Lower Limb Group Research Articles

Ipsilateral transfer of motor skill from lower to upper limb in healthy adults: A randomized controlled trial.

Whereas motor skills of the untrained upper limb (UL) can improve following practice with the other UL, it has yet to be determined if an UL motor skill can improve following practice of that skill with the lower limb (LL). Forty-five healthy subjects randomly participated in a 10-minute single-session intervention of (1) practicing 50 reaching movement (RM) sequences with the non-dominant left LL toward light switches (LL group); or (2) observing the identical 50 light switches sequences (Switches Observation (SO) group); or (3) observing nature films (Nature Observation (NO) group). RM sequence performance with the left UL toward the light switches was tested before and immediately after the intervention and retested after 24 h. Reaching response time improved in the LL group more than in the SO and NO groups in the posttest (pBonferroni = 0.038 and pBonferroni < 0.001, respectively), and improved in the LL group more than in the NO group in the retest (pBonferroni = 0.004). Percentage of fails did not differ between groups across the timepoints. It appears that the actual practice of the RM sequence skill with the UL together with the cognitive element embedded in the observation of the RM sequences contributes to ipsilateral transfer from LL to UL.

Accuracy of Mirror Image Mapping of Lymphatic Tract for High-stage and Reoperative Lymphaticovenular Anastomosis: Intraoperative Analysis and Early Clinical Outcome.

Indocyanine green lymphography (ICGL) generally has a nonlinear pattern in advanced-stage lymphedema. Despite the lack of a linear pattern ICGL, lymphatic vessels have been discovered in several studies. The purpose of this work was to establish lymphatic mapping utilizing information from the contralateral limb and to illustrate the symmetry of lymphatic systems. Data were retrospectively collected from 81 patients who underwent lymphaticovenular anastomosis (LVA) using the contralateral mapping technique during 2018 to 2022. The sensitivity, specificity, accuracy, and negative and positive predictive values of this technique were calculated and analyzed. Lymphatic vessels were identified in 85.2% of the upper and 82.3% of the lower limb presumed sites using the contralateral mapping technique. The positive predictive value for successful LVA anastomosis was 93.8% for upper limb and 92.3% for lower limb cases. This mirror image technique's accuracy was 91.7% and 91.1%, for the upper limb and lower limb group, respectively. Between reoperative and new LVA cases, there was no statistically significant difference in the number, type, or diameter of lymphatic vessels or number of anastomoses. LVA with contralateral mapping technique is an effective method for patients with high-stage lymphedema with a nonlinear pattern on ICGL.

Expression level and clinical significance of LncRNA PVT1 in the serum of patients with LEASO.

Our study aims to investigate the long non-coding RNA plasmacytoma variant translocation 1 (lncRNA PVT1) in lower extremity arteriosclerosis obliterans (LEASO) patient serum and its clinical significance in LEASO. From July 2021 to April 2022, 133 LEASO patients diagnosed at the Qingdao Municipal Hospital were included. Among them, 44 complicated with coronary artery disease (CAD) were classified as the LEASO with CAD group. The remaining 89 were marked as the LEASO group, which was classified into single (n=48) and double (n=41) lower limb groups, with the former being subclassified into the left (n=28) and right (n=20) lower limb groups based on the affected sites. Fifty healthy individuals who came to our hospital for physical examination during the same period were randomly included and defined as the Healthy Control group. PVT1 expression was detected in serum samples from each group using a quantitative reverse transcriptase-polymerase chain reaction , and differences in expression levels were calculated. The ankle-brachial index (ABI) of patients in the LEASO group was measured using a sphygmomanometer, and its correlation with PVT1 was analyzed. Clinical data and laboratory test results (including blood routine, liver and renal function, and blood lipids) were collected for all patients upon admission. Logistic regression analyses were performed to determine the influence of PVT1 and laboratory test results on LEASO. The diagnosis and prediction of LEASO were obtained by combing PVT1 with laboratory test indicators. It was found that lncRNA PVT1 expression was the highest in the serum of the LEASO with CAD group, followed by the LEASO and control groups (P < 0.05). Within the LEASO group, no significant difference in PVT1 expression was seen between the left and right limbs (P > 0.05), nor between the single and double lower limb groups. Furthermore, the PVT1 expression increased with the Rutherford grades, indicating a negative correlation between PVT1 and ABI. Logistic regression analysis revealed that triglycerides (OR = 2.972, 95% CI [1.159-7.618]), cholesterol (OR = 6.655, 95% CI [1.490-29.723]), C-reactive protein (OR = 1.686, 95% CI [1.218-2.335]), and PVT1 (OR = 2.885, 95% CI [1.350-6.167]) were independent risk factors for LEASO. Finally, strong sensitivity was observed in the receiver operating characteristic curve when combining PVT1 with meaningful laboratory indicators to diagnose and predict LEASO. lncRNA PVT1 promotes LEASO occurrence and progression and is related to atherosclerosis severity. The expression of PVT1 was negatively correlated with ABI. Logistic regression analysis suggested that blood lipid levels and inflammatory reactions might be related to LEASO occurrence. PVT1 was incorporated into laboratory indicators to predict LEASO. The subject's working curve area was large, and the prediction results were highly sensitive.

