Disease Of Lower Extremities Research Articles

The correlation between high-sensitivity cardiac troponin levels in diabetic patients’ serum and lower limb lesions: based on NHANES data

ObjectiveTo evaluate the association of hypersensitive cardiac troponin (hs-cTnT), a biomarker of myocardial injury, with diabetic lower extremity disease in American adults.MethodsWe conducted a cross-sectional study (unweighted N=1,196) of diabetic patients aged 40 years or older who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Logistic regression was used to assess the association of hs-cTnT with lower extremity disease, including peripheral neuropathy (as assessed by monofilament test), peripheral artery disease (as assessed by ankle-brachial index), history of foot ulcers, or amputation. All analyses are weighted.ResultsThe prevalence rate of diabetic lower extremity disease was 41.6%. Adjusted hs-cTnT was significantly associated with lower limb disease in adults with diabetes. There is interaction between chronic kidney disease and hs-cTnT, which strongly interferes with the correlation between hs-cTnT and lower extremity lesions in diabetic patients.ConclusionsOur study suggests the usefulness of hs-cTnT as a biomarker for lower extremity lesions in adults with diabetes and highlights the potential direct interaction of hs-cTnT with chronic kidney disease.

Added value of 18Fluorine-fluorodeoxyglucose (18F-FDG) PET/MRI for evaluation of failed back surgery syndrome: comparison with non-contrast MRI.

Given increasing research suggesting the utility of positron emission tomography/magnetic resonance imaging (PET/MRI) in identifying the pain generator of low back pain, our study aims to assess its effectiveness in evaluating the source of pain in patients with failed back surgery syndrome (FBSS) by comparing the performance of fluorine-18-labeled fluorodeoxyglucose (18F-FDG) PET/MRI with conventional MRI. We retrospectively analyzed data from patients with FBSS who underwent 18F-FDG PET and MRI of the lumbar vertebrae and lower extremities for undetermined sources of pain. We assessed 1) The diagnostic reliability and efficacy of MRI and 18F-FDG PET/MRI according to correct differential diagnosis, affected level, and affected side of the pain source compared to the findings of selective root or peripheral nerve block or revision lumbar spine surgery; and 2) The association between standardized uptake value (SUV) and standardized uptake value ratio (SUVR) threshold and accuracy of the suspected pathology on 18F-FDG PET/MRI. Among 30 included patients, the diagnostic accuracy of pain source recognition was higher for 18F-FDG PET/MRI than for MRI alone (1.0 vs. 0.4 in spinal disease and 0.8 vs. 0 in lower extremity disease, both p < 0.05). SUVR values of 1.4-1.5 showed the highest accuracy (0.93), higher than the accuracy obtained using the SUV threshold (0.87). 18F-FDG PET/MRI added value to MRI alone in detecting of hypermetabolic activity associated with pain from spinal and non-spinal sources.

Spinal Neuromodulation for Peripheral Arterial Disease of Lower Extremities: A Ten-Year Retrospective Analysis.

This long-term retrospective study evaluated the survival and amputation outcome of subjects who received neuromodulation therapy for the management of peripheral arterial disease (PAD). The study reviews the health data of a single cohort of 51 patients who received spinal neuromodulation (spinal cord stimulation [SCS] or dorsal root ganglion stimulation [DRG-S]) for PAD from 2007 to 2022 in a single German center. Survival rate and major amputation rate were determined. Pain, quality of life, walking distance, and opioid usage were assessed before implantation (baseline), one, six, and 12 months (M) after implantation, and then annually (during a follow-up visit). Implant-related complications also were documented. In total, 51 patients (37 men [mean age 68.9± 10.2 years], 14 women [mean age (68.7± 14.6 years]) underwent SCS (n= 49) or DRG-S (n= 2) implantation owing to persistent ischemic pain. The follow-up mean years± SD is 4.04± 2.73. At baseline, patients were classified as Rutherford's category 3 (n= 23), category 4 (n= 15) or category 5 (n= 9). At 24 M, 42 of 47 patients did not require a major amputation after the implant. All the patients reported nearly complete pain relief from pain at rest. A total of 75% of patients were able to walk >200 m, and 87% of patients who used opioids at baseline were off this medication at 24 M. Overall, 93% of patients reported an improvement in their overall health assessment. These improved outcomes were sustained through years three to 10 for patients who have reported outcomes. Our single-center data support the efficacy of spinal neuromodulation for improvements in limb salvage, pain relief, mobility, and quality of life. The data also show that neuromodulative therapy has a long-term therapeutic effect in patients with chronic limb pain with Rutherford category 3, 4, and 5 PAD.

