Microdialysis as a tool for antibiotic assessment in patients with diabetic foot: a review.

Diabetic foot is a serious late complication frequently caused by infection and ischaemia. Both require prompt and aggressive treatment to avoid lower limb amputation. The effectiveness of peripheral arterial disease therapy can be easily verified using triplex ultrasound, ankle-brachial/toe-brachial index examination, or transcutaneous oxygen pressure. However, the success of infection treatment is difficult to establish in patients with diabetic foot. Intravenous systemic antibiotics are recommended for the treatment of infectious complications in patients with moderate or serious stages of infection. Antibiotic therapy should be initiated promptly and aggressively to achieve sufficient serum and peripheral antibiotic concentrations. Antibiotic serum levels are easily evaluated by pharmacokinetic assessment. However, antibiotic concentrations in peripheral tissues, especially in diabetic foot, are not routinely detectable. This review describes microdialysis techniques that have shown promise in determining antibiotic levels in the surroundings of diabetic foot lesions.

Subcutaneous Fat Thickness of the Lower Limb is Associated with Trunk Muscle Mass in Patients with Hepatocellular Carcinoma: A Simple Assessment for Sarcopenia Using Conventional Ultrasonography.

OBJECTIVE: Trunk muscle mass can be evaluated by skeletal muscle index (SMI), which is a prognostic factor in patients with hepatocellular carcinoma (HCC); however, this requires the use of computed tomography, and a simpler assessment for trunk muscle mass is urgently needed. We aimed to examine whether an association between SMI and lower extremity compartments including muscle and subcutaneous fat thickness of lower limbs (SFT-LL) could be identified by means of ultrasonography in patients with HCC. METHODS: We retrospectively enrolled male patients with HCC (n=30). Trunk muscle mass was evaluated by SMI using computed tomography. Ultrasonography was used for assessment of muscle and SFT-LL. Factors associated with SMI were evaluated by decision-tree analysis. RESULTS: There was no significant correlation between SMI and muscle thickness of lower limbs. However, a significant correlation was seen between SMI and left SFT-LL (r=0.406, P=0.026). In decision-tree analysis for SMI, left SFT-LL was selected as the initial split variable with an optimal cut-off value of 5 mm. In patients with left SFT-LL ≥ 5 mm, SMI was 39.4±3.4 cm2/m2, whereas SMI was 31.6±6.3 cm2/m2 in patients with left SFT-LL <5 mm. CONCLUSION: Left SFT-LL evaluated by ultrasonography was associated with SMI. Thus, ultrasonography may be a useful tool to evaluate trunk muscle mass. Moreover, left SFT-LL may be a useful indicator of sarcopenia in patients with HCC.

MRI Assessment of Motor Capabilities in Patients with Duchenne Muscular Dystrophy According to the Motor Function Measure Scale.

The research was aimed on the study of motor capabilities on the Motor Function Measure (MFM) scale in ambulant and non-ambulant patients with Duchenne muscular dystrophy, and to conduct a correlation analysis between the results of the MFM scale and Magnetic Resonance Imaging (MRI) data. A total of 46 boys who had genetically confirmed Duchenne muscular dystrophy (age from 2.1 to 16.7 years) and were in clinical rehabilitation were investigated. An assessment was performed according to the Motor Function Measure scale (subsections D1, D2, D3, and the total score), an MRI obtaining T1-VI of the muscles of the pelvic girdle was conducted, and the thighs and lower legs were further assessed in terms of the severity of fibrous-fat degeneration according to the Mercuri scale. In ambulant patients, the ability to stand up and move (D1) was 74.4%, axial and proximal motor functions (D2)­97.6%, distal motor functions (D3)­96.2%, and total score was 87.9%. In non-ambulant patients, the ability to stand up and move (D1) was 1.7%, axial and proximal motor functions (D2)­47%, distal motor functions (D3)­67.5%, and the total score­33.1%. A high inverse correlation (r = −0.7, p < 0.05) of the MRI data of the pelvic girdle and thighs with tasks D1, as well as a noticeable inverse correlation with tasks D2 (r = −0.6, p < 0.05) of the scale MFM, were revealed in the ambulant group of patients. In the non-ambulant group of patients, the MRI data of the lower legs muscles were characterized by a high inverse correlation (r = −0.7, p < 0.05) with tasks D3 and a noticeable inverse correlation (r = −0.6, p < 0.05) with tasks D1 of the MFM scale. Conclusion: The Motor Function Measure scale allows effective assessment of the motor capabilities of patients with Duchenne muscular dystrophy at different stages of the disease, which is confirmed by visualization of fibro-fatty muscle replacement.

