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Introduction: Varicose veins, a prevalent vascular disorder characterized by enlarged and twisted veins, primarily occur in the legs and can cause discomfort, pain, and complications if untreated. Occupations involving prolonged standing or sitting, such as security guards, heighten the risk of developing varicose veins. This study investigates the prevalence of varicose veins among security guards and examines contributing factors such as age, sex, years of experience, and jobrelated activities. Methods: A cross-sectional study was conducted using stratified random sampling to select security guards across various age and experience groups. Data were collected through a structured questionnaire and clinical examinations. Descriptive and inferential statistical analyses, including chi-square tests and logistic regression, were performed using SPSS software to explore associations between demographic/job-related factors and varicose vein prevalence. Results: The study included 100 security guards (81 males, and 19 females). The prevalence of varicose veins was approximately 15%. The age distribution was relatively even, with the majority aged 41-50 years. Experience levels varied, with most guards having 1-5 years of experience. Factors significantly associated with varicose vein prevalence included prolonged standing and sitting, with males showing a slightly higher prevalence than females. Discussion: The findings highlight a notable prevalence of varicose veins among security guards, emphasizing the role of occupational factors. Comparisons with existing literature reveal that while varicose veins are generally more common in women, the higher prevalence in male security guards underscores the need for targeted occupational health strategies. Interventions such as regular breaks, ergonomic adjustments, and compression stockings are recommended to mitigate risks. Conclusion: Varicose veins are prevalent among security guards, influenced by occupational factors like prolonged static postures. Addressing these risks through targeted interventions can improve vascular health and overall well-being in this highrisk occupational group. Future research should focus on longitudinal studies to establish causality and explore gender differences in greater detail. [ABSTRACT FROM AUTHOR]

Exposure to the cold can negatively affect muscle performance. This study compared the effects of two different full-length, lower body, next-to-skin garments on thermal sensation, countermovement jump (CMJ) height and knee frontal plane angle upon landing following cold exposure against a control. After familiarisation, 13 male and 11 female recreationally active adults attended three separate laboratory testing sessions where a randomly assigned next-to-skin garment was used (compression, thermal and control (shorts)). A pre- and post-testing protocol comprising CMJ and drop landings interspersed with a sedentary cooling period of 40 min at 0 °C was adopted. High-speed motion analysis and subjective ratings of thermal sensation were recorded. Exposure to the cold significantly reduced thermal sensation (p < 0.001) scores and CMJ height (p < 0.001). Only female participants felt significantly warmer (p ≤ 0.009) in the next-to-skin garments. Losses in CMJ height were significantly reduced by the next-to-skin garments compared to the control with the thermal garment producing better results. There was little change in knee frontal plane angle upon landing in all the garments tested. Ambient cooling at 0 °C for 40 min had a significant effect on CMJ height and thermal sensation but not knee valgus upon landing. Participants in winter sports should consider next-to-skin garments in conjunction with proper warm-ups and re-warming techniques to protect themselves from the negative effects of the cold. [ABSTRACT FROM AUTHOR]

Background: Venous thromboembolic events, including deep vein thrombosis (DVT) and pulmonary embolism (PE), are frequent complications in patients with intracerebral hemorrhage (ICH). Various prophylactic strategies have been employed to mitigate this risk, such as heparin, intermittent pneumatic compression (IPC), and graduated compression stockings (GCS). The optimal thromboembolic prophylaxis approach remains uncertain due to the lack of randomized controlled trials (RCTs) comparing all interventions. Aims: We conducted a network meta-analysis and meta-analysis to systematically review and synthesize evidence from RCTs and non-randomized studies on the efficacy and safety of thromboembolic prophylaxis strategies in hospitalized ICH patients. Summary of findings: Our study followed a registered protocol (PROSPERO CRD42023489217) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines incorporating the extension for network meta-analyses. Search for eligible studies was performed up to December 2023. We considered the occurrence of DVT, PE, hematoma expansion (HE), and all-cause mortality as outcome measures. A total of 16 studies, including 7 RCTs and 9 non-randomized studies, were included in the analysis. Network meta-analysis revealed that IPC demonstrated the highest efficacy in reducing DVT incidence (odds ratios (OR) 0.30, 95% confidence interval (CI) 0.08–1.16), particularly considering only RCTs (OR 0.33, 95% CI 0.16–0.67). GCS showed the highest safety profile for HE (OR 0.67, 95% CI 0.14–3.13), but without efficacy. Chemoprophylaxis did not reduce the risk of PE events (OR 1.10, 95% CI 0.17–7.19) with a higher occurrence of HE (OR 1.33, 95% CI 0.60–2.96), but the differences were not significant. Conclusion: Our study supports the use of IPC as the primary thromboembolic prophylaxis measure in ICH patients. Further research, including head-to-head RCTs, is needed to strengthen the evidence base and optimize clinical decision-making for thromboembolic prophylaxis in this vulnerable patient population. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to evaluate how the structure of medical compression stockings, including three compression levels and five cross-sections from the ankle to the thigh part, will be changed after washing in different conditions and further investigate the effect of the washing parameters on the medical compression stockings. Design/methodology/approach: By washing medical compression stockings in different conditions and measuring the structures (including the density, the girth, the transversal and lengthwise dimension, the weight per unit area and the thickness) of medical compression stockings from the knee to the thigh part. Findings: It was concluded that the density, the weight per unit and the thickness increase and the girth, the transversal and lengthwise dimension, the weight per unit and the thickness decrease. The change degree of Class one and Class two is greater than Class 3. Moreover, the washing temperature is the most significant factor affecting all the structures of medical compression stockings. Meanwhile, the mechanical actions of the washing machine, like drum speed and washing time, also influence different medical compression stockings structures to different degrees. Research limitations/implications: The washing parameter not only includes the temperature and washing cycles but also has other factors, such as the drum speed and washing time. In addition, different kinds of factors will be influenced by each other. Originality/value: This study can provide consumers advices on the washing of medical compression stockings, and attribute to the optimization of materials and structures to maintain its properties for manufacturers. [ABSTRACT FROM AUTHOR]

This article examines the risk factors and prevalence of deep vein thrombosis (DVT) in patients undergoing major surgeries. It highlights the importance of understanding factors such as age, obesity, smoking, malignancy, and medical conditions, which contribute to two-thirds of initial DVT episodes. The study conducted at a government hospital found that 24% of patients developed DVT, with males and older age groups being more prone to it. Risk factors for DVT included higher BMI, smoking, previous chemotherapy or radiotherapy, general anesthesia, and longer surgery duration. Preoperative DVT prophylaxis is crucial for high-risk patients to reduce DVT incidence post-surgery. [Extracted from the article]

Background and Objectives: Bedridden patients are at a high risk of venous thromboembolism (VTE). Passive devices such as elastic compression stockings and intermittent pneumatic compression are common. Leg exercise apparatus (LEX) is an active device designed to prevent VTE by effectively contracting the soleus muscle and is therefore expected to be effective in preventing disuse of the lower limbs. However, few studies have been conducted on the kinematic properties of LEX. Therefore, this study aimed to compare the exercise characteristics of LEX with those of an ergometer, which is commonly used as a lower-limb exercise device, and examine its effect on the two domains of muscle activity and circulatory dynamics. Materials and Methods: This study used a crossover design in which each participant performed both exercises to evaluate the exercise characteristics of each device. Fifteen healthy adults performed exercises with LEX and an ergometer (Terasu Erugo, SDG Co., Ltd., Tokyo, Japan) for 5 min each and rested for 10 min after each exercise. Muscle activity was measured using surface electromyography (Clinical DTS, Noraxon, Scottsdale, AZ, USA), and circulatory dynamics were recorded using a non-invasive impedance cardiac output meter (Physioflow Enduro, Manatec Biomedical, Paris, France). The primary outcome was the mean percentage of maximum voluntary contraction (%MVC) of the soleus muscle during exercise. Results: The mean %MVC of the soleus muscle was significantly higher in the LEX group, whereas no significant differences were observed across the periods and sequences. Heart rate, stroke volume, and cardiac output increased during exercise and decreased thereafter; however, the differences between the devices were not significant. Conclusions: LEX may not only have a higher thromboprophylaxis effect, but also a higher effect on preventing muscle atrophy as a lower-extremity exercise device. Additionally, LEX could potentially be used safely in patients who need to be monitored for changes in circulatory dynamics. [ABSTRACT FROM AUTHOR]

