High Thigh Research Articles

Utilizing a novel MRI technique to identify adverse muscle composition in end-stage liver disease: A pilot study

Introduction and ObjectivesSarcopenia is a common complication of end-stage liver disease (ESLD), but its exact relationship to myosteatosis and frailty remains unclear. In this pilot study, we tested the feasibility of a specialized MRI protocol and automated image analysis in patients with ESLD. Materials and MethodsIn a single-center prospective study, adult liver transplant candidates with ESLD underwent assessment of muscle composition between 3/2022 and 6/2022 using the AMRA® MAsS Scan. The primary outcome of interest was feasibility of the novel MRI technique in patients with ESLD. We also tested if thigh muscle composition correlated with validated measures of frailty and sarcopenia. ResultsEighteen subjects (71 % male, mean age 59 years) were enrolled. The most common etiologies of cirrhosis were alcohol-related liver disease (44 %) and non-alcohol-associated fatty liver disease (33 %), with a mean MELD-Na of 13 (± 4). The mean time needed to complete the MRI protocol was 14.9 min and only one patient could not complete it due to metal hardware in both knees. Forty-one percent of patients had adverse muscle composition (high thigh fat infiltration and low-fat free muscle volume) and these patients were more likely to have undergone a recent large volume paracentesis (43 % vs. 0 %, p < 0.02). The adverse muscle composition group performed significantly worse on the 6-minute walk test compared to the remainder of the cohort (379 vs 470 m, p < 0.01). ConclusionsThe AMRA® MAsS Scan is feasible to perform in patients with ESLD and can be used to quantify myosteatosis, a marker of muscle quality and potentially muscle functionality in ESLD.

Effect of liraglutide on thigh muscle fat and muscle composition in adults with overweight or obesity: Results from a randomized clinical trial.

Excess muscle fat is observed in obesity and associated with greater burden of cardiovascular risk factors and higher risk of mortality. Liraglutide reduces total body weight and visceral fat but its effect on muscle fat and adverse muscle composition is unknown. This is a pre-specified secondary analysis of a randomized, double-blind, placebo-controlled trial that examined the effects of liraglutide plus a lifestyle intervention on visceral adipose tissue and ectopic fat among adults without diabetes with body mass index ≥30kg/m2 or ≥27kg/m2 and metabolic syndrome. Participants were randomly assigned to a once-daily subcutaneous injection of liraglutide (target dose 3.0mg) or matching placebo for 40weeks. Body fat distribution and muscle composition was assessed by magnetic resonance imaging at baseline and 40-week follow-up. Muscle composition was described by the combination of thigh muscle fat and muscle volume. Treatment difference (95% confidence intervals [CI]) was calculated by least-square means adjusted for baseline thigh muscle fat. The association between changes in thigh muscle fat and changes in body weight were assessed using Spearman correlation coefficients. The effect of liraglutide versus placebo on adverse muscle composition, denoted by high thigh muscle fat and low thigh muscle volume, was explored. Among the 128 participants with follow-up imaging (92.2% women, 36.7% Black), median muscle fat at baseline was 7.8%. The mean percent change in thigh muscle fat over median follow-up of 36weeks was -2.87% among participants randomized to liraglutide (n=73) and 0.05% in the placebo group (absolute change: -0.23% vs. 0.01%). The estimated treatment difference adjusted for baseline thigh muscle fat was -0.24% (95% CI, -0.41 to -0.06, P-value 0.009). Longitudinal change in thigh muscle fat was significantly associated with change in body weight in the placebo group but not the liraglutide group. The proportion of participants with adverse muscle composition decreased from 11.0% to 8.2% over follow-up with liraglutide, but there was no change with placebo. In a cohort of predominantly women with overweight or obesity in the absence of diabetes, once-daily subcutaneous liraglutide was associated with a reduction in thigh muscle fat and adverse muscle composition compared with placebo. The contribution of muscle fat improvement to the cardiometabolic benefits of liraglutide requires further study.

Solvent Content Controlling Strategy for Cocrystallizable Polyesters Enables a Stress-Free Two-Way Shape Memory Effect with Wider Service Temperatures.