Quality of life evaluation and lack of correlation with volumetric results after lymphovenous anastomoses in lymphedema therapy of the lower extremity.

OBJECTIVE: Chronic primary or secondary lymphedema has huge effects on patients' quality of life (QOL) because of the associated swelling and pain, decreased range of motion, and depression and anxiety and generally requires numerous adaptations. Many studies have shown a positive objective effect of lymphovenous anastomoses (LVAs) on chronic lymphedema. In the present study, we assessed the effect of LVAs on QOL in patients with primary or secondary lymphedema of the lower extremity at 6 months after surgery and examined the correlation between changes in the QOL and volumetric measurements. METHODS: Only patients with either primary or secondary lymphedema of the lower extremity who had undergone LVAs were included in the present study. To assess QOL, a specially designed questionnaire based on the Lymphedema Quality of Life Inventory was used to evaluate the subjective therapeutic results from the patients' perspective. Objective therapy success was assessed using three-dimensional volumetric measurements of the lower leg. The measuring points, for both the subjective and the objective measurements, were the day before and 6 months after therapy. RESULTS: The mean change in volume at 6 months after LVA was -6.5% ± 5.6% (P < .001). Significantly better QOL in terms of physical (37.6% ± 25.2%) and psychosocial (27.0% ± 43.0%) domains and practical restrictions (22.3% ± 24.8%) was found (P < .001 for all). No correlation was found between QOL improvement and volume decrease (P > .05). CONCLUSIONS: For patients with lymphedema of the lower extremity, LVAs can lead to a significant volumetric decrease and QOL improvement at 6 months after treatment with no demonstrable relationship between QOL improvement and volume reduction.

Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association.

Lower extremity peripheral artery disease (PAD) affects >230 million adults worldwide and is associated with increased risk of various adverse clinical outcomes (other cardiovascular diseases such as coronary heart disease and stroke and leg outcomes such as amputation). Despite its prevalence and clinical importance, PAD has been historically underappreciated by health care professionals and patients. This underappreciation seems multifactorial (eg, limited availability of the first-line diagnostic test, the ankle-brachial index, in clinics; incorrect perceptions that a leg vascular disease is not fatal and that the diagnosis of PAD would not necessarily change clinical practice). In the past several years, a body of evidence has indicated that these perceptions are incorrect. Several studies have consistently demonstrated that many patients with PAD are not receiving evidence-based therapies. Thus, this scientific statement provides an update for health care professionals regarding contemporary epidemiology (eg, prevalence, temporal trends, risk factors, and complications) of PAD, the present status of diagnosis (physiological tests and imaging modalities), and the major gaps in the management of PAD (eg, medications, exercise therapy, and revascularization). The statement also lists key gaps in research, clinical practice, and implementation related to PAD. Orchestrated efforts among different parties (eg, health care providers, researchers, expert organizations, and health care organizations) will be needed to increase the awareness and understanding of PAD and improve the diagnostic approaches, management, and prognosis of PAD.

Lower Extremity Ulcers.

Lower extremity ulcerations contribute to significant morbidity and economic burden globally. Chronic wounds, or those that do not progress through healing in a timely manner, are estimated to affect 6.5 million people in the United States alone causing, significant morbidity and economic burden of at least an estimated $25 billion annually. Owing to the aging population and increasing rates of obesity and diabetes mellitus globally, chronic lower extremity ulcers are predicted to increase. Here, we explore the pathophysiology, diagnosis, and management of the most (and least) commonly seen lower extremity ulcers.

Meias elásticas de compressão para o tratamento do linfedema de membros inferiores / Compressive elastic bands for the treatment of lower limb lymphedema

