Neuroma morphology: A macroscopic classification system.

INTRODUCTION/AIMS: Neuromas come in different shapes and sizes; yet the correlation between neuroma morphology and symptomatology is unknown. Therefore, we aim to investigate macroscopic traits of excised human neuromas and assess the validity of a morphological classification system and its potential clinical implications. METHODS: End-neuroma specimens were collected from prospectively enrolled patients undergoing symptomatic neuroma surgery. Protocolized images of the specimens were obtained intraoperatively. Pain data (Numeric rating scale, 0-10) were prospectively collected during preoperative interview, patient demographic and comorbidity factors were collected from chart review. A morphological classification is proposed, and the inter-rater reliability (IRR) was assessed. Distribution of neuroma morphology with patient factors, was described. RESULTS: Forty-five terminal neuroma specimens from 27 patients were included. Residual limb patients comprised 93% of the population, of which 2 were upper (8.0%) and 23 (92.0%) were lower extremity residual limb patients. The proposed morphological classification, consisting of three groups (bulbous, fusiform, atypical), demonstrated a strong IRR (Cohen's kappa = 0.8). Atypical neuromas demonstrated higher preoperative pain, compared with bulbous and fusiform. Atypical morphology was more prevalent in patients with diabetes and peripheral vascular disease. DISCUSSION: A validated morphological classification of neuroma is introduced. These findings may assist surgeons and researchers with better understanding of symptomatic neuroma development and their clinical implications. The potential relationship of neuroma morphology with the vascular and metabolic microenvironment requires further investigation.

Temporal localization of upper extremity bilateral synergistic coordination using wearable accelerometers.

Background: The human upper extremity is characterized by inherent motor abundance, allowing a diverse array of tasks with agility and adaptability. Upper extremity functional limitations are a common sequela to Stroke, resulting in pronounced motor and sensory impairments in the contralesional arm. While many therapeutic interventions focus on rehabilitating the weaker arm, it is increasingly evident that it is necessary to consider bimanual coordination and motor control. Methods: Participants were recruited to two groups differing in age (Group 1 (n = 10): 23.4 ± 2.9 years, Group 2 (n = 10): 55.9 ± 10.6 years) for an exploratory study on the use of accelerometry to quantify bilateral coordination. Three tasks featuring coordinated reaching were selected to investigate the acceleration of the upper arm, forearm, and hand during activities of daily living (ADLs). Subjects were equipped with acceleration and inclination sensors on each upper arm, each forearm, and each hand. Data was segmented in MATLAB to assess inter-limb and intra-limb coordination. Inter-limb coordination was indicated through dissimilarity indices and temporal locations of congruous movement between upper arm, forearm, or hand segments of the right and left limbs. Intra-limb coordination was likewise assessed between upper arm-forearm, upper arm-hand, and forearm-hand segment pairs of the dominant limb. Findings: Acceleration data revealed task-specific movement features during the three distinct tasks. Groups demonstrated diminished similarity as task complexity increased. Groups differed significantly in the hand segments during the buttoning task, with Group 1 showing no coordination in the hand segments during buttoning, and strong coordination in reaching each button with the upper arm and forearm guiding extension. Group 2's dissimilarity scores and percentages of similarity indicated longer periods of inter-limb coordination, particularly towards movement completion. Group 1's dissimilarity scores and percentages of similarity indicated longer periods of intra-limb coordination, particularly in the coordination of the upper arm and forearm segments. Interpretation: The Expanding Procrustes methodology can be applied to compute objective coordination scores using accessible and highly accurate wearable acceleration sensors. The findings of task duration, angular velocity, and peak roll angle are supported by previous studies finding older individuals to present with slower movements, reduced movement stability, and a reduction of laterality between the limbs. The theory of a shift towards ambidexterity with age is supported by the finding of greater inter-limb coordination in the group of subjects above the age of thirty-five. The group below the age of thirty was found to demonstrate longer periods of intra-limb coordination, with upper arm and forearm coordination emerging as a possible explanation for the demonstrated greater stability.

Efficacy of robot-assisted gait training on lower extremity function in subacute stroke patients: a systematic review and meta-analysis.

BACKGROUND: Robot-Assisted Gait Training (RAGT) is a novel technology widely employed in the field of neurological rehabilitation for patients with subacute stroke. However, the effectiveness of RAGT compared to conventional gait training (CGT) in improving lower extremity function remains a topic of debate. This study aimed to investigate and compare the effects of RAGT and CGT on lower extremity movement in patients with subacute stroke. METHODS: Comprehensive search was conducted across multiple databases, including PubMed, Web of Science, Cochrane Library, EBSCO, Embase, Scopus, China National Knowledge Infrastructure, Wan Fang, SinoMed and Vip Journal Integration Platform. The database retrieval was performed up until July 9, 2024. Meta-analysis was conducted using RevMan 5.4 software. RESULTS: A total of 24 RCTs were included in the analysis. The results indicate that, compared with CGT, RAGT led to significant improvements in the Fugl-Meyer Assessment for Lower Extremity [MD = 2.10, 95%CI (0.62, 3.59), P = 0.005], Functional Ambulation Category[MD = 0.44, 95%CI (0.23, 0.65), P < 0.001], Berg Balance Scale [MD = 4.55, 95%CI (3.00, 6.11), P < 0.001], Timed Up and Go test [MD = -4.05, 95%CI (-5.12, -2.98), P < 0.001], and 6-Minute Walk Test [MD = 30.66, 95%CI (22.36, 38.97), P < 0.001] for patients with subacute stroke. However, it did not show a significant effect on the 10-Meter Walk Test [MD = 0.06, 95%CI (-0.01, 0.14), P = 0.08]. CONCLUSIONS: This study provides evidence that RAGT can enhance lower extremity function, balance function, walking ability, and endurance levels compared to CGT. However, the quality of evidence for improvements in gait speed remains low.

