Lower Extremity Research Articles

Prevalence and risk factors of deep venous thrombosis of hospitalizations in plateau: a cross-section analysis

BackgroundDeep venous thrombosis (DVT) is a serious public health issue that threatens human health and economic development. Presently, differences in the prevalence of DVT among individuals from different nationalities, residents of high-altitude areas, and those consuming any special diet are unknown. Therefore, we aimed to elucidate the prevalence of and the associated risk factors for DVT in hospitalized patients in the plateau areas.MethodsThe subjects were hospitalized patients in three grade III-a hospitals in the Qinghai Province, China, during January–October 2020. The demographic, clinical, and laboratory data were collected at admission, and ultrasonography of the bilateral lower extremities was performed. The hospital stay-duration was recorded at the time of discharge.ResultsA total of 3432 patients were enrolled, of which 159 (4.60%) were diagnosed with DVT. The age of > 50 years (OR = 2.434, 95% CI: 1.521–3.894252, P < 0.001), residence altitude of ≥ 3000 m (OR = 2.346, 95% CI: 1.239–4.440, P = 0.009), D-dimer level of ≥ 0.5 mg/L (OR = 2.211, 95% CI: 1.547–3.161, P < 0.001), presence of comorbidities (OR = 1.904, 95% CI: 1.386–2.705, P < 0.001), a history of varicose veins (OR = 1.990, 95% CI: 0.959–4.128, P = 0.045), and current medications (OR = 2.484, 95% CI: 1.778–3.471, P < 0.001) were identified as risk factors for DVT in these plateau areas.ConclusionThe prevalence of DVT in the hospitalized patients of the studied plateau areas was 4.60%. We recommend considering individualized risk stratification (age > 50 years, residence altitude ≥ 3000 m, a history of varicose veins, D-dimer level ≥ 0.5 mg/L, current medications, and comorbidities) for patients at the time of admission.

Novel Plasma Biomarkers Associated with Future Peripheral Atherosclerotic Disease and Abdominal Aortic Aneurysm—Insights from Contemporary Prospective Studies from the Malmö Diet and Cancer Study

Introduction: The potential utility of inflammatory and hemodynamic plasma biomarkers for the prediction of incident lower extremity arterial disease (LEAD), carotid artery stenosis (CAS), isolated atherosclerotic disease without concomitant abdominal aortic aneurysm (AAA), and isolated AAA without concomitant atherosclerotic disease has not yet been integrated in clinical practice. The main objective of this prospective study was to find predictive plasma biomarkers for cardiovascular disease and to evaluate differences in plasma biomarker profiles between asymptomatic and symptomatic CAS, as well as between isolated atherosclerotic disease and isolated AAA. Methods: Blood samples collected at baseline from participants in the prospective Malmö Diet and Cancer study (MDCS) cardiovascular cohort (n = 5550 middle-aged individuals; baseline 1991–1994) were used for plasma biomarker analysis. Validation of each incident cardiovascular diagnosis was performed by random sampling. Cox regression analysis was used to calculate hazard ratios (HRs) per one standard deviation increment of each respective log-transformed plasma biomarker with 95% confidence intervals (CI). Results: Adjusted lipoprotein-associated phospholipase A2 (Lp-PLA2) activity (HR 1.33; CI 1.17–1.52) and mass (HR 1.20; CI 1.05–1.37), C-reactive protein (CRP) (HR 1.55; CI 1.36–1.76), copeptin (HR 1.46; CI 1.19–1.80), N-terminal pro-B-type natriuretic peptide (N-BNP) (HR 1.28; 1.11–1.48), and cystatin C (HR 1.19; 95% 1.10–1.29) were associated with incident symptomatic LEAD. Adjusted N-BNP (HR 1.59; CI 1.20–2.11), mid-regional proadrenomedullin (HR 1.40; CI 1.13–1.73), cystatin C (HR 1.21; CI 1.02–1.43), and CRP (HR 1.53; CI 1.13–1.73) were associated with incident symptomatic but not asymptomatic CAS. Adjusted HR was higher for Lp-PLA2 (mass) for incident isolated AAA compared to for isolated atherosclerotic disease. Conclusions: Plasma biomarker profile data support that subclinical vascular inflammation and cardiovascular stress seem to be relevant for the development of atherosclerotic disease and AAA.

