Leg Skin Research Articles

Bird Leg Skin Lesions and Urbanization in a Neotropical Savanna City.

Urban sprawl threatens biodiversity and is responsible for significant changes in the species that live in these environments. Given the high cost of comprehensive surveillance, monitoring disease indirectly, such as detecting skin lesions in birds, may help us better understand the prevalence of diseases affecting wild populations. We assessed the frequency of leg skin lesions, as a proxy of disease presence, in 1,565 individuals of 25 species, along the urban matrix of a large Neotropical city, Brasília, Federal District, Brazil. We tested the hypothesis that there is an increase in the frequency of skin lesions in birds due to urban intensification. We observed an increasing trend in some bird species between the frequency of occurrence of lesions and the intensity of urbanization. Species with a higher number of captures had an increase in the percentage of lesions, indicating that the occurrence of lesions may be linked to higher population density or that detection of the effect occurs only when sample sizes are high and controlled among urbanization categories. Our study highlights how the intensity of urbanization may increase the risk of disease transmission for these species. Unfortunately, studies on this topic are scarce in Neotropical regions, despite the region's high biodiversity and urban expansion.

Endogenous Cushing’s Syndrome Due to Right Adrenal Adenoma Presenting With Bilateral Leg Oedema and Skin Ulceration

Endogenous Cushing’s Syndrome Due to Right Adrenal Adenoma Presenting With Bilateral Leg Oedema and Skin Ulceration

Characteristics of lymphoedema, in particular midline lymphoedema, after treatment for prostate cancer: a retrospective study

BackgroundPatients undergoing treatment for prostate cancer may develop lymphoedema of the midline region. This has a substantial impact on a patient’s quality of life and its diagnosis is often delayed or missed. Therefore, the purpose of this study is to compare the characteristics of patients with leg and midline lymphoedema to patients with only leg lymphoedema.MethodsWe retrospectively collected patient-, cancer-, lymphoedema- and lymphoedema treatment-related data of 109 men with lymphoedema after treatment for prostate cancer. First, 42 characteristics were compared between both groups. Second, factors predicting presence of midline lymphoedema were explored by multivariable analyses.ResultsThe mean age of the patients with lymphoedema was 68 ( ±7) years and mean BMI is 28 (±4) kg/m2. Median duration of lymphoedema before the first consultation was 27 (9;55) months. Based on univariable analyses, patients with leg and midline lymphoedema had more frequently upper leg lymphoedema (89% (31/35) vs. 69% (51/74), p = 0.026), skin fibrosis (34% (12/35) vs. 16% (12/74), p = 0.034) and lymphatic reconstructive surgery (9% (3/35) vs. 0% (0/71), p = 0.020) than patients with only leg lymphoedema. Additionally, patients with leg and midline lymphoedema reported less frequently lower leg lymphoedema (77% (27/35) vs. 95% (70/74), p = 0.007). Based on the multivariable analysis, not having lower leg lymphoedema, skin fibrosis, performing self-bandaging and self-manual lymphatic drainage appear to be predictors for having midline lymphoedema.ConclusionsIf patients with lymphoedema after prostate cancer do not have lower leg lymphoedema, have skin fibrosis, perform self-bandaging or self-manual lymphatic drainage, they possibly have midline lymphoedema.

Abstract 44: Transcutaneous hydrogen sulfide measurement as a way to evaluate skin blood flow

Hydrogen sulfide (H 2 S) generated in the endothelium of small arteries has been shown to contribute to vasodilation, angiogenesis, and antioxidant properties. We have developed a non-invasive way to measure H 2 S emitted by the skin (TAGS™) and have shown that the ratio of leg:arm emitted levels correlate with severity of microvascular impairment in subjects with diabetes. This study evaluated the correlation of transdermal H 2 S ratios with the current gold standard method of evaluating leg skin blood flow, transcutaneous oxygen pressures (tcpO 2 ). TAGS™ measurements were made on the forearm and lower limbs in subjects to calculate the leg:arm ratio while tcpO 2 was recorded only from legs. Other measurements included ankle brachial index (ABI), fasting blood glucose, HbA1c, plasma lipids, blood pressure, and BMI. We observed that TAGS™ ratios correlated strongly with HbA1c (p = 0.0002) and with tcpO 2 (p = 0.0009). In addition, TAGS ratios were significantly lower in subjects with diabetes (0.69 +/- 0.18) compared to healthy controls (1.13 +/- 0.40) (p = <0.0001). These results suggest lower leg:arm ratios of transdermal H 2 S measurements are indicative of impaired microvascular function and that the TAGS™ measurements may be a simpler way than tcpO 2 to detect and monitor diminished skin blood flow that leads to PAD complications.

