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High geostress is a prominent condition in deep excavations and affects the cuttability of deep hard rock. This study aims to determine the influence of confining stress on hard rock fragmentation as applied by a conical pick. Using a true triaxial test apparatus, static and coupled static and dynamic loadings from pick forces were applied to end faces of cubic rock specimens to break them under biaxial, uniaxial and stress-free confining stress conditions. The cuttability indices (peak pick force, insertion depth and disturbance duration), failure patterns and fragment sizes were measured and compared to estimate the effects of confining stress. The results show that the rock cuttabilities decreased in order from rock breakages under stress-free conditions to uniaxial confining stress and then to biaxial confining stress. Under biaxial confining stress, only flake-shaped fragments were stripped from the rock surfaces under the requirements of large pick forces or disturbance durations. As the level of uniaxial confining stress increased, the peak pick force and the insertion depth initially increased and then decreased, and the failure patterns varied from splitting to partial splitting and then to rock bursts with decreasing average fragment sizes. Rock bursts will occur under elastic compression via ultra-high uniaxial confining stresses. There are two critical uniaxial confining stress levels, namely stress values at which peak pick forces begin to decrease and improve rock cuttability, and those at which rock bursts initially occur and cutting safety decreases. In particular, hard rock is easiest to split safely and efficiently under stress-free conditions. Moreover, coupled static preloading and dynamic disturbance can increase the efficiency of rock fragmentation with increasing preloading levels and disturbance amplitudes. The concluding remarks confirm hard rock cuttability using conical pick, which can improve the applicability of mechanical excavation in deep hard rock masses.

The Technical Regulations acting at present time on the highspeed lines construction has severe requirements to the quality of the railway embankments construction. They have to be practically without settlement and work at the stage of the elastic deformations. The purpose of this investigation is to study the process of soils compaction under repeated loads applications, which should have the amplitude- frequencies parameters such as produced by the highspeed running trains. Therefore, a special dynamic triaxial test apparatus was used for the laboratory investigation. The major features of this apparatus were to simulate the wave forms of the vibrations initiated by passing trains. The equipment and experimental procedure are described herein, as well as main results of testings. The first part of the report devoted to the theoretical substantiation of the possibility of the railway embankments construction without settlements. In the second part, the dynamic triaxial tests of the clay soils initially subjected to the elastic compression are described. The character of the void ratio changing during the dynamic elastic compression as compared with the static compression as well as the strength of the soils changing are shown. As the results, the method of compaction of the embankments to be applied during the new highspeed railroads construction is proposed.

Introduction: Free flap transplants for soft tissue reconstruction in the lower extremity are associated with a higher rate of complications compared with other areas. Mobilisation and the resulting hydrostatic pressure put strain on the flaps. In general, these effects are countered by slowly increasing hydrostatic pressure with the leg being compressed by elastic bandages. These postoperative regimes are also called dangling procedures or "flap training", but are not scientifically validated and therefore there is no consensus or guideline leading to a standard treatment regime. The goal of our study was to present an overview of currently performed regimes. Material and Methods: We conducted an email survey by sending a questionnaire to departments for plastic and reconstructive surgery in Germany, Austria and Switzerland, which perform free flap transplantations in the lower extremity. The questionnaire ascertained the starting point and the frequency of the dangling procedures, the introduction of weight-bearing on the operated extremity and the incidence of complications occurring during mobilisation. Results: We included 32 departments and compared them by the number of free flap transplantations performed per year. We found a wide variation between the postoperative treatment regimes. In most departments, flap training is started between the 3rd and 7th day after surgery and lasts between 5 and 15 min. The intervals with which flap training intensity is increased are inhomogeneous as well. The time until full weight-bearing is exerted on the operated extremity ranges from day 5 to week 3 postoperatively. Complications due to flap training were reported by one third of the participating departments. Conclusion: Elastic compression and patient mobilisation after free flap procedures in the lower extremity are considered to be very important in reducing complications and in protecting the flap from edema and volume overload. This article demonstrates that there is a wide variety in flap training regimes. It aims to help readers evaluate their own regimes and provides guidance for an individualised patient-oriented regime.

Background The therapeutic effectiveness of compression therapy depends on the selection of compression hosiery. Objectives To assess efficacy and tolerability of graduated elastic compression stockings (GECS) and inverse graduated elastic compression stockings (PECS). Methods Thirty-two healthy volunteers and thirty-two patients with chronic venous insufficiency were analysed; wear period: one week for each stocking type (randomised, blinded). Primary outcome: volume reduction of ‘Lower leg’ (Image3D®) and ‘Distal leg and foot’ (water plethysmography). Secondary outcomes: clinical symptoms of chronic venous insufficiency assessed by the Venous Clinical Severity Score, side effects and wear comfort in both groups. Results Volume of ‘Lower leg’: significant reduction in healthy volunteers (mean GECS: −37.5 mL, mean PECS: −37.2 mL) and in patients (mean GECS: −55.6 mL, mean PECS: −41.6 mL). Volume of ‘Distal lower leg and foot’: significant reduction in healthy volunteers (mean GECS: −27 mL, mean PECS: −16.7 mL), significant reduction in patients by GECS (mean: −43.4 mL), but non-significant reduction by PECS (mean: −22.6 mL). Clinical symptoms of chronic venous insufficiency were improved significantly better with GECS than with PECS, p Conclusion GECS and PECS reduce volume of the segment ‘Lower leg’ in patients and healthy volunteers. Patients’ volume of the ‘Distal lower leg and foot’, however, were diminished significantly only by GECS ( p = 0.0001). Patients’ complaints were improved by both GECS and PECS, and GECS were superior to PECS.

