1 CHALLENGES OF WATER RESOURCES MANAGEMENT FOR DOWNSTREAM LIVELIHOOD OF THE LOWER MEKONG DELTA, VIETNAM Tran Thi Trieu 1* , Le Anh Tuan 1** , Mira Kakonen 2 1 Department of Environmental and Water Resources Engineering (DEWRE) College of Technology (CoT), Can Tho Unversity (CTU) Campus II, 3/2 street, Can Tho City, Vietnam Corresponding e-mail: * tttrieu@ctu.edu.vn, ** latuan@ctu.edu.vn 2 Water Resources Laboratory, Helsinki University of Technology Tietotie 1E, 02150 Espoo, Finland oOo Abstract The Lower Mekong River Delta (MD), in Vietnam, covers nearly 4 millions hectares and currently supports more than 17 million people living along main rivers and canals and other water bodies. The MD is considered as the country’s most productive agricultural and aquaculture area. Any change in upstream of the Mekong River effects sensitively to the livelihood of people in downstream. A survey on challenges to which downstream grass-level people faces for their water resources management was taken in a downstream district of Tien Giang province. Water related problems were raised, ranked and finally recommendations for solution are given. The most water problem effecting to local livelihood is the polluted water from upstream users. The water resources management for this area needs a coordination among many related organizations in many levels, supports of national legislation as well as the regional and provincial water resources planning. Key words: challenges, Mekong Delta, livelihood, water-related problems. 1. Introduction Water is possible our most precious natural resources. Abundance and quality of water drivers all human systems and those of most other organisms as well (Isobel W. Hathcote, 1998). The MD is really a big rice bowl of Vietnam and an important aquatic and transportation resources of the delta people. It thanks to abundant water resources with alluvium in large scale and complex irrigation canal systems of the Mekong River. Yet, over the past ten years, protection and management of water resources for sustainable livelihood of lower MD population encounters many challenges, especially in downstream areas. The objectives of this study is to understand more the impacts of water to life and the challenges in water resources management to the downstream people whose livelihood are strongly depended on the Mekong River. Tien Giang (figure 1) is located to the north of the Mekong Delta, alongside the Tien River. It is bordered on the north by Long An; on the south by Vinh Long and Ben Tre; on the east by Ho Chi Minh; on the west by Dong Thap. The provincial area is 2,367 sq. km, with population of 1,392,300 habitants (2004) and My Tho City is the provincial capital. In term of water 2 resources, Tien Giang is divided into 2 parts: the East and the West. The East part is effectted by saline intrusion, high tide and embankment erosion while the West part is effectted by flood in the high tide periods. Nowadays, Bones of the Lower Limb Bones of the Lower Limb Bởi: OpenStaxCollege Like the upper limb, the lower limb is divided into three regions The thigh is that portion of the lower limb located between the hip joint and knee joint The leg is specifically the region between the knee joint and the ankle joint Distal to the ankle is the foot The lower limb contains 30 bones These are the femur, patella, tibia, fibula, tarsal bones, metatarsal bones, and phalanges (see [link]) The femur is the single bone of the thigh The patella is the kneecap and articulates with the distal femur The tibia is the larger, weight-bearing bone located on the medial side of the leg, and the fibula is the thin bone of the lateral leg The bones of the foot are divided into three groups The posterior portion of the foot is formed by a group of seven bones, each of which is known as a tarsal bone, whereas the mid-foot contains five elongated bones, each of which is a metatarsal bone The toes contain 14 small bones, each of which is a phalanx bone of the foot Femur The femur, or thigh bone, is the single bone of the thigh region ([link]) It is the longest and strongest bone of the body, and accounts for approximately one-quarter of a person’s total height The rounded, proximal end is the head of the femur, which articulates with the acetabulum of the hip bone to form the hip joint The fovea capitis is a minor indentation on the medial side of the femoral head that serves as the site of attachment for the ligament of the head of the femur This ligament spans the femur and acetabulum, but is weak and provides little support for the hip joint It does, however, carry