Patient Centered Outcomes of a Lymphedema Pump in Patients with Symptomatic Lower Extremity Edema

Phlebolymphedema is a challenging condition to manage, with limited options for effective treatment. For patients, this may be debilitating and lead to infection, loss of independence and affect quality of life (QOL). This study aims to evaluate patient-reported outcomes of an advanced pneumatic compression device (APCD) in the treatment of lower extremity phlebolymphedema. Patients with diagnosis of lower extremity phlebolymphedema at an acute care facility within the New York City Health and Hospitals Cooperation treated with the Flexitouch (FLX; Tactile Systems Technology, Inc, Minneapolis, Minnesota) APCD from December 2021 to March 2023 were evaluated. Patient-perceived subjective outcomes were assessed via a short questionnaire, with subsequent analysis using Chi-squared test. Primary endpoints were subjective improvements in 1) swelling, 2) pain, and 3) ease of use of device as surrogates for patient satisfaction. Secondary endpoint was subjective patient-reported compliance, obtained by investigating 1) if patients were trained to use device, and 2) if patients were using the device. A total of 52 participants were included in this study, consisting of 30.8% male and 69.2% female patients with a mean age of 71.7 years. While selection criteria did not exclude unilateral disease or alternative etiologies, we note that the entire study population had been diagnosed with bilateral lower extremity lymphedema in the setting of chronic venous insufficiency. Other patient characteristics including race, comorbidities and smoking status were documented in Table 1. Table 2 demonstrates the results of Chi-squared analysis. This study noted significant patient-perceived improvement in swelling and pain (91.4% with P < 0.00001; 85.7% with P = 0.00002 respectively) as well as patient-reported ease of use of the FLX device (85.7% with P = 0.00002). Additional secondary findings included a majority of patients reporting being trained on how to use FLX and also maintaining compliance with the device (69.2% with P = 0.005; 67.3% with P = 0.012 respectively). FLX APCD use has been found to demonstrate desirable patient-reported outcomes as a general trend. The participants in this study noted statistically significant subjective improvement in swelling and pain, ease of use of device as well as adherence to training and compliance with device. FLX appears to be positively received by patients, and the authors recommend its consideration for management of bilateral lower extremity phlebolymphedema.

Relationship between quantitative physical activity and deterioration of locomotive function: a cross-sectional study using baseline data from a cohort

BackgroundIn aged society, health policies aimed at extending healthy life expectancy are critical. Maintaining physical activity is essential to prevent the deterioration of body functions. Therefore, it is important to understand the physical activity levels of the target age group and to know the content and intensity of the required physical activity quantitatively. Especially we focused the role of non-exercise activity thermogenesis and sedentary time, which are emphasized more than the introduction of exercise in cases of obesity or diabetes.MethodsA total of 193 patients from 25 institutions were included. Participants underwent a locomotive syndrome risk test (stand-up test, 2-step test, and Geriatric Locomotive Function Scale-25 questionnaire) and were classified into three stages. Physical activity was quantitatively monitored for one week with 3-axial accelerometer. Physical activity was classified into three categories; (1) Sedentary behavior (0 ∼ ≤ 1.5 metabolic equivalents (METs)), (2) Light physical activity (LPA:1.6 ∼ 2.9 METs), and (3) Moderate to vigorous physical activity (MVPA: ≥3 METs). We investigated the relationship between physical activity, including the number of steps, and the stages after gender- and age- adjustment. We also investigated the relationship between social isolation using Lubben’s Social Network Scale (LSNS), as social isolation would lead to fewer opportunities to go out and less outdoor walking.ResultsComparison among the three stages showed significant difference for age (p = 0.007) and Body Mass Index (p < 0.001). After gender-and age-adjustment, there was a significant relation with a decrease in the number of steps (p = 0.002) and with MVPA. However, no relation was observed in sedentary time and LPA. LSNS did not show any statistically significant difference. Moderate to high-intensity physical activity and the number of steps is required for musculoskeletal disorders. The walking, not sedentary time, was associated to the locomotive stages, and this finding indicated the importance of lower extremity exercise.ConclusionsAdjusting for age and gender, the number of steps and moderate to vigorous activity levels were necessary to prevent worsening, and there was no effect of sedentary behavior. Merely reducing sedentary time may be inadequate for locomotive disorders. It is necessary to engage in work or exercise that moves lower extremities more actively.