It is challenging to enhance the stress-free two-way shape memory (stress-free TWSM) effect to obtain a wide range of response temperatures. Herein, a polycaprolactone (PCL)/poly(ω-pentadecalactone) (PPDL) is photocured under UV light irradiation in the solvent of 1,1,2-trichloroethane (TCA), to obtain a series of cross-linked polyesters (CPES). Controlling solvent content (SC) which is removed after the polymerization allows the yielded CPES to perform a regulatable thermodynamic and stress-free TWSM properties. High SC is beneficial to reduce the degree of chain overlap (C/C* ) of PPDL chain segments in the PCL-based CPES network, then causes the cocrystallization of PCL and PPDL and yielding an additional melting-transitions (Tm ). An enhanced stress-free TWSM is obtained in high SC samples (CPES-15-90), reflected in the attainment of a wide range of response temperature, which means a wider service temperature. The enhancement is reflected in higher reversible strain of high SC samples compared with the samples prepared with low SC when varying high trigger temperature (Thigh ). Even at high Thigh , the high SC sample still has reversible strain. Therefore, controlling SC strategy for photocuring copolyester not only provides a new preparation approach for high-performance shape memory (SM) polymers, but also offers new condensed polymer structure to explore.

Association of Thigh Circumference with Physical Fitness and Fall Efficacy in Elderly Women with Osteopenia/Osteoporosis

PURPOSE This study investigated the associations between physical fitness and fall efficacy with thigh circumference in elderly women with osteopenia/osteoporosis.METHODS A total of 166 female participants aged 76.3±5.0 years with –1.0≥T-score of femur neck bone mineral density were voluntarily recruited from local community centers. The participants were classified as low 25%, middle 50%, and high 25% groups based on their thigh circumference. Physical fitness measurements, including strength, flexibility, aerobic endurance, and balance were measured with a standardized protocol. The Korean version of the fall efficacy scale (K-FES) was used to assess fall efficacy. Logistic regression analysis was used to estimate odd ratio (OR) of poor physical fitness and low fall efficacy according to thigh circumference levels.RESULTS In terms of physical fitness, the middle 50% group (OR=0.430, 95% CI=0.194-0.953) and high 25% group (OR=0.129, 95% CI=0.049-0.343) had significantly higher linear trend for poor physical fitness compared to the low 25% group (reference), (p&lt;0.001). In fall efficacy, the middle 50% group (OR=0.279, 95% CI=0.119-0.656) and high 25% group (OR=0.100, 95% CI=0.036-0.275) had significantly higher linear trend for low fall efficacy compared to the low 25% group (reference) (p&lt;0.001).CONCLUSIONS The current findings suggest that maintaining high thigh circumference via regular physical activity and diet may contribute to attenuation of decreased risk for poor physical fitness and low fall efficacy in elderly women with osteopenia/osteoporosis.

Tourniquet-induced lower limb ischemia/reperfusion reduces mitochondrial function by decreasing mitochondrial biogenesis in acute kidney injury in mice.

The mechanisms by which lower limb ischemia/reperfusion induces acute kidney injury (AKI) remain largely uncharacterized. We hypothesized that tourniquet‐induced lower limb ischemia/reperfusion (TILLIR) would inhibit mitochondrial function in the renal cortex. We used a murine model to show that TILLIR of the high thigh regions inflicted time‐dependent AKI as determined by renal function and histology. This effect was associated with decreased activities of mitochondrial complexes I, II, V and citrate synthase in the kidney cortex. Moreover, TILLIR reduced mRNA levels of a master regulator of mitochondrial biogenesis PGC‐1α, and its downstream genes NDUFS1 and ATP5o in the renal cortex. TILLIR also increased serum corticosterone concentrations. TILLIR did not significantly affect protein levels of the critical regulators of mitophagy PINK1 and PARK2, mitochondrial transport proteins Tom20 and Tom70, or heat‐shock protein 27. TILLIR had no significant effect on mitochondrial oxidative stress as determined by mitochondrial ability to generate reactive oxygen species, protein carbonylation, or protein levels of MnSOD and peroxiredoxin1. However, TILLIR inhibited classic autophagic flux by increasing p62 protein abundance and preventing the conversion of LC3‐I to LC3‐II. TILLIR increased phosphorylation of cytosolic and mitochondrial ERK1/2 and mitochondrial AKT1, as well as mitochondrial SGK1 activity. In conclusion, lower limb ischemia/reperfusion induces distal AKI by inhibiting mitochondrial function through reducing mitochondrial biogenesis. This AKI occurs without significantly affecting PINK1‐PARK2‐mediated mitophagy or mitochondrial oxidative stress in the kidney cortex.