Progress and Current Status of Treatment for Lower Limb Varicose Veins

Varicose veins of lower extremities are common venous diseases of lower extremities in clinic [1]. The total number of patients with varicose veins of lower extremities in China has exceeded 100 million, and the incidence rate is about 15% [2]. Therefore, there is a huge number of illnesses and a demand for surgical treatment. At present, the main treatment options for lower limb varicose veins include conservative treatment and surgical treatment. Surgical treatment methods include traditional surgery and minimally invasive surgery. The high ligation and stripping of the great saphenous vein has always been the gold standard for the treatment of lower limb varicose veins. This method is technically mature and clinically effective, but it is a destructive surgery that uses a stripping device to forcefully pull. Therefore, the intraoperative trauma is large, the amount of bleeding is high, and a series of postoperative complications such as hidden nerve damage, subcutaneous congestion, incision bleeding, deep vein thrombosis, etc. are prone to occur. With the increasing demand for skin aesthetics and reducing postoperative complications, minimally invasive surgery has gradually been applied to the treatment of lower limb varicose veins, such as intracavitary laser ablation, intracavitary radiofrequency ablation, Tri Vex minimally invasive rotary cutting, hemodynamic correction, etc. [3]. This article provides a review of the current main treatment methods for lower limb varicose veins, in order to further understand and master the principles and application scope of each treatment method, and to better select personalized treatment plans for varicose vein patients in the future.

Isolated Limb Infusion for Limb-Threatening Sarcomas.

Isolated limb infusion (ILI) treats unresectable extremity malignancies with high-dose regional chemotherapy limited to the limb. This study assessed long-term outcomes after ILI for limb-threatening sarcomas. A retrospective review analyzed patients with an extremity sarcoma who underwent ILI with melphalan and dactinomycin from 2008 to 2023 at a single institution. The study identified 61 patients (52.5% female; median age, 73 years; range, 20-94 years). Of these patients, 68.9% had lower-extremity disease. The median follow-up period was 6.9 years. The overall response rate was 48.3% (complete response [CR], 21.7%; partial response [PR], 26.7%), and the disease control rate (DCR: CR+PR+stable disease [SD]) was 65%. The median progression-free survival (PFS) for the patients with CR/PR/SD/progressive disease (PD) was respectively 16.8/9.6/4.8/2.4 months (P<0.0001). The responders (CR+PR) had significantly longer PFS than the non-responders (SD+PD) (hazard ratio [HR], 6.3; 95% confidence interval [CI], 3.1-12.9; P<0.001). The median in-field PFS times for CR/PR/SD/PD were respectively 16.8/12/4.8/2.4 months (P<0.001). The responders had a significantly longer risk of in-field PFS than the non-responders (HR, 5.9; 95% CI 2.9-12.0; P<0.001). The median distant relapse PFS for CR/PR/SD/PD was not reached (NR)/NR/44.4/40.8 months (P=0.02). The responders had a significantly longer distant relapse PFS than the non-responders (HR, 2.7; range, 1.1-6.8; P=0.04). The median overall survival (OS) was 8.6 years for the responders and 4.1 years for the non-responders (P=0.02). The disease-specific survival (DSS) rates were 87% at 1 year, 71% at 3 years, and 64% at 5 years. The median DSS was not reached for the responders and was 4.1 years for the non-responders (P=0.003). The limb salvage rates at 6 months were 85% at 1 year, 80% at 3 years, and 70% at 5 years. The patients with PD had a higher risk of requiring amputation than the patients with CR+PR+SD (HR, 3.0; 95% CI 1.0-8.7; P=0.04). The 5-year limb salvage rates after ILI are notably high, reaching 70%. After ILI, the responders had significantly better in-field and distant relapse PFS, OS, and DSS.

Safety and Efficacy of Combined Coronary and Peripheral Percutaneous Revascularization: A Proof-of-Concept Study.