Primary Cutaneous Diffuse Large B‑Cell Lymphoma, Leg Type: A Clinical Case

Introduction. Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type it is a rare variant of skin lymphoma that has an aggressive course and a high risk of extracutaneous manifestations.The purpose of this work is to familiarize a wide range of specialists with the clinical manifestations of a rare disease — primary cutaneous diffuse large B-cell lymphoma.Materials and methods. An interesting clinical case is presented and the medical history of a patient with B-cell lymphoma from the skin is analyzed.Results. A differential diagnosis of the disease was made. Based on the study of histological material, the final clinical diagnosis was established and further treatment tactics were determined.Discussion. The patient had spots and plaques on the lower extremities, the sole visible signs of the disease. These symptoms may suggest a positive prognosis and a gradual progression. Diagnostic measures should include gathering medical history, assessing the local condition, and carrying out an excision biopsy early in the examination process for an accurate and prompt diagnosisConclusion. Due to the rarity of this subtype of lymphoma and the limited number of domestic publications on the topic, a more detailed study and description of individual clinical cases can lead to a better understanding of the characteristics of the symptoms and the processes of pathological changes in cells, tissues, and organs. This could potentially lead to the development of more efficient methods for early diagnosis and timely treatment of the condition.

Peripheral neuropathy, gait speed, and lower extremity function in community-dwelling older adults with and without diabetes.

Peripheral neuropathy, gait speed, and lower extremity function in community-dwelling older adults with and without diabetes.

Influenza vaccination-associated cryoglobulinemic vasculitis.

Mixed cryoglobulinemia is a small vessel vasculitis associated with viral infections, mainly hepatitis C virus, however, other important causes include lymphoproliferative and autoimmune disorders. Influenza vaccine-induced cryoglobulinemia has been rarely reported. A 68-year-old male presented on three occasions following influenza vaccination with purpuric rash and lower extremities swelling. His lab work showed mixed cryoglobulins. On his most recent presentation, in addition to the purpura, he presented with thrombocytopenia and nephritic syndrome. A kidney biopsy showed endocapillary proliferative glomerulonephritis with organized deposits, consistent with mixed type cryoglobulinemic glomerulonephritis. The patient was treated with rituximab infusion with progressive improvement of the acute kidney injury (AKI) and complete recovery. It is unclear why cryoglobulins are produced as a response to a vaccination, but this association is important to be aware of for prompt monitoring and treatment.

A robot-based hybrid lower limb system for Assist-As-Needed rehabilitation of stroke patients: Technical evaluation and clinical feasibility

Background:Although early rehabilitation is important following a stroke, severely affected patients have limited options for intensive rehabilitation as they are often bedridden. To create a system for early rehabilitation of lower extremities in these patients, we combined the robotic manipulator ROBERT® with electromyography (EMG)-triggered functional electrical stimulation (FES) and developed a novel user-driven Assist-As-Needed (AAN) control. The method is based on a state machine able to detect user movement capability, assessed by the presence of an EMG-trigger and the movement velocity, and provide different levels of assistance as required by the patient (no support, FES only, and simultaneous FES and mechanical assistance). Methods:To technically validate the system, we tested 10 able-bodied participants who were instructed to perform specific behaviors to test the system states while conducting knee extension and ankle dorsal flexion exercises. The system was also tested on two stroke patients to establish its clinical feasibility. Results:The technical validation showed that the state machine correctly detected the participants’ behavior and activated the target AAN state in more than 96% of the exercise repetitions. The clinical feasibility test showed that the system successfully recognized the patients’ movement capacity and activated assistive states according to their needs providing the minimal level of support required to exercise successfully. Conclusions:The system was technically validated and preliminarily proved clinically feasible. The present study shows that the novel system can be used to deliver exercises with a high number of repetitions while engaging the participants’ residual capabilities through the AAN strategy.

