presentation. Majority (66.7%) of ALL patients had oligo-articular joint involvement. In sJIA, small joints of the hands were most commonly involved. The total WBC count was significantly higher in ALL patients (p-value 0.0065). CRP and LDH values between the two groups showed significant differences (p-value 0.00006 and 0.00001 respectively). Conclusion: The presentation of leukemia with arthralgia or arthritis makes the diagnosis difficult for the physicians. The diagnosis of sJIA must be made with caution keeping the possibility of haematological malignancy in mind.

Biomechanics of Musculoskeletal System and Its Biomimetic Implications： A Review

Biological musculoskeletal system （MSK）, composed of numerous bones, cartilages, skeletal muscles, tendons, ligaments etc., provides form, support, movement and stability for human or animal body. As the result of million years of selection and evolution, the biological MSK evolves to be a nearly perfect mechanical mechanism to support and transport the human or animal body, and would provide enormously rich resources to inspire engineers to innovate new technology and methodology to develop robots and mechanisms as effective and economical as the biological systems. This paper provides a general review of the current status of musculoskeletal biomechanics studies using both experimental and computational methods. This includes the use of the latest three-dimensional motion analysis systems, various medical imaging modalities, and also the advanced rigid-body and continuum mechanics musculoskeletal modelling techniques. Afterwards, several representative biomimetic studies based on ideas and concepts inspired from the structures and biomechanical functions of the biological MSK are dis- cussed. Finally, the major challenges and also the future research directions in musculoskeletal biomechanics and its biomimetic studies are proposed.

Promoting musculoskeletal system soft tissue regeneration by biomaterial-mediated modulation of macrophage polarization

Musculoskeletal disorders are common in clinical practice.Repairing critical-sized defects in musculoskeletal systems remains a challenge for researchers and surgeons,requiring the application of tissue engineering biomaterials.Successful application depends on the response of the host tissue to the biomaterial and specific healing process of each anatomical structure.The commonly-held view is that biomaterials should be biocompatible to minimize local host immune response.However,a growing number of studies have shown that active modulation of the immune cells,particularly macrophages,via biomaterials is an effective way to control immune response and promote tissue regeneration as well as biomaterial integration.Therefore,we critically review the role of macrophages in the repair of injured musculoskeletal system soft tissues,which have relatively poor regenerative capacities,as well as discuss further enhancement of target tissue regeneration via modulation of macrophage polarization by biomaterial-mediated immunomodulation(biomaterial properties and delivery systems).This active regulation approach rather than passive-evade strategy maximizes the potential of biomaterials to promote musculoskeletal system soft tissue regeneration and provides alternative therapeutic options for repairing critical-sized defects.

Screening for musculoskeletal system malformations and birth injuries in newborns:Results of a screening program in two hospitals in Shenzen,China

Importance:There are a variety of musculoskeletal malformations and injuries that can occur in newborns.These can be a significant cause of perinatal death or a reason for miscarriage and can lead to long-term functional issues if not managed appropriately.There is no systematic and well-established screening program for neonatal musculoskeletal malformations and injuries in China now.Objective:To report the incidence and types of congenital musculoskeletal malformations in two hospitals in Shenzhen City,to explore and discuss the details of the screening procedure and improve future prevention and treatment.Methods:From October 2013 to May 2014,2564 one-day-old newborns were screened by a pediatric orthopedic physical examination,in combination with ultrasonography when required,and the incidence and variety of diseases were recorded statistically.Results:Among 2564 screened newborns,the following musculoskeletal conditions were identified:congenital muscular torticollis(CMT)(seven cases,0.27%),hip subluxation(four cases,0.16%),hip dysplasia(47 cases,1.83%),congenital talipes equinovarus(CTEV)(two cases,0.08%),congenital talipes calcaneovalgus(15 cases,0.58%),polydactyly(nine cases,0.35%),syndactyly(one case,0.04%),and spinal hemivertebra(one case,0.04%).Additionally,there were five(0.19%)neonates with birth injuries.Interpretation:It is feasible to carry out neonatal screening and identification of musculoskeletal malformations and birth injuries in China.This is helpful as timely detection and early intervention for many of these conditions can avoid permanent functional impairment in these children.

