Study of Transtibial Prosthesis at ALC, Chennai, with Special Reference to Modular Prosthesis

INTRODUCTION: WHO estimates that there are 800 million persons with disability in the world and 100 million of them are in India alone. National sample survey organization (The Survey in the 58th Round) in 2002 has shown that 1.85 crore disabled person i.e. 1.8% of the total estimated population present in our country. Of them, 10.66 million (58% of all the disabled) are having Locomotor Disability. There are 8.3 lakh (78/1000 disabled) are with limb loss (NSSO, 2002). Amongst them, most are Transtibial amputee and they need a prosthetic device of appropriate design and at a reasonable cost to perform as effective as the lost limb. Whether as a result of trauma or disease, amputation has always been a part of human experience. There has always been the desire to replace the lost part for functional, cosmetic reasons or for a combination of both. In our national policy and as a result of implementation of Persons with Disability Act’95, an all round effort in this regard was made. Now there is an increased demand for prosthetic fitment services and efforts are made by our government to fit artificial limb by camp approach in order to cover a majority of the amputees. AIM OF THE STUDY: This study was conducted at The Artificial Limb Fitting Center of the Government Institute of Rehabilitation Medicine, Chennai. The Aim of the study was to analyse the two commonly used prosthesis namely the Laminated Exoskeletal Transtibial Prosthesis and the Modular Transtibial Prosthesis in terms of cost, efficacy, utility and also to identify the demographics profile in the study group. SUBJECTS AND METHODS: Thirty unilateral Transtibial amputees of which fifteen using Laminated B.K. Prosthesis with SACH foot and fifteen using Modular B.K Prosthesis with SACH foot for more than 6 months attending ALC, Chennai were selected for the study. The study was conducted between Jan 2011 to May 2011. The patients were explained about the study. A case history format, questionnaires as per published PEQ (Prosthesis evaluation questionnaires) and consent form was filled for each of the selected cases. All the subjects had a general health check up and counseling. INCUSION CRITERIA: 1. Unilateral Below Knee Amputees, 2. Age between 10- 65 years, 3. Amputee using Laminated or Modular Transtibial Prosthesis for more than 6 months, 4. Willingness to cooperate in the study, 5. No residual limb swelling or wound. EXCLUSION CRITERIA: 1. Amputees with other associated limb loss, 2. Amputees with the problems in the sound leg such as fracture and deformities, 3. Amputees without prosthesis, 4. Unmotivated persons. SUMMARY: The study was conducted on 30 unilateral below knee amputees at ALC, Chennai, to compare the cost, efficacy and utility of Transtibial prosthesis. To summarise 1. 63.3% of amputee belongs to age group of 16 -45 years 2. Majority of amputees were males 76.67% were males. 3. 40% of the patients were Daily Laborers 4. Train and Road Traffic Accident were the commonest cause of amputation 70%. 5. The average stump length percentage was 43.31 %. The mean stump length was 20.07 cm. 6. Laminated Prosthesis was costlier than Modular Prosthesis 7. Laminated Prosthesis was cosmetically unacceptable in 40% & Modular in 20% of patients 8. Threshold in doorway was the commonest (70%) Architectural Barrier. 9. Heaviness of Prosthesis was complained by 33% of patients with Laminated Prosthesis and 20 % Patients using Modular Prosthesis. 10. There was no statistical significant findings in terms of ease of performing daily activities such as Sitting, Walking, Toileting, Dressing, Cycling, House Hold, Field Work Place and Recreational Activities. CONCLUSION: This study was aimed to find out the cost, efficacy and utility of the two types of Transtibial Prosthesis i.e. Modular Transtibial Prosthesis and Laminated Transtibial. Prosthesis (Conventional) with SACH foot. It was found that Modular Prosthesis was superior in terms of low cost, high cosmesis and more comfort with a comparable efficacy and utility as compared to the Laminated Prosthesis. In smaller institutions where there is limited financial and manpower availability relative to the patient load Modular Prosthesis is definitely going to be a better choice for Transtibial Amputees. The lesser cost of fabrication of modular prosthesis is an added advantage. Disadvantages of fabricating modular prosthesis are it requires expertise and prefabricated Modular kits must be available. This would mean that it requires a well equipped institutional set up such as ALC, Chennai with adequately trained Prosthetist and facilities for gait analysis and training. The combination of skills, concepts, and techniques of the amputation surgeon, prosthetist, and has enabled amputees to successfully compete in sports and other recreational activities because of their prostheses, rather than inspite of them. Hence due consideration has to be given while designing lower limb prosthesis and it should to cater to the amputee’s need. So as Meanly S. has stated in 1995 the major objective of Prosthetics the world over is to restore the amputee as functional a capacity as possible in his cultural environmental , at the same time achieving a good cosmetic result. Therefore we conclude from the study that comparing Modular Transtibial Prosthesis with conventional laminated Transtibial prosthesis, modular prosthesis is by far superior in terms of technology, cost effectiveness, comfort and cosmesis

Antimicrobial and antioxidant activities of salt stress callus of Brinjal (Solanum melongena L.)