Botulinum toxin-A injection improves motor recovery in patients with stroke

Aim: Spasticity that occurs after a stroke may contribute to disability. Botulinum toxin type-A (BTX-A) injections are commonly used to manage spasticity. This study sought to determine the effectiveness of BTX-A injections on spasticity and motor recovery in patients with stroke. Materials and Methods: Twenty-five patients with stroke scheduled for BTX-A injection for spasticity were included in the study. The patients were analyzed in two groups: upper limb and lower limb group. A single dose of BTX-A was applied to the patients. Before, 2, and 12 weeks after BTX-A injections, motor function was assessed using Brunnstrom recovery stages, and spasticity was evaluated according to Modified Ashworth Scale (MAS). The lower limb group additionally underwent the Functional Ambulation Classification (FAC) and 10-meter walking test. Results: Mean age of patients was 54.96 ± 12.84 years. Eighteen patients were enrolled in the upper limb group and 23 in the lower limb group. Clinical evaluation of the upper limb group two weeks after injections demonstrated a significant decrease in shoulder adductor muscle MAS, elbow, wrist, and finger flexor muscles MAS, and a significant improvement in Brunnstrom recovery stages for the upper limb and hand (p&lt;0.05). At week 12, spasticity decreased only for the shoulder adductor muscles. In the lower limb group, clinical evaluation at week 2 showed a decrease in the knee extensor and toe flexor muscles MAS. Assessment of the patients at week 12 found a significant improvement in Brunnstrom recovery stage for the lower limbs (p&lt;0.05). There was no statistically significant recovery in the FAC and 10-meter walking test (p&gt;0.05). Conclusion: This study supports that BTX-A injections are effective for improving spasticity and motor function in patients with stroke.

MÉTODOS DE TREINAMENTO DE FORÇA FÍSICA NO ENSINO E TREINAMENTO DE BADMINTON

ABSTRACT Introduction In badminton performance, athletes need to precisely manage the movements of mastered techniques to quickly complete the swing and regroup the strength of the upper and lower limbs to hit the ball quickly. Objective Study the effect of strength exercise on the physical performance of badminton players according to training. Methods 24 badminton players were randomly divided into lower limb, upper limb, and control groups. The lower limb group and upper limb group were trained for eight weeks. The final test was conducted, and the data were properly compared and analyzed. Results After eight weeks of intense strength training, the badminton throwing ability of the upper limb group was significantly improved; In the lower limb group, the effect of improving the CVM contraction ability of bilateral knee extensors was not evidenced, and the centrifugal contraction ability of the bilateral knee extensors was significantly improved. Conclusion The experiment shows that strength training can help athletes’ physical performance, positively impacting their performance. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