INTRODUÇÃO: O linfedema é uma doença crônica progressiva, ocasionada por insuficiência do processo de drenagem linfática, que causa edema tecidual. Não há nenhum tratamento curativo para o linfedema e no âmbito do Sistema Único de Saúde (SUS), estão listados dois procedimentos de manejo do linfedema: o atendimento fisioterapêutico e o tratamento cirúrgico do linfedema. As meias elásticas de compressão seriam uma opção de tratamento autogerido, o que pode reduzir a sobrecarga do sistema por procedimentos eletivos. PERGUNTA: O uso de meias elásticas de compressão é eficaz, efetivo, seguro e custo-efetivo para o tratamento de pacientes com linfedema primário ou secundário? EVIDÊNCIAS CIENTÍFICAS: A busca recuperou duas coortes prospectivas. O estudo de Brambilla et al., 2006 demonstrou diferença estatisticamente significante na redução do volume dos membros inferiores (mensurada por uso de fita métrica em vários pontos dos membros inferiores) entre os pacientes que utilizaram as meias elásticas de compressão em relação aos pacientes do grupo controle (que não usaram as meias). Contudo, as circunferências dos membros inferiores foram reduzidas de maneira irregular, 40% dos pacientes tratados com as meias elásticas de compressão apresentaram aumento do volume do membro e apenas 16,67% das reduções foram consideradas satisfatórias. Já o estudo de Godoy et al., 2017, uma coorte do tipo antes e depois, demonstrou diferença estatisticamente significante entre as meias de compressão de 30/40 mmHg e as de 20/30 mmHg, sendo esta última não efetiva na manutenção do volume dos membros após quatro semanas em relação a linha de base. Porém, nessa última coorte, as meias elásticas de compressão foram utilizadas para manutenção do volume dos membros após redução completa do edema por outros procedimentos terapêuticos. Não foram encontrados estudos referentes à adesão das meias elásticas de compressão na população com linfedema. Nenhum dos estudos incluídos relatou dados de segurança. As duas coortes apresentaram baixa qualidade metodológica, uma vez que receberam 5 estrelas ou menos nas ferramentas de Newcastle-Ottawa. A certeza da evidência de todos os desfechos, avaliada pelo Grading of Recommendations Assessment, Development and Evaluation, foi muito baixa. ANÁLISE DE IMPACTO ORÇAMENTÁRIO: Para um horizonte temporal de 5 anos, a incorporação das meias elásticas de compressão para linfedema ocasionaria um aumento de gastos estimados, em cinco anos, de R$117.900.922,59 a R$136.039.526,07, a depender da prevalência. CONSIDERAÇÕES FINAIS: As evidências disponíveis acerca da efetividade das meias elásticas de compressão em indivíduos com linfedema de membros inferiores são escassas e, de forma geral, de qualidade baixa. A avaliação econômica estimou uma RCEI R$ 2.155,87, ao passo que análise de impacto orçamentário estima um custo acumulado em cinco anos de até R$ 136 milhões no cenário de incorporação das meias elásticas de compressão. Não foram identificadas recomendações sobre o uso de meias elásticas no tratamento do linfedema em agências internacionais de ATS. Dessa forma, recomendações sobre o uso da tecnologia são permeadas de incertezas e devem ser realizadas com cautela. RECOMENDAÇÃO PRELIMINAR DA CONITEC: A Conitec, em sua 92ª reunião ordinária, realizada nos dias 04 de novembro de 2020, deliberou que a matéria fosse disponibilizada em consulta pública com recomendação preliminar não favorável à incorporação no SUS das meias elásticas de compressão como parte do tratamento de pacientes com linfedema de membros inferiores. Considerou-se, entre outros fatores, que, há escassez de evidências sobre o uso das meias elásticas de compressão no tratamento do linfedema de membros inferiores. Além disso, as poucas evidências disponíveis foram consideradas frágeis, com baixo número amostral e baixa qualidade, sendo, portanto, insuficientes para determinar com robustez a efetividade, a segurança, a custo-efetividade e o impacto orçamentário decorrente da incorporação das meias de compressão. CONSULTA PÚBLICA: O relatório de recomendação inicial da CONITEC foi disponibilizado para contribuições por meio da consulta pública nº 64/2020 entre os dias 25/11/2020 e 14/12/2020. Foram recebidas 163 contribuições, sendo 93 contribuições de cunho técnico-científico e 70 contribuições de experiência pessoal ou opinião, destas 84,7% discordavam com a recomendação preliminar da Conitec. RECOMENDAÇÃO FINAL: Os membros da Conitec presentes na 94ª reunião ordinária, no dia 03 de janeiro de 2021, deliberaram por unanimidade recomendar a não incorporação das meias elásticas de compressão para o tratamento de pacientes com linfedema. Os membros presentes entenderam que não houve argumentação suficiente para alterar a recomendação inicial. Foi assinado o registro de deliberação nº 585. DECISÃO: Não incorporar as meias elásticas de compressão como parte do tratamento de pacientes com linfedema de membros inferiores, do Sistema Único de Saúde - SUS, conforme Portaria nº 03, publicada no Diário Oficial da União nº 34, seção 1, página 93, em 22 de fevereiro de 2021.