A comprehensive musculoskeletal and peripheral nervous system assessment of war-related bilateral upper extremity amputees

Background: Upper limb amputations are one of the unpleasant war injuries that armed forces are exposed to frequently. The present study aimed to assess the musculoskeletal and peripheral nervous systems in Iraq-Iran war veterans with bilateral upper extremity amputation.Methods: The study consisted of taking a history and clinical examinations including demographic data, presence and location of pain, level of amputation, passive and active ranges of movement of the joints across the upper and lower extremities and spine, manual palpation, neurological examination, blood circulation pulses and issues related to a prosthetic limb. In this study, 103 Iranian bilateral upper extremity amputees(206 amputations) from the IranIraq war were evaluated, and a detailed questionnaire was also administered.Results: The most common level of amputation was the finger or wrist level(108, 52.4%). Based on clinical examination, we found high frequencies of limited active and passive joint range of movement across the scapula, shoulder, elbow, wrist and metacarpophalangeal, interphalangeal and thumb joints. Based on muscle strength testing, we found varying degrees of weakness across the upper limbs. Musculoskeletal disorders included epicondylitis(65, 31.6%), rotator cuff injury(24, 11.7%), bicipital tendonitis(69, 33.5%), shoulder drop(42, 20.4%) and muscle atrophy(19, 9.2%). Peripheral nerve disorders included carpal tunnel syndrome in 13(6.3%) and unilateral brachial plexus injury in 1(1%). Fifty-three(51.5%) were diagnosed with facet joint syndrome at the level of the cervical spine(the most frequent site). Using a prosthesis was reported by 65(63.1%), both left and right sides. The back was the most common site of pain(71.8%).Conclusion: The high prevalence of neuro-musculoskeletal disorders among bilateral upper extremity amputees indicates that they need regular rehabilitation care.

Risk factors for musculoskeletal injuries in the military: a qualitative systematic review of the literature from the past two decades and a new prioritizing injury model

Background: Musculoskeletal injuries(MSkIs) are a leading cause of health care utilization, as well as limited duty and disability in the US military and other armed forces. MSkIs affect members of the military during initial training,operational training, and deployment and have a direct negative impact on overall troop readiness. Currently, a systematic overview of all risk factors for MSkIs in the military is not available.Methods: A systematic literature search was carried out using the PubMed, Ovid/Medline, and Web of Science databases from January 1, 2000 to September 10, 2019. Additionally, a reference list scan was performed(using the “snowball method”). Thereafter, an international, multidisciplinary expert panel scored the level of evidence per risk factor, and a classification of modifiable/non-modifiable was made.Results: In total, 176 original papers and 3 meta-analyses were included in the review. A list of 57 reported potential risk factors was formed. For 21 risk factors, the level of evidence was considered moderate or strong. Based on this literature review and an in-depth analysis, the expert panel developed a model to display the most relevant risk factors identified, introducing the idea of the “order of importance” and including concepts that are modifiable/nonmodifiable, as well as extrinsic/intrinsic risk factors.Conclusions: This is the qualitative systematic review of studies on risk factors for MSkIs in the military that has attempted to be all-inclusive. A total of 57 different potential risk factors were identified, and a new, prioritizing injury model was developed. This model may help us to understand risk factors that can be addressed, and in which order they should be prioritized when planning intervention strategies within military groups.

The Analysis of the Effective Systemic Lidocaine Dosage on the Expression of HMGB1 mRNA on Mice with Sterile Musculoskeletal Injury

A severe injury can trigger an inflammation response and excessive response can cause multiple organ failure. HMGB1 is an early inflammation mediator in sterile injury and a late inflammation mediator in infection. It is an important mediator in severe sepsis and always associated with the severity of organ failure. Previous studies showed that the administration of systemic lidocaine could inhibit the expression of HMGB1 on septic mice with musculoskeletal injury. Nine male adult Balb/c mice were grouped by simple random sampling method into three groups of intravenous lidocaine injection dosages: 2 mg/kg, 3 mg/kg, 4 mg/kg. Musculoskeletal injury was done by breaking the left femoral bone in a close manner. Peripheral blood sampling was done 4 hours after injury and 2 hours after lidocaine therap. To evaluate the expression level of HMGB1 mRNA, RT-PCR was used. The result of our study showed that intravenous lidoaine administration on the 3 groups could decrease the level of HMGB1. In conclusion, lidocaine hold an important role in clinical diseases by inhibiting HMGB1.