Abstract Background Deep vein thrombosis (DVT) is common in patients undergoing gynecological surgery. We aimed to investigate the preventive efficacy in DVT of graduated compression stockings (GCS) alone and in combination with intermittent pneumatic compression (GCS + IPC) after gynecological surgery. Methods In November 2022, studies on the use of GCS and GCS + IPC for the prevention of DVT after gynecological surgery were searched in seven databases. After literature screening and data extraction based on specific inclusion and exclusion criteria, preventive efficacies, including the risk of DVT and anticoagulation function, of GCS and GCS + IPC were compared. Finally, sensitivity analysis and Egger’s test were performed to evaluate the stability of the meta-analysis. Results Six publications with moderate quality were included in this meta-analysis. The results showed that GCS + IPC significantly reduced DVT risk (P = 0.0002) and D-dimer levels (P = 0.0005) compared with GCS alone. Sensitivity analysis and Egger’s test showed that the combined results of this study were stable and reliable. Conclusions Compared with GCS alone, GCS + IPS showed a higher preventive efficacy against DVT in patients following gynecological surgery.

Background: Deep vein thrombosis (DVT) is common in patients undergoing gynecological surgery. We aimed to investigate the preventive efficacy in DVT of graduated compression stockings (GCS) alone and in combination with intermittent pneumatic compression (GCS + IPC) after gynecological surgery. Methods: In November 2022, studies on the use of GCS and GCS + IPC for the prevention of DVT after gynecological surgery were searched in seven databases. After literature screening and data extraction based on specific inclusion and exclusion criteria, preventive efficacies, including the risk of DVT and anticoagulation function, of GCS and GCS + IPC were compared. Finally, sensitivity analysis and Egger's test were performed to evaluate the stability of the meta-analysis. Results: Six publications with moderate quality were included in this meta-analysis. The results showed that GCS + IPC significantly reduced DVT risk (P = 0.0002) and D-dimer levels (P = 0.0005) compared with GCS alone. Sensitivity analysis and Egger's test showed that the combined results of this study were stable and reliable. Conclusions: Compared with GCS alone, GCS + IPS showed a higher preventive efficacy against DVT in patients following gynecological surgery. Highlights: GCS + IPC could significantly reduce the risk of DVT than GCS alone. GCS + IPC could significantly reduce the D-dimer than GCS alone. The involved studies were all RCTs and had no significant publication bias. Sensitivity analysis indicated that the combined results were stable. [ABSTRACT FROM AUTHOR]

Varicose veins are defined as „any dilated, elongated, or tortuous veins, regardless of their size". During pregnancy, blood pressure in the veins of the lower limbs increases 2-3-fold. The prevalence of varicose veins during pregnancy is high (18-70%). Risk factors for the development of the disease include the following: a positive family history, multiparity, interpregnancy intervals < 2 years, age > 35 years, obesity, smoking, thyroid disorders, and diabetes. Varicose veins of the lower limbs significantly affect the quality of life of pregnant women. Symptoms of the disease include heaviness in the legs, itching, paraesthesia, cramps, and oedema. The gold standard for the diagnosis of varicose veins is duplex Doppler ultrasound of the veins. Treatment of varicose veins of the lower limbs in pregnant women is challenging due to limited options for surgical techniques. Treatment involves the use of compression stockings and nighttime rest with legs elevated at a 30° angle. [ABSTRACT FROM AUTHOR]

Background: Chronic ulcers of the lower limb (CULL) are characterized by non-healing skin loss, often associated with vascular, neurological, infectious, traumatic, or tumoral factors. These ulcers are prevalent, recurrent, severe, and have significant socio-economic implications. While Western data show a higher prevalence among women and the elderly, with varying rates (0.10% to 0.80%), developing countries, especially in sub-Saharan Africa, report a higher prevalence among young men due to infectious causes. Despite their impact, CULL often lacks attention from health authorities, resulting in delays in medical consultation. This study aims to share experiences in understanding the epidemioclinical aspects and management of CULL. Objective: The objective was to offer a comprehensive overview of the epidemiological and clinical characteristics and treatment strategies for chronic lower limb ulcers observed at the University Hospital Center of Dermatology in Bamako. Patients and Methods: Conducted at the Dermatology and Venereology Department of the University Hospital Center of Dermatology in Bamako, this cross-sectional study spanned a period from January to December 2021. It included 520 patients, with 22.1% having chronic ulcers of the lower limbs. Males (52.2%) were predominant, with an average age of 42.4 years. Trauma triggered 73.0% of the cases, and more than half waited over a year before seeking medical help. Bacteriological examinations revealed microbial infections in 67.8% of the cases. Results: There was a 22.1% prevalence of chronic lower limb ulcers among the 520 patients. Males represented 52.2%, with a median age of 42.4 years. Trauma was the primary trigger in 73.0% of the cases. Bacteriological examinations identified various infections, with 67.8% being infectious in origin. There were diverse characteristics in size, shape, and edge conditions of the ulcers. Trauma was the leading factor in 73.0% of the cases. Bacteriological examinations identified Gram-negative bacilli, Staphylococcus aureus, Streptococcus, with 67.8% of the ulcers being infectious in origin. There was outpatient treatment in 64.3% of the cases. Therapies included postural drainage, venotonics, vasculoprotectors, analgesics, compression stockings, and surgical interventions. Antibiotic therapy based on antibiograms for infectious ulcers. There was maintenance treatment with delayed penicillin in recurrent cases; successful skin grafting in 80.9% of cases, with 40.8% achieving complete healing in less than three months. [ABSTRACT FROM AUTHOR]

The article "GesR: Health Law" in the 6/2024 issue contains various essays and case law on the topic of health law. An essay by Prof. Dr. Laura Münkler discusses the role of municipalities in outpatient healthcare. Another essay by Leon Zurawski examines system failures in outpatient psychotherapy and the possibility for patients to be treated outside the statutory health insurance system. The case law covers various topics such as limitation periods, reimbursement claims, and documentation obligations. Other judgments deal with information claims against pharmaceutical companies, criminal liability for prescribing compression stockings and other medical topics. The text also includes reports on various court decisions and conference reports. There are also reviews of a book and current information on various topics such as tuberculosis and hospital reform. It also mentions a new database exclusively available to subscribers of a commentary. Information is also provided about a labor law publication that includes various modules and supplementary deliveries. Further information and orders are available on the website otto-schmidt.de. [Extracted from the article]

Chronic venous insufficiency (CVI) represents a risk factor for cardiovascular events. The first-line treatment includes the use of compression stockings and lifestyle changes. Natural products, such as flavonoids, could be used to improve the effects of compression therapy due to their anti-inflammatory and anti-oxidant properties. This study aims to evaluate the effects of a dietary supplement containing baicalin, bromeline and escin in CVI patients. A retrospective cohort study was performed by using the medical records of CVI affected outpatients. Patients treated with the dietary supplement were defined as "users". A modified Venous Clinical Severity Score (VCSS) was calculated, including pain, inflammation, vessels induration and skin pigmentation. All clinical variables were evaluated at baseline (T0), after 30 (T1) and 90(T2) days in "users" and "non-users". Out of 62 patients, 30 (48.4%) were "users". No difference was observed between groups at baseline. A lower VCSS value was recorded in "users" than that observed in "non-users" at T2 (7.0 (4.0–9.0) vs. 9.0 (5.0–10.0); p = 0.025). Vessels' induration and pain significantly reduced in 53.3% and 43.3% of "users" and in 18.8% and 9.4% of "non-users". Only "users" (33.3%) showed a reduction of the inflammatory signs as well as a decrease in malleolar circumference, from 29.0 (26.5–30.0) to 27.5 (26.0–28.5) (p < 000.1). A reduction of C-reactive Protein levels was found in "users" compared to "non-users" at T2 (1.0 (0.9–1.2) vs. 1.3 (1.0–1.5); p = 0.006). These findings suggest that implementation of a dietary supplement could improve the clinical outcomes of CVI patients. [ABSTRACT FROM AUTHOR]