Dynamic oxygen assessment techniques enable determination of anesthesia's impact on tissue.

Tissue oxygenation is well understood to impact radiosensitivity, with reports demonstrating a significant effect of breathing condition and anesthesia type on tissue oxygenation levels and radiobiological response. However, the temporal kinetics of intracellular and extracellular oxygenation have never been quantified, on the timescale that may affect radiotherapy studies. C57BL/6 mice were anesthetized using isoflurane at various percentages or ketamine/xylazine (ket/xyl: 100/10 mg/kg) (N = 48). Skin pO2 was measured using Oxyphor PdG4 and tracked after anesthetization began. Oxyphor data was validated with relative measurements of intracellular oxygen via protoporphyrin IX (PpIX) delayed fluorescence (DF) imaging. Ex vivo localization of both PdG4 Oxyphor and PpIX were quantified. Under all isoflurane anesthesia conditions, leg skin pO2 levels significantly increased from 12-15 mmHg at the start of anesthesia induction (4-6 minutes) to 24-27 mmHg after 10 minutes (p < 0.05). Ketamine/xylazine anesthesia led to skin pO2 maintained at 15-16 mmHg throughout the 10-minute study period (p < 0.01). An increase of pO2 in mice breathing isoflurane was demonstrated with Oxyphor and PpIX DF, indicating similar intracellular and extracellular oxygenation. These findings demonstrate the importance of routine anesthesia administration, where consistency in the timing between induction and irradiation may be crucial to minimizing variability in radiation response.

A procedure for surveillance data-driven risk assessment to inform Campylobacter risk-based control

In this study is presented a procedure for surveillance data-driven risk assessment, which can be used to inform inter-sectorial Campylobacter risk-based control, e.g. within National Action Plans and One Health (OH) systems. Campylobacter surveillance data (2019 to 2022) and a published quantitative microbial risk assessment (QMRA) model were used, to show the procedure. Moreover, an interface tool was developed in Excel for showing descriptive statistics on measured apparent flock prevalence (AP) and concentrations (colony forming units per gram, cfu/g) on the meat, together with their related QMRA outputs. Currently (mid-2024), Danish fresh broiler meat is produced by four slaughterhouse companies (A, B, C and D), where approximately 30 % of the annually slaughtered broiler flocks are randomly culture tested, on one leg skin (LS) sample per flock sampled from chilled carcasses. Data variables were: date of sampling, farm-ID, within farm house-ID, flock-ID, slaughterhouse name, sample-ID, and Campylobacter concentrations. Flocks were classified as carcass positive with a concentration ≥ 10 cfu/g. The data was fed into the QMRA model to assess: a) the average risk of human campylobacteriosis per serving (during a month or year), and b) the monthly/annual risk of 2022 relative (RR) to the baseline (average) risk from the previous three years. The descriptive statistics and the risk assessment (RA) were carried out at national level and for each slaughterhouse. In 2022, the national RR was 1.03, implying that the average annual risk increased by approximately 3 % compared to the baseline. Nevertheless, for slaughterhouses A, B and D, the annual risk decreased by ≈ 22 %, 21 % and 43 %, respectively; whereas for slaughterhouse C it increased by 48 %. Monthly risk estimates showed seasonal variations, according to the visualized changes of AP and meat contaminations. The national monthly RR was >1 in July and from September to December. During those months: slaughterhouse C had always RR > 1, slaughterhouse A had a relative increase of risk in July, slaughterhouse B in July and November, and slaughterhouse D in October and December. The procedure and the tools used in this study, allow identifying the impact of seasonality and food-chain stages (i.e. slaughterhouses and their broilers sourcing farms) on the risk per serving, so that Campylobacter risk-based control could be implemented accordingly, from farm to fork, across consecutive surveillance periods. The same principles could be applied in other countries, food chains, and/or for other foodborne pathogens, when similar data and QMRA models are available.