EXPERIMENTAL STUDY ON THE IMPACT OF INTERMITTENT STRENGTHENING TRAINING ON ATHLETES

ABSTRACT Introduction: High-intensity interval training (HIIT) refers to multiple short-term high-intensity exercises. Objective: To study the impact of sprint interval training (SIT) on the athletic ability of elite rugby players. Method: 36 male rugby players from a sports college were selected. They were randomly divided into upper limb training (Group A), lower limb training (Group B), and routine training (Group C - control). Group C received routine training for six weeks. Groups A and B added SIT training based on Group C’s upper and lower limb training. Results: After training, the maximum aerobic power (MAP) in Groups A and C was significantly higher (P &lt; 0.05), as well as the myeloperoxidase (MPO) of lower limbs in group B (P &lt; 0.05). After completing 5 and 6 sets of SIT training, blood lactic acid (BLA) was lower in group B (P &lt;0.05). Parameters such as upper limb intermittent sprint exercise capacity and lower-limb aerobic exercise capacity did not significantly change compared with the same parameters before training (P&gt;0.05). Conclusions: Excellent male rugby players can improve their upper limb aerobic and lower limb intermittent sprint athletic ability by integrating different methods of SIT training into their daily training. Level of evidence II; Therapeutic studies - investigation of treatment results.

Impact of Sex, Sleep, Symptoms of Central Sensitization, and Psychosocial Factors in Adolescents with Chronic Musculoskeletal Pain: An Exploratory Study.

This study aimed to explore and compare the associations of psychosocial factors, sleep, and central sensitization with chronic neck, back, limb, and multiregional pain and disability. One thousand seven hundred thirty (n = 1,730) adolescents responded to an online questionnaire containing questions about sociodemographic data, as well as the Nordic Musculoskeletal Questionnaire; the International Physical Activity Questionnaire; the Functional Disability Inventory; the Depression, Anxiety, and Stress Scale; the Basic Scale on Insomnia Complaints and Quality of Sleep; the Pain Catastrophizing Scale; the Tampa Scale of Kinesiophobia; the Child Self-Efficacy Scale; and the Central Sensitization Inventory. Univariable and multivariable regression analysis were used to assess the associations between these variables and pain and disability. Groups were categorized into those with neck (n = 54), back (n = 80), upper limb (n = 52), lower limb (n = 109), or multiregional (n = 1,140) pain. Multivariable analysis showed that symptoms of central sensitization increased the odds of neck, back, and multiregional pain; depression, anxiety and stress, and physical activity increased the odds of multiregional pain; and fear of movement increased the odds of lower limb pain. Female gender increased the odds of pain in all groups, except in the lower limb group. Depression, anxiety, and stress also remained associated with disability in neck, back, upper limb, and multiregional pain; poorer sleep remained associated with disability in neck, upper limb, and multiregional pain; catastrophizing remained associated with back and multiregional pain; and fear of movement and symptoms of central sensitization were associated with disability only in multiregional pain. There are similar but also different variables associated with the presence of pain and disability in the neck, back, limbs, and multiregional pain.

THE INFLUENCE OF ISCHEMIC PRECONDITIONING ON NEUROMUSCULAR PERFORMANCE

ABSTRACT Introduction: Ischemic preconditioning (IPC) has been described in the literature as a resource capable of improving physical performance. Objective: The purpose of this randomized double-blind study was to evaluate the influence of IPC on the neuromuscular performance of trained individuals. Methods: Twenty-four (24) resistance training participants (6 of them women) with a mean age of 25.8 ± 4.6 years were selected and divided into two groups: the upper limb group (ULG) composed of 12 individuals (4 women) and the lower limb group (LLG) composed of 12 individuals (2 women). The maximum repetitions test was applied in the bench press for the ULG and in the 45° leg press for the LLG, with 50% of the one-repetition maximum under control, placebo and IPC conditions, at a random interval of 72 hours between tests. The IPC was applied four hours before the tests by means of an analog sphygmomanometer cuff inflated to 220 mmHg on the arm for the ULG and on the thigh for LLG, with three cycles of five minutes each of ischemia and reperfusion, alternating between the right and left sides. For the placebo, the cuff was inflated to 40 mmHg without causing ischemia. The significance level for the Wilcoxon test was p &lt;0.017, due to the Bonferroni correction. The effect size (ES) was also analyzed. Results: With IPC, the ULG performed 34.8 ± 4.8 repetitions, representing an improvement of 11.29% (IPC vs. control, ES = 0.68 and p = 0.002) and the LLG performed 40.5 ± 15.7 repetitions, representing an improvement of 37.47% (IPC vs. control, ES = 0.84 and p = 0.002). No significant improvements were observed for the placebo in either group. Conclusion: Our data showed that IPC positively influenced neuromuscular performance of both the upper and lower limbs. Level of evidence II; Therapeutic studies investigating the results of treatment (Prospectived comparative studye).