Prevalence of interarm blood pressure difference is notably higher in women; the Viborg population-based screening program (VISP)

BackgroundBilateral blood pressure (BP) measurement is important in cardiovascular prevention for identifying systolic interarm BP difference (IAD) and hypertension. We investigated sex-stratified IAD prevalence and its associations and coexistence with screen-detected peripheral atherosclerosis and hypertension. Furthermore, we determined the proportion misclassified as non-hypertensive when using the lower versus the higher reading arm.MethodsThis sub-study formed part of the Viborg Screening Program (VISP), a cross-sectorial population-based cardiovascular screening programme targeting 67-year-old Danes. VISP includes screening for peripheral atherosclerosis (lower extremity arterial disease and carotid plaque), abdominal aortic aneurysm, hypertension, diabetes mellitus, and cardiac disease. Self-reported comorbidities, risk factors, and medication use were also collected. Among 4,602 attendees, 4,517 (82.1%) had eligible bilateral and repeated BP measurements. IAD was defined as a systolic BP difference ≥ 10 mmHg. IAD-associated factors (screening results and risk factors) were estimated by logistic regression; proportional coexistence was displayed by Venn diagrams (screening results).ResultsWe included 2,220 women (49.2%) and 2,297 men (50.8%). IAD was more predominant in women (26.8%) than men (21.0%) (p < 0.001). This disparity persisted after adjustment [odds ratio (OR) 1.53; 95% confidence interval (CI) 1.32–1.77]. No other association was recorded with the conditions screened for, barring potential hypertension: BP 140–159/90–99 mmHg (OR 1.68, 95% CI 1.44–1.97) and BP ≥ 160/100 mmHg (OR 1.82, 95% CI 1.49–2.23). Overall, IAD and BP ≥ 160/100 mmHg coexistence was 4% in women and 5% in men; for BP ≥ 140/90 mmHg, 13% and 14%, respectively. Among those recording a mean BP ≥ 140/90 mmHg in the higher reading arm, 14.5% of women and 15.3% of men would be misclassified as non-hypertensive compared with the lowest reading arm.ConclusionFemale sex was an independent factor of IAD prevalence but not associated with other arterial lesions. Approximately 15% needed reclassification according to BP ≥ 140/90 mmHg when the lower rather than the higher reading arm was used; verifying bilateral BP measurements improved detection of potential hypertension. In future, the predictive value of sex-stratified IAD should be assessed for cardiovascular events and death to verify its potential as a screening tool in population-based cardiovascular screening.Trial registration for VISPNCT03395509:10/12/2018.

Association between smoking and duration of regional anesthesia – A propensity score matching study

BackgroundPrevious studies have shown shorter duration of general anesthesia in smokers but it is unclear in regional anesthesia among smokers. We investigated the association between smoking status and the duration of regional anesthesia. MethodsA total of 77 patients with a mean age of 47.3 years who underwent lower extremity orthopaedic surgery under regional anesthesia between January 2021 and June 2022 were enrolled. Sixteen patients were smokers and 57 patients were non-smokers. Propensity score matching was performed to balance patient characteristics. Our primary outcome was the time to onset of motor or sensory blockade and the duration required for full recovery of motor or sensory function. ResultsThe time to sensory loss was 43.4 (SD 35.9) minutes in the smoking group and 39.6 (SD 31.7) minutes in the non-smoking group (p = 0.69), and the time to motor blockade was 37.0 (SD 28.4) minutes in the smoking group and 30.1 (SD 24.1) minutes in the non-smoking group (p = 0.35). The time for recovery of sensory function was 1146.7 (SD 197.8) minutes in the smoking group and 1024.6 (SD 177.9) minutes in the non-smoking group (p = 0.024). The time to recovery of motor function was 978.3 (SD 220.5) minutes in the smoking group and 1090.9 (SD 222.8) minutes in the non-smoking group (p = 0.08). The duration of sensory effect was significantly longer in the smoking group than in the non-smoking group. ConclusionsWe found no significant association in the onset of regional anesthesia, but the duration of sensory blockade was significantly longer in the smoking group than in the non-smoking group. Hence, attention should be paid to the risks of the insensate limb in smokers due to prolonged sensory blockade as compared to non-smokers, rather than be concerned about delays in the onset of anesthesia.