Objectives: The occurrence of leg edema in patients with chronic venous disease (CVD) is currently evaluated by visual inspection, palpation, and measurement of limb circumference. The changes of soft tissues morphology in swollen legs have been poorly investigated by ultrasonography (US) in the past. The purpose of this study was to evaluate the effects of medical compression stockings (MCS) on the US morphology of the cutaneous and subcutaneous layers (CL and SCL, respectively) in legs with venous edema. Methods: The morphology of the cutaneous and subcutaneous layers (CL and SCL) was evaluated by US in 18 swollen legs with chronic venous disorders (CVD), before and after 4 weeks of treatment with MCS. Skin morphology was evaluated by using an 8–14 MHz probe with a dedicated setting, 5 cm above the medial malleolus. Results: MCS provoked both quantitative and qualitative changes. A reduction of CL/SCL thickness greater than 20% was observed in 16/18 legs. A reduction of the SCL echogenicity was observed in 14/18 legs. Nine out of 12 legs which showed abnormalities of the CL before treatment showed a structural rearrangement of the dermis and the reappearing of the dermo–hypodermic junction. Conclusions: The reduction of the SCL thickness is to be ascribed to the increase of veno-lymphatic drainage promoted by MCS. The reduction of tissue echogenicity by MCS is a quite innovative concept and it is suggestive for an anti-inflammatory action of MCS on skin tissues. [ABSTRACT FROM AUTHOR]

Background: Various treatment modalities of non-healing ulcers in current setup include topical and systemic antibiotics, surgical debridement, skin grafting, compression stockings, and various types of dressings. The current study evaluates the synergistic effect of topical mupirocin, when used in combination with topical framycetin, placental extract gel and infrared radiation for treating non healing ulcers. Materials & Methods: Using Chit methods 2 groups were divided. Group “M” was treated by topical 2% mupirocin ointment dressing along with infrared radiation and Group “MFP” by topical combination of 2% mupirocin along with infrared radiation& 1% framycetin ointment with 0.1 g placental extract gel dressing on prospective basis in surgery OPD. Recording of data regarding relevant patient details like date of diagnosis of non-healing ulcer, treatment details and their regular follow up was done for 2 months in preformed data sheet on regular basis. After undergoing a detailed clinical examination, relevant investigations were recorded before and after follow up at 4th week and 8th week. The wound debrided was measured in length x width by digital planimetry. Photographs of ulcers before and after topical treatment dressings were taken. Culture and sensitivity of the ulcers were done for infective ulcers at regular visits of patients. Results: The important findings like socio-demographic values, number & percentage of reduction in ulcer area of both groups M and MFP noted in the study were expressed efficiently in tables and graphs. For normal data Statistical analysis was done by student’s “T” test and for data not following normal, Man Whitney U – test was applied to evaluate the significance of best treatment group over the other group. Reduction in ulcer size at 8th week in group M was 60.17 ± 23.25 and reduction in ulcer size at 8th week in group MFP was 89.8 ± 12.57. There was statistical significance between 2 groups (P value<0.001*, Z value: 4.809). Reduction in ulcer size at 4th week in group M was 31.33 ± 17.17 and reduction in ulcer size at 4th week in group MFP was 49.77 ± 10.62. There was statistical significance between 2 groups (P value<0.001*, Z value: 3.947). Conclusion: This study concludes that topical combination of mupirocin, framycetin with placental extract gel and infra-red radiation is more effective in treating chronic wounds and non-healing ulcer very rapidly when compared to other modalities of topical treatment which are already present in healthcare. It also gives a great idea or tool for exploration of future novel topical antibiotic combinations to be used in non-healing ulcers especially of infective origin. [ABSTRACT FROM AUTHOR]

Purpose: Nocturnal asthma is a sign of asthma worsening and could be partially due to more fluid drawn into the thorax during sleep by gravitational force and/or pharyngeal collapse in those with obstructive sleep apnea. Wearing compression stockings during the day reduces fluid shift from the legs to the neck overnight. However, the potential effect of wearing compression stockings to reduce fluid accumulation in the leg and to improve nocturnal small airway narrowing in patients with asthma has not been investigated. This study investigates whether reducing leg fluid volume by wearing compression stockings during the day would attenuate small airway narrowing in patients with asthma before and after sleep. Methods: We enrolled 11 participants with asthma. All participants underwent overnight polysomnography with or without wearing compression stockings for 2 weeks. Before and after sleep, leg fluid volume (LFV) was measured by bioelectrical impedance, and airway narrowing was primarily assessed by respiratory system resistance and reactance at 5 Hz (R5 and X5 respectively) using oscillometry. Results: After 2 weeks of wearing compression stockings, the LFV measured in the evening was reduced (∆ = − 192.6 ± 248.3 ml, p = 0.02), and R5 and X5 improved (∆ = − 0.7 ± 0.9 cmH2O/L/s, p = 0.03 and 0.2 ± 1.4 cmH2O/L/s, p = 0.05 respectively). No changes were observed in the morning. Conclusions: Preventing fluid retention in the legs by wearing compression stockings for 2 weeks during the day, reduced LFV and airway narrowing in the evening in all participants with asthma, but not in the morning after sleep. [ABSTRACT FROM AUTHOR]

Nanotechnology is one of the newest directions for plant-based therapies. Chronic venous disease often predisposes to long-term and invasive treatment. This research focused on the inclusion of vegetal extracts from Sophorae flos (SE), Calendulae flos (CE), and Ginkgo bilobae folium (GE) in formulations with PHB and PLGA polymers and their physicochemical characterization as a preliminary stage for possible use in the development of a complex therapeutic product. The samples were prepared by an oil–water emulsification and solvent evaporation technique, resulting in suspensions with high spreadability and a pH of 5.5. ATR-FTIR analysis revealed bands for stretching vibrations (O-H, C=O, and C-H in symmetric and asymmetric methyl and methylene) in the same regions as the base components, but switched to high or low wavenumbers and absorbance, highlighting the formation of adducts/complexes between the extracts and polymers. The obtained formulations were in the amorphous phase, as confirmed by XRD analysis. AFM analysis emphasized the morphological peculiarities of the extract–polymer nanoformulations. It could be noticed that, in the case of SE-based formulations, the dominant characteristics for SE-PHB and SE-PLGA composition were the formation of random large (SE-PHB) and smaller uniform (SE-PLGA) particles; further on, these particles tended to aggregate in the case of SE-PHB-PLGA. For the CE- and GE-based formulations, the dominant surface morphology was their porosity, generally with small pores, but larger cavities were observed in some cases (CE- and GE-PHB). The highest roughness values at the (8 µm × 8 μm) scale were found for the following samples and succession: CE-PHB < SE-PLGA < SE-PHB-PLGA. In addition, by thermogravimetric analysis, impregnation in the matrix of compression stockings was evaluated, which varied in the following order: CE-polymer > SE-polymer > GE-polymer. In conclusion, nine vegetal extract–polymer nanoformulations were prepared and preliminarily characterized (by advanced physicochemical methods) as a starting point for further optimization, stability studies, and possible use in complex pharmaceutical products. [ABSTRACT FROM AUTHOR]

The article focuses on the use of compression therapy in managing varicose veins, highlighting its efficacy in improving symptoms, reducing leg swelling, and enhancing quality of life for patients with chronic venous disease. Topics discussed include the indications for compression therapy, its role in different stages of varicose veins, and recommendations for its use before and after venous interventions.