Objective: To comprehend every day of older people with venous insufficiency, who use elastic compression socks. Methods: Phenomenological research that interviewed 13 elderly attended Basic Health Units in the state of Minas Gerais, between November 2017 to January 2018. The depositions were organized in categories and discussed according to the Alfred Schütz social phenomenology and theme literature. Results: Emerged from the interviews that make explicit the perspective of the participants regarding their everyday activities with compression elastic socks: “main symptoms of the venous insufficiency relieved”, “adversities that permeate the use of elastic compression socks” and “long term use of compression elastic socks”. Conclusion: For elderly people with chronic venous insufficiency, the use of elastic compression socks promotes relieve of the symptoms; however, it demands help to put them on and take them off and provokes heat sensation and discomfort in the limbs. The elderly showed the expectation to continue the long term use of the elastic sock aiming at avoiding the relapse of varicose ulcer. To validate the adversities related to the use of this compression device may help the elderly to broaden their autonomy and functional capacity, which may be compromised by venous insufficiency.

Background Graduated compression stocking (GCS) use during flights demonstrated to positively impact leg oedema. Nevertheless, these data were collected in a single flight, mainly at the ankle, and using greater than 20 mmHg GCS. This investigation reports data from 16 flights in which the same passenger’s leg circumferences variation were assessed wearing non-graduated ankle-sock or a below-knee 15–20 mmHg GCS. Methods The limb was divided by the circumferences in eight sectors, every 4 cm, labelled from 1 to 8, starting from the ankle up. The assessment was done at the take-off and after a 4-h flight time, for a total of 16 flights. The subject used non-graduated ankle socks (elastic band at 4 cm from B-point) during the outgoing flight and below-knee GCS (15–20 mmHg) during the return flight. Interface pressure was assessed at the ankle point of minimum girth (B) and ascending proximally every 4 cm (B+cm) for the GCS, and at B and at the elastic band level (B + 4 cm) for the sock. Results GCS interface pressure was 13.3 ± 2.5 mmHg in B and 18.1 ± 2.4 mmHg in B + 4 cm. The sock interface pressure was 3.1 ± 0.7 mmHg in B and 8.1 ± 0.9 mmHg at the band level (B + 4 cm). Socks led to a significant total volume increase (117.3 ± 25.8 mL; 5.2% ±1.1%; P Conclusions Leg oedema following a 4-h flight is controlled by

Venous thromboembolism (VT) has always attracted the attention of the scientific community as one of the most common causes of acquired morbidity and mortality in hospitalized patients. The objective of VT prophylaxis protocols is mostly aimed at preventing deep vein thrombosis (DVT) and pulmonary embolisms (PE). Their incidence may in fact be as high as 20% to 40% in high-risk populations, such as polytraumatized and critically ill patients (1). Although low-dose subcutaneous unfractionated heparin (UFH) or low molecular-weight heparin (LMWH) are estimated to reduce VT incidence by 50% (2), several studies (3-5) have demonstrated that mechanical prophylaxis with elastic compression and intermittent pneumatic compression (IPC) can further reduce the incidence of DVT/PE, and are widely advocated in at risk patients.

Nonostante i recenti progressi in tema di wound care, le ulcere varicose degli arti inferiori restano un problema frequente, con un alto tasso di recidiva. In questo lavoro abbiamo esaminato la storia clinica, la storia chirurgica e le patologie associate di 133 pazienti affetti da ulcera varicosa degli arti inferiori, di cui 56 da ulcera recidiva o plurirecidiva. L’analisi dei fattori di rischio potenziale per recidiva ha evidenziato come la presenza di varici recidive, una pregressa trombosi venosa profonda, problemi ortopedici, interventi ortopedici, l’obesità e un’età inferiore a 60 anni siano fattori di rischio potenziale per una recidiva dell’ulcera. La combinazione di uno più fattori di rischio assume significatività per la possibilità di una recidiva; si passa dal 22,7% in assenza di fattori di rischio al 33% per i pazienti che ne presentano due, fino al 57,5% in presenza di tre fattori di rischio e all’81,3% per quattro o più. L’ulcera varicosa richiede un follow-up stretto del paziente e una terapia elastocompressiva continua, che deve vedere una stretta collaborazione del paziente e un’attenzione specifica ai fattori di rischio. Despite recent advances in wound care, varicose ulcers of lower limbs remain frequent and display a high rate of recurrence. In this paper, we examined the clinical, surgical histories and associated diseases of 133 patients with venous ulcers of the lower limbs, which were recurrent in 56 cases. The analysis of potential risk factors for recurrence showed that the presence of recurrent varicose veins, a previous deep venous thrombosis, orthopedic problems, previous orthopedic procedures, obesity and age lower than 60 are potential risk factors for ulcer recurrence. Furthermore, the association of one or more risk factors increased the likelihood of relapse, from 22.7% with no risk factors to 33% with 2 risk factors, up to 57.5% with 3 risk factors, and up to 81.3% with 4 risk factors or more. Venous ulcers require close follow-up and continuous elastic compression, close collaboration by the patient and specific focus on risk factors.

Objective To determine the frequency of use of elastic compression stockings in patients with lower extremity chronic venous disease. Methods An explorational, prospective, transversal, observational, descriptive, analytical study including 168 patients was performed. We identified the proportion of patients using elastic compression stockings. The odds ratio (OR) was used to determine the relation between elastic compression stocking use and previous medical attention for chronic venous disease. Results Only 59 patients (35.1%) were using elastic compression stockings at the time of the study. We determined that the patients who had received previous medical attention to manage chronic venous disease in their lower extremities were >3 times more likely to use elastic compression stockings than patients who had not received previous medical attention (OR = 3.3, p Conclusions Although there is sufficient evidence of the effectiveness of elastic compression stockings for treating chronic venous disease in the lower extremities, their use is relatively infrequent (35.1%).