Assessment of quality of life changes in patients with lower extremity lymphedema using an advanced pneumatic compression device at home.

OBJECTIVE: Lymphedema is associated with significant morbidity and healthcare resource usage. Conventional therapy efficacy has been limited, with poor surgical salvage options. Preliminary studies have demonstrated that the use of advanced pneumatic compression devices (APCDs) improves clinical outcomes. However, limited evidence regarding their role in healthcare cost mitigation or health-related quality of life (QOL) is available. METHODS: The present postmarket, multicenter, single-arm, observational clinical trial conducted in the Veterans Affairs Healthcare System evaluated patients with a diagnosis of primary or secondary edema of unilateral or bilateral lower extremities treated with the Flexitouch APCD (Tactile Medical, Minneapolis, Minn) from February 2016 to March 2019. The patients were assessed at baseline and 12, 24, and 52 weeks from enrollment by limb circumference, QOL assessments (short form-36 and Lymphedema Quality of Life), device compliance, cellulitis episodes, and lymphedema-related healthcare use since the previous visit. The primary endpoints of interest were the QOL at baseline compared with at 12 weeks, unscheduled lymphedema-related clinic visits, and hospital admissions at 52 weeks. The secondary endpoints included the change in limb girth and QOL at 52 weeks compared with baseline. RESULTS: A total of 178 patients with lower extremity lymphedema were prospectively enrolled. The present study reports the interim data for the first 74 subjects to complete 52 weeks of APCD treatment. The cohort was predominately male (94.6%), elderly (mean age, 67 years), obese (median body mass index, 32 kg/m2), and most commonly enrolled for the treatment of phlebolymphedema (71.6%) with largely bilateral lower extremity involvement (91.9%). No significant difference was seen in QOL at 12 weeks. However, at 52 weeks, the Lymphedema Quality of Life scores had significantly improved from baseline (6.3 vs 7.4; P < .0001) and the short form-36 had demonstrated significant improvement from baseline in the physical component (38.6 vs 40.8; P = .035), with an effect toward overall improvement in the mental component (49.9 vs 51.3; P = .549). The limb circumference had decreased significantly at 12 weeks compared with baseline (28.5 cm vs 27.7 cm; P = .0005) in the most affected lower extremity, and this reduction had remained stable for the study duration. APCD treatment was associated with a significant reduction in cellulitis episodes (24.3% vs 8.1%; P = .005), lymphedema-related clinic visits (2.2 vs 0.7; P = .02), urgent care visits (1.2 vs 0.3; P = .004), and hospital admissions (0.5 vs 0.1; P = .047) per patient. CONCLUSIONS: The Flexitouch APCD resulted in initial significant limb girth reduction as early as 12 weeks and a steady and sustained improvement in health-related QOL for ≤1 year. The latter was likely reflective of a decrease in cellulitis episodes and fewer associated lymphedema-related clinic and urgent care visits and hospital admissions.

Sublingual indocyanine green films for non-invasive swallowing assessment and inflammation detection through NIR/SWIR optical imaging.

Indocyanine green (ICG) is the most commonly used FDA-approved agent for clinical optical imaging, administered through injections only, due to its poor membrane permeability. Although ICG has vast potential for non-invasive non-radioactive imaging in patients, the clinical applications are limited by the invasive administration and short half-life in blood circulation. To expand the clinical value of ICG, non-toxic chitosan-based ICG-loaded films were designed for sublingual administration for near-infrared (NIR) and short-wave infrared (SWIR) optical imaging. Two film formulations were developed with different ICG release rates. Mold-casted self-emulsifying films rapidly released ICG (80% in 4 h) in the form of nanosized droplets, which were mostly swallowed and produced significant contrast of upper digestive tract to enable in vivo swallowing evaluations using NIR/SWIR imaging. Regular films released ICG slowly (80% in 25 h), allowing for steady absorption of ICG to systemic circulation. Inflammation in mouse feet was detected within 30 min after sublingual administration with a 1.43-fold fluorescence increase within 1 h at the inflammation sites, comparable to a 1.76-fold increase through intravenous injection. Administering ICG using sublingual films displayed notable potential for non-invasive diagnosis and monitoring of inflammatory conditions and swallowing disorders, addressing a current need for alternatives to ICG parenteral administration.