An 82-year-old man presented to the emergency department with intermittent left lower extremity swelling for the last 4 to 5 months that limited his daily activities. The patient had a negative lower extremity venous duplex 3 months prior and had been treating symptoms with compression stockings but experienced no improvement. Venography showed venous outflow obstruction in his left common iliac vein and the etiology was confirmed to be a lumbar vertebral osteophyte compressing the vein. The patient underwent endovascular treatment with balloon venoplasty and stent placement over the lesion with return of adequate outflow. This report describes treatment of symptomatic left common iliac venous compression with endovascular therapy alone. [ABSTRACT FROM AUTHOR]

Exposure to the cold can negatively affect muscle performance. This study compared the effects of two different full-length, lower body, next-to-skin garments on thermal sensation, countermovement jump (CMJ) height and knee frontal plane angle upon landing following cold exposure against a control. After familiarisation, 13 male and 11 female recreationally active adults attended three separate laboratory testing sessions where a randomly assigned next-to-skin garment was used (compression, thermal and control (shorts)). A pre- and post-testing protocol comprising CMJ and drop landings interspersed with a sedentary cooling period of 40 min at 0 °C was adopted. High-speed motion analysis and subjective ratings of thermal sensation were recorded. Exposure to the cold significantly reduced thermal sensation (p < 0.001) scores and CMJ height (p < 0.001). Only female participants felt significantly warmer (p ≤ 0.009) in the next-to-skin garments. Losses in CMJ height were significantly reduced by the next-to-skin garments compared to the control with the thermal garment producing better results. There was little change in knee frontal plane angle upon landing in all the garments tested. Ambient cooling at 0 °C for 40 min had a significant effect on CMJ height and thermal sensation but not knee valgus upon landing. Participants in winter sports should consider next-to-skin garments in conjunction with proper warm-ups and re-warming techniques to protect themselves from the negative effects of the cold.

Background: After an acute deep venous thrombosis (DVT) of the lower limb, 20% to 63% of patients develop post-thrombotic syndrome (PTS). In this review, we address the efficacy of compression therapy in the treatment of acute DVT of the lower limb, and for the prevention of PTS. Methods: 12 randomized controlled trials (RCTs) and one meta-analysis, with a total of 3751 patients, were identified in a structured literature search. Results: Two RCTs showed that adding compression therapy to drug treatment in the first 9 days of the acute phase of lower limb DVT led to more rapid pain relief (p<0.050) and less swelling (remaining difference in circumference, 1 cm versus 3 cm, p<0.050). As for the prevention of PTS, four RCTs showed a short-term benefit or no benefit of compression therapy. In three further RCTs, medical compression stockings (MCS) brought about a 16% to 27% absolute reduction of the frequency and severity of PTS (47% vs. 20 %, p<0.001; 40% vs. 21% (95% confidence intervals [29.9; 50.1] and [12.7; 29.5], respectively; and 58% vs. 42%, relative risk [RR] 0.73 [0,55; 0.96]). The benefit of MCS was also confirmed in a recent meta-analysis (RR 0.66 [0.44; 0.99], I2 = 88%). Thigh-length MCS were not superior to knee-length MCS for the prevention of PTS (33% vs. 36%, hazard ratio [HR] 0.93 [0.62; 1.41]). Individual, symptom-oriented tailoring of the duration of treatment was not inferior to a fixed treatment duration of 24 months (29% vs. 28%; odds ratio [OR] 1.06 [0.78;1.44]). Conclusion: Compression therapy relieves symptoms in acute DVT and lessens the frequency and severity of PTS. It is therefore recommended as standard treatment. [ABSTRACT FROM AUTHOR]

Varicose veins of the lower extremities (VVLEs) are prevalent globally. This study aims to identify prognostic factors and develop a prediction model for recurrence survival (RS) in VVLEs patients after surgery. A retrospective analysis of VVLEs patients from the Third Hospital of Nanchang was conducted between April 2017 and March 2022. A LASSO (Least Absolute Shrinkage and Selection Operator) regression model pinpointed significant recurrence predictors, culminating in a prognostic nomogram. The model's performance was evaluated by C-index, receiver operating characteristic (ROC) curves, calibration plots, and decision curve analysis (DCA). The LASSO regression identified seven predictors for the nomogram predicting 1-, 2-, and 5-year RS. These predictors were age, body mass index (BMI), hypertension, diabetes, the Clinical Etiological Anatomical Pathophysiological (CEAP) grade, iliac vein compression syndrome (IVCS), and postoperative compression stocking duration (PCSD). The nomogram's C-index was 0.716, with AUCs (Area Under the Curve scores) of 0.705, 0.725, and 0.758 for 1-, 2-, and 5-year RS, respectively. Calibration and decision curve analyses validated the model's predictive accuracy and clinical utility. Kaplan–Meier analysis distinguished between low and high-risk groups with significant prognostic differences (P < 0.05). This study has successfully developed and validated a nomogram for predicting RS in patients with VVLEs after surgery, enhancing personalized care and informing clinical decision-making. [ABSTRACT FROM AUTHOR]

Compression stockings are routinely prescribed after total knee arthroplasty (TKA). Non-compressive sleeves embedded with semiconductor elements (Incrediwear) are designed to enhance blood flow. The objective of this investigation is to compare compression stockings and Incrediwear on post-TKA measures. In this single-center prospective clinical pilot study, patients undergoing TKA were assigned to either the compression stocking (control) or Incrediwear (experimental) group. Subjects were evaluated preoperatively and postoperative at 3 weeks for pain, knee effusion, knee range of motion (ROM), thigh and calf circumferences. Incrediwear subjects had slightly higher preoperative effusion than controls (mean effusion 1.38 vs. 1.16, p =.28); however, by week 3, Incrediwear subjects had lower levels of effusion than controls (1.12 vs. 1.56, p =.015). At week 3, when compared to pre-op, Incrediwear subjects experienced a 19% decrease in effusion while controls experienced a 35% increase in effusion (p =.003). Preoperatively, there were no differences observed between Incrediwear subjects and controls flexion ROM (mean ROM 117 vs. 116, p =.67); however, by week 3, Incrediwear subjects had greater flexion ROM than controls (113 vs. 108, p =.02). Incrediwear subjects experienced only a 3% decrease in flexion ROM while controls experienced a 7% decrease in ROM (p =.07). Incrediwear subjects reported higher preoperative pain than controls (mean pain 4.2 vs. 3.2, p =.051); however, by week 3, there was no difference observed between these groups (2.9 vs. 3.0, p =.440). Non-compressive sleeves embedded with semiconductor elements (Incrediwear) appeared to reduce effusion and improve knee flexion better than traditional compression stockings 3 weeks after total knee arthroplasty. [ABSTRACT FROM AUTHOR]

Introduction: Chronic venous disease (CVD) is a rising problem in Western countries. There are several stages of CVD that can be treated in different ways. One of the methods of treating varicosity, Stage C2 of CVD, is through endovenous laser ablation (EVLA). While still being developed, this method is popular due to its short operation time, less bleeding, quick recovery, and lack of surgical scars. Compression therapy with compression stockings has been widely used as a conservative treatment of early-stage CVD and it's also used after EVLA. However, there are no strong recommendations to use compression therapy after this kind of surgery. Aim and method: The aim of this paper is to review existing knowledge about the benefits of compression therapy and to identify a recommended time period for its use after EVLA. The databases used in the review were Pubmed and Cochrane. Results: Studies focusing on compression therapy for varicose veins after EVLA have questioned the prolonged use of compression therapy, as it brings no additional benefits and might be difficult for patients to adhere to. The existing studies recommended a period no longer than 1--2 weeks. No significant differences were found in reoccurrence rate or return to normal activities between compression and non-compression groups. It has been proven that compression therapy significantly reduces postoperative pain and the consumption of analgesics. Discussion: Compression therapy seems to be a safe option for low pain management. There is a need for further research involving the impact of compression therapy after EVLA, especially in group of low energy delivered settings, as the results of treatment are promising. [ABSTRACT FROM AUTHOR]

