Obesity-related indices as predictors of lower extremity arterial disease in type 2 diabetes mellitus.

PURPOSE: The aim of this study was to investigate the relationship between obesity and lower extremity arterial disease (LEAD) in patients with type 2 diabetes mellitus (T2DM). METHODS: This retrospective study included 1821 patients with type 2 diabetes: 364 patients with LEAD and 1457 patients without LEAD. The patients were divided into training and internal test cohorts in a 7:3 ratio. LASSO regression analysis was used in the training cohort to filter relevant variables. Univariate and multivariate regression analyses were conducted to assess independent risk factors. A diagnostic nomogram was constructed and its discrimination was evaluated using the area under the ROC curve (AUC). The consistency was assessed using a calibration plot. The clinical application of the nomogram was evaluated by performing a decision curve analysis (DCA) and validated by an internal test cohort of the training cohorts. RESULTS: The LEAD group exhibited significantly higher values in obesity-related indices compared to the non-LEAD group, including waist circumference (WC), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), conicity index (CI), body adiposity index (BAI), and abdominal volume index (AVI). Multivariate analysis identified BMI, CI, BAI, and other parameters as independent risk factors for LEAD. A nomogram was constructed, and the AUC value of the nomogram was 0.746 in the training cohort and 0.663 in the internal test cohort. CONCLUSION: Obesity-related indices are associated with LEAD in patients with T2DM. Therefore, it is important to manage waist circumference and weight to reduce the risk of LEAD in patients with T2DM.

Characterizing early postoperative changes in body composition in patients with secondary lymphedema after breast cancer surgery: potential screening indicators for preventive intervention.

[Purpose] To characterize changes in the body composition of individuals with secondary lymphedema that developed in the early postoperative period after breast cancer surgery, before the manifestation of volume increase in the affected limb, and to test its potential as a screening indicator for preventive intervention. [Participants and Methods] A total of 219 patients with breast cancer who underwent axillary lymph node dissection and sentinel lymph node biopsy were included in this study. Body composition (extracellular water content, extracellular water content ratio, low-frequency impedance value, and phase angle) was evaluated using bioelectrical impedance analysis before surgery and three and six months after surgery. Changes in the body composition of the affected limb over time were compared between the lymphedema- and non-lymphedema-affected groups. [Results] Sixteen patients who developed lymphedema six months after breast cancer treatment showed significant changes in all body composition parameters at three months postoperatively, compared to those who did not develop lymphedema. [Conclusion] In patients with upper extremity lymphedema that develops within six months after breast cancer surgery, increases in extracellular water content, extracellular water content ratio, low-frequency impedance, and phase angle may precede apparent volume increases. Our findings suggest the usefulness of these parameters as screening indicators for early treatment triaging.

Revisiting the Muscles and Nerves of Anterior Compartment of the Arm: A Case Report.

During routine dissection of the anterior compartment of the arm region, we encountered several variations in the muscular and neural structures in the right upper extremity of a female cadaver. We observed one superiorly positioned extramuscular head with fibers originating from both the biceps brachii (BB) and coracobrachialis (CB) muscles and one inferiorly positioned extramuscular head with fibers solely from the BB muscle. The musculocutaneous nerve did not penetrate the CB muscle, but instead provided a muscular branch that communicated with the median nerve (MN). Both the MN and brachial artery (BA) flow beneath the extra head. This case suggests that the described variations may contribute to the entrapment of the MN and compression of the BA. Understanding these variations is crucial before surgical intervention. The failure to recognize such anatomical nuances could lead to inadvertent nerve injury or compromised vascular perfusion, emphasizing the need for preoperative planning and intraoperative vigilance.

The effectiveness of unsupervised home-based exercise for improving lower extremity physical function in older adults in Western and Eastern cultures: a systematic review and meta-analysis.

