***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Transtibial amputees encounter stairs and steps during their daily activities . The excessive pressure between residual limb/socket may reduce the walking capability of transtibial prosthetic users during ascent and descent on stairs . The purpose s of the research were to evaluate the interface pressure between Dermo ( shuttle lock ) and Seal-In X5 ( prosthetic valve ) interface systems during stair ascent and descent , and to determine their satisfaction effects on users . METHODS Ten amputees with unilateral transtibial amputation participated in the study .  Interface pressure  was recorded with F-socket transducer ( 9811E ) during stair ascent and descent at self-selected speed . Each participant filled in a question naire about satisfaction and problems encountered with the use of the two interface systems . FINDINGS The result ant mean peak pressure ( kPa ) was significantly lower for the Dermo interface system compared to that of the Seal-In X5 interface system at the anterior , posterior and medial regions during stair ascent ( 63.14 vs. 80.14 , 63.14 vs. 90.44 , 49.21 vs. 66.04 , respectively ) and descent ( 67.11 vs. 80.41 , 64.12 vs. 88.24 , 47.33 vs. 65.11 , respectively ) . Significant statistical difference existed between the two interface systems in terms of satisfaction and problems encountered ( P<0.05 ) . INTERPRETATION The Dermo interface system caused less pressure within the prosthetic socket compared to the Seal-In X5 interface system during stair negotiation . The qualitative survey also showed that the prosthesis users experienced fewer problems and increased satisfaction with the Dermo interface system OBJECTIVE To investigate the effects of 3 dissimilar suspension systems on participants '  satisfaction and perceived problems with their prostheses . DESIGN Question naire survey . SETTING A medical and engineering research center and a university biomedical engineering department . PARTICIPANTS Persons with unilateral transtibial amputation ( N=243 ) , using prostheses with polyethylene foam liner , silicone liner with shuttle lock , and seal-in liner . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Descriptive analyses were performed on the demographic information , satisfaction , and prosthesis-related problems of the study participants . RESULTS The results showed significant differences between the 3 groups regarding the degree of satisfaction and perceived problems with the prosthetic device . Analyses of the individual items revealed that the study participants were more satisfied with the seal-in liner and experienced fewer problems with this liner . The silicone liner with shuttle lock and seal-in liner users reported significant differences in maintenance time compared with the polyethylene foam liner . Users of the silicone liner with shuttle lock experienced more sweating , while those who used the seal-in liner had greater problems with donning and doffing the device . CONCLUSIONS The results of the survey provide a good indication that prosthetic suspension is improved with the seal-in liner as compared with the polyethylene foam liner and silicone liner with shuttle lock . However , further prospect i ve studies are needed to investigate which system provides the most comfort and the least problems for participants Background The suction sockets that are commonly prescribed for transtibial amputees are believed to provide a better suspension than the pin/lock systems . Nevertheless , their effect on amputees ’ gait performance has not yet been fully investigated . The main intention of this study was to underst and the potential effects of the Seal-in ( suction ) and the Dermo ( pin/lock ) suspension systems on amputees ’ gait performance . Methodology /Principal Findings Ten unilateral transtibial amputees participated in this prospect i ve study , and two prostheses were fabricated for each of them . A three-dimensional motion analysis system was used to evaluate the temporal-spatial , kinematics and kinetics variables during normal walking . We also asked the participants to complete some part of Prosthesis Evaluation Question naire ( PEQ ) regarding their satisfaction and problems with both systems . The results revealed that there was more symmetry in temporal-spatial parameters between the prosthetic and sound limbs using the suction system . However , the difference between two systems was not significant ( p<0.05 ) . Evaluation of kinetic data and the subjects ’ feedback showed that the participants had more confidence using the suction socket and the sockets were more fit for walking . Nevertheless , the participants had more complaints with this system due to the difficulty in donning and doffing . Conclusion It can be concluded that even though the suction socket could create better suspension , fit , and gait performance , overall satisfaction was higher with the pin/lock system due to