Thromboembolic disease (TED) is a major cause of maternal mortality and severe morbidity. The pregnant woman presents with some anatomical and physiological modifications that expose her to risk of blood clot and thisrisk issignificantly higher when she gives birth by caesarean section. In this light, the health team has a responsibility to ensure that adequate preventive measures are employed to prevent the occurrence of this disease. This was a descriptive and prospective study which was carried out on patients who had undergone a caesarean section in the YGOPH from September to October 2023 and who had given their concern. Patients were recruited from the anaesthetic consultation room, followed up in the theatre, to the recovery room and to the intensive care and obstetric units. Data was collected on Sociodemographic and clinical characteristics as well as the patient’s risk factors, the non-pharmacological and pharmacological measures of prevention and the evolution of the patient. The data was analysed using the software; Epi info and excel and presented in the form of tables, graphs and charts. We recruited a total of 54 women who had a caesarean section between the age ranges of 18 to 42 years with the mean age of 27.8 years. After the assessment of our patients’ risk factors, 5(9%) patients were classified at the low risk level, 49 (91%)patients at the intermediate and no patient at the high risk level. As regards the nonpharmacological methods, we found out that only 3 (5.3%) patients were putting on the compression stockings, 3 (5.6%) patients were deambulated on the 6-8hours post op. Only 14 (25.9%) patients took the normal amount of fluids in 24hours. The only pharmacological measure of prevention was enoxaparin which was systematically prescribed and 46 (85.2%) patientstook the drug but 8 (14.8%) patients could not afford and did not receive the drug. For those that received the drug, there was a disparity as regards the dosage and the duration of prophylaxis as only 3 (5.5%) took the drug for at least 10days as required. Finally, out of the 54 patients, 15 (27.8%) presented with complications. In this study, it was revealed that, the preventive measures of thromboembolic disease in caesarean section at the YGOPH were not optimal and needed to be improved [ABSTRACT FROM AUTHOR]

CONTEXT: Global sales of compression garments have risen sharply in recent years. Due to the availability of a wide range of compression garments, this study aims to evaluate the effect of two types of compression garments and kinesio tape on edema formation and tissue perfusion in the lower extremities. Over-the-counter compression knee stockings and kinesio tape were compared with a prototype of high-end compression stockings that combine kinesio tape and a common knee bandage. The high-end compression stockings were designed by Cube with the aim of combining the positive effects of kinesio tape and compression garments on edema formation and tissue perfusion. DESIGN: Clinical cross-over study. METHODS: Before and after a 6-hour compression period, the knee regions on both, the treated and non-treated leg, of participants were examined using a 3-D scan to detect changes in volume. Also measured were local temperature (°C), oxygen saturation (SpO2), perfusion index (Pi), blood pressure (mmHg), compression pressure (mmHg), range of motion, body-mass-index (BMI) and limb-circumference (cm). Two different types of compression garments were examined: a novel high-end compression stocking (A) and a common compression stocking (B). In addition, kinesio tape was compared to compression garments (C). After each experimental day, a one-day break was taken to prevent an unwanted overlay effect. Male and female participants between the ages of 18 and 60 were randomly selected. RESULTS: The high-end compression garment (A) showed a statistically significant (P = 0.009) reduction of edema intraindividually. Comparing the three treatment groups, compression (A) lead to a reduction of edema. However, the reduction was not statistically significant (P = 0.585). The compression garment B and kinesio tape showed an increase in edema in the lower limb. There was a positive correlation between the highest compression pressure (A: 9.8 mmHg) and volume decrease over the period of 6 hours. Lighter compression (B: 8.2 mmHg) led to an increase in leg volume after compression application over 6 hours. There was no significant difference in tissue oxygen saturation with the two types of compression and kinesio tape. The tissue temperature below the compression garment was highest in the compression group A. Nevertheless, we could not demonstrate a statistically significant correlation between tissue temperature and volume difference. The range in motion of the lower limb decreased after 6 hours with both compression A and B and with kinesio tape. CONCLUSION: The novel bandage showed a statistically significant reduction in edema when compared intraindividually, but no statistically significant advantage was found when compared with the other compression garment B and kinesio tape. Despite the widespread use of kinesio tape, we did not find any improvement in the range of motion, edema prevention and circulation in the lower limb after application of kinesio tape. [ABSTRACT FROM AUTHOR]

Compression sportswear is specialized clothing chiefly designed for the athletes muscle fatigue reduction. Compression stockings are widely used in sportswear to support muscles and control excessive body vibrations. Compression/interface pressure between the wearer and stocking's surface is considerable in compression sportswear efficacy. However, thermo-physiological comfort is also influential while preparing summer sportswear. The research investigates the effect of fibers type and the inlay yarns number of covering filaments on compression, air permeability, water vapor permeability, and thermal resistance of sportswear compression stockings. Three different fibers, sorbtek (channelized polyester), nylon 6, and micro Nylon (polyamide-6), have been used as main yarns. Also, three distinct levels of covering yarn number of filaments have been utilized. Data have been statistically analyzed using full factorial design of experiment and regression analysis to predict fiber type and the number of covering yarn filaments for achieving desired comfort properties without compromising compression characteristics. [ABSTRACT FROM AUTHOR]

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Background: Chronic edema as a complication of systemic diseases or infections can mimic filarial lymphedema (also known as elephantiasis) and considered so. We describe a case of chronic lymphedema that mimicked elephantiasis in a diabetic man. Case presentation: The patient was a 70-year-old black man, bed-bound at the time of admission following a diagnosis of stroke and hypertension in the previous 5 years. He had been diabetic for 20 years with poorly controlled diabetes mellitus. He suffered recurrent bilateral lower limb skin infections for 5 years prior to admission that culminated into progressive lowerlimb edema. The infections eventually complicated into skin edema, hardening, fissuring, and hyperkeratotic plaques. The physical examination revealed Tinea pedis and bilateral non-pitting edema of lowerlimbs to the level of the knees. Investigations confirmed non-filarial lymphedema-related skin changes. The absence of the classic pebbly/cobblestone skin changes ruled out elephantiasis nostra verrucosa (ENV), with a possibility of it being in the early stages of evolution. The patient's skin fissuring and infections were successfully treated with antibiotics and antifungals while compression stockings helped to relieve the edema. Conclusions: Chronic lymphedema can complicate repeated non-filarial infections of lower limbs. Its fissures are a risk factor for cellulitis, prompting early identification and management of both infections and lymphedema to halt their vicious cycle, especially in at risk populations like diabetics. [ABSTRACT FROM AUTHOR]

Background and Aims: Training in ergonomics is either fragmented or lacking in most GI programs. There are limited real-world data on fellows' perceptions and change in practice after the delivery of a curriculum for ergonomics. We aim to implement a curriculum for endoscopy for our GI fellows and evaluate their response to the same. Methods: We devised and implemented a curriculum with three components, delivered over 6 months for all GI fellows in an academic hospital center. These were one, a comprehensive, hour-long didactics session conducted by an experienced faculty member; two, an interactive session with a physical therapist; and three, provision of free resistance bands and compression stockings to fellows. We conducted a pre- and post-curriculum test. Data are presented as proportions and medians with interquartile range. Results: We surveyed 23 fellows. At baseline, 13.6% (3) had sustained ERI during their training. Only 63.6% (14) of trainees reported confidence in being able to recognize signs and symptoms of ERI. Their median self-reported understanding of ergonomics was 3 on a Likert scale of 1–5, corresponding with "average understanding." The majority of trainees had never reviewed any material on ergonomics prior to this curriculum. In the post-test evaluation, the median self-reported understanding of ergonomics improved to 4, corresponding with "above average understanding." All fellows requested a repeat of the curriculum, either semi-annually or annually. Conclusion: Our data show a positive perception of trainees of a practical, reproducible, and low-cost curriculum for endoscopy incorporated during GI fellowship. [ABSTRACT FROM AUTHOR]

Purpose: Self-care of the feet is one of the cornerstones in the prevention of diabetic foot ulcers (DFU). Often, individuals with diabetes seek help at the pharmacy, but it is still unclear whether the service meets their expectations and needs. The aims were to explore patients' expectations of support from the pharmacy regarding self-care of their feet and explore how patients with diabetes felt that they managed the self-care of their feet.Patients and Methods: The included participants (n = 17), aged 70 ± 9 years, answered surveys regarding their expectations of support from the pharmacy related to self-care of the feet and how they felt that they managed the self-care of their feet. By using software, MyFoot Diabetes, they assessed their risk of developing DFU (ranging from 1 = no risk to 4 = DFU). In addition, a healthcare professional assessed the risk grade.Results: Sixteen patients had not received any information from the pharmacy regarding how to take care of their feet. Several suggestions for ways the pharmacy could help patients with diabetes to take care of their feet were registered. They included having the necessary skills and competence, giving advice regarding self-care, giving information regarding the products they market and have for sale and giving advice on ointments/creams. The participants gave several examples of how they self-managed their feet: by wearing shoes indoors and outdoors, wearing socks and compression stockings as often as possible, being physically active, inspecting their feet, being aware of the fact that their feet have no problems, washing, moisturising their feet, cutting their nails and finally seeking help to prevent DFU.Conclusion: The participants thought that they should receive competent information from the personnel at the pharmacy to improve the self-care of their feet, eg, being given information about which ointments/creams to use.Clinical Trial: NCT05692778.Plain Language Summary: Persons living with diabetes have better opportunities to be physically active, keep on walking and participate in social activity if the feet are in good health. Besides getting support from healthcare, on how to promote good foot health, the pharmacies offer services and products aimed for self-care of the feet. Seventeen persons living with diabetes in the western region of Sweden answered a survey regarding their expectations of support from the pharmacy related to self-care of the feet and how they felt that they managed the self-care of their feet. The study found that persons living with diabetes self-managed their feet in different ways. The services being available from the pharmacies should be improved, promoting good foot health for persons living with diabetes, and in its prolongation prevent the development of diabetic foot ulcers. [ABSTRACT FROM AUTHOR]