Summary. Background: Elastic compression therapy (CT) in patients with peripheral artery disease (PAD) and chronic venous insufficiency (CVI) may compromise arterial perfusion. We evaluated the feasibility of a toe-flexion test, which quantifies dynamic foot perfusion by near-infrared spectroscopy (NIRS), for the assessment of hemodynamic sustainability of CT in PAD patients with CVI. Patients and methods: In this prospective observational study, PAD patients aged 50–85 with combined CVI at CEAP stages II–IV were studied. The ankle-brachial index (ABI) was measured, and foot perfusion was determined after 10 consecutive toe-flexion movements with NIRS sensors placed on the dorsum of each foot. Knee-high open-toe compression stockings were applied, and the degree of compression was measured. Toflex-area was determined by calculating the area under the curve of the oxygenated hemoglobin track recorded by NIRS. A toflex-area reduction > 20 % following CT was arbitrarily defined to identify limbs of patients with improved foot perfusion. These subjects received CT to be worn and a diary to report adherence and symptoms. Results: Forty-seven PAD patients (74 ± 9 years; ABI 0.67 ± 0.24) with CVI were enrolled. For all legs, superimposable toflex-areas were observed for the first two attempts (ICC 0.92). Following application of CT (17 ± 2 mmHg), the toflex-area improved (from –162 ± 110 a.u. to –112 ± 104 a.u.; p 2 = 0.18; p partial = –0.42) while the percentage improvement directly correlated with CEAP class (p = 0.033). Conclusions: The NIRS-assisted test, which is feasible in a laboratory context, objectively discriminates the hemodynamic tolerability of the treatment and identifies subjects with combined PAD and CVI with improved perfusion after CT, in spite of the presence of PAD.

The piezoresistance effect has been investigated in compensated and thermally treated samples of Si : Zn and Si : Zn, Mn under a uniaxial elastic compression. This effect is shown to be caused by changes in the concentration and mobility of current carriers. The anomalous change in the carrier mobility under the compression along crystallographic axis [111] is connected with a change in their scattering on large-scale defect formations., Ефект п’єзорезистентностi дослiджено в компенсованих та термiчно оброблених зразках Si : Zn i Si : Zn, Mn при одновiсному пружному стискуваннi. Показано, що цей ефект зумовлений змiнами концентрацiї та рухливостi носiїв струму. Аномальнi змiни рухливостi носiїв при стиску навколо кристалографiчної осi [111] пов’язанi зi змiною їх розсiювання на великомасштабних утвореннях дефектiв.

The field dependences of the signal of induction transducer U~(H), proportional to the magnetic incremental permeability, were obtained on plastically deformed samples of low-carbon steel subjected to compression in the range of elastic deformation. It was found that the greater the relative elongation of the samples, the greater the magnetic fields in which maxima in the U~(H) curves are observed. The additional elastic compression results in the presence of three maxima in the U~(H) curves instead of two. These maxima are associated with the displacement of 90° and 180° domain walls. Most likely, for small values of compressive stresses in the samples, the third maximum in the U~(H) curves was not visible because of its close position to the maximum in the negative field. Fittings by pseudo-Voigt functions were carried out to determine the fields corresponding to three maxima. A new approach was proposed for the evaluation of internal stresses via determination of the fields of two maxima in the U~(H) curve associated mainly with the displacement of 90° domain walls.

Compressed air energy storage (CAES) is a promising energy conversion storage technology and underground salt caverns are recognized as the appropriate storage places for it. The reduction of air during the withdrawal periods leads to the surrounding rock being unloaded, which threatens the stability of the salt cavern. To investigate the mechanical behavior of surrounding rock under different unloading rates, the confining pressure unloading tests in six unloading rates have been conducted on rock salt. Results show the rock salt undergoes volume expansion at the beginning of unloading due to the reduction of elastic compression strain. The volume strain expands rapidly beyond a threshold, i.e. accelerated strain point. The stresses at failure point and accelerated strain point show that a low unloading rate is beneficial to enhance rock strength. Nevertheless, larger inelastic strain appears in a lower unloading rate. The effect of the unloading rate on rock salt failure mode is that rapid unloading will promote crack growth. Moreover, the relationship between the unloading rate of surrounding rock and the air withdrawal rate is established. The outcome derived from the research can provide some instruction and inspiration for air withdrawal rate design in CAES.

The interpretation of field load tests on piles has many important practical considerations especially with respect to identifying the capacity of a pile. A number of interpretation criteria have been used in the past. With the increase in the use of large-diameter open-ended piles (LDOEPs) for support of infrastructure projects, it is important to ascertain that the interpretation criteria are suitable for LDOEPs. Fourteen of the most commonly used interpretation criteria were chosen for investigation in an effort to determine the best criterion to be used for LDOEPs. These methods were evaluated using a database of 68 load tests conducted on LDOEPs. The applicability of these criteria and their correlation with each other was examined. The effects of the pile diameter, pile length, and the soil type on the performance of each criterion were investigated, as well as the capacities corresponding to several serviceability limit states. It was concluded that none of these methods was superior to the others, and their performance was somewhat correlated. The original Davisson offset method and the New York City Building Code (NYCBC) criteria performed best in comparison to the average of all methods exhibiting the highest accuracy and the lowest of the standard deviations for the load tests considered. A variation of the NYCBC criterion is proposed for LDOEPs, where the capacity is taken at the smallest of (1) a settlement corresponding to the elastic compression plus 0.75 in. (20 mm); (2) the capacity at plunging or strain-softening; or (3) settlement corresponding to 5 % of the pile diameter, unless the settlement threshold is modified by the structural engineer of record. The proposed criterion is not influenced by diameter, length, or soil type. Additionally, the proposed criterion is well correlated with several well-known published criteria and introduces safeguards against capacities corresponding to excessive settlement in slender piles.