Background. Lower extremity peripheral artery disease (LEPAD) frequently coexists with coronary artery disease (CAD) in patients with multisite vascular disease (MVD). While percutaneous revascularization is well-established for both LEPAD and CAD, limited evidence exists for patients eligible for both procedures. Specifically, the feasibility of concomitant LEPAD and CAD percutaneous revascularization remains unknown. Objectives. To compare the efficacy and safety of concomitant coronary and lower extremity elective percutaneous revascularization. Methods. Between 2012 and 2021, we included 135 patients in an observational, retrospective single-center registry. The population was stratified into two groups: 45 patients (concomitant group) underwent simultaneous coronary and peripheral percutaneous interventions, and 90 patients (deferred group) underwent two separate procedures within one year. The primary efficacy endpoint was major adverse cardiovascular events (MACE) at one year, while the primary safety endpoint was in-hospital contrast-induced nephropathy (CIN). Results. Study groups were well-balanced in baseline characteristics. In terms of coronary features, the concomitant revascularization group more often underwent single-vessel percutaneous coronary intervention (PCI), while the deferred group had multivessel PCI with diffuse coronary disease. No differences were detected in the number of LEPAD lesions between groups. For the primary efficacy endpoint, the incidence of MACE at one year was 37.8% in the concomitant group vs. 34.4% in the deferred group (HR 1.20, 95% CI 0.64-2.10; p = 0.61). No significant differences were found in CIN occurrence between the concomitant and deferred groups (11.1% vs. 8.9%; OR 1.30; 95% CI 0.36-4.21; p = 0.68). Conclusions. Multisite vascular disease patients eligible for CAD and LEPAD percutaneous revascularization exhibited a high cardiovascular risk profile with diffuse multivessel coronary and lower extremity disease. Our study suggests the efficacy and safety of concomitant coronary and lower extremity percutaneous revascularization based on one-year MACE incidence and in-hospital CIN. However, dedicated studies are warranted to confirm the short- and long-term outcomes of the concomitant revascularization strategy.

Results of the Simultaneous Combination of Ponatinib and Blinatumomab in Philadelphia Chromosome-Positive ALL.

Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical Trial Updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.In this analysis, we update our experience with the chemotherapy-free regimen of blinatumomab and ponatinib in 60 patients with newly diagnosed Philadelphia chromosome (Ph)-positive ALL. At a median follow-up of 24 months, the complete molecular response rate by reverse transcriptase-polymerase chain reaction was 83% (67% at the end of course one), and the rate of measurable residual disease negativity by next-generation clono-sequencing was 98% (45% at the end of course one). Only two patients underwent hematopoietic stem cell transplantation (HSCT). Seven patients relapsed: two with systemic disease, four with isolated CNS relapse, and one with extramedullary Ph-negative, CRLF2-positive pre-B ALL. The estimated 3-year overall survival rate was 91% and event-free survival rate was 77%. Three patients discontinued blinatumomab because of adverse events (related, n = 1; unrelated, n = 2) and nine discontinued ponatinib because of cerebrovascular ischemia, coronary artery stenosis, persistent rash, elevated liver function tests with drug-induced fatty liver, atrial thrombus, severe arterial occlusive disease of lower extremities, pleuro-pericardial effusion, and debilitation. In conclusion, the simultaneous combination of ponatinib and blinatumomab is a highly effective and relatively safe nonchemotherapy regimen. This regimen also reduces the need for intensive chemotherapy and HSCT in first remission in the majority of patients.

APOC1 rs445925 and rs4420638 polymorphic variants as genetic predictors of occlusive peripheral arterial disease of lower extremities

Aim. To study the involvement of APOC1 rs445925 and rs4420638 single nucleotide polymorphisms (SNP) in the development of occlusive peripheral arterial disease (PAD) of lower extremities.Material and methods. The study included 1278 people, including 630 patients with occlusive PAD and 648 relatively healthy individuals. Genotyping of APOC1 rs445925 and rs4420638 SNPs was performed using the MassARRAY-4 genomic mass spectrometer. The analysis of the association of alleles, genotypes, haplotypes and diplotypes with the risk of occlusive PAD was performed using the statistical programs SNPStats, PLINK, v1.9 and STATISTICA 13.3. The adaptive permutation test was used to assess statistical significance of associations (Pperm).Results. The rs445925-A (Pperm=1,0×10-6) and rs4420638-G (Pperm=0,006) alleles, as well as the rs445925-G/A-A/A (Pperm=1,0×10-6) and rs4420638-A/G-G/G (Pperm=0,006) genotypes were associated with an increased risk of occlusive PAD. The rs445925 polymorphism was also associated with the blood cholesterol level in patients with occlusive PAD (Pperm=0,04). The rs445925A-rs4420638A and rs445925A-rs4420638G haplotypes, as well as three APOC1 diplotypes, showed a pronounced relationship with a predisposition to occlusive PAD. In particular, the rs445925G/A×rs4420638A/A (odds ratio (OR) 6,59, 95% confidence interval (CI) 4,20-10,35, P=2,4×10-19) and rs445925G/A×rs4420638A/G (OR 4,24, 95% CI 2,23-8,03, P=2,0×10-6) diplotypes were associated with an increased risk of occlusive PAD. The rs445925G/G×rs4420638A/A diplotype had a protective effect on the disease development (OR 0,26, 95% CI 0,20-0,35, P=1,3×10-20). Associations of haplotypes with the severity of peripheral arterial stenosis of various locations were also revealed (P&lt;0,05).Conclusion. The study results established for the first time that APOC1 rs445925 and rs4420638 polymorphic variants are part of a genetic predisposition to occlusive PAD and have a significant effect on the severity of peripheral arterial stenosis. The molecular mechanisms underlying the identified genotypic associations can affect not only lipid metabolism disorders, but also the proliferation of immunocompetent cells, platelet activation and aggregation processes, inflammation and apoptosis.