Global Disability Burdens of Diabetes-Related Lower-Extremity Complications in 1990 and 2016.

OBJECTIVE: No study has reported global disability burden estimates for individual diabetes-related lower-extremity complications (DRLECs). The Global Burden of Disease (GBD) study presents a robust opportunity to address this gap. RESEARCH DESIGN AND METHODS: GBD 2016 data, including prevalence and years lived with disability (YLDs), for the DRLECs of diabetic neuropathy, foot ulcer, and amputation with and without prosthesis were used. The GBD estimated prevalence using data from systematic reviews and DisMod-MR 2.1, a Bayesian meta-regression tool. YLDs were estimated as the product of prevalence estimates and disability weights for each DRLEC. We reported global and sex-, age-, region-, and country-specific estimates for each DRLEC for 1990 and 2016. RESULTS: In 2016, an estimated 131 million people (1.8% of the global population) had DRLECs. An estimated 16.8 million YLDs (2.1% global YLDs) were caused by DRLECs, including 12.9 million (95% uncertainty interval 8.30-18.8) from neuropathy only, 2.5 million (1.7-3.6) from foot ulcers, 1.1 million (0.7-1.4) from amputation without prosthesis, and 0.4 million (0.3-0.5) from amputation with prosthesis. Age-standardized YLD rates of all DRLECs increased by between 14.6% and 31.0% from 1990 estimates. Male-to-female YLD ratios ranged from 0.96 for neuropathy only to 1.93 for foot ulcers. The 50- to 69-year-old age-group accounted for 47.8% of all YLDs from DRLECs. CONCLUSIONS: These first-ever global estimates suggest that DRLECs are a large and growing contributor to the disability burden worldwide and disproportionately affect males and middle- to older-aged populations. These findings should facilitate policy makers worldwide to target strategies at populations disproportionately affected by DRLECs.

Lymphedema Impact and Prevalence International Study: The Canadian Data.

Background: Chronic edema/lymphedema is defined as edema present for more than 3 months. It is underrecognized and undertreated. The International Lymphedema Framework developed an international study, Lymphedema Impact and Prevalence International (LIMPRINT), to estimate the prevalence and impact of chronic edema in heterogeneous populations. Canada participated in this study. Methods and Results: Participants were recruited from an outpatient chronic wound management clinic. At a study visit, the following tools were administered: The Core Tool, Demographics and Disability assessment (WHODAS 2.0), Quality-of-life assessment (LYMQOL + EQ-5D), Details of swelling, Wound assessment, and Cancer. Data were entered into an international database (Clindex), and country-specific data were analyzed. Sixty-eight subjects were enrolled. Fifty-seven percent were males and 43% females. More than 90% were older than 45 years. Only 7.35% had primary lymphedema. Most had lower extremity edema (65 of 68). Over half (47.06%) were morbidly obese with body mass index of >40. The most common underlying condition was venous disease. Only 8 of 68 had a history of cancer. While 72.06% had a history of cellulitis, only 10.2% had been hospitalized in the past year. 39.71% had an open wound. More than 75% had received multilayer bandaging, compression garments, wound dressings, and extensive counseling. Few had received manual lymphatic drainage, which is not funded. Disability was less than expected. Conclusion: Chronic edema/lymphedema is an underrecognized condition. These data and the wider LIMPRINT study are important tools to advocate for wider recognition and funding of treatment by health care systems.

Negative pressure dressings are no better than standard dressings for open fractures.

The studyEffect of negative pressure wound therapy vs standard wound management on 12-month disability among adults with severe open fracture of the lower limb: the WOLLF randomised clinical trial.Costa ML, Achten J, Bruce J, et al; UK WOLLF CollaborationPublished on 9 October 2018 JAMA 2018;319:2280-8.This project was funded by the National Institute for Health Research Health Technology Assessment Programme (project number 10/57/20).To read the full NIHR Signal, go to: https://discover.dc.nihr.ac.uk/content/signal-000655/negative-pressure-dressings-are-no-better-than-standard-dressings-for-open-fractures.

Lower Extremity Fractures in Hospitalized Pediatric Patients Following Road Traffic Accidents.