The water imbalance of skeletal muscle and muscle weakness in patients with heart failure.

A high extracellular water (ECW) to intracellular water (ICW) ratio of skeletal muscle as assessed by bioelectrical impedance analysis is reportedly associated with loss of muscle strength. However, the validity of this index for heart failure (HF), which is likely associated with changes in the water distribution, is unclear. This study involved 190 patients with HF. The total ECW and ICW of both upper and lower extremities were measured, and a high ECW/ICW ratio was defined as an ECW/ICW ratio higher than the median (≥0.636 for men, ≥0.652 for women). Low muscle strength was defined as reduced handgrip strength according to the criteria established by the Asian Working Group for Sarcopenia. Patients with a high ECW/ICW ratio had a lower handgrip strength (21.1±8.1kg vs. 27.6±9.3kg, P≤0.05) and 6min walk distance (329±116m vs. 440±114m) than those with a low ECW/ICW ratio. An increasing ECW and/or decreasing ICW was associated with a higher ECW/ICW ratio and a lower handgrip strength (P<0.05). In the multivariate logistic regression analysis, a high ECW/ICW ratio and low skeletal muscle mass were independently associated with low muscle strength (P<0.05). A high ECW/ICW ratio in limb muscles, that is, the water imbalance of increasing ECW and/or decreasing ICW, is useful in assessing muscle quality in patients with HF.

The correlation between generalized joint hypermobility and musculoskeletal disorders in female dancers

Background: Bali is a popular tourist destination because of its unique culture. One of its unique features is the Balinese dance, which is used to welcome guests, perform arts, and perform religious ceremonies. Many Balinese dancers experience generalized joint hypermobility (GJH) without realizing it, which may have a negative impact on them, especially if they have a problem of musculoskeletal pain. Methods: This research used an analytical observational design of a cross-sectional study. This study employed the sampling technique of purposive technique with a total sampling method. The inclusion criteria for this study were traditional Balinese dancers living in Denpasar city, female, aged 14-20, and having dancing experience more than 1 year. Exclusion criteria were subjects after surgery for fractures or other musculoskeletal injuries in the upper or lower extremities, subjects with signs of acute inflammation in the joints, and those unwilling to be research subjects. The number of samples was calculated using the lame show formula, and 85 samples were obtained. Data was collected by measuring GJH and musculoskeletal disorders using the Nordic body map questionnaire. Results: Based on the bivariate analysis test with Spearman's rho, p-value = 0.000 (p &lt; 0.05) was obtained for the two independent variables with a correlation coefficient of r = 0.797. Conclusion: Based on the research results, it can be concluded that there is a relationship between GJH and MSDs in the Balinese dancer population in Denpasar City.

Chronic Venous Disease: Pathophysiological Aspects, Risk Factors, and Diagnosis.

Chronic venous disease (CVD) is highly prevalent in the general population and encompasses a range of pathological and hemodynamic changes in the veins of the lower extremities. These alterations give rise to a variety of symptoms, with more severe forms resulting in venous ulceration, which causes morbidity and high socioeconomic burden. The origins and underlying mechanisms of CVD are intricate and multifaceted, involving environmental factors, genetics, hormonal factors, and immunological factors that bring about structural and functional alterations in the venous system. This review offers the latest insights into the epidemiology, pathophysiology, and risk factors of CVD, aiming to provide a comprehensive overview of the current state of knowledge. Furthermore, the diagnostic approach for CVD is highlighted and current diagnostic tools are described.