Ultrasound evaluation and grading of neuromuscular disease in lower extremities among diabetic patients.

To explore the clinical utility of ultrasound in evaluating and grading neuromuscular diseases in the lower extremities of patients with diabetes mellitus. A total of 126 inpatients from the Department of Diabetes at Zhangzhou Affiliated Hospital of Fujian Medical University, China, were recruited from June 2020 to December 2022. The cohort included 69 patients with type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN group) and 57 patients with T2DM but without DPN (non-DPN group). Additionally, 80 healthy controls were included. High-frequency ultrasound was used to scan the common peroneal, sural, and tibial nerves, measuring their transverse (D1) and anteroposterior (D2) diameters, and calculating the cross-sectional area (CSA). Changes in the internal echo of the extensor digitorum brevis (EDB) muscle, including maximum thickness and CSA, were also recorded. The DPN group was further subdivided based on disease duration to assess ultrasonic changes over time and the statistical significance of these variations. Ultrasonic changes such as uneven internal echo reduction, ill-defined epineurial boundaries, and obscured cribriform structures were most prevalent in the DPN group. Significant differences in ultrasound parameters (D1, D2, CSA) were observed among the groups (all P<0.05), with the most pronounced changes in the DPN group. In patients with a disease duration of over 15 years, a significant increase in CSA of lower extremity nerves and a decrease in CSA of the EDB were noted compared to those in the 5-10 years subgroup (19.89±0.98 vs 19.00±0.94; 5.25±0.74 vs 5.93±0.94; all P<0.05). High-frequency ultrasound provides a valuable imaging basis for diagnosing and monitoring DPN, demonstrating significant changes in nerve and muscle parameters among diabetic patients.

Phase-contrast Magnetic Resonance Angiography of Foot at Ultra-high field 5 T System: Visualization of Distal Small Vessels and Enhancement by Warm Water Immersion

Ultra-high field strength magnetic resonance has been proven to offer improved visualization of the distal intracranial vessels and branches, but its effectiveness for visualization of the peripheral vasculature has not been investigated. We aimed to assess the visualization of distal lower-extremity vessels using three-dimensional phase-contrast magnetic resonance angiography (3D PC-MRA) at 5T field strength in combination with warm water immersion (WWI). Participants were prospectively recruited and underwent 3T, and 5T 3D PC-MRA of the feet with and without WWI (water temperature between 40°C and 45°C for a duration of 10minutes). Patients with suspected lower-extremity peripheral arterial disease underwent computed tomography angiography for lesion identification. Signal-to-noise ratio (SNR), subjective scoring, quantitative vessel segmentation, and flow velocity were performed to assess vessel visualization before and after WWI. Friedman's test was conducted to determine statistical significance. Out of 30 participants (mean age, 46.2±5.9; males, 20; lower-extremity vessel disease, 10), 900 vessel segments were available for evaluation. 5T images showed significantly higher scores for image quality and foot vessel visualization than 3T (all P<0.05). WWI further improved the visualizing scores (percentage of score 3: 40.2% (193/480), 66.2% (318/480)), SNR (44.27 vs 67.78, P<0.001), total branch count (151.92±29.17 vs 225.63±16.76; P<0.001), and the flow velocity (0.72±0.03 vs 0.48±0.11cm/s; P<0.001). 3D PC-MRA at 5T effectively visualizes foot vessels in patients with lower-extremity disease. Furthermore, WWI can significantly enhance the depiction of distal and small vessels.