Musculoskeletal complications in long COVID-19:A systematic review

BACKGROUND Coronavirus disease 2019(COVID-19)has crippled humanity since early 2020.Various sequelae of COVID-19 have been reported in different body systems.Musculoskeletal symptoms are widely reported during COVID-19 infection,but musculoskeletal complications in long COVID-19 are underreported.However,post-COVID-19 survivors have reported complaints of persisting or new-onset fatigue,myalgia,arthralgia,arthritis,muscle weakness,etc in clinical practice.The well-known detrimental effects of steroids on the musculoskeletal system coupled with their over-the-counter availability can also be anticipated since they were the cornerstone of life-saving management in this pandemic.AIM To determine the musculoskeletal complications in long COVID.METHODS We performed a systematic review of‘systematic reviews and meta-analyses’.RESULTS Of the 63 articles screened,24 articles were included.Two articles specifically discussed children and adolescents.One article discussed rehabilitation intervention.No article addressed rehabilitation of musculoskeletal issues in long COVID-19 in particular.Fatigue was the most common musculoskeletal complication.CONCLUSION Fatigue is found to be very common along with myalgia and arthralgia.There were no studies on rehabilitation intervention in musculoskeletal complications specifically.Considering the lacuna in literature and the needs of the current situation,further studies are warranted to standardize effective rehabilitation interventions in musculoskeletal complications.More homogenous studies are needed.Studies on functional impairment due to musculoskeletal involvement are essential.

Quantification of Ride Comfort Using Musculoskeletal Mathematical Model Considering Vehicle Behavior

This research aims to quantify driver ride comfort due to changes in damper characteristics between comfort mode and sport mode,considering the vehicle’s inertial behavior.The comfort of riding in an automobile has been evaluated in recent years on the basis of a subjective sensory evaluation given by the driver.However,reflecting driving sensations in design work to improve ride comfort is abstract in nature and difficult to express theoretically.Therefore,we evaluated the human body’s effects while driving scientifically by quantifying the driver’s behavior while operating the steering wheel and the behavior of the automobile while in motion using physical quantities.To this end,we collected driver and vehicle data using amotion capture system and vehicle CAN and IMU sensors.We also constructed a three-dimensional musculoskeletal mathematical model to simulate driver movements and calculate the power and amount of energy per unit of time used for driving the joints and muscles of the human body.Here,we used comfort mode and sport mode to compare damper characteristics in terms of hardness.In comfort mode,damper characteristics are soft and steering stability is mild,but vibration from the road is not easily transmitted to the driver making for a lighter load on the driver.In sport mode,on the other hand,damper characteristics are hard and steering stability is comparatively better.Still,vibration from the road is easily transmitted to the driver,whichmakes it easy for a load to be placed on the driver.As a result of this comparison,it was found that a load was most likely to be applied to the driver’s neck.This result in relation to the neck joint can therefore be treated as an objective measure for quantifying ride comfort.

Epidemiological Patterns of Work-Related Musculoskeletal Disorders among Healthcare Workers in Five Reference Hospitals in the City of Douala, Cameroon