High Inter-muscular Fat Is Associated with Poor Mobility Function in Older Adults, Only When Accompanied by Low Muscle Area (P01-026-19)

ObjectivesTo determine whether the associations between thigh inter-muscular-fat area, anthropometric characteristics and physical performance varies in old adults with low vs. high thigh muscle cross-sectional area. MethodsCross-sectional analysis of year 6 data from 1903 participants (52.2% women) of the Health ABC study aged 74–85y. Mid-thigh muscle composition (by CT), body composition (DXA) and physical performance were compared across quartiles of mid-thigh inter-muscular fat area. General linear model univariate analysis was used to study the associations between inter-muscular fat area and physical function according to low or high mid-thigh muscle cross-sectional area (using the 50th percentile). ResultsIn participants with low mid-thigh muscle area, there was a threshold effect in which high inter-muscular fat was related to poor mobility function after the 2nd quartile (>23.7 cm2 in men and >21.3 cm2 in women). While, in participants with high mid-thigh muscle area, high inter-muscular fat was not associated with poor mobility function. Inter-muscular fat had no significant association with isokinetic knee strength in participants with either low or high muscle area. However, across all inter-muscular fat conditions, participants with low muscle area had lower leg strength than those with high muscle area. ConclusionsThe negative effects of inter-muscular fat in aging are greatly influenced by the presence of concurrent low muscle mass. Funding SourcesNIA/NIH.

Temozolomide targets and arrests a doxorubicin-resistant follicular dendritic-cell sarcoma patient-derived orthotopic xenograft mouse model

Follicular dendritic cell sarcoma (FDCS) is a very rare and highly recalcitrant disease. A patient’s doxorubicin-resistant FDCS was previously established orthotopically on the right high thigh into the biceps femoris of mice to establish a patient-derived orthotopic xenograft (PDOX) model. The aim of the present manuscript was to identify an effective drug for this recalcitrant tumor. Here, we evaluated the efficacy of temozolomide (TMZ), trabectedin (TRAB) and pazopanib (PAZ) on the FDCS PDOX model. PDOX mouse models were randomized into five groups of eight to nine mice, respectively. Group 1, untreated control with PBS, i.p.; Group 2, treated with doxorubicin (DOX), 2.4 mg/kg, i.p., weekly for 3 weeks; Group 3, treated with PAZ, 50 mg/kg, oral gavage, daily for 3 weeks; Group 4, treated with TMZ, 25 mg/kg, oral gavage, daily for 3 weeks; Group 5, treated with TRAB, 0.15 mg/kg, i.v., weekly for 3 weeks. Body weight and tumor volume were assessed 2 times per week. TMZ arrested the FDCS PDOX model compared to the control group (p < 0.05). PAZ and TRAB did not have significant efficacy compared to the control group (p = 0.99, p = 0.69 respectively). The PDOX tumor was resistant to DOX (p= 0.99). as was the patient. The present study demonstrates that TMZ is effective for a PDOX model of FDCS established from a patient who failed DOX treatment, further demonstrating the power of PDOX to identify effective therapy including for tumors that failed first line therapy.

Degeneration in ACL Injured Knees with and without Reconstruction in Relation to Muscle Size and Fat Content-Data from the Osteoarthritis Initiative.