Effect of knee osteoarthritis on the postoperative outcome of proximal femoral nail anti-rotation in the treatment of intertrochanteric fractures in the elderly: a retrospective analysis

BackgroundThe proximal femoral nail anti-rotation (PFNA) is a commonly used internal fixation system for intertrochanteric fractures (IFs) in older adults. Knee osteoarthritis (KOA) is a degenerative lower extremity disease that occurs most frequently in the elderly. Some patients have already had KOA before the IFs. However, whether KOA impacts the postoperative outcome of IFs has not been reported.ObjectiveThis study aimed to investigate the effect of KOA on the fracture side on the outcome after PFNA for IFs in the elderly.MethodsBetween January 2016 and November 2021, 297 elderly patients treated with PFNA for IFs were enrolled in this study. They were divided into two groups according to the American Rheumatism Association KOA clinical and radiographic criteria: the control group and the KOA group. Intraoperative bleeding, operative time, length of hospital stay, postoperative time out of bed, fracture healing time, postoperative complications, postoperative Harris hip function score, and Barthel ability to daily living Score were compared between the two groups. Follow-up was routinely scheduled at 1, 3, 6, and 12 months postoperatively.ResultsBased on the exclusion criteria, 254 patients who met the requirements were left to be included in this study, including the control group (n = 133) and the KOA group (n = 121). Patients were followed up for a mean of 17.5 months (12–24 months). There was no significant difference between the two groups in preoperative demographic data, intraoperative blood loss, operation time, and length of stay in the hospital. The control group was statistically significant compared to the KOA group in terms of postoperative time out of bed (17.8 ± 4.0 days vs. 19.1 ± 5.8 days), fracture healing time (13.7 ± 2.2 weeks vs. 14.6 ± 3.7 weeks), and postoperative complications (12.8 vs. 23.1%). The Harris hip function score and Barthel ability to daily living score were higher in the control group than in the KOA group at 1, 3, 6, and 12 months postoperatively (the control group: 63.8 ± 10.9, 71.8 ± 10.3, 81.5 ± 8.7, and 91.6 ± 6.3 vs. The KOA group 61.0 ± 10.4, 68.6 ± 9.1, 79.0 ± 9.2, and 88.5 ± 5.9).ConclusionsIn elderly patients with IFs combined with KOA of the fracture side treated with PFNA internal fixation, KOA increases the incidence of postoperative complications of the fracture, prolongs postoperative time out of bed and fracture healing, and reduces postoperative hip function and ability to daily living. Therefore, treating KOA on the fractured side needs to be considered when treating IFs in the elderly.

Quantitative two-dimensional phase-contrast magnetic resonance imaging characterization of lower extremity venous disease: venous reflux versus venous obstruction.

Lower extremity venous disease (LEVD) is a complex disorder, and determining the etiology of LEVD is paramount for treatment selection. Two-dimensional phase-contrast magnetic resonance imaging (2D PC-MRI) can provide an objective measure of hemodynamic status and may help differentiate between different etiologies of LEVD. A total of 271 participants, including 256 symptomatic patients with venous lower extremity disease and 15 healthy volunteers, were collected in this cohort study. It is a single-center prospective observational study using 2D PC-MRI analysis to assess the hemodynamic characteristics of patients with LEVD among participants recruited between April 2017 and October 2021 at a tertiary hospital. The approval institutional review board number for this study were 201802137B0, 201901058B0, 202100938B0, and 202102344B0. Participants were classified as venous reflux (VR) and venous obstruction (VO) by standard ultrasonography. 2D PC-MRI by 1.5 T scanner revealed stroke volume (SV), forward flow volume (FFV), absolute stroke volume (ASV), mean flux (MF), velocity time integral (VTI), and mean velocity (MV) for each selected venous segments. 2D PC-MRI assessed 167 diseased legs from the 116 VR patients [mean age ± standard deviation (SD): 57.9±12.8 years; 39 males] and 113 diseased legs from the 95 VO patients (mean age ± SD: 66.4±12.8 years; 42 males). 2D PC-MRI analysis demonstrated discrimination ability to differentiate from VR to VO [SV, FFV, ASV, MF, VTI, and MV in the various venous segments, respectively, P≤0.001; area under the curve (AUC) =62-68.8%, P≤0.001 by Mann-Whitney U test]. The ratio data (morbid limb to normal limb) in the same individual with single-leg disease revealed differences between VR and VO (SV, FFV, ASV, and MF in the various venous segments, respectively; P<0.05; AUC =60.2-68.7%, P≤0.05 by Mann-Whitney U test). The most favorable differentiating variables of ratios were FFV in the great saphenous veins [AUC =68.7%, 95% confidence interval (CI): 59.8-77.6%] and ASV in the external iliac veins (AUC =67.4%, 95% CI: 58.7-76.2%). Quantitative 2D PC-MRI analysis is capable of differentiating VR from VO. It also provides an important diagnostic capability for preoperative evaluation.