Elephantiasis nostras verrucosa (ENV) is a rare and extreme complication of chronic non-filarial lymphedema. It can lead to severe disfiguration of body parts, especially the lower extremities, and is characterized by non-pitting edema and papulonodules with a verrucose or cobblestone-like appearance. Obesity is a risk factor of ENV. Various treatments have been reported for ENV. A 52-year-old woman presented to our outpatient dermatology clinic with non-pitting edema, cobblestone-like papulonodules, and erythematous plaques on both legs for 2 years. Her medical history included morbid obesity with a body mass index of 44.8 kg/m2, hypertension, and type II diabetes mellitus. Biopsy specimens obtained from skin lesions showed multiple dilated lymph nodes throughout the papillary and reticular dermis. Doppler ultrasonography and lymphoscintigraphy revealed lymph stasis and lymphedema, respectively. Based on clinical, histopathological, and imaging findings, the final diagnosis was ENV. She was initially treated with conservative approaches such as compression stockings and dietary intervention for a month. She went on a low-calorie diet (1350 kcal/day) consisting protein 50.7 g/day, fat 32.5 g/day, and carbohydrate 202.7 g/day, for a month. Owing to the hyperkeratotic lesions, she was given oral acitretin 0.3 mg/kg/day. The dosage was increased to 0.6 mg/kg/day after one month. The lesions were slightly flattened after 2 months of therapy. Acitretin was ceased. Early identification is crucial for preventing morbidity in patients with ENV. Management of ENV is challenging for physicians because of the lack of definitive treatment and poor prognosis. In the management of ENV, it is crucial to treat underlying causes, such as obesity. Acitretin induces loosening and thinning of the hyperkeratotic stratum corneum. Thus, it can result in improvement of cutaneous ENV lesions. [ABSTRACT FROM AUTHOR]

Background: In neurosurgical patients, the risk of developing venous thromboembolism (VTE) is high due to the relatively long duration of surgical interventions, usually long immobilization time after surgery, and possible neurological deficits which can negatively influence mobility. In neurosurgical clinical practice, there is lack of consensus on optimal prophylaxis against VTE, mechanical or pharmacological. Objective: To systematically review available literature on the incidence of VTE in neurosurgical interventions and to establish an optimum prevention strategy. Methods: A literature search was performed in PubMed, Embase, Web of Science, Cochrane Library, and EmCare, based on a sensitive search string combination. Studies were selected by predefined selection criteria, and risk of bias was assessed by Newcastle–Ottawa Quality Assessment Scale and Cochrane risk of bias. Results: Twenty-five studies were included, half of which had low risk of bias (21 case series, 3 comparative studies, 1 RCT). VTE was substantially higher if the evaluation was done by duplex ultrasound (DUS), or another systematic screening method, in comparison to clinical evaluation (clin). Without prophylaxis DVT, incidence varied from 4 (clin) to 10% (DUS), studies providing low molecular weight heparin (LMWH) reported an incidence of 2 (clin) to 31% (DUS), providing LMWH and compression stockings (CS) reported an incidence of 6.4% (clin) to 29.8% (DUS), and providing LMWH and intermittent pneumatic compression devices (IPC) reported an incidence of 3 (clin) to 22.3% (DUS). Due to a lack of data, VTE incidence could not meaningfully be compared between patients with intracranial and spine surgery. The reported incidence of pulmonary embolism (PE) was 0 to 7.9%. Conclusion: Low molecular weight heparin, compression stockings, and intermittent pneumatic compression devices were all evaluated to give reduction in VTE, but data were too widely varying to establish an optimum prevention strategy. Systematic screening for DVT reveals much higher incidence percentages in comparison to screening solely on clinical grounds and is recommended in follow-up of neurosurgical procedures with an increased risk for DVT development in order to prevent occurrence of PE. [ABSTRACT FROM AUTHOR]

Purpose: Hospitalisation and surgery are major risk factors for venous thromboembolism (VTE). Intermittent pneumatic compression (IPC) and graduated compression stockings (GCS) are common mechanical prophylaxis devices used to prevent VTE. This review compares the safety and efficacy of IPC and GCS used singularly and in combination for surgical patients. Methods: Ovid Medline and Pubmed were searched in a systematic review of the literature, and relevant articles were assessed against eligibility criteria for inclusion along PRISMA guidelines. Results: This review is a narrative description and critical analysis of available evidence. Fourteen articles were included in this review after meeting the criteria. Results of seven studies comparing the efficacy of IPC versus GCS had high heterogeneity but overall suggested IPC was superior to GCS. A further seven studies compared the combination of IPC and GCS versus GCS alone, the results of which suggest that combination mechanical prophylaxis may be superior to GCS alone in high-risk patients. No studies compared combination therapy to IPC alone. IPC appeared to have a superior safety profile, although it had a worse compliance rate and the quality of evidence was poor. The addition of pharmacological prophylaxis may make mechanical prophylaxis superfluous in the post-operative setting. Conclusion: IPC may be superior to GCS when used as a single prophylactic device. A combination of IPC and GCS may be more efficacious than GCS alone for high-risk patients. Further high-quality research is needed focusing on clinical relevance, safety and comparing combination mechanical prophylaxis to IPC alone, particularly in high-risk surgical settings when pharmacological prophylaxis is contraindicated. [ABSTRACT FROM AUTHOR]

Venous thromboembolism (VTE) is common in patients with trauma, and thromboprophylaxis has been advocated. However, conflicting results regarding VTE rates in the Asian population following orthopaedic procedures have been presented. We aimed to investigate the VTE incidence in Taiwanese patients with pelvic and/or acetabular fractures and identify the associated risk factors. We included 402 patients who underwent surgery for pelvic and/or acetabular fractures. All patients received mechanical thromboprophylaxis with graduated compression stockings. Duplex scanning was performed postoperatively or during follow-up when signs or symptoms of deep vein thrombosis (DVT) developed. Variables with a significance level of ≤ 0.1 in the univariate analyses were introduced into the multivariate logistic regression analysis to identify DVT risk factors. The overall DVT and symptomatic pulmonary embolism (PE) rate was 3.48% (14/402 patients). Among patients with DVT, 46.1% were asymptomatic. Patients with VTE were significantly older than those without. Multivariate logistic regression analysis revealed that age was a VTE risk factor. The incidence of DVT and symptomatic PE in our cohort was low. Advanced age was a risk factor for VTE. These findings could help clinicians develop appropriate prevention and treatment strategies for VTE in Taiwanese patients with pelvic and/or acetabular fractures. [ABSTRACT FROM AUTHOR]