Correlation of atherosclerosis and osteoarthritis in ancient Egypt: A standardized evaluation of 45 whole-body CT examinations

ObjectiveTo correlate atherosclerosis (Ath) and osteoarthritis (OA) in mummies from ancient Egypt. MaterialsWhole-body CT examinations of 23 mummies from the Ägyptisches Museum und Papyrussammlung, Berlin, Germany, and 22 mummies from the Museo Egizio, Turin, Italy. MethodsAth was assessed in five anatomical regions by means of preserved arterial calcifications. OA was assessed using the Kellgren and Lawrence (1957) classification. ResultsStatistical analysis revealed no correlation between Ath and total OA. A significant association was found for Ath and the upper limb group for OA grade >1 and for Ath and the lower limb group, consisting mainly of the hip and knee, for OA grade >2 OA. ConclusionsThe association of Ath and advanced OA of the hip and knee is comparable in prevalence to those reported in recent clinical studies, despite the low life expectancy and the different environment and lifestyle of the ancient Egyptians. SignificanceThis is the first study to correlate findings of Ath and OA in ancient Egypt statistically. The diseases of Ath and OA are common ailments with enormous and increasing impacts on public health. LimitationsThe large number of cardiovascular diseases was indicated only by arterial calcifications that resisted the post-mortem changes of the mummification process. Also, the assessed OA was on radiological OA. Suggestions for Further ResearchGenomic studies of ancient Egyptian mummies may reveal genetic risk factors for Ath and OA that could be shared in ancient and modern populations.

Functional autonomy and sarcopenia markers in women over 55 years of age

Introduction: Some parameters used to diagnose sarcopenia and functional autonomy disorders can lead to interpretation and classification errors. Objective: To analyze sarcopenia markers and their relationship with the strength and gait of physically active older women aged between 55 and 76 years. Materials and Methods: Analytical observational study conducted in 178 physically active Colombian women who were distributed in two age groups (group 1: 55-66 years, n=98, and group 2: 67-76 years, n=80). A multiple linear regression model was used to establish possible correlations between strength and gait indicators (dependent variables) and body composition (independent variables). Results: Fat mass and appendicular mass (appendicular lean/height2(kg/m2)) explained power variance in the lower limbs in group 1 (G1) (SJ: p=0.001, R2=0.56; CMJ: p=0.001, R2=0.51; CMJAS: R2=0.60, p=0.001). Similar results were observed in group 2 (G2) (SJ: R2=0.32, DW1=2.14; CMJ: R2=0.51, DW2=2.38; CMJAS: R2=0.41, DW3=2.56). Furthermore, fat mass explained variance in gait pattern in G1 and G2 differently (G1: p=-0.006; R2=20%; G2: p=-0.001; R2=29%). Conclusion: Recording fat and appendicular mass allow studying negative changes in lower limb strength and their effect on gait pattern, as well as identifying the type of sarcopenia and functional autonomy disorders in physically active Colombian women aged 55 to 76 years.