1352-P: Ethnic Disparities in Diabetic Complications in the U.S.

Objective: To estimate the prevalence of diabetes (DM) complications and assess risk factors for complications by ethnicity and DM duration. Methods: We used National Health and Nutrition Examination Survey data, 1999-2018. We defined cardiovascular disease (CVD) as a history of heart failure, stroke, or heart attack; chronic kidney disease (CKD) as an eGFR &amp;lt;60, albuminuria, or both; retinopathy as retinal microaneurysms or blot hemorrhages; and lower extremity disease (LED) as peripheral neuropathy, peripheral artery disease, or ulcers. We assessed the age-adjusted prevalence of each complication and multivariable logistic regressions for risk factors related to any complication by ethnicity in new (DM&amp;lt; 10 y without insulin) and established patients (DM≥10 y). Results: Non-Hispanic Whites (W) had the highest CVD rates, followed by Blacks (B), Mexican Americans (M), and Asian Americans (A) in both new (31% W, 21% B, 14% M, 11% A) and established patients (38% W, 36% B, 29% M, 28% A). Blacks had the highest CKD rates in both new (40% B, 33% W, 31% A, 30% M) and established patients (63% B, 52% M, 51% W, 40% A). For retinopathy, in new patients, Mexican Americans had the highest rate (27% M, 20% B, 12% W), while in established patients, Whites had the most (62% W, 61% B, 57% M). Blacks had the highest rates for LED in both new (52% B, 47% W, 45% M) and established patients (78% B, 68% W, 59% M). Male gender was a risk factor for any DM complication in Asian Americans (new patients, odds ratio 3.9, 95% CI 2-7.5; established, 2.5, 1.1-5.4). Obesity was a risk factor in Black new patients (1.4, 1-1.8). Poor glycemic control was a risk factor in Asian American (4, 2.2-7.6) and White new patients (1.5, 1.1-2.1), and Black established patients (1.7, 1.2-2.4). Conclusions: White patients had the highest rate of CVD, while Blacks had the most CKD and LED. Mexican Americans with &amp;lt; 10 y of DM had more retinopathy than their ethnic counterparts. Interventions to integrate the male sex and promote weight and glycemic control may reduce DM complications in ethnic minorities. Disclosure Y.Yoshida: None. V.Fonseca: Consultant; Abbott, Corcept Therapeutics, Eli Lilly and Company, Other Relationship; BRAVO4HEALTH, LLC, Research Support; Fractyl Health, Inc., Stock/Shareholder; Amgen Inc. Y.Zu: None.

Associations of Cardiac Biomarkers With Peripheral Artery Disease and Peripheral Neuropathy in US Adults Without Prevalent Cardiovascular Disease.

NT-proBNP (N-terminal pro-B-type natriuretic peptide), high-sensitivity cardiac troponin T (hs-troponin T), and high-sensitivity cardiac troponin I (hs-troponin I) are increasingly being recommended for risk stratification for a variety of cardiovascular outcomes. The aims of our study were to establish the prevalence and associations of elevated NT-proBNP, hs-troponin T, and hs-troponin I with lower extremity disease, including peripheral artery disease (PAD) and peripheral neuropathy (PN), in the US general adult population without known cardiovascular disease. We also assessed whether the combination of PAD or PN and elevated cardiac biomarkers was associated with an increased risk of all-cause and cardiovascular mortality. We conducted a cross-sectional analysis of the associations of NT-proBNP, hs-troponin T, and hs-troponin I with PAD (based on ankle-brachial index <0.90) and PN (diagnosed by monofilament testing) in adult participants aged ≥40 years of age without prevalent cardiovascular disease in NHANES (National Health and Nutrition Examination Survey) 1999 to 2004. We calculated the prevalence of elevated cardiac biomarkers among adults with PAD and PN and used multivariable logistic regression to assess the associations of each cardiac biomarker, modeled using clinical cut points, with PAD and PN separately. We used multivariable Cox proportional hazards models to assess the adjusted associations of cross categories of clinical categories of each cardiac biomarker and PAD or PN with all-cause and cardiovascular mortality. In US adults aged ≥40 years, the prevalence (±SE) of PAD was 4.1±0.2% and the prevalence of PN was 12.0±0.5%. The prevalence of elevated NT-proBNP (≥125 ng/L), hs-troponin T (≥6 ng/L), and hs-troponin I (≥6 ng/L for men and ≥4 ng/L for women) was 54.0±3.4%, 73.9±3.5%, and 32.3±3.7%, respectively, among adults with PAD and 32.9±1.9%, 72.8±2.0%, and 22.7±1.9%, respectively, among adults with PN. There was a strong, graded association of higher clinical categories of NT-proBNP with PAD after adjusting for cardiovascular risk factors. Clinical categories of elevated hs-troponin T and hs-troponin I were strongly associated with PN in adjusted models. After a maximum follow-up of 21 years, elevated NT-proBNP, hs-troponin T, and hs-troponin I were each associated with all-cause and cardiovascular mortality, with higher risks of death observed among adults with elevated cardiac biomarkers plus PAD or PN compared with elevated biomarkers alone. Our study establishes a high burden of subclinical cardiovascular disease defined by cardiac biomarkers in people with PAD or PN. Cardiac biomarkers provided prognostic information for mortality within and across PAD and PN status, supporting the use of these biomarkers for risk stratification among adults without prevalent cardiovascular disease.