Introduction: Work-related musculoskeletal disorders (WRMSDs) are a public health problem and have forced many workers to quit their jobs prematurely. This study investigated the prevalence and risk factors of WRMSDs among Healthcare workers in five reference hospitals in the City of Douala-Cameroon. Methods: A cross-sectional study was conducted in 2022 among 561 healthcare workers working in five reference hospitals in the city of Douala, Cameroon. Participants were selected using a convenient sampling technique. Data were collected with structured questionnaires;data on the demographics and risk factors were collected using a well-designed questionnaire, while estimation of the prevalence of WRMSDs was done using the Modified Nordic questionnaire. Results: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was 83.4% (468/561). The prevalence per professional groups was as follows: 88.8% (71) for Medical Laboratory Scientists (MLS), 81.9% (289) for nurses, 21 (80.8%) for Physiotherapists (PTs) and 78.8% (41) for Medical Doctors (MDs). There was a significant difference (p = 0.001) in the prevalence of WRMSDs with respect to place of work where healthcare workers from HLD recorded the highest prevalence 89.9%, while Healthcare workers from NBDH were 2.91 times at risk (AOR = 2.91;95% CI: 1.32 - 6.41;p = 0.001) to develop WRMSDs than healthcare workers in the other hospitals. With respect to body region, the highest prevalence of WRMSDs was recorded on the lower back, 58.8% with the lowest at the elbows 11.2%. The age group 30 to 39 years was significantly associated with WRMSDs at level of the shoulder (p = 0.002), upper back (p = 0.019), elbows (p Conclusion: The overall prevalence rate of WRMSDs among healthcare workers in Douala hospitals was high. The prevalence of WRMSDs is highest among MLS and nurses and the most affected body parts are;lower back, neck and upper back. Working on the same posture, stressful job, and repetitive tasks were the major risk factors associated to WRMSDs among healthcare workers in Douala hospitals.

Adult-onset hypophosphatemic osteomalacia as a cause of widespread musculoskeletal pain:A retrospective case series of single center experience

BACKGROUND Osteomalacia(OM)is frequently confused with various musculoskeletal or other rheumatic diseases,especially in patients with adult-onset widespread musculoskeletal pain because of its low prevalence and non-specific manifestations.AIM To facilitate the early diagnosis and etiology-specific treatment of adult-onset hypophosphatemic OM.METHODS A retrospective review of medical records was performed to screen adult patients who visited a physiatry locomotive medicine clinic(spine and musculoskeletal pain clinic)primarily presenting with widespread musculoskeletal pain at a single tertiary hospital between January 2011 and December 2019.We enrolled patients with hypophosphatemia,high serum bone-specific alkaline phosphatase levels,and at least one imaging finding suggestive of OM.RESULTS Eight patients with adult-onset hypophosphatemic OM were included.The back was the most common site of pain.Proximal dominant symmetric muscle weakness was observed in more than half of the patients.Bone scintigraphy was the most useful imaging modality for diagnosing OM because radiotracer uptake in OM showed characteristic patterns.Six patients were diagnosed with adefovir(ADV)-induced Fanconi syndrome,and the other two patients were diagnosed with tumor-induced OM and light-chain nephropathy,respectively.After phosphorus and vitamin D supplementation and treatment for the underlying etiologies,improvements in pain,muscle strength,and gait were observed in all patients.CONCLUSION Mechanical pain characteristics,hypophosphatemia,and distinctive bone scintigraphy patterns are the initial diagnostic indicators of adult-onset hypophosphatemic OM.ADV-induced Fanconi syndrome is the most common etiology of hypophosphatemic OM in hepatitis B virus-endemic countries.

High Prevalence of Musculoskeletal Disorders and Self-Medication among Street Vendors in Bangui, Central African Republic (CAR)

Introduction: Musculoskeletal disorders (MSDs) are a set of peri-articular conditions that result mainly in pain and functional discomfort. They represent a major occupational health problem in all areas of activity. The objective of this work was to determine the prevalence of MSDs among street vendors in the city of Bangui in the Central African Republic (CAR). Methods: A cross-sectional study was conducted from September 01 to October 31, 2021 in Bangui, the capital of CAR. The study population consisted of street vendors which were included at the entrance of 4 large markets of Bangui after giving informed consent. The sample size, calculated according to the Schwartz formula, was 384. Sociodemographic data (age, gender, level of education, marital status), professional data (the duration of sale in hours, the distance traveled per day);and health data (the health problems suffered by itinerant sellers and the means of dealing with them) were collected using a pre-established self-questionnaire. This collected data was processed using Microsoft Excel 2013 and Epi-Info version 7 software. Results: Among 384 street vendors included, women represented a quarter (24.9%). The average age was 27 years;the 25-34 age group was the most represented (50%). About two-thirds (64.8%) sold for at least 12 hours and traveled more than 10 km (69.3%) per day. The main health problems reported by street vendors were musculoskeletal disorders (95.8%). Their locations concerned the upper limbs shoulder 65.36% (251), elbow 24.22% (93). Non-ergonomic postures that stress the back and joints all day long, causing pain are risk factors for MSDs. These MSDs were treated by self-medication with non-steroidal anti-inflammatory drugs (22.0%), mainly sold on the street. Conclusion: MSDs dominated the health problems of street vendors. These problems raise the need for recognition and support for these workers to optimize their performance while preserving their health through awareness and good management of MSDs whose chronicity generates a disability.