Comparison of measurement methods of lower limb length in hip arthroplasty for femoral neck fracture

To compare the accuracy of three methods for measuring the length of both lower limbs in hip arthroplasty for femoral neck fracture in the elderly, and to introduce a "shoulder to shoulder" anatomical location marking method for femur. From January 2017 to January 2019, 90 elderly patients with femoral neck fracture were treated with hip replacement, including 39 males and 51 females, aged 65 to 96(78.0±7.4) years, 56 cases of total hip and 34 cases of hemi hip. According to garden classification, there were 7 cases of typeⅡ, 63 cases of type Ⅲ and 20 cases of type Ⅳ. The patients were divided into three groups according to different measurement methods:contralateral contrast method (group A) of 19 cases, shuck test method (group B) of 28 cases, and "shoulder to shoulder" anatomical marker localization method (Group C) of 43 cases. The accuracy of the three methods was compared by measuring the length difference of lower limbs in vitro and imaging. All patients completed the operation successfully. After total hip arthroplasty, the length of lower limbs in group A was(12.9±8.6) mm, and that in group B was(10.3±4.4) mm. After hemiarthroplasty, the length of lower limbs in group A was (13.2±7.2) mm, group B was (8.7±3.5) mm, and group C was (6.3±2.8) mm; the measurement results of unequal length of lower limbs after total hip arthroplasty were(12.9±8.1) mm in group A, (9.6±4.0) mm in group B and (6.6±2.6) mm in group C. The results of factorial analysis of variance showed that the differences among the three groups were statistically significant (F=9.763, P<0.01). The difference between two groups showed that the length of lower limbs in group A and group B was higher than that in group C(P<0.05). There was no significant differencebetween total hip arthroplasty and hemiarthroplasty (F=0.270, P=0.605). Three different intraoperative measurement methods for postoperative lower limb length difference were group C<group B<group A, the accuracy of group C was the highest. The "shoulder to shoulder" anatomic localization marking method can reduce the length of lower limbs simply, effectively and accurately in the elderly patients with femoral neck fracture hip replacement.

Body location of “New World” cutaneous leishmaniasis lesions and its impact on the quality of life of patients in Suriname

Cutaneous leishmaniasis (CL) is a chronic skin infection caused by Leishmania parasites, causing single or multiple skin nodules and ulcers on the exposed body locations. Healing of lesions is followed by scar formation. Active and healed CL lesions may affect patient’s health related quality of life (HRQL). The aim of this study was to determine whether the body location of the leishmaniasis lesions affects the HRQL of localized CL patients in Suriname. The HRQL of 163 patients with CL was assessed by Skindex-29 and EQ-5D/VAS questionnaires. Forty-six patients out of the total study population also participated in a qualitative anthropological study involving in depth interviews. All patients were allocated in 4 groups in the following hierarchy: head and face, upper limbs, lower limbs and trunk. Patients with lesions on the lower limbs had significantly higher Skindex-29 scores, indicating worse HRQL, in the symptom scale compared to lesions on head/face and trunk. The lower limb group was more likely to report problems in the dimensions self-care, mobility, daily activities and pain/discomfort of the EQ-5D. Little to no social stigma was reported in the in-depth interviews. The findings of this study indicate that Surinamese patients with CL lesions located on the lower limbs had more impairment in HRQL than on other body locations. Stigma related to CL seems to be virtually absent in Suriname.

The muscle reflex and chemoreflex interaction: ventilatory implications for the exercising human.

We examined the interactive influence of the muscle reflex (MR) and the chemoreflex (CR) on the ventilatory response to exercise. Eleven healthy subjects (5 women/6 men) completed three bouts of constant-load single-leg knee-extension exercise in a control trial and an identical trial conducted with lumbar intrathecal fentanyl to attenuate neural feedback from lower-limb group III/IV muscle afferents. The exercise during the two trials was performed while breathing ambient air ([Formula: see text] ~97%, [Formula: see text]~84 mmHg, [Formula: see text] ~32 mmHg, pH ~7.39), or under normocapnic hypoxia ([Formula: see text] ~79%, [Formula: see text] ~43 mmHg, [Formula: see text] ~33 mmHg, pH ~7.39) or normoxic hypercapnia ([Formula: see text] ~98%, [Formula: see text] ~105 mmHg, [Formula: see text] ~50 mmHg, pH ~7.26). During coactivation of the MR and the hypoxia-induced CR (O2-CR), minute ventilation (V̇e) and tidal volume (VT) were significantly greater compared with the sum of the responses to the activation of each reflex alone; there was no difference between the observed and summated responses in terms of breathing frequency (fB; P = 0.4). During coactivation of the MR and the hypercapnia-induced CR (CO2-CR), the observed ventilatory responses were similar to the summated responses of the reflexes (P ≥ 0.1). Therefore, the interaction between the MR and the O2-CR exerts a hyperadditive effect on V̇e and VT and an additive effect on fB, whereas the interaction between the MR and the CO2-CR is simply additive for all ventilatory parameters. These findings reveal that the MR:CR interaction further augments the ventilatory response to exercise in hypoxia.NEW & NOTEWORTHY Although the muscle reflex and the chemoreflex are recognized as independent feedback mechanisms regulating breathing during exercise, the ventilatory implications resulting from their interaction remain unclear. We quantified the individual and interactive effects of these reflexes during exercise and revealed differential modes of interaction. Importantly, the reflex interaction further amplifies the ventilatory response to exercise under hypoxemic conditions, highlighting a potential mechanism for optimizing arterial oxygenation in physically active humans at high altitude.