Dual-mobility cup total hip arthroplasty improves the quality of life compared to internal fixation in femoral neck fractures patients with severe neuromuscular disease in the lower extremity after stroke: a retrospective study.

This study aimed to demonstrate that dual-mobility cup total hip arthroplasty (DMC-THA) can significantly improve the quality of life (QOL) of elderly femoral neck fracture patients with severe neuromuscular disease in unilateral lower extremities due to stroke hemiplegia compared to internal fixation (IF). Fifty-eight cases of severe neuromuscular disease in the unilateral lower extremities with muscle strength < grade 3/5 due to stroke were retrospectively examined From January 2015 to December 2020. Then, patients were divided into DMC and IF groups. The QOL was examined using the EQ-5D and SF-36 outcome measures. The physical and mental statuses were assessed using the Barthel Index (BI) and e Fall Efficacy Scale-International (FES-I), respectively. Patients in the DMC group had higher BI scores than those in the IF group at different time point. Regarding mental status, the FES-I mean score was 42.1 ± 5.3 in the DMC group and 47.3 ± 5.6 in the IF group (p = 0.002). For the QOL, the mean SF-36 score was 46.1 ± 18.3 for the health component and 59.5 ± 15.0 for the mental component in the DMC group compared to 35.3 ± 16.2 (p = 0.035), and 46.6 ± 17.4 (p = 0.006) compared to the IF group. The mean EQ-5D-5L values were 0.733 ± 0.190 and 0.303 ± 0.227 in the DMC and IF groups (p = 0.035), respectively. DMC-THA significantly improved postoperative QOL compared to IF in elderly patients with femoral neck fractures and severe neuromuscular dysfunction in the lower extremity after stroke. The improved outcomes were related to the enhanced early, rudimentary motor function of patients.

Antithrombotic Therapy in Peripheral Artery Disease: Current Evidence and Future Directions.

Patients with peripheral artery disease (PAD) are at an increased risk of major adverse cardiovascular events, and those with disease in the lower extremities are at risk of major adverse limb events primarily driven by atherothrombosis. Traditionally, PAD refers to diseases of the arteries outside of the coronary circulation, including carotid, visceral and lower extremity peripheral artery disease, and the heterogeneity of PAD patients is represented by different atherothrombotic pathophysiology, clinical features and related antithrombotic strategies. The risk in this diverse population includes systemic risk of cardiovascular events as well as risk related to the diseased territory (e.g., artery to artery embolic stroke for patients with carotid disease, lower extremity artery to artery embolism and atherothrombosis in patients with lower extremity disease). Moreover, until the last decade, clinical data on antithrombotic management of PAD patients have been drawn from subanalyses of randomized clinical trials addressing patients affected by coronary artery disease. The high prevalence and related poor prognosis in PAD patients highlight the pivotal role of tailored antithrombotic therapy in patients affected by cerebrovascular, aortic and lower extremity peripheral artery disease. Thus, the proper assessment of thrombotic and hemorrhagic risk in patients with PAD represents a key clinical challenge that must be met to permit the optimal antithrombotic prescription for the various clinical settings in daily practice. The aim of this updated review is to analyze different features of atherothrombotic disease as well as current evidence of antithrombotic management in asymptomatic and secondary prevention in PAD patients according to each arterial bed.