BACKGROUND: Ageing leads to decreased physical function, which can impact independent living and raise health risks, increasing demand on healthcare resources. Finding affordable and accessible exercise to improve physical function is necessary for a population seemingly resistant to strength and balance training in leisure settings. This review aimed to evaluate whether unsupervised home-based exercises improve lower extremity function in older adults. METHODS: We systematically searched for randomised controlled trials (RCTs) and cluster RCTs investigating unsupervised home-based exercises' effects on physical function in older adults through English and Mandarin databases. Studies' methodological quality was assessed using the Cochrane's Risk of Bias Tool. Meta-analyses were conducted on lower extremity functions outcomes. RESULTS: Of the 6791 identified articles, 10 English studies (907 participants) were included, 8 studies (839 participants) were used for final meta-analysis, with no Mandarin studies. Studies were largely based in Europe with mostly moderate risk of bias. Most interventions were multicomponent lasting 10-40 min/session, 3 times/week. Meta-analysis showed no statistically significant differences in 5 sit-to-stand (p = 0.05; I2 = 0%), maximal knee extension strength (p = 0.61; I2 = 71%), 10 m maximal walking speed (p = 0.22; I2 = 30%), timed-up-to-go (p = 0.54; I2 = 0%), and short physical performance battery (p = 0.32; I2 = 98%) between exercise and control groups. CONCLUSIONS: This meta-analysis suggests that unsupervised home-based exercise programmes have little impact on lower extremity functions in older adults. This review is limited by the small number of included studies, sample sizes, and high heterogeneity. There is a need to understand why this format lacks efficacy, and design more beneficial home-based exercise programmes.

Effects of end-effector robotic arm reach training with functional electrical stimulation for chronic stroke survivors.

BACKGROUND: Upper-extremity dysfunction significantly affects dependence in the daily lives of stroke survivors, limiting their participation in the social environment and reducing their quality of life. OBJECTIVES: This study aimed to investigate the effect of end-effector robotic arm reach training (RAT) with functional electrical stimulation (FES) on upper-limb motor recovery in chronic stroke survivors. METHODS: In this single-blinded randomized controlled trial, 28 chronic stroke survivors were randomized to receive RAT-with-FES and RAT-without-FES for 40 min/day, three times per week over a 4-week period, and the data of 26 participants were used in the final analysis. Upper-limb motor recovery was measured using the Fugl-Meyer assessment (FMA), and kinematics (movement time, speed, and distance) during reaching movements toward targets placed in three directions (ipsilateral, median, and contralateral sides) were measured using a robotic arm. RESULTS: The upper-limb motor recovery (FMA and kinematics) improvement for the within-group comparisons tended to be greater in the RAT-with-FES group than in the RAT-without-FES group. However, in the between-group comparison, no significant differences were found in FMA, and significant differences were observed only for 2 distance parameters of kinematic factors: total (23.0% vs. 1.7%) and straight total (25.5% vs. 2.6%) distance on the ipsilateral side (p < 0.05). CONCLUSIONS: This study was unable to clearly reveal the positive effects of electrical stimulation combined with robotic arm training. However, we believe that it provides basic data that furthers our understanding of the role of hybrid neuroprostheses in stroke rehabilitation and the factors determining successful treatment.

Dynamic Perioperative Platelet Activity and Cardiovascular Events in Peripheral Artery Disease.