BackgroundAnterior cruciate ligaments (ACL) injuries represent a major risk factor for early osteoarthritis (OA).PurposeTo evaluate the prevalence and 4-year progression of knee OA measured with 3T MR-imaging in individuals with ruptured, reconstructed or normal ACL and to assess the impact of thigh muscle characteristics.MethodsA total of 54 knees (23/54 male, 31/54 female) were recruited from the Osteoarthritis Initiative (OAI). At baseline, 15/54 subjects had prevalent ACL ruptures and 15/54 subjects had prevalent ACL reconstruction (24/54 normal ACL). Western Ontario and McMasters Universities Arthritis Index (WOMAC) scores, Physical Activity Scores of the Elderly (PASE) and thigh muscle characteristics including strength, fat infiltration (Goutallier score) and thigh muscle cross-sectional area (CSA) MR measurements were obtained at baseline. Whole-organ MR-imaging Scores (WORMS) were obtained at baseline and at a 4-year follow-up time-point. Multivariate regression models, adjusting for covariates (age, gender, body mass index), were used for statistical analysis.ResultsAt baseline, subjects with prevalent ACL ruptures had worse WORMS total scores (mean±SEM, 44.1±3.5) than subjects with ACL reconstruction (30.8±4.0; P = 0.015) and worse than subjects with normal ACL (21.3±3.0; P<0.001). Cartilage scores were worse in both femorotibial compartments in ACL injured knees than in knees with normal ACL (P<0.05). Knees with ACL reconstruction showed an increased degeneration of the medial meniscus (P = 0.036), cartilage degeneration at the medial femoral condyle (P = 0.011). In a multivariate regression model, including both ACL groups and total muscle characteristics as influence parameters, high thigh muscle CSA, high muscle/ fat ratio and low Goutallier scores were associated with less degenerative changes at the knee, independent of ACL status. Knees with ACL reconstruction showed an increased progression of cartilage degeneration at the medial tibia compared to the normal ACL group (P = 0.027).ConclusionsHigh thigh muscle CSA is associated with less degenerative changes at the knee, independent of the ACL status and may potentially be advantageous in the prevention of early OA.

P5025 Production of chickens with high body weights, low amounts of abdominal fat, and a high thigh meat yield using DNA microsatellite marker-assisted selection

P5025 Production of chickens with high body weights, low amounts of abdominal fat, and a high thigh meat yield using DNA microsatellite marker-assisted selection

Donor-site morbidity following harvest of the transverse myocutaneous gracilis flap for breast reconstruction.

The transverse myocutaneous gracilis flap provides adequate autologous tissue for breast reconstruction from the high thigh region, but flap harvest may affect the patient's activities of daily living, sexuality, and quality of life. The authors evaluated the reconstruction outcome, postoperative donor-site complications, and quality-of-life outcomes. All patients who underwent transverse myocutaneous gracilis breast reconstruction performed by the senior author (M.H.) since 2007 were included in the study. Patient files were reviewed, and a questionnaire was used to assess patient satisfaction. Forty-nine transverse myocutaneous gracilis flaps were performed in 36 patients for breast reconstruction. Total flap necrosis occurred in two flaps (4 percent). Additional fat grafting was required in 61 percent of flaps, and donor-site complications occurred in 59 percent of patients. Wound dehiscence and infection were the most commonly encountered donor-site complications. However, by harvesting less skin and gracilis muscle, there was a statistically significant (p<0.001) lower complication rate in the last 16 patients. Twenty-two patients with at least 6 months of follow-up were included in the questionnaire study. Eighteen returned questionnaires. Most patients were happy to very happy with their result and could go about their activities of daily living. There was no statistically significant correlation between the independent variables (e.g., age, body mass index, and radiotherapy) and the dependent variables (e.g., breast satisfaction, sexuality, and donor-site morbidity). There was a statistically significant difference regarding donor-site satisfaction when comparing patients with and without donor-site complications (p=0.01). Although fat grafting was often required, patients were happy with the result of their transverse myocutaneous gracilis breast reconstruction. Donor-site complications correspondence inversely to patient satisfaction. Therapeutic, IV.

Hemodynamic changes in the femoral vein with increasing outflow resistance.