Presentation and patterns of reinterventions after revascularization in patients with premature Peripheral Arterial Disease

Premature peripheral arterial disease (PAD) (age ≤ 50) has been shown to negatively impact the outcomes of lower extremity revascularization (LER). Patients with premature PAD have an increased risk of major amputation compared to older patients. The primary goal of this study is to compare the frequency of reinterventions after LER in patients with premature PAD to their older counterparts with common age of presentation (i.e., 60-80 years). A retrospective review of consecutive patients undergoing LER for PAD in a single center was performed. Clinical, procedural, and socioeconomic characteristics were compared between patients with premature PAD and the older group. Perioperative as well as long-term outcomes were captured and compared including mortality, major amputation, reintervention rate and frequency, as well as major adverse limb events (MALEs). There were 1,274 patients who underwent LER (4.3% premature, 61.8% age 60-80). Premature PAD patients were more likely to be females of racial minorities. Notably, the mean distressed communities index (DCI) score was significantly higher in the premature PAD group compared to the older patients. Patients with premature PAD were significantly more likely to have end-stage renal disease but less likely to have hypertension, hyperlipidemia, and coronary artery disease compared to older patients. There was no significant difference in perioperative complications. After a mean follow up of 5 years, patients with premature PAD were significantly more likely to undergo more frequent reinterventions compared to older patients. Kaplan-Meier curves showed similar overall survival and MALE-free survival between the 2 groups. Patients with premature PAD are likely to undergo more frequent reinterventions after initial LER and have similar 5-year survival curves compared to patients at least 20 years older. Demographic and socioeconomic differences impacting patients with premature PAD, even in this relatively underpowered institutional experience, are striking and warrant further investigation.

Selective iliofemoral stent placement for complex pediatric cases: a decade of institutional experience.

Pediatric iliofemoral venous thromboembolism that is resistant to conventional treatments poses significant management challenges. Stent placement represents a potentially underutilized strategy in children when stenosis or thrombosis persists intraprocedurally or recurs postoperatively, despite treatments such as venoplasty, lysis, and thrombectomy. This study aims to report our institutional experience with iliofemoral stenting in 17 pediatric patients with recurrent iliofemoral venous thromboembolism or stenosis. We performed an IRB-approved retrospective review of pediatric patients (<18 years of age) who underwent iliofemoral venous stenting for recurrent stenosis or thrombosis between January 2012 and December 2022 at a single tertiary care institution. Patient demographics, risk factors for venous thromboembolism, presenting symptoms, and procedural characteristics were recorded. The primary outcome was stent patency rates at interval imaging follow-up. Seventeen patients with mean age of 14.6 years (range 7-17) and mean BMI of 27.7 were stented during the study period. Sixteen of 17 patients presented with evidence of May-Thurner anatomy. 14/17 patients presented with acute iliofemoral venous thromboembolism, 2/17 with chronic venous thromboembolism, and 1/17 with left lower extremity swelling without thrombosis. Seventy-three total angiographic procedures were performed, which included angioplasty, lysis, and thrombectomy, and 23 stent placements. Patients underwent an average of 3 procedures (range 1-9) over a mean of 2.8 months (range 0-17 months) prior to undergoing stent placement. Stents were deployed successfully in all patients. The median follow-up was 18 months (range, 1-77 months). Primary and secondary patency rates were 13/17 (76%) and 14/14 (100%) at 12 months and 12/17 (71%) and 14/14 (100%) at 24 months, respectively. In our experience of 17 patients, stent placement appears to be a durable option for children with iliofemoral venous thromboembolism following failure to establish vessel patency or development of recurrent thrombosis/stenosis postoperatively.