Compression therapy, prescribed as elastic compression stockings, is the cornerstone in the management of post-thrombotic syndrome. The effectiveness of elastic compression stockings has recently been called into question in a large randomized placebo-controlled trial. The findings however may be less contradictory than assumed and presented. The mechanistic substrate for the effectiveness of compression therapy is based on its ability to counteract venous hypertension, which is a central aspect in the pathophysiology of post-thrombotic syndrome. Nevertheless, despite elastic compression stockings a significant percentage (20–50%) of patients develops post-thrombotic syndrome, suggesting that there are other factors to be considered next to compression. Every patient has an individual baseline risk value, constituted of non-modifiable and modifiable risk factors (i.e. age, sex, bodyweight etcetera). Straining patients at risk is therefore crucial. Exploring additional or alternative forms of therapy is desirable as well since these are in addition to the risk factors, costs aspects and quality of life, puzzle pieces in the management of post-thrombotic syndrome, which once pieced together enables multifactorial yet individualized therapy.

The purpose of this study was to identify the effects of the application of elastic compression stockings and lower extremities exercise on edema and pain of lower extremities in hospital nurses. The participants were 30 hospital nurses working at a general hospital. The participants were categorized into three groups such as, 10 for an experimental group of the application of the elastic compression stocking, 10 for another experimental group of the application of Lower extremities exercise and 10 for a control group. Edema of the lower extremities were measured in terms of the girths of ankles and calves. And pain of the lower extremities were measured in terms of the score by NRS(Numerical Rating Scale). The data were analyzed with Frequency, Percentage, Mean, Standard Deviation, -test and ANOVA to identify the participants' characteristics, SPSS Win 21.0 program was used for analysing. There are significant differences in lower extremity edema among the experimental group of lower extremities exercise, experimental group of elastic compression stocking and control group was supported(Rt Calf F=0.645, p=.000, Lt Calf F=21.941, p=.000). There are significant differences in lower extremity pain the experimental group of lower extremities exercise, experimental group of elastic compression stocking and control group was supported(Rt: F==7.320, p=.000 Lt: F=10.623, p=.000). In conclusion, in has been appeared that the lower extremities exercise and wearing elastic compression stocking have effedted in relieving low extremity edema and pain scale for nurses.

The study aims to explore the comprehensive reasons for patients' non-compliance with graded elastic compression stockings (GECS) as the treatment for lower limb varicose veins. Phenomenological analysis was applied in this qualitative study. The patients diagnosed with lower limb varicose veins and undergoing elective surgery who showed non-compliance with GECS as the treatment were invited to have semi-structured, in-depth, face-to-face interviews. Colaizzi method was employed to analyze the data for emerging themes associated with the reasons for patients' non-compliance. Four main themes and nine subthemes related to the reasons for non-compliance with GECS for lower limb varicose veins were summarized. The main themes that emerged were (1) gaps in the knowledge of GECS therapy as a treatment for lower limb varicose veins, (2) few recommendations from the doctors and nurses, (3) disadvantages of GECS, and (4) sociopsychological factors. These themes provide data for policy and planning to improve patients' compliance with GECS in China. Patients, healthcare professionals, and policy makers should share the responsibility to improve patients' compliance with GECS therapy.

User-oriented custom-fit compression garment (CG) catering to individual preferences is fast growing. This study aims to establish and verify a new three-dimensional (3D) modeling and design system of custom-fit functional compression garment including digitalized body scanning, digital knitting design and performance assessment. The personalized numerical 3D models of human and elastic compression fabrics were created based on medical magnetic resonance scanning images, anthropometry, and finite element analysis. The developed numerical model was validated using experimental data and demonstrated agreement with the measured skin pressure profiles. The tissue deformations, curvature variations and internal stress distributions by the designed and fabricated CG were visualized via the developed numerical model and used for assessment of biomechanical effects of the designed CG on the specific subject. The applicability of the proposed digitalized development and assessment system for custom-fit pressure product was demonstrated, which would not only contribute to improving custom-fit, pressure function and wearing comfort, but also conform to the promising trend of automation and data exchange in modern textile and fashion manufacturing technologies.

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Objective: to validate an algorithm for the choice of the abdominoplasty surgical technique among the five approaches established in the literature, according to the characteristics of the abdominal wall. Methods: we conducted a retrospective study of 245 patients undergoing abdominoplasty, for whom the method of choice of the surgical technique was the proposed algorithm, based on the degree of abdominal flaccidity determined by bimanual maneuver. We studied its applications and conveniences, as well as the complications inherent in each group studied. Results: according to the algorithm used, the most frequently chosen technique was “Technique IV” (transverse dermolipectomy of Pitanguy - or with a Baroudi-Kepke incision), in 25.71% of the cases. “Technique I” (mini abdominoplasty) had the lowest incidence and the lowest rate of complications. On the opposite, “Technique III”, dermolipectomy with remaining vertical scarring, presented a higher incidence of complications, requiring extreme caution in its indication, particularly in relation to patients’ expectations regarding the resulting scar and its legal aspects. Among all conducts, the most frequent complication was seroma, with a 10.2% occurrence, solved by simple syringe aspiration and use of elastic compression mesh. Conclusion: the proposed algorithm facilitated the choice of abdominoplasty techniques, offering satisfactory results, which are in line with the complication rates published in the world literature. RESUMO Objetivo : validar um algoritmo para a escolha da técnica cirúrgica de abdominoplastia, entre as cinco abordagens consagradas na literatura, de acordo com as características da parede abdominal. Método: estudo retrospectivo de 245 pacientes submetidos à abdominoplastias, em que o método de escolha da técnica cirúrgica teve como ferramenta o algoritmo proposto, baseado no grau de flacidez abdominal determinado por manobra bimanual. Foram estudadas suas aplicações e conveniências, bem como identificadas as complicações inerentes a cada grupo estudado. Resultados: de acordo com o algoritmo empregado, a técnica mais frequentemente eleita foi a “Técnica IV” (dermolipectomia transversa à Pitanguy - ou com incisão de Baroudi-Kepke), em 25,71% dos casos. A “Técnica I” (miniabdominoplastia) demonstrou a menor incidência e a menor taxa de complicações. A “Técnica III”, dermolipectomia com cicatriz vertical remanescente, ao contrário, apresentou maior incidência de complicações, requerendo extrema cautela na sua indicação, particularmente frente às expectativas dos pacientes quanto à cicatriz resultante e seus aspectos legais. Entre todas as condutas, a complicação mais frequente foi o seroma, com 10,2% de ocorrência entre os 245 casos operados, resolvido pela simples aspiração com seringa, e uso de malha compressiva elástica. Conclusão: o algoritmo proposto contribuiu para facilitar a escolha das técnicas na abdominoplastia, oferecendo resultados satisfatórios, que se alinham com as taxas de complicações publicadas na literatura mundial.