Dynamic optical coherence tomography for imaging acute wound healing.

The aim of this study was to investigate acute wound healing with dynamic optical coherence tomography (D-OCT). From 22 patients with 23 split skin graft donor sites, vessels at four wound edges, the wound bed, and adjacent and unaffected skin of the contralateral leg were measured by D-OCT at six time points from surgery to 4 weeks of healing. Changes in vessel orientation, density, diameter, morphology and pattern in horizontal, vertical and 3D images were analysed for wound healing and re-epithelialization. At 300 μm depth, there were significant differences of blobs and serpiginous vessels between normal and wounded skin. The wound had significantly more vertically oriented vessels, a higher degree of branching, vessel density and diameter compared with healthy skin. 3D images showed increased angiogenesis from healthy skin towards the wound centre, significantly higher vessel density at the wound than at normal skin and the highest at the interface. During wound healing blobs, coils and serpiginous vessels occurred significantly more frequently in lesional than healthy skin. Vessel density was greatest at the beginning, decreased and then increased by 4 weeks post-surgery. D-OCT helps to evaluate acute wound healing by visualizing and quantifying blood vessel growth in addition to re-epithelialization.

Intermuscular adipose tissue accumulation is associated with higher tissue sodium in healthy individuals.

High tissue sodium accumulation and intermuscular adipose tissue (IMAT) are associated with aging, type 2 diabetes, and chronic kidney disease. In this study, we aim to investigate whether high lower-extremity tissue sodium accumulation relates to IMAT quantity and whether systemic inflammatory mediators and adipocytokines contribute to such association. Tissue sodium content and IMAT accumulation (percentage of IMAT area to muscle area) were measured in 83 healthy individuals using sodium imaging (23Na-MRI) and proton (1H-MRI) imaging of the calf. Insulin sensitivity was assessed by glucose disposal rate (GDR) measured with the hyperinsulinemic-euglycemic clamp. Median (interquartile range) muscle and skin sodium contents were 16.6 (14.9, 19.0) and 12.6 (10.9, 16.7) mmol/L, respectively. Median IMAT was 3.69 (2.80, 5.37) %. In models adjusted for age, sex, BMI, GDR, adiponectin, and high-sensitivity C-reactive protein, increasing tissue sodium content was significantly associated with higher IMAT quantity (p = 0.018 and 0.032 for muscle and skin tissue sodium, respectively). In subgroup analysis stratified by sex, skin sodium was significantly associated with IMAT only among men. In interaction analysis, the association between skin sodium and IMAT was greater with increasing levels of high-sensitivity C-reactive protein and interleukin-6 (p for interaction = 0.022 and 0.006, respectively). Leg muscle and skin sodium are associated with IMAT quantity among healthy individuals. The relationship between skin sodium and IMAT may be mediated by systemic inflammation.

In vitro skin puncture methodology for material characterization

Quantifying the mechanical behavior of skin has been foundational in applications of cosmetics, surgical techniques, forensic science, and protective clothing development. However, previous puncture studies have lacked consistent and physiological boundary conditions of skin. To determine natural skin tension, excision of in situ porcine skin resulted in significantly different diameter reduction (shrinkage) in leg (19.5 %) and abdominal skin (38.4 %) compared to flank skin (28.5 %) (p = 0.047). To examine effects of initial tension and pre-conditioning, five conditions of initial tension (as percentage of diameter increase) and pre-conditioning were tested in quasistatic puncture with a 5 mm spherical impactor using an electrohydraulic load frame and custom clamping apparatus. Samples with less than 5 % initial tension resulted in significantly greater (p = 0.011) force at failure (279.2 N) compared to samples with greater than 25 % initial tension (195.1 N). Eight pre-conditioning cycles of 15 mm displacement reduced hysteresis by 45 %. The coefficient of variance was substantially reduced for force, force normalized by cutis thickness, displacement, stiffness, and strain energy up to 46 %. Pre-conditioned samples at physiological initial tension (14–25 %) resulted in significantly greater (p = 0.03) normalized forces at failure (278.3 N/mm) compared to non-conditioned samples of the same initial tension (234.4 N/mm). Pre-conditioned samples with 14–25 % initial tension, representing physiological boundary conditions, resulted in the most appropriate failure thresholds with the least variation. For in vitro puncture studies, the magnitude of applied initial tension should be defined based on anatomical location, through a shrinkage experimentation, to match natural tension of skin. Characterizing the biological behavior and tolerances of skin may be utilized in finite element models to aid in protective clothing development and forensic science analyses.