Compression stockings/socks are one of the most essential materials to treat vascular disorders in veins. However, the comfort of wearing such stockings over prolonged period of time is a major problem. There is limited research in the area of comfort optimization while retaining the compressional performance. The current work is carried out with an aim to determine the optimum level of the input factors e.g., knitting structure, plaiting yarn linear density and main yarn linear density for achieving desired stretch recovery percentage and thermo-physiological comfort properties of compression socks used in treatment of vascular disorders. Their optimum combination was determined by using Taguchi based techniques for order of preference by similarity to ideal solution i.e., TOPIS. In this study, thickness, areal density, air permeability, thermal resistance, over all moisture management capacity (OMMC), stretch and recovery % were optimized simultaneously by using Taguchi-TOPSIS method. The results showed that linear density of plaiting and main yarn has significant influence on all the comfort related properties for compression stockings/socks. The optimum sample had linear density 20 denier for Lycra covered by 70 denier of nylon 66 in the plaiting yarn. It also suggested 120 denier nylon 66 in the main yarn knitted into a plain single jersey structure. The percentage contribution of the factors i.e., structure, plaiting yarn linear density and main yarn linear density was obtained by using ANOVA which are 7%, 31% and 42% respectively. It is worth mentioning that in case of compression stockings, the main yarn linear density has more significant effect on comfort properties as compared to other independent parameters. The results were verified by experiment, and the accuracy was relatively high (maximum error 8.533%). This study helped to select suitable knit structure with the change of linear densities of plaiting yarn and main yarn for comfortable compression stocking/sock and will fulfill the potential requirement for treatment of venous/vascular disorders. The novel methodology involving TOPSIS method helped in analyzing the cumulative contribution of the input parameters to achieve optimum compression as well as comfort performance. This modern approach is based on contemporary scientific principles and statistical approximations. This study may provide benchmark solutions to complex problems involving multiple interdependent criteria. [ABSTRACT FROM AUTHOR]

Background: There are no data on the daily regimen of compression therapy in patients with chronic venous disease. This systematic review aimed to establish the optimal daily duration of compression treatment. Methods: A systematic search of CENTRAL and MEDLINE was performed to identify RCTs, non-RCTs, reviews, systematic reviews, meta-analyses, and guidelines evaluating the use of compression regimens in the treatment of varicose veins. Results: Thirty-two RCTs, three non-RCTs, four observational studies, and two crossover trials reporting the duration and regimes of compression treatment fulfilled the inclusion criteria. The daily duration of compression was reported in patients after invasive treatment, for venous ulcer treatment, in patients with venous symptoms. The quality of the studies varied. We could not conduct a meta-analysis due to the heterogeneity of the research data and their quality. Twenty-three studies reported results of compression usage after invasive procedures. Eight studies reported daily duration regimens in patients with venous ulcers. Nine studies reported the impact of compression on venous symptoms and/or edema or limb volume change. One study was conducted to assess if compression improves QoL in venous patients. While there was a clear difference found in the daily duration depending on the clinical scenario, no data in support of exact regimens were found. Conclusions: There are no reliable data supporting exact daily regimens of compression treatment in various cohorts of CVD patients. [ABSTRACT FROM AUTHOR]

Objective: The primary objective of this systematic review and meta-analysis was to elucidate the rate of venous thromboembolism (VTE) after endovenous interventions for varicose veins in the presence of pharmacological and mechanical thromboprophylaxis versus mechanical thromboprophylaxis alone. Background: The VTE rate after endovenous procedures for varicose veins is higher than other day-case procedures and could be reduced with pharmacological thromboprophylaxis. Methods: The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines with a registered protocol (PROSPERO: CRD42021274963). Studies of endovenous intervention for superficial venous incompetence reporting the predefined outcomes with at least 30 patients were eligible. Data were pooled with a fixed effects model. Results: There were 221 trials included in the review (47 randomized trial arms, 105 prospective cohort studies, and 69 retrospective studies). In randomized trial arms, the rate of deep venous thrombosis with additional pharmacological thromboprophylaxis was 0.52% (95% CI, 0.23%–1.19%) (9 studies, 1095 patients, 2 events) versus 2.26% (95% CI, 1.81%–2.82%) (38 studies, 6951 patients, 69 events) with mechanical thromboprophylaxis alone. The rate of pulmonary embolism in randomized trial arms with additional pharmacological thromboprophylaxis was 0.45% (95% CI, 0.09–2.35) (5 studies, 460 participants, 1 event) versus 0.23% (95% CI, 0.1%–0.52%) (28 studies, 4834 participants, 3 events) for mechanical measures alone. The rate of EHIT grade III to IV was 0.35% (95% CI, 0.09–1.40) versus 0.88% (95% CI, 0.28%–2.70%). There was 1 VTE-related mortality and 1 instance of major bleeding, with low rates of minor bleeding. Conclusions: There is a significant reduction in the rate of DVT with additional pharmacological thromboprophylaxis and routine prescription of anticoagulation after endovenous varicose vein intervention should be considered. VTE risk for individual study participants is heterogeneous and risk stratification in future randomized interventional studies is critical to establish the clinical effectiveness and safety of additional pharmacological thromboprophylaxis. [ABSTRACT FROM AUTHOR]

Medical compression stockings failed or didn't reach expected positive functions in practical uses, one of the reasons is related to the inaccurate or inappropriate of pressure distributions. Three-dimensional (3D) scanning and analysis were carried out to extract human anthropometric data. Knitting parameters were engineering designed and theoretical pressure profiles were predicted by mathematical models, according to integrative considerations of Standard, leg morphology and machine parameter setting. The predicted pressure distributions for Class I, II & III MCSs generally in predefined ranges. The actual measured pressure values were greater than predicted at all tested regions for Series 1 of MCSs. The MCSs combined structure A and B at calf region make the effect of homogenizing pressure around calf cross-section. It's feasible and valuable to develop MCSs based on knitting parameters, 3D body scanning individually and pre-defined pressure distribution ergonomically to match directly patient-specific medical requirements and healthcare. [ABSTRACT FROM AUTHOR]

Laila Bar,1,2 Darryn Marks,3 Susan Brandis1 1Department of Occupational Therapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, Australia; 2Department of Occupational Therapy, Gold Coast University Hospital, Southport, Queensland, Australia; 3Department of Physiotherapy, Bond University, Faculty of Health Science and Medicine, Robina, Queensland, AustraliaCorrespondence: Laila Bar, Department of Occupational Therapy, Level 4, Bond Institute of Health and Sport, 2 Promethean Way, Robina, Queensland, 4226, Australia, Tel +61 413 855 090, Email laila.bar@student.bond.edu.auPurpose: Poor patient adherence to compression stockings remains a difficult and pervasive problem for clinicians, with costly repercussions for patients and health-care systems. The purpose of this paper was to describe the application of behavior change theory to the systematic development of a suite of resources, aimed at improving patient adherence to wearing compression stockings.Methods: Employing a non-empirical approach, behavior-change theory was used to develop an innovative intervention as part of a multi-phase project. Target behaviors, barriers and potential enablers were identified in relation to stocking adherence. An impact-likelihood matrix for behavior prioritization was used to identify possible areas for intervention within occupational therapy outpatient clinics. Selection of suitable resources and their consequent development were based on a narrative and problem-solving process by a panel of clinical experts.Results: Of 14 potential domains embedded in the Theoretical Domains Framework, the key target behaviors and barriers were associated with eight domains. Michie’s Behavior Change Wheel revealed recommendations in six subdivisions and of these, four intervention functions were selected by the panel, based on their potential impact and likelihood of adoption in clinical practice. Findings led to the development of a suite of resources comprising a new questionnaire, a clinical decision tree, augmented by clinical answer sheets corresponding to each of the barriers.Conclusion: Application of behavior change theory informed the design of a behavior change intervention comprising an integrated suite of resources for novice and experienced clinicians.Practice Implications: These novel resources have potential to improve patient adherence to compression stockings and consequently generate health-care savings through reduced need for wound care products, and medical interventions with translation to other settings and conditions requiring compression stockings. Patient outcomes will likely be improved with reduced pain, improved quality of life and earlier resumption of usual occupations.Keywords: compression stockings, adherence, behavior change theory, Behavior Change Wheel, COM-B model, Theoretical Domains Framework, venous leg ulcers

Stage III lymphedema, also known as elephantiasis, is the most advanced stage and involves the occurrence of large deformities. This article reports the case of a 30‑year‑old woman with bilateral stage III lymphedema who weighed 109 kg. The largest circumference measurements below the knee were 97 cm on the right leg and 76 cm on the left leg. Intensive treatment was performed, involving 8 hour per day of mechanical lymphatic therapy with the RAGodoy® device, which performs passive plantar flexion and extension, 15 min of cervical lymphatic therapy per day, and the use of non‑elastic laced compression stockings. Treatment resulted in a considerable loss of edema as well as the occurrence of folds of excess skin, which were resolved by continuing treatment in a slower, non‑intensive manner. Folds of excess skin are common during the treatment of large lymphedemas until reaching standards of normality or near normality but can be resolved with further clinical treatment. [ABSTRACT FROM AUTHOR]