Background Patients’ adherence to elastic compression stockings is difficult to evaluate, and therefore we create a short self-questionnaire and validate its psychometric properties. Methods We reduce the questions with Varimed rotation analysis, evaluate its internal consistency using Cronbach’s alpha test and its external validity by comparison to electronic thermic captors. Receiver operating characteristic (ROC) analysis was used to determine a threshold and determine its sensitivity and specificity. Results The initial questionnaire was reduced from 22 to 5 questions rated from 0 to 4. The internal consistency and its external validity are good, and the ROC analysis shows that values > 3 correspond to poor compliance with a sensitivity of 88.1% and a specificity of 63.1%. Conclusion The adherence score is valid for the detection of patients poorly compliant to the wearing of elastic compression. Its small number of questions makes it a suitable for a screening in everyday practice.

Background. Elastic compression stockings (ECS) are effective in preventing and reducing occupational edema (OE), but the optimal pressure according to the prevalent working position during the day is still controversial. Objective. To compare the effectiveness of ECS with different pressures (15–20 mmHg or 20–30 mmHg) for reducing OE in individuals working in different prolonged postures. Methods. This cross-sectional study comprised 116 lower limbs of 58 individuals divided into three groups according to their prevalent postures over the day (sitting, standing, or combination). Volumetric measurements were taken at the beginning and at the end of three consecutive days. On the first day, individuals did not use compression stockings; on the second and third days, they used, respectively, 15–20 mmHg and 20–30 mmHg knee-length stockings. Differences between morning and evening volumes (measured edema) were calculated, compared, and correlated. Results. Volumetric variations were significantly lower on the second compared to the first day when individuals in all three groups used 15–20 mmHg compression stockings (p-value < 0.001). Measurements were even lower when they used 20–30 mmHg stockings: this decrease was more significant for the sitting (p-value < 0.001) than the standing (p-value < 0.05) and combined groups (p-value < 0.05). Reduction of measured edema was more significant in individuals working in a prolonged seated position. No significant difference was found only on comparing sitting and standing groups after the use of the 15–20 mmHg compression stockings. Conclusions. The use of ECS over a working day reduces OE in prolonged sitting, standing, and combined positions, with the reductions being greater with the higher pressure.

International audience; Compression therapy with stockings or bandage is the most common treatment for venous or lymphatic disorders. The objective of this study was to investigate the influence of bandage mechanical properties, application technique and subject morphology on the interface pressure, which is the key of this treatment. Bandage stretch and interface pressure measurements (between the bandage and theleg) were performed on 30 healthy subjects (15 men and 15 women) at two different heights on the lower leg and in two positions (supine and standing). Two bandages were applied with two application techniques by a single operator. The statistical analysis of the results revealed: no significant difference in pressure between men and women, except for the pressure variation between supine and standing position; a very strong correlation between pressure and bandage mechanical properties (p

Resume Grâce a de multiples mecanismes d’action, la compression elastique possede de tres nombreuses indications therapeutiques, voire preventives. Le pharmacien doit les connaitre pour delivrer les dispositifs, mais egalement conseiller et eduquer le patient quelle que soit la situation.

Objectives To study the differences in impact on venous hemodynamics between larger size strong graduated elastic compression stockings (GECS) and appropriate size strong/moderate GECS. Method In healthy legs fitted for a small (Group S; n = 8) and large (Group L; n = 8) GECS, air plethysmography was performed without GECS, with an appropriate size strong GECS (GECS1), with a three-size too large strong GECS (GECS2), and with an appropriate size moderate GECS (GECS3) in this order. Results In Group S, interface pressure with GECS2 was equal to or higher than that with GECS3. Decreased venous volume, unchanged ejection volume, and decreased residual volume were achieved by GECS, but differences in these parameters among GECS were not observed. Although insignificant, a similar tendency was found in Group L. Conclusions A larger size strong GECS seemed to have equivalent interface pressure and impact on venous hemodynamics compared to an appropriate size moderate or strong GECS.