Ethanolic and methanolic salt stress callus extracts of Solanum melongena L. were tested for in vitro antimicrobial and free radical scavenging assayssuch as DPPH (1,1-diphenyl-2-picrylhydrazyl) and ABTS+(2,2\u27Azinobis (3-ethyl benzo-thizoline-6-sulfonic acid) . In both the extracts the zone of inhibition is higher in Escherichia coli, Klebsiella pneumonia, Staphylococcus aureusand Streptococcus pyogenesat 90 µl concentration against the control. The antifungal activity of these extracts also the zone of inhibition is higher at 90 µl concentration against the control. The DPPH activity of different concentration of solvent extracts (1 mg/ml to 5 mg/ml) along with standard ascorbic acid among the five different concentration (50 µg/ml to 250 µg/ml) of extracts tested, the higher percentage of inhibition was observed in 250 µg/ml of methanol extract followed by ethanolic extract against the standard ascorbic acid. In ABTS+ activity the absorbance was increased with the increasing concentrations of both methanolic and ethanolic callus extracts

Restoration and natural revival of clam populations at Tuticorin Bay, Tamil Nadu after a mass mortality incident

Bivalves play key role in ecosystem stabilisation due to inherent filter feeding capability and clams are important components of soft bottom benthic communities. In the Tuticorin Bay, mass mortality of fishes and shellfishes was observed in Februay 2008. The probable cause for the large scale mortality has been indicated as increased levels of ammonia (Asha et al., 2009). A rapid survey was conducted in the bay to assess the impact on the bivalve fauna

Bacterial foraging-optimized PID control of a two-wheeled machine with a two-directional handling mechanism

This paper presents the performance of utilizing a bacterial foraging optimization algorithm on a PID control scheme for controlling a five DOF two-wheeled robotic machine with two-directional handling mechanism. The system under investigation provides solutions for industrial robotic applications that require a limited-space working environment. The system nonlinear mathematical model, derived using Lagrangian modeling approach, is simulated in MATLAB/Simulink(®) environment. Bacterial foraging-optimized PID control with decoupled nature is designed and implemented. Various working scenarios with multiple initial conditions are used to test the robustness and the system performance. Simulation results revealed the effectiveness of the bacterial foraging-optimized PID control method in improving the system performance compared to the PID control scheme

Case studies on heat stress related perceptions in different industrial sectors in southern India

Linkages between thermal loads and its physiological consequences have been widely studied in non-tropical developed country settings. In many developing countries like India, despite the widespread recognition of the problem, limited attempts have been made to estimate health impacts related to occupational heat stress and fewer yet to link heat stress with potential productivity losses. This is reflected in the ubiquity of workplaces with limited or no controls to reduce exposures. As a prelude to understanding the feasibility of alternative interventions in different industrial sectors, we present case studies from 10 different industrial units in Tamil Nadu, Chennai, which describe perceptions of occupational heat stress among the workers and supervisors/management

DNA resection in eukaryotes: deciding how to fix the break

DNA double-strand breaks are repaired by different mechanisms, including homologous recombination and nonhomologous end-joining. DNA-end resection, the first step in recombination, is a key step that contributes to the choice of DSB repair. Resection, an evolutionarily conserved process that generates single-stranded DNA, is linked to checkpoint activation and is critical for survival. Failure to regulate and execute this process results in defective recombination and can contribute to human disease. Here, I review recent findings on the mechanisms of resection in eukaryotes, from yeast to vertebrates, provide insights into the regulatory strategies that control it, and highlight the consequences of both its impairment and its deregulation

A two-wheeled machine with a handling mechanism in two different directions

Despite the fact that there are various configurations of self-balanced two-wheeled machines (TWMs), the workspace of such systems is restricted by their current configurations and designs. In this work, the dynamic analysis of a novel configuration of TWMs is introduced that enables handling a payload attached to the intermediate body (IB) in two mutually perpendicular directions. This configuration will enlarge the workspace of the vehicle and increase its flexibility in material handling, objects assembly and similar industrial and service robot applications. The proposed configuration gains advantages of the design of serial arms while occupying a minimum space which is unique feature of TWMs. The proposed machine has five degrees of freedoms (DOFs) that can be useful for industrial applications such as pick and place, material handling and packaging. This machine will provide an advantage over other TWMs in terms of the wider workspace and the increased flexibility in service and industrial applications. Furthermore, the proposed design will add additional challenge of controlling the system to compensate for the change of the location of the COM due to performing tasks of handling in multiple directions