OBJECTIVE: Patients with peripheral artery disease (PAD) undergo lower extremity revascularization (LER) for symptomatic relief or limb salvage. Despite LER, patients remain at increased risk of platelet-mediated complications, such as major adverse cardiac and limb events (MACLE). Platelet activity is associated with cardiovascular events; yet little is known about the dynamic nature of platelet activity over time. We therefore investigated the change in platelet activity over time and its association with long-term cardiovascular risk. METHODS: Patients with PAD undergoing LER were enrolled into the multicenter, prospective Platelet Activity and Cardiovascular Events (PACE) study. Platelet aggregation was assessed by light transmission aggregometry (LTA) to submaximal epinephrine (0.4µ M) immediately prior to LER, and on post-operative day 1 or 2 (POD1) and 30 (POD30). A hyperreactive platelet phenotype was defined as >60% aggregation. Patients were followed longitudinally for MACLE, defined as the composite of death, myocardial infarction, stroke, major lower extremity amputation, or acute limb ischemia leading to reintervention. RESULTS: Among 287 patients undergoing LER, mean age was 70 ± 11 years, 33% were female, 61% were white, and 89% were on baseline antiplatelet therapy. Platelet aggregation to submaximal epinephrine induced a bimodal response; 15.5%, 16.8%, and 16.4% of patients demonstrated a hyperreactive platelet phenotype at baseline, POD1, and POD30, respectively. Platelet aggregation increased by 18.5% (P=0.001) from baseline to POD1, which subsequently returned to baseline at POD30. After a median follow-up of 19 months, MACLE occurred in 165 (57%) patients. After adjustment for demographics, clinical risk factors, procedure type, and antiplatelet therapy, platelet hyperreactivity at POD1 was associated with a significant hazard of long-term MACLE (aHR 4.61, 95% CI 2.08-10.20, P<0.001). CONCLUSION: Among patients with severe PAD, platelet activity increases following LER. Platelet hyperreactivity to submaximal epinephrine on POD1 is associated with long-term MACLE. Platelet activity following LER may represent a modifiable biomarker associated with excess cardiovascular risk.

Clinician and patient experiences with shared decision-making to promote daily arm use for individuals with chronic stroke: an exploratory qualitative study.

Purpose: To explore the attitudes and experiences of clinicians and individuals with chronic stroke on the use of shared decision-making (SDM) during upper extremity rehabilitation to improve daily arm use in the home environment. Specifically, we aimed to describe clinician and client perspectives regarding the facilitators and barriers to using SDM within the context of a self-directed upper extremity intervention for individuals living in the community with chronic stroke. Methods: Data were collected within the context of an interventional study examining the feasibility of the Use My Arm-Remote intervention. Focus group interviews were conducted with the clinicians (n = 3) providing the intervention and individual semi-structured interviews with the participants (n = 15) of the study. All interview data were collected after the end of the intervention period. Data were analyzed using thematic analysis. Results: The following themes were identified: (1) Equal partnership; (2) Enhancing clinician confidence; and (3) This is different. Facilitators and barriers were identified within each theme. Key facilitators for clinicians were competence with SDM and patient characteristics; while facilitators for patients were open and trusting relationships with clinicians and personalized experience. Key barriers to SDM for clinicians were lack of expertise in SDM and participant buy in; while patients identified a lack of foundational knowledge of stroke rehabilitation as a potential barrier. Conclusions: Key barriers were analyzed using the consolidated framework for advancing implementation science to interpret results and identify strategies for enhancing the implementation of SDM in a virtual setting. The CFIR-ERIC tool highlighted the need for targeted educational meetings and materials to address the training and educational needs of both clinicians and patients for future iterations of this intervention.

Predictive utility of a combination of the modified caprini risk assessment score and D-dimer for the evaluation and management of lower extremity venous thrombosis after lung cancer surgery.