an important artery that supplies the head of the femur 1/15 Bones of the Lower Limb Femur and Patella The femur is the single bone of the thigh region It articulates superiorly with the hip bone at the hip joint, and inferiorly with the tibia at the knee joint The patella only articulates with the distal end of the femur The narrowed region below the head is the neck of the femur This is a common area for fractures of the femur The greater trochanter is the large, upward, bony projection located above the base of the neck Multiple muscles that act across the hip joint attach to the greater trochanter, which, because of its projection from the femur, gives additional leverage to these muscles The greater trochanter can be felt just under the skin on the lateral side of your upper thigh The lesser trochanter is a small, bony prominence that lies on the medial aspect of the femur, just below the neck A single, powerful muscle attaches to the lesser trochanter Running between the greater and lesser trochanters on the anterior side of the femur is the roughened intertrochanteric 2/15 Bones of the Lower Limb line The trochanters are also connected on the posterior side of the femur by the larger intertrochanteric crest The elongated shaft of the femur has a slight anterior bowing or curvature At its proximal end, the posterior shaft has the gluteal tuberosity, a roughened area extending inferiorly from the greater trochanter More inferiorly, the gluteal tuberosity becomes continuous with the linea aspera (“rough line”) This is the roughened ridge that passes distally along the posterior side of the mid-femur Multiple muscles of the hip and thigh regions make long, thin attachments to the femur along the linea aspera The distal end of the femur has medial and lateral bony expansions On the lateral side, the smooth portion that covers the distal and posterior aspects of the lateral expansion is the lateral condyle of the femur The roughened area on the outer, lateral side of the condyle is the lateral epicondyle of the femur Similarly, the smooth region of the distal and posterior medial femur is the medial condyle of the femur, and the irregular outer, medial side of this is the medial epicondyle of the femur The lateral and medial condyles articulate with the tibia to form the knee joint The epicondyles provide attachment for muscles and supporting ligaments of the knee The adductor tubercle is a small bump located at the superior margin of the medial epicondyle Posteriorly, the medial and lateral condyles are separated by a deep depression called the intercondylar fossa Anteriorly, the smooth surfaces of the condyles join together to form a wide groove called the patellar surface, which provides for articulation with the patella bone The combination of the medial and lateral condyles with the patellar surface gives the distal end of the femur a horseshoe (U) shape Watch this video to view how a fracture of the mid-femur is surgically repaired How are the two portions of the broken femur stabilized during surgical repair of a fractured femur? Patella The patella (kneecap) is largest sesamoid bone of the body (see [link]) A sesamoid bone is a bone that is incorporated into the tendon of a muscle where that tendon crosses a joint The sesamoid bone articulates with the underlying bones to ...BioMed Central Page 1 of 11 (page number not for citation purposes) Journal of NeuroEngineering and Rehabilitation Open Access Research Quantification of functional weakness and abnormal synergy patterns in the lower limb of individuals with chronic stroke Nathan Neckel* 1,3 , Marlena Pelliccio 1,2 , Diane Nichols 1,2 and Joseph Hidler 1,3 Address: 1 Center for Applied Biomechanics and Rehabilitation Research(CABRR), National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010, USA, 2 Physical Therapy Service, National Rehabilitation Hospital, 102 Irving Street, NW, Washington, DC 20010, USA and 3 Department of Biomedical Engineering, Catholic University, 620 Michigan Ave., NE, Washington, DC 20064, USA Email: Nathan Neckel* - 06neckel@cua.edu; Marlena Pelliccio - marlena.pelliccio@medstar.net; Diane Nichols - diane.nichols@medstar.net; Joseph Hidler - hidler@cua.edu * Corresponding author Abstract Background: The presence of abnormal muscle activation patterns is a well documented factor limiting the motor rehabilitation of patients following stroke. These abnormal muscle activation patterns, or synergies, have previously been quantified in the upper limbs. Presented here are the lower limb joint torque patterns measured in a standing