A System-Wide Investigation of the Dynamics of Wnt Signaling Reveals Novel Phases of Transcriptional Regulation

Aberrant Wnt signaling has been implicated in a wide variety of cancers and many components of the Wnt signaling network have now been identified. Much less is known, however, about how these proteins are coordinately regulated. Here, a broad, quantitative, and dynamic study of Wnt3a-mediated stimulation of HEK 293 cells revealed two phases of transcriptional regulation: an early phase in which signaling antagonists were downregulated, providing positive feedback, and a later phase in which many of these same antagonists were upregulated, attenuating signaling. The dynamic expression profiles of several response genes, including MYC and CTBP1, correlated significantly with proliferation and migration (P<0.05). Additionally, their levels tracked with the tumorigenicity of colon cancer cell lines and they were significantly overexpressed in colorectal adenocarcinomas (P<0.05). Our data highlight CtBP1 as a transcription factor that contributes to positive feedback during the early phases of Wnt signaling and serves as a novel marker for colorectal cancer progression

Modulation of enhancer looping and differential gene targeting by Epstein-Barr virus transcription factors directs cellular reprogramming

Epstein-Barr virus (EBV) epigenetically reprogrammes B-lymphocytes to drive immortalization and facilitate viral persistence. Host-cell transcription is perturbed principally through the actions of EBV EBNA 2, 3A, 3B and 3C, with cellular genes deregulated by specific combinations of these EBNAs through unknown mechanisms. Comparing human genome binding by these viral transcription factors, we discovered that 25% of binding sites were shared by EBNA 2 and the EBNA 3s and were located predominantly in enhancers. Moreover, 80% of potential EBNA 3A, 3B or 3C target genes were also targeted by EBNA 2, implicating extensive interplay between EBNA 2 and 3 proteins in cellular reprogramming. Investigating shared enhancer sites neighbouring two new targets (WEE1 and CTBP2) we discovered that EBNA 3 proteins repress transcription by modulating enhancer-promoter loop formation to establish repressive chromatin hubs or prevent assembly of active hubs. Re-ChIP analysis revealed that EBNA 2 and 3 proteins do not bind simultaneously at shared sites but compete for binding thereby modulating enhancer-promoter interactions. At an EBNA 3-only intergenic enhancer site between ADAM28 and ADAMDEC1 EBNA 3C was also able to independently direct epigenetic repression of both genes through enhancer-promoter looping. Significantly, studying shared or unique EBNA 3 binding sites at WEE1, CTBP2, ITGAL (LFA-1 alpha chain), BCL2L11 (Bim) and the ADAMs, we also discovered that different sets of EBNA 3 proteins bind regulatory elements in a gene and cell-type specific manner. Binding profiles correlated with the effects of individual EBNA 3 proteins on the expression of these genes, providing a molecular basis for the targeting of different sets of cellular genes by the EBNA 3s. Our results therefore highlight the influence of the genomic and cellular context in determining the specificity of gene deregulation by EBV and provide a paradigm for host-cell reprogramming through modulation of enhancer-promoter interactions by viral transcription factors

Biophysical Property and Broad Anti-HIV Activity of Albuvirtide, a 3-Maleimimidopropionic Acid-Modified Peptide Fusion Inhibitor

Albuvirtide (ABT) is a 3-maleimimidopropionic acid (MPA)-modified peptide HIV fusion inhibitor that can irreversibly conjugate to serum albumin. Previous studies demonstrated its in vivo long half-life and potent anti-HIV activity. Here, we focused to characterize its biophysical properties and evaluate its antiviral spectrum. In contrast to T20 (Enfuvirtide, Fuzeon), ABT was able to form a stable α-helical conformation with the target sequence and block the fusion-active six-helix bundle (6-HB) formation in a dominant-negative manner. It efficiently inhibited HIV-1 Env-mediated cell membrane fusion and virus entry. A large panel of 42 HIV-1 pseudoviruses with different genotypes were constructed and used for the antiviral evaluation. The results showed that ABT had potent inhibitory activity against the subtypes A, B and C that predominate the worldwide AIDS epidemics, and subtype B′, CRF07_BC and CRF01_AE recombinants that are currently circulating in China. Furthermore, ABT was also highly effective against HIV-1 variants resistant to T20. Taken together, our data indicate that the chemically modified peptide ABT can serve as an ideal HIV-1 fusion inhibitor