easy donning and doffing of the prosthesis . Trial Registration i rct .ir I RCT For this r and omized crossover trial , we compared two common transtibial socket suspension systems : the Alpha liner with distal locking pin and the Pe-Lite liner with neoprene suspension sleeve . Our original hypotheses asserted that increased ambulatory activity , wear time , comfort , and satisfaction would be found with the elastomeric suspension system . Thirteen subjects completed the study . Following 2.5-month accommodation to each condition , ambulatory activity was recorded ( steps/minute for 2 weeks ) , and subjects completed three question naires specific to prosthesis use and pain : the Prosthesis Evaluation Question naire ( PEQ ) , a Brief Pain Inventory ( BPI ) excerpt , and the Socket Comfort Score ( SCS ) . Upon completion , subjects selected their favored system for continued use . Ten subjects preferred the Pe-Lite and three the Alpha . Subjects spent 82 % more time wearing the Pe-Lite and took 83 % more steps per day . Ambulatory intensity distribution did not differ between systems . No statistically significant differences were found in question naire results . Subject feedback for each system was both positive and negative BACKGROUND The interface pressure between the residual limb and prosthetic socket has a significant effect on an amputee 's satisfaction and comfort . Liners provide a comfortable interface by adding a soft cushion between the residual limb and the socket . The Dermo and the Seal-In X5 liner are two new interface systems and , due to their relative infancy , very little are known about their effect on patient satisfaction . The aim of this study was to compare the interface pressure with these two liners and their effect on patient satisfaction . METHODS Nine unilateral transtibial amputees participated in the study . Two prostheses were fabricated for each amputee , one with the Seal-In liner and one with the Dermo liner .  Interface pressure was measured at the anterior , posterior , medial and lateral regions during walking on the level ground . Each subject filled in a Prosthetic Evaluation Question naire ( PEQ ) regarding the satisfaction with the two liners . Findings The mean peak pressures with the Seal-In liner was 34.0 % higher at the anterior , 24.0 % higher at the posterior and 7.0 % higher at the medial regions of the socket ( P=0.008 , P=0.046 , P=0.025 ) than it was with the Dermo Liner . There were no significant differences in the mean peak pressures between the two liners at the lateral regions . In addition , significant difference was found between the two liners both for satisfaction and problems ( P<0.05 ) . Interpretation There was less interface pressure between the socket and the residual limb with the Dermo liner . The results indicated that the Dermo liner provides more comfort in the socket than the Seal-In liner OBJECTIVE To investigate the effect of a vacuum-assisted socket suspension system as compared with pin suspension on lower extremity amputees . DESIGN R and omized crossover with 3-week acclimation . SETTING Household , community , and laboratory environments . PARTICIPANTS Unilateral , transtibial amputees ( N=20 enrolled , N=5 completed ) . INTERVENTIONS ( 1 ) Total surface-bearing socket with a vacuum-assisted suspension system ( VASS ) , and ( 2 ) modified patellar tendon-bearing socket with a pin lock suspension system . MAIN OUTCOME MEASURES Activity level , residual limb volume before and after a 30-minute treadmill walk , residual limb pistoning , and Prosthesis Evaluation Question naire . RESULTS Activity levels were significantly lower while wearing the vacuum-assisted socket suspension system than the pin suspension ( P=.0056 ; 38,000 ± 9,000 steps per 2 wk vs 73,000 ± 18,000 steps per 2 wk , respectively ) . Residual limb pistoning was significantly less while wearing the vacuum-assisted socket suspension system than the pin suspension ( P=.0021 ; 1 ± 3 mm vs 6 ± 4 mm , respectively ) . Treadmill walking had no effect on residual limb volume . In general , participants ranked their residual limb health higher , were less frustrated , and cl aim ed it was easier to ambulate while wearing a pin suspension compared with the VASS . CONCLUSIONS The VASS result ed in a better fitting socket as measured by limb movement relative to the prosthetic socket ( pistoning ) , although the clinical relevance of the small but statistically significant difference is difficult to discern . Treadmill walking had no effect , suggesting that a skilled prosthetist can control for daily limb volume fluctuations by using conventional , nonvacuum systems . Participants took approximately half as many steps while wearing the VASS which , when coupled with their subjective responses , suggests a preference for the pin suspension system Objective The objectives of this study were to compare the effects of a newly design ed magnetic suspension system with