position of sixteen chronic hemiparetic stroke subjects and sixteen age matched controls used to examine differences in strength and coordination between the two groups. Methods: With the trunk stabilized, stroke subjects stood on their unaffected leg while their affected foot was attached to a 6-degree of freedom load cell (JR3, Woodland CA) which recorded forces and torques. The subjects were asked to generate a maximum torque about a given joint (hip abduction/adduction; hip, knee, and ankle flexion/extension) and provided feedback of the torque they generated for that primary joint axis. In parallel, EMG data from eight muscle groups were recorded, and secondary torques generated about the adjacent joints were calculated. Differences in mean primary torque, secondary torque, and EMG data were compared using a single factor ANOVA. Results: The stroke group was significantly weaker in six of the eight directions tested. Analysis of the secondary torques showed that the control and stroke subjects used similar strategies to generate maximum torques during seven of the eight joint movements tested. The only time a different strategy was used was during maximal hip abduction exertions where stroke subjects tended to flex instead of extend their hip, which was consistent with the classically defined "flexion synergy." The EMG data of the stroke group was different than the control group in that there was a strong presence of co-contraction of antagonistic muscle groups, especially during ankle flexion and ankle and knee extension. Conclusion: The results of this study indicate that in a standing position stroke subjects are significantly weaker in their affected leg when compared to age-matched controls, yet showed little evidence of the classic lower-limb abnormal synergy patterns previously reported. The findings here suggest that the primary contributor to isometric lower limb motor deficits in chronic stroke subjects is weakness. Published: 20 July 2006 Journal of NeuroEngineering and BioMed Central Page 1 of 9 (page number not for citation purposes) Journal of Foot and Ankle Research Open Access Research Foot posture influences the electromyographic activity of selected lower limb muscles during gait George S Murley* 1,2 , Hylton B Menz 2 and Karl B Landorf 1,2 Address: 1 Department of Podiatry, Faculty of Health Sciences, La Trobe University, Bundoora, Australia and 2 Musculoskeletal Research Centre, Faculty of Health Sciences, La Trobe University, Bundoora, Australia Email: George S Murley* - g.murley@latrobe.edu.au; Hylton B Menz - h.menz@latrobe.edu.au; Karl B Landorf - k.landorf@latrobe.edu.au * Corresponding author Abstract Background: Some studies have found that flat-arched foot posture is related to altered lower limb muscle function compared to normal- or high-arched feet. However, the results from these studies were based on highly selected populations such as those with rheumatoid arthritis. Therefore, the objective of this study was to compare lower limb muscle function of normal and flat-arched feet in people without pain or disease. Methods: Sixty adults aged 18 to 47 years were recruited to this study. Of these, 30 had normal- arched feet (15 male and 15 female) and 30 had flat-arched feet (15 male and 15 female). Foot posture was classified using two clinical measurements (the arch index and navicular height) and four skeletal alignment measurements from weightbearing foot x-rays. Intramuscular fine-wire electrodes were inserted into tibialis posterior and peroneus longus under ultrasound guidance, and surface EMG activity was recorded from tibialis anterior and medial gastrocnemius while participants walked barefoot at their self-selected comfortable walking speed. Time of peak amplitude, peak and root mean square (RMS) amplitude were assessed from stance phase EMG data. Independent samples t-tests were performed to assess for significant differences between the normal- and flat-arched foot posture groups. Results: During contact phase, the flat-arched group exhibited increased activity of tibialis anterior (peak amplitude; 65 versus 46% of maximum voluntary isometric contraction) and decreased activity of peroneus longus (peak amplitude; 24 versus 37% of maximum voluntary isometric contraction). During midstance/propulsion, the flat-arched group exhibited increased activity of tibialis posterior (peak amplitude; 86 versus 60% of maximum voluntary isometric contraction) and decreased activity of peroneus longus (RMS amplitude; 25 versus 39% of maximum voluntary isometric contraction). Effect sizes for these