OBJECTIVE: The objective of this study was to examine the utility of a combination of the modified Caprini score and D-dimer levels for the evaluation and management of lower extremity venous thrombosis following lung cancer surgery. The purpose was to offer insights for developing clinical intervention programs. METHODS: The study sample consisted of 224 patients who underwent surgery for lung cancer at the First Central Hospital of Baoding City. General patient data and D-dimer levels on the first day post-surgery were collected. The modified Caprini risk assessment score was calculated. All patients underwent ultrasonography of the lower limb veins before and after surgery to identify venous thrombosis in the lower limb veins. Differences in lower extremity venous thrombosis and D-dimer levels among patients in various modified Caprini score groups were compared and analyzed. RESULTS: Based on the modified Caprini risk assessment score, all patients were categorized into three groups: the low-risk, medium-risk, and high-risk groups. The groups did not differ significantly in terms of age, but the differences in the rates of lower extremity venous thrombosis in the low, intermediate, and high-risk Caprini risk groups (16.5%, 19.2%, and 37.1%, respectively) were statistically significant. Out of the total 224 patients, 47 (21%) were diagnosed with venous thromboembolisms post-surgery, and all of them had thrombosis of the intermuscular veins of the lower extremity. The difference in the modified Caprini risk assessment score between patients with and without lower extremity venous thrombosis was statistically significant (P = 0.035), as were the postoperative D-dimer levels (1.28 ± 1.64 vs. 2.69 ± 2.77, respectively; P < 0.05) between these two groups of patients. The modified Caprini risk assessment score showed an association with lower extremity venous thrombosis (r = 0.15, P = 0.56) with an area under the receiver operating characteristic curve (AUC) of 0.59. CONCLUSION: In this study, we found that combining the modified Caprini risk assessment score with D-dimer measurements enhanced the accuracy of assessing the severity of deep vein thrombosis (DVT). This combination can be beneficial in evaluating thrombosis risk post-lung cancer surgery and holds significant clinical utility.

Relationships of Leg Ischemia Symptoms and Carotid Artery Atherosclerosis with Hypertensive-Disorders-of-Pregnancy-Associated Peptides in Patients with Lower Extremity Arterial Disease.

Objectives: We have proposed seven peptides with low molecular weights in blood as biomarkers for the diagnosis of hypertensive disorders of pregnancy (HDP). The purpose of this cross-sectional study was to investigate the relationships of the HDP-associated peptides with symptoms of leg ischemia and degree of atherosclerosis in patients with lower extremity arterial disease (LEAD). Methods: The subjects were 165 outpatients with LEAD (145 men and 20 women aged 74.3 ± 8.1 years [47-93 years]). Their symptoms of leg ischemia, leg arterial flow, and degree of atherosclerosis were evaluated using the Rutherford classification of Clinical Ischemia Category, ankle-brachial index (ABI) and the intima-media thickness (IMT) of carotid arteries, respectively. Serum concentrations of the HDP-related peptides were measured by mass spectrometry. Results: The grade of the Rutherford classification was positively associated with levels of the peptides with m/z 2091 and 2378 and was inversely associated with levels of the peptide with m/z 2081. The category of the Rutherford classification was inversely associated with ABI. There were no HDP-associated peptides that showed significant relationships with IMT. Conclusions: The peptides with m/z 2081, 2091, and 2378 are possible biomarkers of leg ischemia but are not associated with carotid atherosclerosis in LEAD patients.

Major Lower Limb Amputation for Chronic Limb-Threatening Ischemia Is Associated with Poor Long-Term Survival: 4-Year Follow-Up of a Single-Center Experience.

Objective: Despite advances in medicine, 30% of patients with chronic limb-threatening ischemia (CLTI) require major lower limb amputation (MLLA). The long-term outcome of this cohort is poorly described. Methods: In all, 154 patients undergoing MLLA for CLTI during 2018-2020 were analyzed for short-term and long-term outcomes and prosthesis use. Results: In total, 106 below-knee amputations and 48 above-knee amputations were followed up for a mean duration of 50 months (37-78). The mean age of the cohort was 63 years. The majority were male (60%) with multiple comorbidities, including diabetes (83.8%), hypertension (49.4%), ischemic heart disease (20%), and smoking (32.5%). An equal proportion underwent MLLA as primary (45%) or secondary (55%). 30-day mortality was 6%. The mean length of in-hospital stay was 18 days (3-56). Overall survival rates at 1st, 2nd, and 4th year were 73%, 64%, and 35%, respectively. On a multivariate regression analysis, a higher level of amputation had a significant impact on mortality (p = 0.015). 54% of amputees had a prosthetic limb. However, the primary use of prosthesis was for cosmesis, with only 12% mobile independently. Conclusions: MLLA for CLTI is associated with poor early and long-term survival. Prosthesis use and mobility are extremely poor in the Sri Lankan context.