Background: The objective of this study is to investigate the effectiveness of medium pressurized elastic compression stockings usage after isolated vena saphena parva stripping. Material and Methods: Between 2001 January2014 March, 60 patients (40 women, 20 men, mean age; 39± 11 years, 35 to 58 years range) treated with vena saphena parva ligation and total stripping for isolated vena saphena parva insufficiency, were enrolled in this retrospective study. Elastic bandage applied postoperatively. Patients were divided into two groups according to use of additional compression stocking for 4 weeks; as stockings using group, (group 1; 18 women, 12 men, mean age 35±12.2, 23 to 47 years) and as no stockings using group, (group 2; 22 women, 8 men, mean age 38±10.8, 27 to 49 years) and. Primary outcomes and secondary outcomes were evaluated. Results: Extremity volumes in Group 1 and Group 2 were reduced from preoperatively 4600±540 ml and 4740 ± 420 ml to postoperatively 4440±430 ml and 4660 ± 400 ml, respectively. There were no differences between two groups by means of time to return to work and complications. Extremity volumes and Visual Analogue Scale pain scores were detected statistically significant reduction at the end of 4 weeks in group 1. Conclusion: Additional use of compression stockings after isolated vena saphena parva stripping can provide significant reduction in extremity edema and visual analog scale pain score. On the other hand, developing complications and time to return to work in both groups seem similar, Amaç: Bu çalışmanın amacı, izole Vena SafenaParva stripingi sonrasında orta basınçlı elastikkompresyon çorabı kullanılmasının etkinliğiniaraştırmaktır.Gereç ve Yöntem: 2011 Ocak ile 2014 Marttarihleri arası izole Vena Safena Parva yetmezliğinedeniyle opere edilen 60 hasta (40 kadın, 20 erkek,yaş ortalaması; 39± 11, 35-58 yaş arası) burandomize kontrollü retrospektif çalışmaya dahiledildi. Ekstremitelere postoperatif 3 gün boyuncaelastik bandaj uygulandı. Hastalar ilaveten 4haftalık kompresyon çorabı giyenler (Grup 1; 18kadın, 12 erkek, yaş ortalaması 35±12,2, 23-47 yaşarası] ve giymeyenler (Grup 2; 22 kadın, 8 erkek,yaş ortalaması 38±10.8, 27-49 yaş arası.) olmaküzere iki gruba ayrıldı. Primer sonlanım vesekonder sonlanım sonuçları değerlendirildi.Bulgular: Çalışma ve kontrol grubunda bacakortalama hacimleri sırasıyla preoperatif 4600±540ve 4740 ± 420 ml iken postoperatif 4. hafta sonunda4440±430 ml ve 4660 ± 400 ml’e geriledi. Dörthaftalık takip döneminde işe dönüş,komplikasyonlar açısından fark gözlenmedi. Bacakhacimleri ve vizuel analog skala ağrı skorlarındagrup 1’de istatistiki olarak anlamlı derecede birazalma saptandı.Sonuç: İzole vena safena parva stripingi sonrasıilave elastik kompresyon çorabı giyilmesiekstremite ödemi ve postoperatif ağrı hissindeanlamlı derecede azalma sağlayabilir. Diğer taraftanvaris çorabı kullananlar ile kullanmayanlarkomplikasyon gelişimi ve işe dönüş zamanıaçısından benzer görünmektedir.Anahtar Kelimeler: Vena safena parva, striping,komplikasyon, skleroterapi

• Compliance to elastic compression stockings (ECS) can affect treatment efficacy of PTS.

Мета роботи – покращити результати комплексного консерва- тивного лікування хворих літнього та старечого віку на трофічні виразки нижніх кінцівок на тлі хронічної венозної, серцево- судинної недостатності та цукрового діабету ІІ типу з викорис- танням ад'ювантної загальної та місцевої фармакотерапії в умо- вах амбулаторії загальної практики та сімейної медицини. Матеріал і методи. У статті представлено десятирічний досвід консервативного лікування 834 хворих на трофічні виразки нижніх кінцівок венозної та іншої етіології в умовах стаціонару сільської дільничної лікарні та лікарської амбулаторії загальної практики і сімейної медицини з використанням ад'ювантного загального ліку- вання на основі Орегонського протоколу (1999), а також місцево- мазевих лікувальних пов’язок (Унна-Кефера) з дотриманням прин- ципу перебігу фаз ранового процесу і застосуванням лікувальної та пожиттєвої, щоденної еластичної компресії. Результати. При виразках діаметром від 2 до 5см (344) курс ліку- вання до повної епітелізації становив від 2 до 5 тижнів; а при трофічних виразках у діаметрі від 6 до 9 см (179) – 6-10 тижнів. У 31 хворого загоєння проходило під пов’язкою Унна-Кефера , а в 59 хворих при виразках діаметром більше 10 см терміни лікування становили 15-18 тижнів, з багаторазовим використанням пов’я- зок Унна-Кефера. У 44 (7 %) пролікованих хворих наступили реци- диви виразок через порушення режиму компресійної терапії. Висновки. Таким чином, застосування вищенаведеного лікування з дотриманням принципу лікування з врахуванням перебігу фаз рано- вого процесу та лікувальної і пожиттєвої, щоденної еластичної компресії, дає можливість у 93 % отримати стійкий лікувальний ефект., Цель работы – улучшить результаты комплексного консервативного лечения больных пожилого и старческого возраста с трофическими язвами нижних конечностей на фоне хронической венозной, сердечно-сосудистой недостаточности и сахарного диабета II типа с использованием адювантной общей и местной фармакотерапии в условиях амбулатории общей практики и семейной медицины. Материал и методы. В статье представлено десятилетний опыт консервативного лечения 834 больных с трофическими язвами нижних конечностей венозной и другой тиологии во врачебной амбулатории общей практики и семейной медицины, с дневным стационаром при использовании адювантного общего лечения на основе Орегонского протокола (1999), а в местной терапии – мазевых лечебных повязок, в т.ч. Унна-Кефера, с тщательным соблюдением принципа течения фаз раневого процесса, а также применения лечебной и пожизненной, ежедневной ластической компрессии. Результаты. При язвах диаметром от 2 до 5см (344) курс лечения до полной пителизации был от 2 до 6 недель; а при ТВ в диаметре от 6 до 9 см (179) составлял 6-10 недель. При том, у 31 из них заживление наступало под повязкой Унна-Кефера, а у 59 больных при язвах диаметром больше 10 см строки лечения были 15-18 недель, с многоразовым использованием повязок Унна-Кефера. В 44 (7 %) пролеченных больных наступили рецидивы язв из-за нарушения режима компрессионной терапии. Выводы. Таким образом, применение вышеуказанного лечения с соблюдением принципа течения фаз раневого процесса, а также лечебной, и пожизненной, ежедневной ластической компрессии, дат возможность в 93 % получить стойкий лечебный ффект., Objective. The aim of the work is to improve the results of complex conservative treatment of elderly and senile patients with trophic ulcers of the lower extremities on the background of chronic venous, cardiovascular insufficiency and type II diabetes mellitus with the use of adjuvant general and local pharmacotherapy in a general practice and family medicine outpatient setting. Materials and methods. The paper presents ten years of conservative treatment 834 patients (of them: in working age – 209, in the elderly and senile – 625), the trophic ulcers of the lower limbs and other venous etiology in a district hospitals (2007-2012) and in ambulatory general practice and family medicine (2013-2016), using a common adjuvant treatment Oregon protocol based (1999) and locally – ointment medical dressings, including Unna's boot, carefully principle of motion phases of wound healing, and the use of medical daily elastic compression. Result. Ulcers with a diameter of 2 to 5cm (344) treatment to complete epithelialization was between 2 to 5 weeks; and ulcers in diameter from 6 to 9 cm (179), he was 6-10 weeks. Thus, in 31 patients healing took place under the bandage Unna's boot and in 59 patients with ulcers with a diameter of 10 cm treatment periods were 15-18 weeks, with repeated use of Unna's boot. In 44 (7 %) treated patients with recurrent ulcers occurring due to violation of compression therapy. Conclusion. Thus, the use of above mentioned treatment, taking into account current phases of wound healing, and medical daily elastic compression makes it possible to get a 93 % sustained therapeutic effect.