Lower extremity fractures (LEFs) caused by road traffic accidents (RTAs) can result in significant morbidity and account for a substantial part of nonfatal injuries requiring hospitalization. This study investigated the epidemiology of RTA-associated LEFs in the pediatric population. Based on the National Trauma Registry, data of 28,924 RTA hospitalized pediatric patients were reviewed. Data were analyzed according to LEF mechanism of injury, age distribution, fracture types, associated injuries, surgical treatment, and their interrelations.A total of 4970 (17.18%) sustained LEFs, with the highest risk for motorcycle-associated RTA, followed by pedestrians. Approximately 1 of 4 patients had multiple fractures. Forty percent (2184 cases) sustained additional injuries, for which car-associated RTAs were at the greatest risk (61%, P < 0.0001), followed by pedestrians and motorcycles (46%-45%, P < 0.0001). Overall, head/neck/face injuries were the most commonly associated injuries. The tibia was the most fractured bone (42%), followed by the femur, fibula, foot, and ankle. This distribution varied according to RTA mechanism. Forty-one percent of cases required fracture treatment in an operating room. As patients were older, the greater the chance they required further treatment in the operating room (P < 0.0001).This large-scale study on the epidemiology of LEFs in the pediatric population following RTA provides unique information on epidemiological characteristics of LEF, pertinent both to medical care providers and to health policy makers allocating resources and formulating prevention strategies in the attempt to deal with the burden of road traffic accidents.Level of Evidence: Prognostic and epidemiologic study, level II.

Assessment of the Probability of Post-thrombotic Syndrome in Patients with Lower Extremity Deep Venous Thrombosis.

This study was performed to assess the probability of post-thrombotic syndrome (PTS) after treatment of lower extremity deep venous thrombosis (LEDVT). Patients with LEDVT undergoing their first treatments in Nanjing First Hospital from January 2013 to December 2014 were enrolled in this study (156 patients were enrolled in the training cohort, and 135 patients were enrolled in the validation cohort). 51 and 45 patients developed PTS in the two cohorts, respectively. Independent risk factors for PTS were investigated in the training cohort, and these independent risk factors were employed to develop the APTSD scoring system with which to predict the probability of PTS. Four independent risk factors for PTS were identified: iliac vein compression syndrome, residual iliac-femoral vein thrombosis, residual femoral-popliteal vein thrombosis and insufficient anticoagulation. Patients in the training cohort were divided into 2 groups according to the APTSD score of ≤7.0 and >7.0 points regarding the probability of PTS (median PTS-free time, 21.82 vs. 18.84 months; P < 0.001). The accuracy of this score system was 81.7% for the training cohort and 82.5% for the validation cohort. Patients with an APTSD score of >7.0 points may have an increased probability of developing PTS.

WHO disability assessment schedule 2.0 is related to upper and lower extremity disease-specific quality of life.

PURPOSE: We evaluated whether two disease-specific quality of life instruments (Disabilities of the Arm, Shoulder and Hand, DASH and Western Ontario & McMaster Universities Osteoarthritis Index, WOMAC) reflect a patient's perception of general disability using the WHO Disability Assessment Schedule 2.0 (WHODAS 2.0) and determined whether disability components are explained by upper and lower extremity HRQOL. METHODS: We recruited 421 participants, 50 years or older without stroke, cancer, or history of surgery for musculoskeletal disease, who participated in the NAMGARAM Cohort. Upper extremity HRQOL was determined with the DASH score and lower extremity HRQOL with the WOMAC; as a measure of disability, we obtained WHODAS 2.0 component. Multiple regression modeling was used to assess the relative contributions made by upper and lower extremity HRQOL to disability. RESULTS: When adjusted for covariates, the DASH total score was correlated with getting around (ß = 0.217, p < 0.001) and social participation (ß = 0.226, p < 0.001), and the WOMAC total score was correlated with getting around (ß = 0.363, p < 0.001), life activation (ß = 0.363, p < 0.001), and social participation (ß = 0.301, p < 0.001). QOL significantly correlated with upper extremity disorders (ß = 0.081, p = 0.018) or lower extremity disorders (ß = 0.095 p = 0.004). CONCLUSION: We found that in a community-based population, perceived activity limitation and social participation were associated with upper and lower extremity HRQOL. Since the WHODAS 2.0 does not target a specific disease (as opposed to DASH and WOMAC), it can be used to compare disabilities caused by different diseases.

A 1470-nm laser combined with foam sclerotherapy in day surgery: a better choice for lower limb varicose veins.