In post-thrombotic and May-Thurner syndromes, the iliac veins may be scarred, compressed, or obstructed. Obesity and increased intra-abdominal pressure may also hamper the venous return. Therefore, measurements of outflow resistance (OR) impeding venous return may be helpful to select patients for intervention and to assess the impact of intervention. A proof-of-concept study is presented in healthy volunteers where OR is quantified using duplex assessment of the femoral vein (FV) at mid-thigh following predetermined inflation pressures with a high thigh tourniquet. Twenty-two consecutive subjects (15 male) without evidence of venous disease by clinical and duplex examination were studied. Two male exclusions were due to bifid FVs. Median (range) baseline characteristics were age 30years (24-57years), height 173cm (158-197cm), weight 72kg (50-97kg), leg length 80cm (74-94cm), and FV diameter 11.2mm (6.8-14.8mm). Subjects were examined standing with the test leg nonweight-bearing, resting gently on the floor. A 26-cm-wide calf cuff was attached to an intermittent pneumatic compression device that delivered three compressions per minute at 120mm Hg. A high thigh cuff, 12cm wide, was inflated just before each calf compression in multiples of 20mm Hg, from 0 to 120mm Hg, to provide a standard OR. FV waveform parameters were recorded using duplex beneath each thigh-cuff inflation pressure and repeated three times. OR was calculated using change in pressure (P2-P1)/Flow (Q). Pressure P2 was 120mm Hg minus the additional height to the duplex transducer. P1 was assumed tobe zero. Flow was cross-sectional area (π× diameter [d](2)/4)× velocity. The velocity parameters chosen were peakvelocity (PV), time-averaged mean velocity (TAMV), andTAMV from start to peak. Peak velocity, TAMV, and TAMV to peak all decreased significantly (P< .0005; Friedman) with increasing thigh cuff pressure with P< .0005 correlations (Spearman) of r= .842, r= .488, and r= .744, respectively. Furthermore, increasing thigh cuff pressure at 0, 20, 40, 60, 80, 100, and 120mm Hg also caused a gradual and significant increase in median (interquartile range) OR at 27 (19-34), 30 (21-42), 30 (23-44), 40 (26-47), 46 (32-51), 61 (38-71), and 79 (45-134) resistance units, respectively (P< .0005; Friedman, and r= .516; Spearman). Higher baseline (innate) OR values were found in taller (P= .002) and heavier (P= .043) subjects. Hemodynamic velocity parameters in the femoral vein attenuate progressively with increasing venous obstruction. Outflow resistance (OR) can be quantified using duplex measurements when they are substituted into equations of fluid mechanics. Optimization of this novel technique, which requires an IPC outflow challenge test, may provide useful information in the assessment and treatment of patients.

English

This study examined the replacement of dry heat treated mango kernel at different levels (0, 10, 20 and 30%) in the diet of 120 Anak broiler birds. The birds were allotted to four treatments of 10 birds each and the experiment was replicated 3 times. They were fed ad libitum and data were collected on performance [feed intake, weight gain, and feed conversion ratio (FCR)], blood and serum parameters (packed cell volume (PCV), haemoglobin (Hb) concentration, red blood cell (RBC) count, white blood cell (WBC) count total protein and albumin] and carcass parameters (thigh weight, drumstick weight, breast weight, back weight and wing weight). Average final weight and average weight gain were significantly (p < 0.05) high in birds placed on 0 and 30% dry heat treated mango kernel, while FCR was significantly low in birds fed with 30% heat treated mango kernel. Birds on 0% heat treated mango kernel had significantly high thigh, drumstick breast, back and wing weights (p < 0.05), followed by birds on 30% heat treated mango kernel. PCV and RBC shows significant differences (p < 0.05) in favour of birds on 0 and 20% heat treated mango kernel. Total protein and albumin were significantly high (p < 0.05) in birds fed with 10% heat treated mango kernel; urea was significantly high in birds fed with 10 and 20% heat treated mango kernel. Alanine transaminase (ALT) also shows high significant difference (p < 0.05) in birds fed with 30% heat treated mango kernel, but all values falls within the normal range for broilers. This study reveals that dry heat treated mango kernel can be used in broiler diet up to 30% maize replacement without any adverse effect. Key words: Mango kernel, heat, broiler, carcass.