Computed Tomography System for Total Knee Replacement Planning and Comparison with Plain Radiography Measured by an Orthopedic Surgeon

Abstract In this study, a new CT measurement system was developed for preoperation evaluation of total knee replacement (TKR). To validate the developed imaging processing systems, TKR patients with and without a bowed lower limb were recruited. All patients underwent plain radiographs and CT scan before a TKR procedure. The precision and effectiveness of two measurements validated by an orthopedic surgeon and evaluated using the developed 3D computed tomography image system were compared. In vivo statistics data, particularly for Taiwanese patients, showed no difference between bowed lower limb and normal lower limb groups. The results of this study did not reveal a significant difference between the 3D-reconstructed CT images and 2D plain radiographs. However, the proposed 3D-reconstructed CT image measurement system demonstrated consistent measurements for TKR patients and for the bowed lower limb group in preoperative evaluation. The implemented system could be used in conjunction with the current 2D radiograph approach. The proposed system assist surgeons and patients when discussing operations and clinical approaches. Clinical results validated the system.

Factors associated with functional outcome in patients having limb salvage surgery for primary malignant bone sarcoma using TESS

Introduction: Achieving maximum functional outcome in primary malignant bone sarcoma surgery (PMBS) patients, is challenging for both patients and clinicians. This study, aimed to evaluate different factors that affect postoperative functional outcome of the primary malignant bone sarcoma patients following upper limb (UL) and lower limb (LL) salvage surgery using Toronto Extremity Salvage Score (TESS).Methods: 136 PMBS adult patients were identified and were grouped as lower limb (LL) and upper limb (UL). Each group then sub-grouped to major and minor surgeries. Their functional outcome was compared using TESS by demographic variables(gender and age), neoadjuvant/adjuvant therapy and tumour variables (anatomical sites). In the UL groups, TESS was also compared for major and minor surgery subgroups based on their dominant or non-dominant limb.Results: The result of TESS has revealed that chemotherapy, radiotherapy, and gender have no effect on the functional outcome in PMBS patients. Functional outcome however was significantly affected by age in both LL and UL groups. The TESS was significantly different between major and minor subgroups in UL group with p= 0.0001. In patients with upper LSS on their dominant limb, no significant difference between major/ minor surgery subgroups was observed with p=0.077.Conclusion: Our findings using TESS revealed that factors such as patient’s age, and type of surgery (major or minor) in PMBS patients will affect the patients’ functional outcome after LSS especially in those PMBS patients with upper LSS.