A 69-year-old male patient comes to the Community Pharmacy requesting a cream to help him improve the swelling he has in his legs. For the evaluation of this clinical case, we follow the scheme proposed by the FC Pharmaceutical Care Forum (AF-FC Forum). It is suspected that it is an Insufficiently Treated Health Problem, giving place to a Negative Result associated with Medication (RNM). The Minor Ailment Service is carried out and registered in SEFAC e_XPERT INDICA+PRO. In the first intervention, an ointment based on Sodium Polysulphate 5 mg/g and health advice it is recommended. Two weeks later, the first evaluation is carried out and the patient presents some improvement, but continues with swelling in his legs. On the second visit, normal compression stockings and capsules based on natural extracts are indicated to help eliminating liquids, as well as keep going with the ointment. In the second evaluation, the patient comments that the proposed combination works well for him and that the health problem is practically solved. [ABSTRACT FROM AUTHOR]

Venous thrombo-embolism (VTE) is one of the serious complications in stroke patients. Early diagnosis and proper treatment are warranted to mitigate morbidity and mortality. Epidemiological evidence available so far favours much lower risk of VTE among Asians. Pharmacological management against VTE is highly effective but it is expensive and increases the chances of bleeding. Can the antithrombotic treatment be recommended as a prophylaxis against VTE among Asian population or we have cheaper, effective, and safer options available? Nonpharmacological treatment to prevent the incidence of VTE include graduated compression stockings, intermittent pneumatic compressions and early mobilization. Putting these options into action without pharmacological treatment may prove sufficient and effective without risking the patients to suffer from bleeding complications, particularly in cases where the severity of illness and chances of VTE are low. In such cases, non-pharmacological prophylaxis may prove more cost effective. This will improve the quality of care in regions where most of the healthcare expenses are managed through out-of-pocket spending. [ABSTRACT FROM AUTHOR]

Objective: The goal of this study was to evaluate and compare lower-leg muscle fatigue, edema, and discomfort induced by the prolonged standing of security guards wearing regular socks and those wearing 15–20 or 20–30 mmHg compression stockings as intervention. Background: Compression stockings are sometimes used by individuals standing all day at work. However, quantitative evidence showing their potential benefits for lower-leg health issues in healthy individuals during real working conditions is lacking. Method: Forty male security employees participated in the study. All were randomly assigned to the control or one of the two intervention groups (I15–20 or I20–30). Lower-leg muscle twitch force, volume, and discomfort ratings were measured before and after their regular 12-hr standing work shift. Results: Significant evidence of lower-leg long-lasting muscle fatigue, edema, and discomfort was observed after standing work for guards wearing regular socks. However, no significant changes were found for guards wearing either compression stockings. Conclusion: In healthy individuals, compression stockings seem to attenuate efficiently the tested outcomes in the lower leg resulting from prolonged standing. Application: Occupational activities requiring prolonged standing may benefit from 15–20 or 20–30 mmHg compression stockings. As similar benefits were observed for both levels of compression, the lower level may be sufficient. [ABSTRACT FROM AUTHOR]

Enhanced recovery after surgery (ERAS) recommendations for cesarean section (ERAC), likely the most common reason for laparotomy in women, were issued in 2018–19. We examined how current perioperative management at cesarean section in Austrian hospitals aligns with ERAS recommendations. We surveyed the 21 largest public obstetric units in Austria for alignment with 20 of the 31 strong ERAS recommendations regarding perioperative maternal care at cesarean section. We also looked at how the German-language clinical guideline for cesarean section (AWMF Guideline Sectio caesarea) aligns with ERAS recommendations. The 21 obstetric units cared for about 51% of all births in Austria in 2019. Cesarean section rates ranged from 17.7% to 50.4%. All 21 units implemented the five strong recommendations regarding patient information and counselling, regional anesthesia, euvolemia and multimodal analgesia. The least implemented strong recommendation was the one for the use of pneumatic compression stockings to prevent thromboembolic disease (0/21 units). Overall, all 21 units implemented ≥11 and 13 (62%) implemented ≥15 (≥75%) of the 20 strong recommendations; no unit implemented all 20 strong recommendations. There were no differences in the implementation of strong recommendations according to hospital volume. Even in the absence of formal adoption of ERAS program for cesarean section many perioperative ERAS recommendations are already implemented in Austria. The least implemented recommendations were the use of pneumatic compression stockings (0 of 21 units) and immediate catheter removal (4 of 21 units). Only 10 of the 20 ERAS recommendations we looked at are included in the current German-language clinical guideline for cesarean section. [ABSTRACT FROM AUTHOR]

Post thrombotic syndrome (PTS) is a serious complication of deep venous thrombosis (DVT). There were always debates on the efficacy of elastic compression stockings (ECS) in prevention for post thrombotic syndrome. To assess effects of elastic compression stockings and ECS's wearing time on post thrombotic syndrome after diagnosis of deep venous thrombosis. PubMed, Cochrane Library, Embase, Web of Science were last searched on 23 November 2022 for studies assessing effects of elastic compression stockings or theirs wearing time on post thrombotic syndrome after diagnosis of deep venous thrombosis. 9 randomized controlled trials were included. Wearing elastic compression stockings was associated with a statistically reduction in the overall post thrombotic syndrome rate (RR 0.73, 95 % CI 0.53 to 1.00; P = 0.05; I2 = 82 %). No significant difference in severe post thrombotic syndrome rate, recurrent deep venous thrombosis rate, and death rate was seen whether wearing elastic compression stockings or not. The pooled effect of studies comparing different wearing time of elastic compression stockings showed no significant difference in post thrombotic syndrome rate, severe and moderate post thrombotic syndrome rate, recurrent deep venous thrombosis syndrome rate and death rate. Wearing ECS can reduce the risk of developing PTS after DVT and a wearing time of less than or equal to 1 year is comparable to 2 years wearing. The results support ECS's role as a foundation therapy for preventing PTS. • Wearing elastic compression stockings can significantly reduce the risk of developing the post thrombotic syndrome after deep venous thrombosis. • For the wearing duration of elastic compression stockings, less than or equal to 1 year was comparable to 2 years. • Choosing appropriate pressure and improving patient adherence can help prevent post thrombotic syndrome better. [ABSTRACT FROM AUTHOR]

Context: Compression socks have become increasingly popular with athletes due to perceived enhancement of exercise performance and recovery. However, research examining the efficacy of compression socks to reduce exercise-associated muscle damage has been equivocal, with few direct measurements of markers of muscle damage. Objective: To examine the influence of compression socks worn during a marathon on creatine kinase (CK) levels. Design: A randomized controlled trial. Setting: 2013 Hartford Marathon, Hartford, CT. Participants: Adults (n = 20) randomized to control (CONTROL; n = 10) or compression sock (SOCK; n = 10) groups. Main Outcome Measures: Blood samples were collected 24 hours before, immediately after, and 24 hours following the marathon for the analysis of CK, a marker of muscle damage. Results: Baseline CK levels did not differ between CONTROL (89.3 [41.2] U/L) and SOCK (100.0 [56.2] U/L) (P= .63). Immediately following the marathon (<1 h), CK increased 273% from baseline (P< .001 for time), with no difference in exercise-induced changes in CK from baseline between CONTROL (+293.9 [278.2] U/L) and SOCK (+233.1 [225.3] U/L; P= .60 for time x group). The day following the marathon (<24 h), CK further increased 1094% from baseline (Fc.001 for time), with no difference in changes in CK from baseline between CONTROL (+ 1191.9 [1194.8] U/L) and SOCK (+889.1 [760.2] U/L; P = .53 for time x group). These similar trends persisted despite controlling for potential covariates such as age, body mass index, and race finishing time (Ps > .29). Conclusions: Compression socks worn during a marathon do not appear to mitigate objectively measured markers of muscle damage immediately following and 24 hours after a marathon. [ABSTRACT FROM AUTHOR]