Lymphedema in a patient with decompensated cirrhosis

The lymphatic system is critical in body fluid homeostasis. Although lymphatic vascular expansion prevents the development of ascites and oedema in the early stages of liver cirrhosis, compensatory mechanisms cannot achieve this in the advanced stages due to lymphatic dysfunction. A 36-year-old male patient, who had been followed up for cryptogenic cirrhosis for 15 years, had been complaining of excessive swelling in his legs for the last 4 years. Excessive swelling in the legs was accompanied by skin rashes and ulcers, and the leg skin had an orange peel appearance characteristic of lymphedema. Bilateral lower extremity artery and venous system colour Doppler ultrasonography showed that the vascular structures of the right lower extremity arterial and venous system were open, and the flow rate, direction and spectrum were normal. The patient, who could not undergo liver transplantation due to organ limitations, died due to sepsis following lymphedema-induced wound infection. In conclusion, this case suggests that lymphedema should be considered in the presence of oedema in cases of decompensated cirrhosis, and the necessary conservative treatments should be applied.

Tuberculosis-induced osteomyelitis of the right distal tibia in a healthy male, a Saudi infant.

Background: Tuberculosis (TB) is a challenging disease; however, it is preventable and curable in most cases. In 2022, TB was the second most common single infection leading to death worldwide after coronavirus disease. Almost 10 million people get infected with TB every year. TB manifests clinically in two types: pulmonary and extrapulmonary; the pulmonary type is the most common. Case presentation: A 17-month-old medically free male infant was referred to our institution with right distal leg pain, swelling and skin changes, started 1 month ago. Since then, both pain and swelling worsened and led to limping. The father denied any history of recent trauma, fever, cough, night sweating, infections, contact with sick patients, skin rashes in other body parts, or any other systematic changes. The baby was delivered at full term by cesarian-section due to placenta previa, with a birth weight of 3500 g, Prenatal and postnatal history is unremarkable. The patient was vitally stable and appeared healthy with no dysmorphic features. He was able to bear weight on his feet; however, his gait and walking abilities could not be assessed. Local examination showed swelling, erythema, and tenderness over the right distal tibia with an intact range of motion. The patient was admitted and initial investigations were done for him. After close observation and multiple investigations, a diagnosis of TB-induced right tibial osteomyelitis was made, and first-line management was initiated. Conclusion: This report highlights the importance of orthopedic surgeons in considering TB-induced osteomyelitis in the differential diagnosis of vague musculoskeletal symptoms.

Passive heat therapy to improve cardiometabolic health in persons with a spinal cord injury — a pilot study