Influence of Timing of Stenting on Condition of Venous Valves of Lower Extremities, Frequency and Severity of Development of Post-Thrombotic Disease

INTRODUCTION: Acute deep vein thrombosis (DVT) of the lower extremities (LE) is a life-threatening condition, accompanied by high rates of disability among people of working age. Despite early detection of DVT and the use of recommended antithrombotic therapy, damage to the venous wall, development of valvular reflux and post-thrombotic disease (PTD) inevitably occur. The clinical picture of PTD becomes evident after the development of valve incompetence, which leads to vertical venous reflux and chronic venous hypertension. Timely elimination of venous obstruction can preserve the functionality of valve structures, which will subsequently help reduce the frequency and severity of PTD. AIM: To evaluate the impact of the timing of stenting on the condition of the venous valves, the frequency and severity of the development of PTD in patients with acute DVT of LE. MATERIALS AND METHODS: A prospective interventional study included 49 patients with acute iliofemoral thrombosis. After selective thrombolysis, 25 patients underwent early (within 7 days) and 24 patients underwent delayed (7–30 days) stenting. The incidence and severity of PTD was assessed on the Villalta scale at 3, 6 and 12 months. The effect of treatment on the condition of the venous valves of the LE was assessed at 12 months. On ultrasound examination, reflux was assessed using a scoring system. RESULTS: At 12 months, 2 (8%), 13 (52%), and 10 (40%) patients who underwent delayed stenting, developed severe, moderate, or mild PTD, respectively. In the early stenting group, 6 (25%) patients had no symptoms of PTD, 15 (62.5%) and 3 (12.5%) developed mild and moderate PTD, respectively (p = 0.0005). At 12 months, in the early stenting group, the absence of reflux was recorded in 6 (25%) patients, 4 (17%) patients had valve reflux in the femoral segment, and 14 (58%) in the popliteal segment. In the delayed stenting group, valvular incompetence of both segments was detected in 12 (48%) patients; in 4 (16%) and 9 (36%) patients, the valves of the femoral and popliteal veins were preserved; there were no patients without reflux in both segments. Treatment results for this indicator were better if early stenting was performed (p = 0.0005). CONCLUSION: Early stenting after selective thrombolysis in patients with proximal DVT of LE leads to a decrease in the incidence and severity of symptoms of PTD, and can reduce the incidence of reflux in the deep veins.

Valproic acid induced Stevens–Johnson syndrome

A 27-year-old transgender female at the stage of gender transition with bipolar disorder for which she received valproic acid developed multiple petechial rashes on the chest, upper and lower extremities, local erythematous lesions with forming blisters, large-platelet peeling on the face, neck, chest and inguinal area, erosion on the oral mucosa. She was diagnosed with drug eruption, Stevens–Johnson syndrome. The diagnosis was verified on the basis of complaints, medical history, clinical picture, laboratory findings. Treatment included valproic acid withdrawal, dexamethasone, infusion therapy, vancomycin, cyclosporine A. Against the background of the therapy, skin condition was improved: there was the epithelization of ulcerative defects and the absence of new elements.

Prospective longitudinal cohort study of quantitative muscle magnetic resonance imaging in a healthy control population.

Quantitative muscle magnetic resonance imaging (qMRI) is a valuable methodology for assessing muscular injuries and neuromuscular disorders. Notably, muscle diffusion tensor imaging (DTI) gives insights into muscle microstructural and macrostructural characteristics. However, the long-term reproducibility and robustness of these measurements remain relatively unexplored. The purpose of this prospective longitudinal cohort study was to assess the long-term robustness and range of variation of qMRI parameters, especially DTI metrics, in the lower extremity muscles of healthy controls under real-life conditions. Twelve volunteers (seven females, age 44.1 ± 12.1 years, body mass index 23.3 ± 2.0 kg/m2) underwent five leg muscle MRI sessions every 20 ± 4 weeks over a total period of 1.5 years. A multiecho gradient-echo Dixon-based sequence, a multiecho spin-echo T2-mapping sequence, and a spin-echo echo planar imaging diffusion-weighted sequence were acquired bilaterally with a Philips 3-T Achieva MR System using a 16-channel torso coil. Fifteen leg muscles were segmented in both lower extremities. qMRI parameters, including fat fraction (FF), water T2 relaxation time, and the diffusion metrics fractional anisotropy (FA) and mean diffusivity (MD), were evaluated. Coefficients of variance (wsCV) and intraclass correlation coefficients (ICCs) were calculated to assess the reproducibility of qMRI parameters. The standard error of measurement (SEM) and the minimal detectable change (MDC) were calculated to determine the range of variation. All tests were applied to all muscles and, subsequently, to each muscle separately. wsCV showed good reproducibility (≤ 10%) for all qMRI parameters in all muscles. The ICCs revealed excellent agreement between time points (FF = 0.980, water T2 = 0.941, FA = 0.952, MD = 0.948). Random measurement errors assessed by SEM and the MDC were low (< 12%). In conclusion, in this study, we showed that qMRI parameters in healthy volunteers living normal lives are stable over 18 months, thereby defining a benchmark for the expected range of variation over time.