The combination of tibial anterior translation and axial rotation into a single biomechanical factor improves the prediction of patient satisfaction over each factor alone in patients with ACL reconstructed knees

PurposeThe purpose of this study was to identify biomechanical factors, in both reconstructed and healthy knees, that correlate with patient satisfaction after ACL reconstruction.MethodsSeventeen patients who had undergone unilateral ACL reconstruction were reviewed 9 years post-op. Patients completed subjective questionnaires and underwent manual knee laxity testing (Lachman-Trillat, KT-1000, and pivot shift) and automated laxity testing. During automated testing, both legs were rotated into external rotation and then internal rotation until peak rotational torque reached 5.65 Nm. Load-deformation curves were generated from torque and rotation data. Features of the curves were extracted for analysis. Total leg rotation and anterior laxity during KT-1000 testing were combined into a single factor (Joint Play Envelope or JPE). Patients were divided into groups based on patient satisfaction scores (Group 1: Higher Satisfaction, Group 2: Lower Satisfaction, Group 3: Unsatisfied). Load-deformation curve features and manual laxity testing results were compared between groups 1 and 2 to determine which biomechanical factors could distinguish between the groups. Diagnostic screening values were calculated for KT-1000 testing, the pivot shift test, total leg rotation and JPE.ResultsDuring manual testing, no significant differences in biomechanical factors were found when comparing reconstructed knees in group 1 and group 2. When comparing the reconstructed and healthy knees within group 2, the reconstructed knees had a significantly higher displacement during the KT-1000 manual maximum test (p < 0.002). When considering the reconstructed knees alone, neither the result of the pivot shift test nor KT-1000 testing could distinguish between group 1 and group 2. During automated testing, there were no significant differences between the groups when comparing the reconstructed lower limbs. The healthy lower limbs in group 2 had more maximum external rotation (p < 0.02) and decreased stiffness at maximum external rotation (p < 0.02) when compared to the healthy lower limbs in group 1. Total leg rotation was unable to distinguish between group 1 and group 2. JPE could distinguish between group 1 and group 2 when considering the reconstructed limb alone (p < 0.02). All four diagnostic screening values for JPE were equal or higher than in the other criteria. JPE also showed the most significant correlation with patient satisfaction.ConclusionsJoint Play Envelope is an objective measure that demonstrated improved predictive value as compared to other tests when used as a measure of satisfaction in patients with ACL reconstructed knees.

Patient factors affecting the Toronto extremity salvage score following limb salvage surgery for bone and soft tissue tumors.

The Toronto extremity salvage score (TESS) assesses physical function following limb salvage for bone and soft tissue sarcoma. In 2012, Clayer et al. showed increasing age affects the TESS score in normal individuals. The purpose of this study was to investigate what other patient factors affect outcome? We reviewed the TESS scores, age, sex, BMI, diagnosis, smoking status, and social deprivation score of patients who have undergone limb salvage in our unit. Data were extracted from our tumor database and reviewed. Statistical analysis was performed using Wilcoxon pairwise test and linear regression analysis. Four hundred and ninety-eight TESS scores were found for 198 patients. Data were analyzed separating upper limb (UL) and lower limb (LL) tumors. In the UL group, being female (P = 0.01) and having a bone lesion (P < 0.001) were associated with a lower TESS score. In the LL group, being female (P = 0.04), increasing age (P = 0.002), having a bone lesion (P < 0.001), increasing BMI (P < 0.001), and smoking (P = 0.005) were associated with a lower TESS score. Analysis has shown that female sex, increasing age and BMI, smoking and having a bone lesion have an adverse effect on physical function following limb salvage, as indicated by the mean TESS score. J. Surg. Oncol. 2016;113:804-810. © 2016 Wiley Periodicals, Inc.

The Effect of Teriparatide on Fracture Healing of Osteoporotic Patients: A Meta-Analysis of Randomized Controlled Trials.

Purpose. This meta-analysis is to assess the effectiveness of teriparatide in fracture healing and clinical function improvement of the osteoporotic patients. Methods. We searched PubMed, Embase, Web of Science, and the Cochrane databases for randomized and quasi-randomized controlled trials comparing teriparatide to placebo, no treatment, or comparator interventions in the osteoporotic patients. Results. Five studies with 251 patients were included. Patients treated with teriparatide therapy had a significant shorter radiological fracture healing time compared with those in the control group (mean difference [MD] −4.54 days, 95% confidence interval [CI] −8.80 to −0.28). Stratified analysis showed that lower limb group had significant shorter healing time (MD −6.24 days, 95% CI −7.20 to −5.29), but upper limb group did not (MD −1 days, 95% CI −2.02 to 0.2). Patients treated with teriparatide therapy showed better functional outcome than those in the control group (standardized mean difference [SMD] −1.02, 95% CI −1.81 to −0.22). Patients with therapy duration over 4 weeks would have better functional outcome (SMD −1.68, 95% CI −2.07 to −1.29). Conclusions. Teriparatide is effective in accelerating fracture healing and improving functional outcome of osteoporotic women. However, more clinical studies are warranted in order to determine whether the results are applicable to males and the clinical indications for teriparatide after osteoporotic fractures.