significant findings ranged from 0.48 to 1.3, representing moderate to large differences in muscle activity between normal-arched and flat- arched feet. Conclusion: Differences in muscle activity in people with flat-arched feet may reflect neuromuscular compensation to reduce overload of the medial longitudinal arch. Further research is required to determine whether these differences in muscle function are associated with injury. Published: 26 November 2009 Journal of Foot and Ankle Research 2009, 2:35 doi:10.1186/1757-1146-2-35 Received: 24 June 2009 Accepted: 26 November 2009 This article is available from: http://www.jfootankleres.com/content/2/1/35 © 2009 Murley et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Journal of Foot and Ankle Research 2009, 2:35 http://www.jfootankleres.com/content/2/1/35 Page 2 of 9 (page number not for citation purposes) Background Human foot posture is highly variable among healthy individuals and ranges from flat- to high-arched [1]. While foot posture is strongly influenced by some sys- temic conditions, such as neurological and rheumatolog- ical diseases, there is emerging evidence Case report Open Access Rare case of autonomic instability of the lower limb presenting as painless Complex Regional Pain Syndrome type I following hip surgery: two case reports AJ Shyam Kumar 1 *, SKS Wong 2 and JG Andrew 2 Address: 1 All Wales Higher Specialist Training Scheme, Rhos Gwyn, Abergele Road, Colwyn Bay LL29 9AE, UK and 2 Department of Trauma & Orthopaedics, Ysbyty Gwynedd, Penrhosgarnedd, Bangor LL57 2PW, UK Email: AJSK* - ajshyamkumar@hotmail.co.uk; SKSW - fxsurgeon@googlemail.com; JGA - Glynne.Andrew@nww-tr.wales.nhs.uk * Corresponding author Published: 29 May 2009 Received: 9 May 2008 Accepted: 22 January 2009 Journal of Medical Case Reports 2009, 3:7271 doi: 10.1186/1752-1947-3-7271 This article is available from: http://jmedicalcasereports.com/jmedicalcasereports/article/view/7271 © 2009 Kumar et al; licensee Cases Network Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Introduction: According to the International Association for the Study of Pain criteria of 1994, pain is a diagnostic requirement for Complex Regional Pain Syndrome type I. However, other authors have suggested that patients can rarely present with the sensory and vascular symptoms of Complex Regional Pain Syndrome without pain. This entity has not been reported following hip surgery in the English medical literature. Case presentation: We present two cases of Complex Regional Pain Syndrome-like symptoms following hip surgery and with the total absence of pain. The first case was a 29-year-old Caucasian woman who had a reattachment of the g reater trochanter fo llowing non-union of an intertrochanteric osteotomy of the hip. Five weeks later, the patient presented with features of Complex Regional Pain Syndrome but with the absence of pain. The second patient was a 20-year-old Caucasian woman who had undergone an open debridement and repair of a torn acetabular labrum. Ten days later, the patient presented with features suggestive of Complex Regional Pain Syndrome which was again painless. Both patients were non-weight bearing at presentation and the symptoms resolved following recommencement of weight bearing. Conclusions: The authors believe these symptoms are manifestations of vascular changes to the lower limb as a result of non-weight bearing status. Painless Complex Regional Pain Syndrome-like symptoms may occur in patients who are kept non-weight bearing following hip surgery. However, vascular insufficiency and deep venous thrombosis must be excluded before this diagnosis is made. If the clinical situation permits, early weight bearing may relieve symptoms. Orthopaedic and vascular surgeons should be aware of this entity when a postoperative patient presents to them with the above clinical picture. This is also relevant to general practitioners who are likely to see the patients in the postoperative period. Page 1 of 3 (page number not for citation purposes) Introduction Pain out of proportion to the injury is an essential criterion for the diagnosis of Complex Regional Pain Syndrome (CRPS) type I [1-3]. We present two cases of CRPS like symptoms following hip surgery but with the complete absence of pain. Case presentation Patient 1 A 29-year-old Caucasian woman had a varus intertrochan- teric osteotomy with trochanteric advancement for an old malunited femoral neck fracture. The femoral neck fracture was sustained in a childhood injury and was treated conservatively. The patient underwent reattachment of the greater