Placement of an aortomonoiliac stent graft without femorofemoral revascularization in endovascular aneurysm repair: a case report

IntroductionEndovascular aortic repair, if technically feasible, is the treatment of choice for patients with a contained ruptured aortic aneurysm who are unfit for open surgery.Case presentationWe report the case of an 80-year-old Caucasian man who presented with an unusually configured, symptomatic infrarenal aortic aneurysm. His aneurysm showed an erosion of the fourth lumbar vertebra and a severely arteriosclerotic pelvic axis. A high thigh amputation of his right leg had been performed 15 months previously. On his right side, occlusion of his external iliac artery, common femoral artery, and deep femoral artery had occurred. His aneurysm was treated by a left-sided aortomonoiliac stent graft without femorofemoral revascularization, resulting in occlusions of both internal iliac arteries. No ischemic symptoms appeared, although perfusion of his right side was maintained only over epigastric collaterals.ConclusionsThe placement of aortomonoiliac stent grafts for endovascular treatment of infrarenal aortic aneurysms without contralateral revascularization is a feasible treatment option in isolated cases. In this report, access problems and revascularization options in endovascular aneurysm repair are discussed.

Determinants of lower-body muscle power in early postmenopausal women.

To investigate the association between muscle size, density, and fiber composition; body composition; maximal isometric knee extension strength (KES); and lower-body muscle power in healthy postmenopausal women. Cross-sectional analysis of baseline data from a 1-year randomized controlled experiment. University-based research laboratory. Seventy-eight healthy postmenopausal women aged 50 to 57. Maximal lower-body muscle power was assessed using vertical jump height (VJH). Maximal isometric KES was measured on a dynamometer chair. Computed tomography scans were used to determine lean-tissue cross-sectional area and density of the thigh and lower leg muscles. Relative area occupied by type I, IIa, IIax, and IIx muscle fibers was assessed from the vastus lateralis muscle. lean body mass and total body fat mass were assessed using bioelectrical impedance. High VJH was associated with low body fat mass, high KES, and high density of thigh and lower leg muscles. Multivariate linear regression modeling revealed that high thigh muscle density (beta=0.242; P=.019), relative area occupied by the fastest muscle fiber types (IIax+IIx; beta=0.246; P=.007), KES (beta=0.247; P=.007), and low body fat mass (beta=-0.455; P<.001) were independently associated with high VJH, accounting for 45% of the variability in VJH. This study showed that thigh muscle composition, muscle strength, and body fat mass are important determinants of lower-body muscle power production during weight-bearing activity in healthy postmenopausal women.

Atypical Proximal Limb Pain of Suspected High Lumbar Stenotic Origin Arising from Severe Aortoiliac Disease – Leriche’s Syndrome

We present the cases of two middle aged women who were referred to our physiatric spine center with chronic and proximal lower extremity pain complaints of suspected upper lumbar and stenotic origin. Their histories, physical examinations, and imaging studies were not convincing for a primary radicular pain generator. Non-invasive arterial Doppler studies demonstrated a significant brachial to high thigh pressure discrepancy without a focal segmental drop affecting the more distal lower extremity vasculature. Computed tomography (CT) angiograms confirmed advanced aorto-iliac atherosclerotic disease in each case. Spine practitioners are often consulted by the medical community to direct care in patients with suspected lumbar stenosis. These atypical cases of patients with isolated proximal lower extremity pain remind us of the symptomatic overlap between neurogenic and vascular claudication and emphasize the importance of a detailed history, physical examination, and appropriate imaging studies in identifying patients with primary arterial insufficiency.

Poster 85: Severe aortoiliac occlusive disease presenting as suspected symptomatic high lumbar stenosis: a report of 2 cases