Influence of Timing of Stenting on Condition of Venous Valves of Lower Extremities, Frequency and Severity of Development of Post-Thrombotic Disease

INTRODUCTION: Acute deep vein thrombosis (DVT) of the lower extremities (LE) is a life-threatening condition, accompanied by high rates of disability among people of working age. Despite early detection of DVT and the use of recommended antithrombotic therapy, damage to the venous wall, development of valvular reflux and post-thrombotic disease (PTD) inevitably occur. The clinical picture of PTD becomes evident after the development of valve incompetence, which leads to vertical venous reflux and chronic venous hypertension. Timely elimination of venous obstruction can preserve the functionality of valve structures, which will subsequently help reduce the frequency and severity of PTD. AIM: To evaluate the impact of the timing of stenting on the condition of the venous valves, the frequency and severity of the development of PTD in patients with acute DVT of LE. MATERIALS AND METHODS: A prospective interventional study included 49 patients with acute iliofemoral thrombosis. After selective thrombolysis, 25 patients underwent early (within 7 days) and 24 patients underwent delayed (7–30 days) stenting. The incidence and severity of PTD was assessed on the Villalta scale at 3, 6 and 12 months. The effect of treatment on the condition of the venous valves of the LE was assessed at 12 months. On ultrasound examination, reflux was assessed using a scoring system. RESULTS: At 12 months, 2 (8%), 13 (52%), and 10 (40%) patients who underwent delayed stenting, developed severe, moderate, or mild PTD, respectively. In the early stenting group, 6 (25%) patients had no symptoms of PTD, 15 (62.5%) and 3 (12.5%) developed mild and moderate PTD, respectively (p = 0.0005). At 12 months, in the early stenting group, the absence of reflux was recorded in 6 (25%) patients, 4 (17%) patients had valve reflux in the femoral segment, and 14 (58%) in the popliteal segment. In the delayed stenting group, valvular incompetence of both segments was detected in 12 (48%) patients; in 4 (16%) and 9 (36%) patients, the valves of the femoral and popliteal veins were preserved; there were no patients without reflux in both segments. Treatment results for this indicator were better if early stenting was performed (p = 0.0005). CONCLUSION: Early stenting after selective thrombolysis in patients with proximal DVT of LE leads to a decrease in the incidence and severity of symptoms of PTD, and can reduce the incidence of reflux in the deep veins.

Application of Swedish Massage Therapy for Lower Extremities to Alleviate Muscle Cramps in Chronic Kidney Disease Patients

Swedish Massage is a non-pharmacological therapy recommended to reduce muscle cramps for patients with chronic kidney disease during hemodialysis treatment. Aims: To provide a nursing care with Swedish Massage of lower extremities therapy in order to reduce muscle cramps in patients with chronic kidney disease. Methodology: This descriptive study aimed to characterise the use of Swedish massage for alleviating muscle cramps among hemodialysis patients. Results: Mr. A's pain scale score after given Swedish massage decreased from 6 to 1 and Mr. S's score decreased from 4 to 0. Scientific Novelty: It is significant for advancing theoretical understanding. Conclusion: Swedish Massage therapy has been shown to alleviate muscle cramps.