Musculoskeletal Ultrasonography for the Assessment of Combined Drug Therapy for Rheumatoid Arthritis

Background: To evaluate the effect of treatment on musculoskeletal ultrasound (MSUS) and explore whether MSUS are associated with therapeutic response in rheumatoid arthritis (RA) patients treated with Tofacitinib in combination with methotrexate (MTX). Methods: We enrolled 102 RA patients treated with Tofacitinib in combination with MTX from a multicenter, exploratory, short-term, prospective and observational ultrasound cohort study of patients who received biologic or targeted synthetic disease-modifying antirheumatic drug (DMARD) therapy. We evaluated the patients’ clinical disease activity and musculoskeletal ultrasound (MSUS) scores. The serum concentrations of two venous blood inflammatory indicators were evaluated (c-reactive protein [CRP], erythrocyte sedimentation rate [ESR]) by multiplex bead assays at baseline, 3, and 6?months: the change over 6?months was defined as the P value. Before MSUS score treatment, an associate chief physician tested the wrist joints of each patient at the first treatment, and the attending physician with 3 years of MSUS experience and 7 years of work experience also performed semi-quantitative scores on the same RA patients and tested the consistency of the results. Results: Tofacitinib in combination with MTX significantly improved the clinical disease activity and MSUS score over 6?months. Serum ESR and CRP were significantly elevated at 6?months after the Tofacitinib in combination with MTX introduction (P P P Conclusions: MSUS scores may be useful for predicting RA patients’ therapeutic responses to abatacept.

Boxing Practitioners Physiology Review: 2. Systemic Responses and Adaptations

The present journal paper is the second of the three parts of a whole boxing practitioners physiology review. It is related to the boxing practice-derived systemic responses and adaptations. The first part of the review has dealt with kinanthropometric parameters, skeletal muscle recruitment and ergometry. The following and third part of the review is going to deal with dietary supplementation, weight control, recovery, altitude, faith, life expectancy, gender and childhood. Search engines and printed documents have helped gather the information that have been commented in the present and second part: responses and/or adaptations relating to 1) metabolism, 2) skeleton, 3) nervous system, 4) endocrine system, 5) cardiovascular system, 6) urinary tract and 7) pulmonary system. Detailed titles and subtitles of this part of the review are found at the end of the journal paper introduction. The main teachings from the present journal paper may be acquired through the consultation of the tables and figures that are positioned in the text, not forgetting the reminders and advice(s) that appear at the end of each of the seven parts of the journal paper (2.1.6., 2.2.2., 2.3.2., 2.4.2., 2.5.4, 2.6.4. and 2.7.3.).

Therapeutic Effects of Acupuncture on Tendinopathy: Systematic Review and Meta-Analysis

Objective:To compare the effects of acupuncture and other treatments on tendinopathy through Meta-analysis.Methods:Computerized databases,including PubMed,EBSCO,EMBASE,WanFang database,Web of Science,OVID and Cochrane Library were searched for trials concerning acupuncture for tendinopathy from establishing time to October 2021.Randomized controlled trials,quasi-randomized controlled trials,and non-randomized controlled trials related to acupuncture for tendinopathy were involved.Ultimately,we used Review Manager 5.3 to perform a Meta-analysis of included studies.Results:Meta-analysis of ten studies showed that the reductions in visual analog scale were significantly different between two groups whether in short-time follow-up(MD=–0.61,95%CI[–1.07 to–0.15],P=0.009)or in long-time follow-up(MD=–1.92,95%CI[–2.08 to–1.77],P<0.00001).The cure rates were significantly different(OR=8.97,95%CI[1.57–51.09],P=0.01),as well as the adverse events(OR=0.91,95%CI[0.30–2.74],P=0.87).Conclusion:Acupuncture provides superior pain relief,improvement in function,and safety than other control conditions/active non-acupuncture interventions in tendinopathy patients.