This open registry aimed to evaluate the clinical evolution of postpartum varicose veins (VVs), in healthy women after the second pregnancy, how these veins regain shape and competence, and possible treatments. The registry included two groups of women: (1) those who used elastic compression stockings, and (2) who used an oral venotonic agent (Pycnogenol, 100 mg/d). A total of 12 evaluation targets were established. Minor symptoms were scored in an analogue scale line. A visual analogue scale line evaluated the overall satisfaction relative to elastic compression or Pycnogenol. Overall 133 women completed the registry evaluation with at least 3 months of follow-up. The resulting two registry groups were comparable. At 3 and 6 months in the Pycnogenol group the number of veins and incompetent sites were lower. At 6 months there were 13.3% of patients with edema in controls versus 3.2% in the Pycnogenol group. Spider veins decreased in Pycnogenol patients. Cramps and other minor symptoms were less common in the Pycnogenol group. In both groups there was a significant improvement at 6 months with better results in the Pycnogenol group. The need for treatment was limited with a decreased need for sclerotherapy, surgery, and conservative treatments in the Pycnogenol group. The overall satisfaction was higher among Pycnogenol patients, and compliance was optimal. Re-evaluation at 12 months indicated that the variations in VVs and spider vein clusters and the associated symptoms did not change. Most remodeling appeared to happen within 6 months after the pregnancy. It was concluded that the use of Pycnogenol improves signs/symptoms of postpartum VVs, and venous function and shape seem to return faster to prepartum, physiological pattern with its use.

Compression therapy is the standard first-line treatment for chronic venous insufficiency and venous ulceration, and remains so despite progress in both ablative and reconstructive venous surgery. The goal of compression therapy is to facilitate rapid ulcer healing, maintain functional mobility of the patient, and prevent recurrence. Compression therapy is effective at promoting reasonably rapid ulcer healing. Compression therapy should create internal pressures that are evenly distributed within the leg that maximize the effect of calf muscle contraction and thus optimize venous blood return to the heart. Prior to the initiation of compression therapy for venous ulceration, patients must be educated about their chronic disease and the need to comply with their treatment plan in order to heal ulcers and prevent recurrence. Compression therapy is most commonly delivered with gradient elastic compression stockings. Stockings are less bulky than other forms of compression therapy and therefore perhaps more comfortable.

BACKGROUND The aim of this study was to establish whether maximalist shoes engender fewer muscular oscillations than minimalist shoes and determine to what extent these shoes, when combined with elastic compression (EC), help reduce muscle oscillations. For that purpose, we tested the effects of various levels of compression on the muscular oscillations in maximalist and minimalist footwear. METHODS Eleven volunteers executed 16 one-minute passages on a flat treadmill in a randomized order: maximalists or minimalists, walking (6 km/h) or running (10 km/h), without EC (control condition [CON]) or with EC applying different pressures (9.6 mmHg, 14.5 mmHg and 20.4 mmHg). The muscular oscillations were measured on both thighs, on the rectus femoris and on the vastus medialis with tri-axial accelerometers. RESULTS Muscular oscillations are lower in maximalist shoes than in minimalist shoes, for both walking to 6 km/h and running to 10 km/h (P