Objective: To test the effect of repeated heat therapy on markers of inflammation, glucose metabolism and vascular health in persons with a spinal cord injury (SCI). It was hypothesized that the heat therapy intervention would lead to a reduction in the fasting concentration of inflammatory markers as well as an improvement in glucose tolerance and microvascular function.Methods: Five adults with thoracic SCI ((1 female, age: 43 (27 – 60) yrs, BMI: 29 (23 to 30) kg/m2, years since injury: 7 (1 – 11) yrs)) enrolled in an 8-week passive heat therapy intervention consisting of 24 session during which the oral temperature was elevated by 1°C by means of a water-perfused suit and heating blankets. The number of completed sessions, time to reach the desired oral temperature and adverse events were reported. Thermoregulatory and perceptual responses to a single passive heat therapy session were assessed during the first session of the intervention. Fasting interleukin-6 (IL-6), C-reactive protein (CRP) and glucose concentration were measured in plasma before and after the chronic intervention. Additionally, thermal hyperemia in sensate (i.e., arm) and insensate (i.e., leg) skin through laser Doppler flowmetry were determined at 39°C and 45°C pre- and post-intervention. Descriptive data are expressed as median (range).Results: The median time to reach a 1°C increase in oral temperature during passive heating was 53 (49 – 75) min, which was accompanied by a final mean skin temperature of 38.6 (36.5 – 38.9)°C, a thermal comfort of 2 (0 – 4) on a 0 to 5 ratings scale and a basic affect of +3 (+1 - +4) on a -5 to +5 rating scale. Four out of the five participants completed all prescribed passive heating sessions. However, in two participants a number of sessions (N = 10 and 2 out of 24 sessions) were stopped at 0.8°C due to thermal discomfort. There were no skin burns or signs of autonomic dysreflexia. All participants remained hemodynamically stable throughout the sessions. Resting IL-6 and CRP changed from 3.2 (2.7 – 10.5) pg/ml to 8.1 (7.6 – 11.1) pg/ml and 0.40 (0.14 – 1.16) to 1.11 (0.51 – 1.26) pg/ml, respectively. Fasting glucose concentration changed from 90.0 (85.5 – 206.0) mg/dl to 94.5 (69 – 266) mg/dl. Cutaneous vascular conductance at 39°C as a percentage of maximal vasodilation at the arm and leg changed from 23.2 (11.2 – 36.0)% to 30.4 (13.8 – 46.1)% and 34.3 (30.4 – 49.4)% to 47.4 (6.7 – 52.8)%, respectively. Conclusion: These preliminary findings suggest that it is feasible, well-tolerated and safe for persons with SCI to engage in repeated heat therapy. A full data set of this ongoing study is needed to provide more conclusive insight into its effects on cardiometabolic health outcomes. VA Rehabilitation R&amp;D (I21RX003724-01A1). This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Practice and community nurses' views and experiences of helping people manage risk factors for recurrent lower limb cellulitis: A qualitative interview study

AbstractBackgroundCellulitis is a painful infection of the skin and underlying tissues, commonly affecting the lower leg. Approximately one‐third of people experience recurrence. Nurses who work in general practice (practice nurses) and see people at home (community or district nurses) could have an important role in managing risk factors for cellulitis, such as long‐term leg swelling, wound care and skin care.ObjectiveTo explore practice and community nurses' views and experiences of helping people to manage risk factors for recurrent lower limb cellulitis.MethodsSemi‐structured, telephone interviews with 21 practice and community nurses in England from October 2020 to March 2021. Interviews were transcribed verbatim and analysed using reflexive thematic analysis.ResultsNurses face multiple challenges when supporting people to manage risk factors for recurrent lower limb cellulitis. Key challenges include limited time and access to resources such as Doppler equipment, and the physical and psychosocial capabilities of patients to self‐manage. Nurses identified potential strategies to overcome these challenges, such as placing greater emphasis on prevention and supporting self‐management by providing resources for patients and support networks (paid and unpaid carers) to reinforce knowledge post‐consultation and develop skills to self‐care.ConclusionsWe identified a need to develop and evaluate resources, such as support materials, for nurses to use to help patients reduce their risk of recurrent cellulitis.

Menthol alleviates post-race elevations in muscle soreness and metabolic and respiratory stress during running.

We evaluated (1) whether participating in middle- and long-distance running races augments muscle soreness, oxygen cost, respiration, and exercise exertion during subsequent running, and (2) if post-race menthol application alleviates these responses in long-distance runners. Eleven long-distance runners completed a 1500-m race on day 1 and a 3000-m race on day 2. On day 3 (post-race day), either a 4% menthol solution (Post-race menthol) or a placebo solution (Post-race placebo) serving as a vehicle control, was applied to their lower leg skin, and their perceptual and physiological responses were evaluated. The identical assessment with the placebo solution was also conducted without race participation (No-race placebo). The integrated muscle soreness index increased in the Post-race placebo compared to the No-race placebo (P < 0.001), but this response was absent in the Post-race menthol (P = 0.058). Oxygen uptake during treadmill running tended to be higher (4.3%) in the Post-race placebo vs. No-race placebo (P = 0.074). Oxygen uptake was 5.4% lower in the Post-race menthol compared to the Post-race placebo (P = 0.018). Minute ventilation during treadmill running was 6.7-7.6% higher in the Post-race placebo compared to No-race placebo, whereas it was 6.6-9.0% lower in the Post-race menthol vs. Post-race placebo (all P ≤ 0.001). The rate of perceived exertion was 7.0% lower in the Post-race menthol vs. Post-race placebo (P = 0.007). Middle- and long-distance races can subsequently elevate muscle soreness and induce respiratory and metabolic stress, but post-race menthol application to the lower legs can mitigate these responses and reduce exercise exertion in long-distance runners.