Setting: Outpatient physiatric spine center. Patients: 2 patients with the chief complaint of proximal thigh pain. Case Descriptions: 2 middle-aged female smokers were referred by their primary care physician with bilateral thigh pain that had persisted for several years. Each presented with a lumbar magnetic resonance imaging, which demonstrated upper lumbar stenosis. In each case, bilateral and circumferential thigh pain was described, which prohibited the patient from ambulating extended distances and was relieved through quiet standing. A detailed history and radiographic review were not convincing for a corroborative radicular stressor. Each patient was neurologically intact and had diminished lower-extremity pulses. Segmental arterial Doppler studies were performed. Assessment/Results: In each case, a markedly diminished ankle-brachial index was observed. Although a focal drop in pressure was not observed between lower-limb segments, a significant reduction was appreciated when comparing the high thigh to brachial pressure measurements. Computed tomography (CT) angiograms confirmed severe aortoiliac atherosclerotic disease. Each patient was treated with an antiplatelet agent prior to further considering aortofemoral bypass. One patient’s carotid Doppler image revealed severe bilateral occlusion that led to a prompt endarterectomy. Discussion: Neurogenic claudication can present with proximal and anterior lower-extremity pain arising from a high lumbar and stenotic radicular stressor. Vascular claudication most commonly arises from atherosclerosis obliterans, and smoking remains a primary risk factor. Isolated proximal limb pain with ambulation, Leriche’s syndrome, can arise from aortoiliac occlusive disease. Conclusions: Spine practitioners are often consulted to determine if a patient’s limb complaints are arising from a spinal pain generator. These atypical cases highlight a less common pain distribution in the vascular patient, the symptomatic overlap between neurogenic and vascular claudication, and the challenges that arise when evaluating the patient with combined disease.

High thigh muscle strength but not bone mass in young horseback-riding females.

To evaluate whether the type of weight-bearing loading subjected to the skeleton during horseback-riding was associated with differences in bone mass and muscle strength of the thigh, we investigated bone mass and isokinetic muscle strength in 20 female horse riders (age 17.9 +/- 0.6 years) who were riding 7.0 +/- 3.4 hours/week, and 20 nonactive females (age 17.8 +/- 1.1 years). The groups were matched according to age, weight, and height. Areal bone mineral density was measured in total body, head, lumbar spine, right femoral neck, Ward's triangle, and trochanter, the whole dominant and nondominant humerus, and in specific sites in the right femur diaphysis, distal femur, proximal tibia, and tibia diaphysis using dual X-ray absorptiometry. Isokinetic concentric and eccentric peak torque of the quadricep and hamstring muscles were measured using an isokinetic dynamometer. There were no significant differences in bone mass between the horseback riders and nonactives at any site measured. The horse riders were significantly (P < 0.05-0.01) stronger in concentric hamstrings strength at 90 degrees/second and 225 degrees/second and in eccentric quadricep and hamstring strength at 90 degrees/second. Horseback riding in young females is associated with a high muscle strength of the thigh, but not with a high bone mass.

Differential expression of galanin immunoreactivities in the primary sensory neurons following partial and complete sciatic nerve injuries

Neuropeptide expression in primary sensory neurons is highly plastic in response to peripheral nerve axotomy. While neuropeptide changes following complete sciatic nerve injury have been extensively studied, much less is known about the effects of partial sciatic nerve injuries on neuropeptide plasticity. Galanin, a possible endogenous analgesic peptide, was up-regulated in primary sensory neurons following complete sciatic nerve injury. We investigated the effects of partial sciatic nerve injuries on galanin expression in primary sensory neurons, and compared this effect with that after complete sciatic nerve injury. Complete transection, partial transection and chronic constriction injury were made, respectively, on the sciatic nerves of three groups of rats at high thigh level. Animals were allowed to survive for four and 14 days before being killed. L4 and L5 dorsal root ganglia, L4–5 spinal cord and lower brainstem were processed for galanin immunocytochemical staining. After all three types of sciatic nerve injuries, galanin-immunoreactive neurons were significantly increased in the ipsilateral dorsal root ganglia, and galanin-immunoreactive axonal fibres were dramatically increased in the superficial laminae of the dorsal horn and the gracile nuclei, compared to the contralateral side. However, in partial injury models, the percentages of galanin-immunoreactive dorsal root ganglion neurons were significantly higher than in complete nerve transection. Size frequency distribution analysis detected that more medium- and large-size galanin-immunoreactive dorsal root ganglion neurons were present after partial nerve transection and constriction injury than after complete nerve transection. Using a combined approach of retrograde tracing of flurorescent dyes and galanin immunostaining, we found that a partial transection increased the proportions of galanin-immunoreactive neurons among both axotomized and non-axotomized neurons. Galanin-immunoreactive axonal fibres were not only detected in the superficial laminae, but also in the deeper laminae of the dorsal horn of partial injury animals. Furthermore, more galanin-immunoreactive axonal fibres were observed in the ipsilateral gracile nuclei of partially injured rats than in completely injured rats. We conclude that partial sciatic nerve injuries induced greater galanin up-regulation in medium- and large-size dorsal root ganglion neurons than complete sciatic nerve injury. Galanin expression in primary sensory neurons seems to be differentially regulated following partial and complete sciatic nerve injuries.