Speed and surface steepness affect internal tibial loading during running

Background:Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury.Runners encounter varied surface steepness(gradients)when running outdoors and may adapt their speed according to the gradient.This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients.Methods:Twenty recreational runners ran on a treadmill at 3 different speeds(2.5 m/s,3.0 m/s,and 3.5 m/s)and gradients(level:0%;uphill:+5%,+10%,and+15%;downhill:-5%,-10%,and-15%).Force and marker data were collected synchronously throughout.Bending moments were estimated at the distal third centroid of the tibia about the medial-lateral axis by ensuring static equilibrium at each 1%of stance.Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse.Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses.Results:There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress.Higher running speeds resulted in greater tibial loading.Running uphill at+10%and+15%resulted in greater tibial loading than level running.Running downhill at-10%and-15%resulted in reduced tibial loading compared to level running.There was no difference between+5%or-5%and level running.Conclusion:Running at faster speeds and uphill on gradients≥+10%increased internal tibial loading,whereas slower running and downhill running on gradients≥-10%reduced internal loading.Adapting running speed according to the gradient could be a protective mechanism,providing runners with a strategy to minimize the risk of tibial stress injuries.

Bionic Design and Analysis of a Novel Quadruped Robot with a Multistage Buffer System

Large quadruped mammals,such as ruminants,have outstanding motion ability,including running and bounding.These advanced motion abilities are related to the buffer effect of their complicated musculoskeletal systems.However,the buffer effect of most bio-robots is not satisfactory owing to the simple design of their buffer systems.In this paper,a physiological analysis of the ruminant musculoskeletal system is presented to explain the intrinsic buffer mechanism of motion.Based on the physical buffer parts of the ruminant limbs,the corresponding bionic mappings were determined.These mappings were used to guide the mechanism design of the robot multistage buffer system.The multistage buffer system includes two main buffer mechanisms:the first stage and the second stage.The buffer mechanism analysis of the first stage and multiple stages is discussed in theory to compare the effects between the normal single buffer system and the novel multistage buffer system.Then,the detailed mechanical structure of the limbs was designed based on the limb mechanism design.To further verify the superior efficacy of the multistage buffer system,the corresponding walking simulation experiments were conducted after the virtual prototype of a quadruped robot with a novel limb was built completely.Both theoretical analysis and simulation experiments prove that the bionic robot design with the novel multistage buffer system achieves better motion performance than the traditional robot buffer design and can be regarded as the design template of the robot limb.

Upper extremity vascular injuries:Etiology,management and outcome

BACKGROUND Vascular injuries of the upper extremities are considered relatively rare injuries affecting mostly the young population.They often are complex injuries accompanied by other musculoskeletal trauma or trauma in other anatomic locations.Their management is challenging since they can lead to disabilities with major socioeconomic effects.AIM To analyze data about the mechanism of injury,the management algorithm and functional outcomes of vascular injuries of the upper extremity.METHODS One hundred and fifteen patients(96 males and 19 females)with arterial injuries of the upper extremity treated in a tertiary trauma center from January 2003 to December 2022 was conducted.Mean patients’age was 33.7 years and the mean follow up time was 7.4 years.Patients with Mangled Extremity Severity Score≥7 and Injury Severity Score≥20,previous upper limb surgery or major trauma and any neuromuscular or psychiatric disease were excluded,from the study.RESULTS A penetrating trauma was the most common cause of injury.The radial artery was the artery injured in most of the cases(37.4%)followed by the ulnar(29.5%),the brachial(12.1%)and the axillary(6%).A simultaneous injury of both of the forearm’s arteries was in 15.6%of the cases.In 93%of the cases there were other concomitant musculoskeletal injuries of the extremity.Tendon lacerations were the most common,followed by nerve injuries.The postoperative functional scores(full Disabilities of the Arm,Shoulder,and Hand and VAS)had very satisfactory values.CONCLUSION Although vascular injuries of the upper extremity are rare,they may occur in the context of major combined musculoskeletal trauma.Although a multidisciplinary approach is essential to optimize outcome,the ability of trained hand surgeons to repair all injuries in combined vascular and musculoskeletal upper extremity trauma,excluding isolated vascular injuries,ensures shorter operative times and better functional outcomes.