Anesthetic Oxygen Use and Sex Are Critical Factors in the FLASH Sparing Effect

IntroductionUltra-high dose-rate (UHDR) radiation has been reported to spare normal tissue compared to conventional dose-rate (CDR) radiation. However, important work remains to be done to improve the reproducibility of the FLASH effect. A better understanding of the biological factors that modulate the FLASH effect may shed light on the mechanism of FLASH sparing. Here, we evaluate whether sex and/or use of 100% oxygen as carrier gas during irradiation contribute to the variability of the FLASH effect. MethodsC57BL/6 mice (24 male, 24 female) were anesthetized using isoflurane mixed with either room air or 100% oxygen. Subsequently, the mice received 27 Gy of either 9 MeV electron UHDR or CDR to a 1.6 cm2 diameter area of the right leg skin using the Mobetron linear accelerator. The primary post-radiation endpoint was time to full thickness skin ulceration. In a separate cohort of mice (4 male, 4 female) skin oxygenation was measured using PdG4 Oxyphor under identical anesthesia conditions. ResultsIn the UHDR group, time to ulceration was significantly shorter in mice that received 100% oxygen compared to room air, and amongst them female mice ulcerated sooner compared to males. However, no significant difference was observed between male and female UHDR mice that received room air. Oxygen measurements showed significantly higher tissue oxygenation using 100% oxygen as the anesthesia carrier gas compared to room air, and female mice showed higher levels of tissue oxygenation compared to males under 100% oxygen. ConclusionThe FLASH sparing effect is significantly reduced using oxygen during anesthesia compared to room air. The FLASH sparing was significantly lower in female mice compared to males. Both tissue oxygenation and sex are likely sources of variability in UHDR studies. These results suggest an oxygen-based mechanism for FLASH, as well as a key role for sex in the FLASH skin sparing effect.

Impact of Lifestyle on Differences in Skin Hydration of Selected Body Areas in Young Women

Measuring skin hydration is important for dermatology research, cosmetic practice, and daily skincare; it provides valuable insight into skin assessment and predicts treatment outcomes. This study investigated the level of skin hydration on various parts of the body in female university students, utilizing corneometry for measurement. Demographic, water intake, skincare, and exercise habit data were collected. The highest hydration levels were on the face (n = 40), followed by cleavage skin (n = 42), neck skin (n = 48), and leg skin (n = 42). Differences were observed between the chin and forehead (106.06 ± 21.06 vs. 91.20 ± 26.68; p = 0.001) and the chin and cheek (106.06 ± 21.06 vs. 92.00 ± 27.63; p &gt; 0.001). The differences in the hydration measurement results on cleavage were not significant (right clavicle 55.1 ± 12.93; left clavicle 51.84 ± 10.00; sternum 53.55 ± 16.3; p = 0.379). On the neck, the middle point exhibited the highest hydration (left 41.7 ± 11.3; middle 49.2 ± 12; right 47.2 ± 8.2; p &gt; 0.001). The skin on the thigh was significantly drier than that on the shank (31.09 ± 6.89 vs. 33.54 ± 6.28; p = 0.008). Water consumption was positively associated with skin hydration and the amount of physical activity. We conclude that every skin area is characterized by different levels of hydration. Water intake and physical activity contribute to improved skin hydration.

Efficacy of Airbo·Wave in Nighttime Compression for Leg Lymphedema.

Objectives: This study aimed to clarify the efficacy of Airbo·Wave EV1 in nighttime compression therapy as part of complex decongestive therapy (CDT) for leg lymphedema. Patients and Methods: We retrospectively reviewed 33 patients with leg lymphedema who used Airbo·Wave EV1 between April 2021 and September 2022. In these patients, the changes in leg volume and skin hardness were assessed using a scale ranging from 1 (softest) to 7 (hardest), and dermal thickness before and after the use of Airbo·Wave EV1 was evaluated. Results: Twenty-two patients used Airbo·Wave EV1 for nighttime compression in CDT. Their skin hardness in the lower calf decreased mildly (mean scale: before, 3.9; after, 3.6 [p <0.05]), but the leg volume and skin thickness were unchanged. Eleven patients who were nonadherent could restart compression therapy by using Airbo·Wave EV1. Their skin hardness in the medial lower calf (before, 5.1; after, 4.3 [p <0.05]), leg volume (before, 8412 mL; after, 8191 mL [p <0.01]), and skin thickness in the medial and lateral lower leg were reduced. Conclusion: Airbo·Wave EV1 could improve skin hardness in the calf area. Moreover, it is a safe procedure for the nonadherent while reducing leg volume reasonably.