that of two existing suspension methods on pistoning inside the prosthetic socket and to compare satisfaction and perceived problems among transtibial amputees . Design In this prospect i ve study , three lower limb prostheses with three different suspension systems were fabricated for ten transtibial amputees . The participants used each of the three prostheses for 1 mo in r and om order . Pistoning inside the prosthetic socket was measured by motion analysis system . The Prosthesis Evaluation Question naire was used to evaluate satisfaction and perceived problems with each suspension system . Results The lowest pistoning motion was found with the suction system compared with the other two suspension systems ( P < 0.05 ) . The new suspension system showed peak pistoning values similar to that of the pin lock system ( P = 0.086 ) . The results of the question naire survey revealed significantly higher satisfaction rates with the new system than with the other two systems in donning and doffing , walking , uneven walking , stair negotiation , and overall satisfaction ( P < 0.05 ) . Conclusions The new suspension system has the potential to be used as an alternative to the available suspension systems . The pistoning motion was comparable to that of the other two systems . The new system showed compatible prosthetic suspension with the other two systems ( suction and pin lock ) . The satisfaction with donning and doffing was high with the magnetic system . Moreover , the subjects reported fewer problems with the new system A clinical trial was conducted to evaluate the efficiency of ICEROSS on r and omly selected 46 male transtibial amputees . After rejection , only 27 ( 58.69 % ) amputees volunteered for various stages of the ICEROSS trial . All 27 were categorized into Group A-persons in employment ( n = 16 ) and Group B-persons out of employment or economically inactive ( n = 11 ) . The study was conducted on the basis of question naire information , clinical examination and objective tests . The pre- and post-ICEROSS status were compared between the groups . Group A was younger and did better . Trauma was the main cause of amputation . There were certain changes of the stump before and after ICEROSS . The amputees with ICEROSS suspension performed better and had improved mobility in Group A. At the workplace , dynamic activities were less than the static activities ( p < 0.001 ) and there were overall improvements in comfort and performance of amputees with ICEROSS Trans-tibial amputees with different indications for amputation often have stump problems . Many active amputees have limits in daily life and sports activities because of pressure ulcers , friction , allergic dermatitis or volume changes . Many methods and material s have been tried to make a well-fitted socket . A new polyurethane concept had been design ed with a shock absorbing effect . The purpose of this prospect i ve study was to compare a conventional suspension with a polyurethane concept with regard to the amputees ' satisfaction , socket comfort , physical capacity and to analyse the long-term effect . The total material includes 29 unilateral transtibial amputees . They answered a question naire after 2 months use of the polyurethane concept and were interviewed after 3 and 5 years . After 3 years 22 amputees and after 5 years 20 amputees used the polyurethane concept . Gait was registered in 7 amputees . Speed and symmetry index ( SI ) for temporal , stride and kinematics variables were used to evaluate gait . The amputees reported that the polyurethane concept was better or much better in physical capacity in 117 ( 67 % ) and socket comfort was better or much better in 119 ( 82 % ) compared with the conventional suspension . There was no obvious symmetry difference in gait variables in speed , step length , step time or single support or in kinematics knee variables . The amputees tended to walk faster , decrease in symmetry in temporal and stride variables and increase in symmetry in kinematics variables with the polyurethane concept . After 5 years 6 had died and 20 amputees of the surviving 23 used the polyurethane concept . Conclusions : The polyurethane concept increased comfort considerably and physical activity increased when the trans-tibial amputees changed from conventional suspension . Gait registration was not useful to evaluate the amputees ' satisfaction or socket comfort The ICEX ® system ( Ossur , Icel and ) , allows a socket to be manufactured directly onto the stump and is thought to provide improved comfort due to better pressure distribution whilst being easier to fit and manufacture . The aims of 
    Output:
    
Conclusion : There is insufficient research to differentiate between the user experience of different transtibial liners .
Clinical relevance The available evidence suggests that the user experience of commonly reported problems ( e.g. sweating ) may be very similar between different liners .