A program of operative angioplasty: Endovascular intervention and the vascular surgeon

Vascular surgeons are ideally suited to select and perform endovascular interventions either as primary therapy or as an adjunct to bypass surgery. Attaining proficiency in endovascular techniques is an important goal in the training of vascular surgeons. We report our initial experience with a program of endovascular intervention performed in the operating room by vascular surgeons. During the previous three years, we performed 109 angioplasty procedures, 60 aortoiliac (55%), 32 femoropopliteal (29%), and 17 popliteal/tibial (16%), using guidewires and angioplasty balloons directed by intraoperative digital subtraction C-arm arteriography with road-mapping capabilities. Indications for angioplasty included disabling claudication in 59 patients (54%), rest pain in 18 (17%), and tissue loss in 32 (29%). Angioplasty was accompanied by stent placement in 39 of 60 aortoiliac procedures (65%) and in two of 32 femoral procedures (6%). In 16 cases (15%), the endovascular procedure was performed in conjunction with a bypass procedure. In selected cases (15, 14%), duplex scanning was the sole diagnostic method used before surgery to identify the lesion, eliminating the need for preoperative arteriographic scans. Segmental pressure measurements, duplex ultrasound scans, and treadmill exercise testing as indicated were performed before and after surgery. The efficacy of the endovascular intervention was assessed at 3-month intervals during the first year and at 6-month intervals thereafter. A successful results was defined using criteria recommended by the Ad Hoc Subcommittee on Reporting Standards for Endovascular Procedures from the Society for Vascular Surgery/International Society for Cardiovascular Surgery. This included the combination of symptomatic improvement, obtaining an anatomically successful result with < 30% residual lumen stenosis, and elimination of the translesion gradient with an improvement in high thigh-brachial index or ankle-brachial index greater than 0.15. Initial success was achieved in 55 of 60 aortoiliac (92%), 28 of 32 femoropopliteal (88%), and 16 of 17 popliteal/tibial (94%) angioplasty procedures. Clinical follow-up has been achieved in all cases, with continued clinical success rates of 80%, 75%, and 82% for aortoiliac, femoropopliteal, and popliteal/tibial angioplasty procedures, respectively, with a mean follow-up of 15.7 months. These results confirm the value of a program in which C-arm technology was used by vascular surgeons in the performance of angioplasty and stenting procedures in the operating room. This experience in therapeutic endovascular intervention will facilitate the credentialing process for future vascular surgeons.

Lower limb colour flow imaging: A comparison with ankle: Brachial measurements and angiography

Peripheral lower limb vascular disease represents a substantial health problem. Arteriography is currently the 'gold standard' imaging modality. However, much effort is presently being channeled towards alternative non-invasive techniques. To date, this involves mainly the interpretation of ankle: brachial pressure indices and segmental pressure measurements. A prospective pilot study of 20 patients (40 limbs) comparing these two techniques with colour Doppler ultrasound was carried out. Although ankle: brachial indices could accurately predict disease (sensitivity 100%, accuracy 92.5%), it failed to localize it; neither a high thigh: brachial index nor segmental drop could localize disease to the iliac (accuracy 70%) or femoro-popliteal (accuracy 55%) vessels respectively. Colour Doppler ultrasound correctly differentiated iliac from femoro-popliteal disease. It had an overall diagnostic accuracy of 90% in the femoral and popliteal vessels for both occlusion and stenosis and diagnosed 10 of 11 iliac lesions. Colour Doppler ultrasound has many advantages over pressure measurements in that it can both diagnose and localize arterial lesions accurately. We feel that using both techniques prior to angiography can accurately separate patients into either a surgical or angioplasty group. This may help utilize angiographic resources and radiologists' time more efficiently as well as reducing radiation dose to both patients and staff.