Tuberculosis-induced osteomyelitis of the right distal tibia in a healthy male Saudi infant: a case report

Background: Tuberculosis (TB) is a challenging disease; however, it is preventable and curable in most cases. In 2022, TB was the second most common single infection leading to death worldwide after coronavirus disease. Almost 10 million people get infected with TB every year. TB manifests clinically in two types: pulmonary and extrapulmonary; the pulmonary type is the most common. Case presentation: A 17-month-old medically free male infant was referred to our institution with right distal leg pain, swelling and skin changes, started 1 month ago. Since then, both pain and swelling worsened and led to limping. The father denied any history of recent trauma, fever, cough, night sweating, infections, contact with sick patients, skin rashes in other body parts, or any other systematic changes. The baby was delivered at full term by cesarian-section due to placenta previa, with a birth weight of 3500 g, Prenatal and postnatal history is unremarkable. The patient was vitally stable and appeared healthy with no dysmorphic features. He was able to bear weight on his feet; however, his gait and walking abilities could not be assessed. Local examination showed swelling, erythema, and tenderness over the right distal tibia with an intact range of motion. The patient was admitted and initial investigations were done for him. After close observation and multiple investigations, a diagnosis of TB-induced right tibial osteomyelitis was made, and first-line management was initiated. Conclusion: This report highlights the importance of orthopedic surgeons in considering TB-induced osteomyelitis in the differential diagnosis of vague musculoskeletal symptoms.

Variasi Ukuran Payudara sebagai Daya Tarik Fisik Perempuan di Masyarakat Lampung

Sexual selection occurs when living organisms, including humans, exhibit specific preferences for morphological traits related to health and fertility when choosing a mate. Various physical characteristics such as body size and shape, leg length, skin color, hair length and color, facial features, and breast size contribute to the physical attractiveness of females in mate selection. Breasts can serve as a particular attraction for males, as they are believed to be associated with health and fertility for reproductive purposes. Sexual selection leads to a range of breast sizes, from small to large, within a population. The aim of this research is to investigate the variation in breast size preferences among females in the Indonesian society, specifically in Lampung. The study was conducted by distributing both online and offline questionnaires randomly with breast size stimuli in the form of images. Descriptive data analysis was employed to examine the variation in breast size preferences. Very large breast sizes were considered healthy and feminine by respondents, while medium sizes were deemed attractive. Married male respondents preferred larger breast sizes on average compared to unmarried respondents. Higher-income respondents tended to select larger breast sizes. Respondents with lower educational backgrounds tended to prefer smaller breast sizes. Respondents residing in rural areas preferred larger breast sizes compared to those living in urban areas. In conclusion, sexual selection applied among the population of Lampung in the context of breast size preferences.

The Defensive Behaviors and Milk Production of Pastured Dairy Cattle in Response to Stable Flies, Horn Flies, and Face Flies.

Thirty-four crossbred dairy cows were observed on pasture six times per week from June to August 2014 at the University of Minnesota West Central Research and Outreach Center grazing dairy in Morris, MN, for defensive behaviors in response to three species of muscid flies. Counts of stable flies (Stomoxys calcitrans (L.)), horn flies (Haematobia irritans (L.)), and face flies (Musca autumnalis DeGeer) were recorded before and after pasture observation. Individual cows were monitored for 5 min intervals to observe the frequencies of five different defensive behaviors: front and back leg stomps, head tosses, skin twitches, and tail swishes. Fly numbers averaged 5 stable flies per leg, 37 horn flies per side, and 1 face fly per face during the study. The fly counts and behavior frequencies increased with ambient temperature. The results showed a very strong relationship between the numbers of flies and numbers of defensive behaviors, though correlations between specific flies and behaviors were low. Younger cows had fewer stable flies and horn flies than older cows. The thresholds of flies to lower production for pastured organic dairy cows may be greater than 5 for stable flies, 37 for horn flies, and 1 for face flies.