trochanter for a failed trochanteric fixation approximately 4 weeks after her initial operation. She was discharged 2 days after the second procedure. Approximately 5 weeks later, the general practitioner referred her to the vascular surgeons with painless discolouration of the BioMed Central Page 1 of 3 (page number not for citation purposes) Journal of Medical Case Reports Open Access Case report Pneumococcal sepsis presenting as acute compartment syndrome of the lower limbs: a case report Sudeendra Doddi, Tarun Singhal* and Prakash Sinha Address: Department of General Surgery, Princess Royal University Hospital, Farnborough Common, Orpington, Greater London, BR6 8ND, UK Email: Sudeendra Doddi - sdoddi001@o2.co.uk; Tarun Singhal* - tasneemtarun@hotmail.com; Prakash Sinha - Prakash.Sinha@bromleyhospitals.nhs.uk * Corresponding author Abstract Introduction: Acute compartment syndrome is a surgical emergency requiring immediate fasciotomy. Spontaneous onset of acute compartment syndrome of the lower limbs is rare. We present a very rare case of pneumococcal sepsis leading to spontaneous acute compartment syndrome. Case presentation: A 40-year-old Caucasian man presented as an emergency with spontaneous onset of pain in both legs and signs of compartment syndrome. This was confirmed on fasciotomy. Blood culture grew Streptococcus pneumoniae. Conclusion: Sepsis should be strongly suspected in bilateral acute compartment syndrome of spontaneous onset. Introduction Acute compartment syndrome of the limbs, if diagnosed late or left untreated, can have grave consequences such as myonecrosis, contractures, functional impairment, limb amputation, renal failure and death. Hence, prompt decompression by way of fasciotomy is vital. Diagnosis of compartment syndrome is essentially clinical-pain out of proportion to the clinical situation, weakness, pain on passive stretch of the muscles, hypoaesthesia and tense- ness of the compartment [1]. The cause of the compres- sion syndrome is addressed once the pressure is released. There have been a few case reports of Streptococcus pyogenes causing acute spontaneous compartment syndrome [2]. However, this is the first report of spontaneous acute bilateral lower leg compartment syndrome caused by sep- sis due to Streptococcus pneumoniae. Case presentation A 40-year-old previously well Caucasian man presented as an emergency with a 1-day history of vomiting and pain in both legs. There was no history of trauma or infection in the lower limbs and he was not on any regular medica- tion. He did admit to having a sore throat for the past week for which he did not seek medical attention. On examination, he was apyrexial and normotensive with a heart rate of 120/minute. His tonsils were enlarged though not inflamed. There were no meningeal signs or skin rash. Chest and abdominal examination were nor- mal. Both his legs were swollen, tense and tender. The dorsalis pedis pulse was palpable equally. There was no paraesthesia or weakness in his legs. He weighed 70 kg. There were several abnormalities in his blood tests (Table 1). The significant abnormalities noted were: white blood Published: 9 February 2009 Journal of Medical Case Reports 2009, 3:55 doi:10.1186/1752-1947-3-55 Received: 25 February 2008 Accepted: 9 February 2009 This article is available from: http://www.jmedicalcasereports.com/content/3/1/55 © 2009 Doddi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Journal of Medical Case Reports 2009, 3:55 http://www.jmedicalcasereports.com/content/3/1/55 Page 2 of 3 (page number not for citation purposes) cell count (WBC) 29.4 × 10 9 /L (normal range, 4.0 to 11.0), neutrophils 25.4 × 10 9 /L (2.0 to 7.5), haemoglobin 21.9 g/dL (13.0 to 18.0), urea 12.1 mmol/L (2.1 to 7.1), creatinine 219 μmol/L (84 to 114). The platelet count, electrolytes, liver function test and clotting were normal. Blood, urine and throat swabs were taken for microbiology. The urine dipstick, chest X-ray and electrocardiogram (ECG) were ... articulation form the ankle joint: The superomedial surface of the talus bone articulates with the medial malleolus 7/15 Bones of the Lower Limb of the tibia, the top of the talus articulates with the distal... during movements of the joint The patella is found in the tendon of the quadriceps femoris muscle, the large muscle of 3/15 Bones of the Lower Limb the anterior thigh that passes across the anterior... for the talus”) that supports the medial side of the talus bone Bones of the Foot The bones of the foot are divided into three groups The posterior foot is formed by the seven tarsal bones The