Factors affecting the evolution of type III shunts of the greater saphenous vein after the first step of the CHIVA 2 strategy Massimo Cappelli, Raffaele Molino Lova, Mauro Pinelli, Claude Franceschi Veins and Lymphatics, 2024 The CHIVA 2 strategy is a two-step surgical procedure for treating type III venous-venous shunts in the territory of the Greater Saphenous Vein (GSV). The first step consists of disconnecting the incompetent GSV tributary, either N3 or N4. Once a new N2 re-entry perforator vein has developed, or the GSV incompetence has reached the pre-existing N2 re-entry perforator vein, both documented by the re-appearance of GSV reflux during the follow-up, the second step of the CHIVA 2 strategy, i.e. the closure of the saphenous-femoral junction, can be performed. In this paper we addressed the intriguing question of whether it was possible to identify the pre-operative factors able to favourably affect the hemodynamic stability of type III shunts of the GSVs treated by the only first step of the CHIVA 2 strategy. Our data show that the pre-operative GSV anterograde flow, detectable all along the GSV course even soon after the first step of the procedure, plays a pivotal role in ensuring the hemodynamic stability of the treated GSV, which may not need the second step up to 45% of cases.
The troubled course of the CHIVA Cure through clinical studies: a critical review Massimo Cappelli, Raffaele Molino Lova, Mauro Pinelli, Claude Franceschi Veins and Lymphatics, 2023 The treatment of Superficial Venous Insufficiency (SVI) encompasses a wide and disparate array of techniques, ranging from destructive procedures (endovascular ablation, stripping and sclerotherapy) to the conservative hemodynamic procedure (CHIVA). This variety of options betrays a wide degree of uncertainty on the recommended treatment, mainly due to technical biases in performing the CHIVA Cure that heavily affect the results from Randomized Controlled Trials (RCTs). In fact, the authors of the last Cochrane Review (CR) on the CHIVA Cure disowned its superiority based on the results from five RCTs in which more than 200 of the overall 419 participants allocated to the CHIVA arm had actually received treatments other than the CHIVA Cure. Further, the Guidelines (GLs) from both the American and the European Society for Vascular Surgery recommend the CHIVA Cure only to vascular surgeons experienced with this technique, contradicting what is expected of a specialist, i.e. mastery of the treatment of diseases in his or her specialty. Finally, CRs and GLs do not take into any account the ethically relevant issue that destructive procedures, recommended for vascular surgeons not experienced in the CHIVA Cure, will fatally deprive the patient of the Great Saphenous Vein (GSV), which is the first-choice infra-inguinal graft for the treatment of severe peripheral artery disease and to ward off the severely disabling condition resulting from limb loss, when angioplasty/stenting is not feasible. In this paper we review and discuss the RCTs, CRs, and GLs concerning the CHIVA Cure available at June 2023 on Medline and Cochrane Central databases.
A low-power ankle-foot prosthesis for push-off enhancement Alessandro Mazzarini, Matteo Fantozzi, Vito Papapicco, Ilaria Fagioli, Francesco Lanotte, et al. Wearable Technologies, 2023 Passive ankle-foot prostheses are light-weighted and reliable, but they cannot generate net positive power, which is essential in restoring the natural gait pattern of amputees. Recent robotic prostheses addressed the problem by actively controlling the storage and release of energy generated during the stance phase through the mechanical deformation of elastic elements housed in the device. This study proposes an innovative low-power active prosthetic module that fits on off-the-shelf passive ankle-foot energy-storage-and-release (ESAR) prostheses. The module is placed parallel to the ESAR foot, actively augmenting the energy stored in the foot and controlling the energy return for an enhanced push-off. The parallel elastic actuation takes advantage of the amputee’s natural loading action on the foot’s elastic structure, retaining its deformation. The actuation unit is designed to additionally deform the foot and command the return of the total stored energy. The control strategy of the prosthesis adapts to changes in the user’s cadence and loading conditions to return the energy at a desired stride phase. An early verification on two transtibial amputees during treadmill walking showed that the proposed mechanism could increase the subjects’ dorsiflexion peak of 15.2% and 41.6% for subjects 1 and 2, respectively, and the cadence of about 2%. Moreover, an increase of 26% and 45% was observed in the energy return for subjects 1 and 2, respectively.
An impairment-specific hip exoskeleton assistance for gait training in subjects with acquired brain injury: a feasibility study Chiara Livolsi, Roberto Conti, Eleonora Guanziroli, Þór Friðriksson, Ásgeir Alexandersson, et al. Scientific Reports, 2022 This study was designed to investigate the feasibility and the potential effects on walking performance of a short gait training with a novel impairment-specific hip assistance (iHA) through a bilateral active pelvis orthosis (APO) in patients with acquired brain injury (ABI). Fourteen subjects capable of independent gait and exhibiting mild-to-moderate gait deficits, due to an ABI, were enrolled. Subjects presenting deficit in hip flexion and/or extension were included and divided into two groups based on the presence (group A, n = 6) or absence (group B, n = 8) of knee hyperextension during stance phase of walking. Two iHA-based profiles were developed for the groups. The protocol included two overground gait training sessions using APO, and two evaluation sessions, pre and post training. Primary outcomes were pre vs. post-training walking distance and steady-state speed in the 6-min walking test. Secondary outcomes were self-selected speed, joint kinematics and kinetics, gait symmetry and forward propulsion, assessed through 3D gait analysis. Following the training, study participants significantly increased the walked distance and average steady-state speed in the 6-min walking tests, both when walking with and without the APO. The increased walked distance surpassed the minimal clinically important difference for groups A and B, (respectively, 42 and 57 m > 34 m). In group A, five out of six subjects had decreased knee hyperextension at the post-training session (on average the peak of the knee extension angle was reduced by 36%). Knee flexion during swing phase increased, by 16% and 31%, for A and B groups respectively. Two-day gait training with APO providing iHA was effective and safe in improving walking performance and knee kinematics in ABI survivors. These preliminary findings suggest that this strategy may be viable for subject-specific post-ABI gait rehabilitation.