Endovenous laser coagulation of varicose veins: evolution continues

The article discusses the evolution of the endovenous laser ablation technique for the treatment of varicose vein disease of lower extremities. The history of studies aimed at improving the endovenous laser ablation is provided. The authors described the features of endovenous laser ablation with wavelengths from λ = 0.445 to 1.94 µm, alongside with edge- and radial-emitting working fibers, as well as fibers with radiation absorption at its distal end. The physical and biophysical mechanisms of the most popular to-date method for outpatient treatment of varicose vein disease of lower extremities are reviewed. The propagation process of laser radiation in the scattering medium is described, and the important role of the radiation scattering effect on the depth of its penetration into biological tissues is shown. The processes that take place during endovenous laser ablation are considered. The difference in physical processes that take place during the use of laser radiation mainly absorbed by hemoglobin (hemoglobin-absorbed range) and by water (water-absorbed range) is described. Expedience of simulating the processes that take place during endovenous laser ablation with the use of blood plasma has been substantiated. The blood plasma simulation demonstrated the decisive action of laser-induced boiling on thermal damage to the vein wall, which causes its fibrous transformation. It has been shown that the use of radial-emitting fibres during intense boiling generates steam bubbles around the site of radiation coupling. The contents of such steam bubbles do not absorb radiation, which thus reaches the venous wall, causing its symmetrical thermal damage. The advantages of using water-absorbing radiation with a wavelength of λ = 1.94 µm in conjunction with a radial-emitting fibre have been substantiated.

IATROGENIC SYSTEMIC LYMPHEDEMA FOLLOWING MULTIPLE MYELOMA TREATMENT

Lymphedema is a debilitating disease characterized by abnormal lymphatic drainage, either due to primary maldevelopment of the lymphatic system or to secondary injury. The clinical features of primary and secondary lymphedema differ, with primary lymphedema more often involving progressive bilateral lower extremity disease as compared to secondary lymphedema characteristically having more localized symptoms related to the origin of injury. This case presentation describes a patient who presented with bilateral lower extremity swelling, left greater than the right, with imaging results to support the diagnosis of lymphedema. During the time he was followed in our clinic, our team witnessed rapid progression of his lymphedema despite compliance with conservative management. We believe that the primary mechanism of systemic damage to our patient's lymphatic system is the lenalidomide and bortezomib therapy prescribed to treat multiple myeloma. This review explores the relationship between lenalidomide, bortezomib, and lymphedema in efforts of understanding this unique pathology of iatrogenic lymphedema mimicking primary nature.

Peripheral Neuropathy and Vision and Hearing Impairment in US Adults With and Without Diabetes.

We aimed to assess the associations of peripheral neuropathy (PN) with vision and hearing impairment among adults aged ≥40 years who attended the lower-extremity disease exam for the National Health and Nutrition Examination Survey (United States, 1999-2004). Overall, 11.8% (standard error (SE), 0.5) of adults had diabetes, 13.2% (SE, 0.5) had PN (26.6% (SE, 1.4) with diabetes, 11.4% (SE, 0.5) without diabetes), 1.6% (SE, 0.1) had vision impairment, and 15.4% (SE, 1.1) had hearing impairment. The prevalence of vision impairment was 3.89% (95% CI: 2.99, 5.05) among adults with PN and 1.29% (95% CI: 1.04, 1.60) among adults without PN (P < 0.001). After adjustment, PN was associated with vision impairment overall (odds ratio (OR) = 1.48, 95% confidence interval (CI): 1.03, 2.13) and among adults without diabetes (OR = 1.80, 95% CI: 1.17, 2.77) but not among adults with diabetes (P for interaction = 0.018). The prevalence of hearing impairment was 26.5% (95% CI: 20.4, 33.7) among adults with PN and 14.2% (95% CI: 12.4, 16.3) among adults without PN (P < 0.001). The association of PN with moderate/severe hearing impairment was significant overall (OR = 2.55, 95% CI: 1.40, 4.64) and among adults without diabetes (OR = 3.26, 95% CI: 1.80, 5.91). Overall, these findings suggest an association between peripheral and audiovisual sensory impairment that is unrelated to diabetes.

Prevalence and risk factors of lower extremity disease in high risk groups in Malawi: a stratified cross-sectional study

ObjectiveLow/middle-income countries face a disproportionate burden of cardiovascular diseases. However, among cardiovascular diseases, burden of and associations with lower extremity disease (LED) (peripheral arterial disease and/or neuropathy) is neglected. We...