Risk Stratification of Necrotizing Fasciitis Based on the Initial Procalcitonin Concentration: A Single Center Observational Study

Necrotizing fasciitis (NF) is a potentially fatal subcutaneous tissue and fascia infection. We studied the role of serum procalcitonin in the identification and assessment of severity of sepsis in patients with NF. A retrospective analysis was conducted from January 2000 to December 2013 for all patients who admitted to surgical intensive care with provisional diagnosis of NF. Patients were categorized into four groups based on the initial procalcitonin concentrations (Group I: <0.5 low risk, Group II: ≥0.5-<2 moderate risk, Group III: ≥2-<10 high risk, and Group IV: ≥10 ng/mL high likelihood of severe sepsis). During the study period, 331 cases were identified to have NF with a mean age of 51 ± 14 years. Serum procalcitonin was tested in 62 cases (only between 2011 and December 2013) and all were positive (Group I: 22%, Group II: 18%, Group III: 21%, and Group IV: 39%). The most common affected regions were thigh and chest in Group II (46% and 9%, respectively), lower limbs in Group III (46%), and perineum and abdomen in Group IV (25% and 21%, respectively). In the four groups, 21 patients developed septic shock (Group I: 0%, Group II: 14%, Group III: 24%, and Group IV: 62%). The cut off procalcitonin value for septic shock was 5.6 ng/mL. Using receiver-operating characteristic curve, this cut off with the Area under the Curve (AUC) of 0.77 was found to have sensitivity 81% and specificity 67%. Sequential Organ Failure Assessment (SOFA) score was substantially greater in Group III and Group IV in comparison to Group I and Group II, p = 0.006. Procalcitonin levels were correlated well with SOFA score (r = 0.34, p = 0.007). There were 17 deaths in the four groups (Group I: 6%, Group II: 23%, Group III: 12%, and Group IV: 59%). Initial procalcitonin concentration in NF carries an important prognostic value and it correlates well with SOFA score and can predict the development of septic shock early in patients with NF.

Phase II Pragmatic Randomized Controlled Trial of Patient-Led Therapies (Mirror Therapy and Lower-Limb Exercises) During Inpatient Stroke Rehabilitation

Background and objective. Patient-led therapy has the potential to increase the amount of therapy patients undertake during stroke rehabilitation and to enhance recovery. Our objective was to assess the feasibility and acceptability of 2 patient-led therapies during the acute stages of stroke care: mirror therapy for the upper limb and lower-limb exercises for the lower limb. Methods. This was a blind assessed, multicenter, pragmatic randomized controlled trial of patient-led upper-limb mirror therapy and patient-led lower leg exercises. Stroke survivors with upper and lower limb limitations, undergoing inpatient rehabilitation and able to consent were recruited at least 1 week poststroke. Results. Both interventions proved feasible, with >90% retention. No serious adverse events were reported. Both groups did less therapy than recommended; typically 5 to 15 minutes for 7 days or less. Participants receiving mirror therapy (n = 63) tended to do less practice than those doing lower-limb exercises (n = 31). Those with neglect did 69% less mirror therapy than those without (P = .02), which was not observed in the exercise group. Observed between-group differences were modest but neglect, upper-limb strength, and dexterity showed some improvement in the mirror therapy group. No changes were seen in the lower-limb group. Conclusions. Both patient-led mirror therapy and lower-limb exercises during inpatient stroke care are safe, feasible, and acceptable and warrant further investigation. Practice for 5 to 15 minutes for 7 days is a realistic prescription unless strategies to enhance adherence are included.