Predictors of Mortality in 433 Nonagenarians Inside the Mugello Study: A 10 Years Follow-Up Study Silvia Pancani, Gemma Lombardi, Francesco Sofi, Anna Maria Gori, Roberta Boni, et al. Journal of Aging and Health, 2022 Objective to identify the predictors of mortality in a cohort of nonagenarians inside the “Mugello study” after 10 years follow-up. Methods Information on sociodemographic data, cognitive and functional status, lifestyle, medical history, and drug use was collected from 433 non-selected participants aged 90-99 years, living in the Mugello area (Italy). Participants were followed over 10 years and their dates of death were retrieved from the municipal registers. Cox regression analysis was used to determine significant potential prognostic factors. Results The mortality rate was 96.5%. Cox proportional hazards analysis showed that a lower cognitive status was significantly associated with higher mortality as well as a poorer functional status, a higher comorbidity, and a higher number of drugs consumption. Discussion Impaired cognitive function, loss of functional independence, higher comorbidity, and higher drugs intake were the stronger predictors of mortality.
Serum TSH and Daily Physical Activity in a Cohort of Nonagenarians: Results from the Mugello Study Andrea Di Blasio, Giulia Di Dalmazi, Pascal Izzicupo, Ines Bucci, Cesidio Giuliani, et al. Journal of Functional Morphology and Kinesiology, 2022 Background. The current literature does not furnish clear data concerning the relationship between thyroid function, sedentary time and daily physical activity (PA) in older adults with euthyroid condition. The aim of this study was to investigate the association of serum Thyrotropin-Stimulating Hormone (TSH), free Triiodothyronine (fT3) and free Thyroxine (fT4) with sedentary time and PA in a cohort of nonagenarians. Methods. A total of 108 nonagenarians (92.8 ± 3.2 years), participating in the Mugello Study, and with complete data on thyroid function, sedentary time, PA and sleeping (objectively collected through a multisensory device), were considered for the analysis. Results. Mainly, TSH negatively correlated with time spent lying down, and positively correlated with METs. fT4 levels were negatively associated with mean daily metabolic equivalents (METs) and with low-intensity PA practice (LIPAT), and positively associated with lying down and sleeping time. Similar results have been shown in the female sample. Mainly, participants with high-normal (third tertile) versus low-normal TSH (first tertile) had higher moderate-intensity PA (MIPAT) (p = 0.03). In the female sample, first TSH tertile had higher METs (p = 0.010), LIPAT (p = 0.02), MIPAT (p = 0.01) and lower time lying down (p = 0.04) than third TSH tertile. Conclusion. High-normal serum TSH and low-normal fT4 are associated with higher levels and intensity of daily PA, together with higher MIPAT continuity, in the oldest-old.
Assessing Relationships between Physically Demanding Work and Late-Life Disability in Italian Nonagenarian Women Living in a Rural Area Gemma Lombardi, Silvia Pancani, Francesca Lorenzini, Federica Vannetti, Guido Pasquini, et al. International Journal of Environmental Research and Public Health, 2022 As more and more persons live into their 90s and beyond, investigating causes of disability in the oldest-old population is relevant for public health implications to plan preventive strategies and rehabilitation interventions. A negative association between physically demanding work and midlife physical function has been shown, but there is a paucity of longitudinal studies investigating possible work-related long-term effects in the oldest old. This study investigates the relationship between physically demanding work exposure and late-life physical performances, disability, general health status, and quality of life in a sample of women aged 90 years and over inside the Mugello Study. Sociodemographic data, cognitive and functional status, lifestyle, medical history, drug use, and work history were collected from 236 participants. Farmers had a lower percentage of individuals with preserved independence in basic activities of daily living compared to other occupations. However, in the multivariate analysis, only a higher cognitive function remained associated with functional independence. While confirming the well-known association between cognitive and functional decline in very old age, our results do not support the hypothesis that the negative effects of physical work exposure observed in midlife are relevant to predict disability in nonagenarian women.
Lipid and metabolite correlation networks specific to clinical and biochemical covariate show differences associated with sexual dimorphism in a cohort of nonagenarians Francesca Di Cesare, Leonardo Tenori, Gaia Meoni, Anna Maria Gori, Rossella Marcucci, et al. Geroscience, 2022 This study defines and estimates the metabolite-lipidic component association networks constructed from an array of 20 metabolites and 114 lipids identified and quantified via NMR spectroscopy in the serum of a cohort of 355 Italian nonagenarians and ultra-nonagenarian. Metabolite-lipid association networks were built for men and women and related to an array of 101 clinical and biochemical parameters, including the presence of diseases, bio-humoral parameters, familiarity diseases, drugs treatments, and risk factors. Different connectivity patterns were observed in lipids, branched chains amino acids, alanine, and ketone bodies, suggesting their association with the sex-related and sex-clinical condition-related intrinsic metabolic changes. Furthermore, our results demonstrate, using a holistic system biology approach, that the characterization of metabolic structures and their dynamic inter-connections is a promising tool to shed light on the dimorphic pathophysiological mechanisms of aging at the molecular level.