BackgroundPost-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) that is characterised by chronic pain, swelling, and skin changes in the affected limb. One of every three people with DVT will develop post-thrombotic complications within five years. Several non-pharmaceutical measures are used for prevention of post-thrombotic syndrome during the acute phase of DVT. These include elevation of the legs and compression therapy. Clinicians and guidelines differ in their assessment of the utility of compression therapy for treatment of DVT. This is an update of a review first published in 2003.ObjectivesTo determine relative effectiveness and rate of complications when compression therapy is used in people with deep vein thrombosis (DVT) for prevention of post-thrombotic syndrome (PTS).Search methodsFor this update, the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (20 March 2017) and CENTRAL (2017, Issue 2). The CIS also searched trial registries for details of ongoing or unpublished studies. SelectioncriteriaWe included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of compression therapy, such as bandaging and elastic stockings, in people with clinically confirmed DVT. The primary outcome was the occurrence of PTS.Data collection and analysis Two review authors (DK and EvL) identified and assessed titles and abstracts for relevance, and a third review author (DA) verified this assessment independently. Review authors imposed no restrictions on date or language of publications. Three review authors (DA, DK, EvL) used data extraction sheets to independently extract study data. We resolved disagreements by discussion.Main resultsWe identified 10 RCTs with a total of 2361 participants that evaluated compression therapy. The overall methodological quality of these trials was low. We used only five studies in meta-analysis owing to differences in intervention types and lack of data. Three studies compared elastic compression stockings (pressure of 30 to 40 mmHg at the ankle) versus no intervention. Two studies compared elastic compression stockings (pressure 20 to 40 mmHg) versus placebo stockings. Overall, use of elastic compression stockings led to a clinically significant reduction in the incidence of PTS (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.38 to 1.01; P = 0.05; 1393 participants; 5 studies; low-quality evidence); no reduction in the incidence of severe PTS (RR 0.78, 95% CI 0.53 to 1.15; P = 0.21; 1224 participants; 4 studies; low-quality evidence); and no clear difference in DVT recurrence (RR 0.94, 95% CI 0.69 to 1.28; 1212 participants; 4 studies; P = 0.69; low-quality evidence). We did not pool data on the incidence of pulmonary embolism because this information was poorly reported, but we observed no differences between groups included in individual studies (low-quality evidence).Two studies evaluated effects of compression in the acute phase versus no compression treatment and found no differences in the incidence of PTS (RR 0.76, 95% CI 0.49 to 1.16; P = 0.2; 101 participants). One study reported that thigh-length stockings did not provide better protection against development of PTS than knee-length stockings (RR 0.92, 95% CI 0.66 to 1.28; P = 0.6; 267 participants). Another trial reported that wearing compression stockings for two years seemed to be superior to wearing them for one year in terms of PTS incidence.Two of the 10 included studies described patient satisfaction and quality of life (moderate-quality evidence), using different measurement systems. The first study showed significant improvement in well-being and DVT-related quality of life with compression treatment (P Authors'conclusionsLow-quality evidence suggests that elastic compression stockings may reduce the occurrence of PTS after DVT. We downgraded the quality of evidence owing to considerable heterogeneity between studies and lack of or unclear risk of blinding due to clinical assessment scores. No serious adverse effects occurred in these studies. Large randomised controlled trials are needed to confirm these findings because of current lack of high-quality evidence and considerable heterogeneity.

Background Post-thrombotic syndrome (PTS) is a long-term complication of deep vein thrombosis (DVT) that is characterised by chronic pain, swelling, and skin changes in the affected limb. One of every three people with DVT will develop post-thrombotic complications within five years. Several non-pharmaceutical measures are used for prevention of post-thrombotic syndrome during the acute phase of DVT. These include elevation of the legs and compression therapy. Clinicians and guidelines differ in their assessment of the utility of compression therapy for treatment of DVT. This is an update of a review first published in 2003. Objectives To determine relative effectiveness and rate of complications when compression therapy is used in people with deep vein thrombosis (DVT) for prevention of post-thrombotic syndrome (PTS). Search methods For this update, the Cochrane Vascular Information Specialist (CIS) searched the Cochrane Vascular Specialised Register (20 March 2017) and CENTRAL (2017, Issue 2). The CIS also searched trial registries for details of ongoing or unpublished studies. Selection criteria We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of compression therapy, such as bandaging and elastic stockings, in people with clinically confirmed DVT. The primary outcome was the occurrence of PTS. Data collection and analysis Two review authors (DK and EvL) identified and assessed titles and abstracts for relevance, and a third review author (DA) verified this assessment independently. Review authors imposed no restrictions on date or language of publications. Three review authors (DA, DK, EvL) used data extraction sheets to independently extract study data. We resolved disagreements by discussion. Main results We identified 10 RCTs with a total of 2361 participants that evaluated compression therapy. The overall methodological quality of these trials was low. We used only five studies in meta-analysis owing to differences in intervention types and lack of data. Three studies compared elastic compression stockings (pressure of 30 to 40 mmHg at the ankle) versus no intervention. Two studies compared elastic compression stockings (pressure 20 to 40 mmHg) versus placebo stockings. Overall, use of elastic compression stockings led to a clinically significant reduction in the incidence of PTS (risk ratio (RR) 0.62, 95% confidence interval (CI) 0.38 to 1.01; P = 0.05; 1393 participants; 5 studies; low-quality evidence); no reduction in the incidence of severe PTS (RR 0.78, 95% CI 0.53 to 1.15; P = 0.21; 1224 participants; 4 studies; low-quality evidence); and no clear difference in DVT recurrence (RR 0.94, 95% CI 0.69 to 1.28; 1212 participants; 4 studies; P = 0.69; low-quality evidence). We did not pool data on the incidence of pulmonary embolism because this information was poorly reported, but we observed no differences between groups included in individual studies (low-quality evidence). Two studies evaluated effects of compression in the acute phase versus no compression treatment and found no differences in the incidence of PTS (RR 0.76, 95% CI 0.49 to 1.16; P = 0.2; 101 participants). One study reported that thigh-length stockings did not provide better protection against development of PTS than knee-length stockings (RR 0.92, 95% CI 0.66 to 1.28; P = 0.6; 267 participants). Another trial reported that wearing compression stockings for two years seemed to be superior to wearing them for one year in terms of PTS incidence. Two of the 10 included studies described patient satisfaction and quality of life (moderate-quality evidence), using different measurement systems. The first study showed significant improvement in well-being and DVT-related quality of life with compression treatment (P < 0.05) compared with bed rest, and the second study showed no differences in quality of life scores between compression and placebo groups. Four studies poorly reported side effects (low-quality evidence) that included itching, erythema, and other forms of allergic reaction and described no serious adverse events. Compliance with wearing of compression stockings was generally high but varied across studies. Authors' conclusions Low-quality evidence suggests that elastic compression stockings may reduce the occurrence of PTS after DVT. We downgraded the quality of evidence owing to considerable heterogeneity between studies and lack of or unclear risk of blinding due to clinical assessment scores. No serious adverse effects occurred in these studies. Large randomised controlled trials are needed to confirm these findings because of current lack of high-quality evidence and considerable heterogeneity.