Day surgery is being more and more adopted by clinicians. Higher wavelength lasers give patients better experience than lower wavelength lasers, which makes it more suitable for day surgery. This study compares the short- and mid-term efficacy, postoperative morbidity, and patient satisfaction of "1470-nm endovenous laser ablation (EVLA) combining foam sclerotherapy in day surgery" with "810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery" on great saphenous vein (GSV) insufficiency postoperatively. A single-institution historical cohort study of 194 patients was performed in Shanghai Ninth People's Hospital, China. Ninety-seven patients received 1470-nm EVLA combining foam sclerotherapy in day surgery ("1470-nm group"), and 97 patients received 810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery recommended by guidelines ("810-nm group"). No significant difference was found between the 1470-nm group and the 810-nm group in terms of GSV occlusion rate (both 100%), complication rate, and recurrence rate (8.2 vs. 11.3%) during the period of 1-12 months after surgery. Serious complications in the 1470-nm group and 810-nm group were 0 and 1.0%. Minor complications in the 1470-nm group and 810-nm group were ecchymosis at 20.6 and 18.6%, edema at 69.1 and 63.9%, and paresthesia around ankle at 0 and 3.1%, respectively. Advantage of the 1470-nm group over the 810-nm group was statistically significant considering the patient perioperative comfort and economic cost. Treatment of 1470-nm EVLA combining foam sclerotherapy in day surgery has similar efficacy as the 810-nm EVLA with high ligation combining foam sclerotherapy in hospital surgery in GSV insufficiency and is more comfortable with less incision, hospitalization procedure, and medical costs. It may be a new option for patients who are afraid or unable to be hospitalized.

Identifying lower limb specific and generalised joint hypermobility in adults: validation of the Lower Limb Assessment Score.

BACKGROUND: The Lower Limb Assessment Score (LLAS) has only been validated in a paediatric population. The aim of this study was to validate the use of the LLAS in an adult population by: i) evaluating its ability to discriminate between different extents of lower limb hypermobility, ii) establishing a cut-off score to identify lower limb hypermobility, and iii) determining if the LLAS is able to identify Generalised Joint Hypermobility (GJH). METHODS: Participants were recruited across three groups representing varying degrees of hypermobility. They were assessed using the LLAS, Beighton score and clinical opinion. Pearson's correlation coefficient and MANOVA were used to assess between-group differences in the LLAS. The cut-off score was determined using median and inter-quartile ranges and the Receiver Operator Characteristic Curve. The ability of the LLAS to identify GJH was assessed using percent agreement with clinical opinion. RESULTS: One hundred twelve participants aged 18-40 years were recruited. The LLAS distinguished the control from the likely hypermobile and known hypermobile cohorts (both p < 0.001), as well as the likely hypermobile from the known hypermobile cohort (p = 0.003). The LLAS cut-off score for identifying lower limb hypermobility was ≥7/12 with a specificity of 86% and sensitivity of 68%. The LLAS accurately identified those with GJH with high percentage agreement compared to clinical opinion across all cohorts (69-98%). CONCLUSIONS: The LLAS is a valid tool for identifying lower limb specific hypermobility and GJH in adults at a cut-off score of ≥7/12. It demonstrates excellent specificity and moderate sensitivity, and discriminates well between extents of hypermobility.

The Value of Using a SkinFibroMeter for Diagnosis and Assessment of Secondary Lymphedema and Associated Fibrosis of Lower Limb Skin.

BACKGROUND: Skin fibrosis is a clinically serious pathological process of secondary lymphedema (SLE). The detection of latent or incipient skin fibrosis, including early tissue changes, using sensitive diagnostic equipment is essential. The SkinFibroMeter has been used in skin care; however, its ability to assess skin fibrosis in patients with SLE of the lower limb has not been explored. METHODS AND RESULTS: In this study, 45 female patients with secondary unilateral lower limb LE and 15 healthy female volunteers were enrolled. The skin stiffness values of affected and healthy limbs were measured by using the SkinFibroMeter, and skin samples were assayed by Masson staining. The circumference and interstitial fluid of limbs were also measured and analyzed. Increasing skin stiffness with increasing severity of SLE of the lower limb and skin stiffness significantly positively correlated with stage of lower limb SLE. CONCLUSIONS: Our results demonstrate that the SkinFibroMeter is very sensitive and accurate for detecting skin fibrosis of edematous limb. Therefore, this new instrument is a promising prospect for diagnosis and assessment of skin fibrosis in patients with lower limb SLE.