Choosing ankle tourniquets in foot and ankle surgery: Beyond postoperative pain considerations.

This editorial critically explores the use of ankle vs thigh tourniquets in foot and ankle surgery based on a recent study that found no significant difference in postoperative pain between the two placement techniques. Despite these findings, we argue for the preferential use of ankle tourniquets, highlighting their potential benefits in reducing venous blood stasis and minimizing soft tissue injury. This approach underscores the importance of considering long-term patient outcomes and vascular health beyond immediate postoperative pain. By integrating study findings with broader clinical considerations, we hereby advocate for a nuanced approach to tourniquet use that prioritizes patient safety and long-term recovery in conjunction with immediate postoperative pain.

Development and External Validation of a Motor Intention-Integrated Prediction Model for Upper Extremity Motor Recovery After Intention-Driven Robotic Hand Training for Chronic Stroke.

OBJECTIVE: To derive and validate a prediction model for minimal clinically important differences (MCIDs) in upper extremity (UE) motor function after intention-driven robotic hand training using residual voluntary electromyography (EMG) signals from affected UE. DESIGN: A prospective longitudinal multicenter cohort study. We collected preintervention candidate predictors: demographics, clinical characteristics, Fugl-Meyer assessment of UE (FMAUE), Action Research Arm Test scores, and motor intention of flexor digitorum and extensor digitorum (ED) measured by EMG during maximal voluntary contraction (MVC). For EMG measures, recognizing challenges for stroke survivors to move paralyzed hand, peak signals were extracted from 8 time windows during MVC-EMG (0.1-5s) to identify subjects' motor intention. Classification and regression tree algorithm was employed to predict survivors with MCID of FMAUE. Relationship between predictors and motor improvements was further investigated. SETTING: Nine rehabilitation centers. PARTICIPANTS: Chronic stroke survivors (N=131), including 87 for derivation sample, and 44 for validation sample. INTERVENTIONS: All participants underwent 20-session robotic hand training (40min/session, 3-5sessions/wk). MAIN OUTCOME MEASURES: Prediction efficacies of models were assessed by area under the receiver operating characteristic curve (AUC). The best effective model was final model and validated using AUC and overall accuracy. RESULTS: The best model comprised FMAUE (cutoff score, 46) and peak activity of ED from 1-second MVC-EMG (MVC-EMG 4.604 times higher than resting EMG), which demonstrated significantly higher prediction accuracy (AUC, 0.807) than other time windows or solely using clinical scores (AUC, 0.595). In external validation, this model displayed robust prediction (AUC, 0.916). Significant quadratic relationship was observed between ED-EMG and FMAUE increases. CONCLUSIONS: This study presents a prediction model for intention-driven robotic hand training in chronic stroke survivors. It highlights significance of capturing motor intention through 1-second EMG window as a predictor for MCID improvement in UE motor function after 20-session robotic training. Survivors in 2 conditions showed high percentage of clinical motor improvement: moderate-to-high motor intention and low-to-moderate function; as well as high intention and high function.

Results from a comparative study to evaluate the treatment effectiveness of a nonpneumatic compression device vs an advanced pneumatic compression device for lower extremity lymphedema swelling (TEAYS study).

OBJECTIVE: Advanced pneumatic compression devices (APCDs) have been shown to be effective in treatment of lower extremity lymphedema in the home setting. However, adherence to self-care has been poor, and APCDs require patients to remain immobile during treatment. We evaluated the safety and efficacy of a novel nonpneumatic compression device (NPCD) for treating lower extremity lymphedema vs an APCD. METHODS: A randomized, crossover head-to-head study was performed at nine sites in 2023. Patients were randomized to either the NPCD or a commercially available APCD. Patients used the randomly assigned initial device for 90 days with a 4-week washout period before a comparable 90-day use of the second device. RESULTS: A total of 71 patients (108 affected limbs) with lower extremity lymphedema were analyzed. Compared with the APCD, the NPCD was associated with a greater mean decrease in limb edema volume (a mean limb volume decrease of 369.9 ± 68.19 mL [P < .05] vs 83.1 ± 67.99 mL [P < .05]). Significant improvement in Quality of Life was achieved for NPCD and but not for APCD treatment (score improvement of 1.01 ± 0.23 [P < .05] for NPCD vs 0.17 ± 0.18 [P > .05] for APCD). Patients reported greater adherence (81% vs 56%; P < .001) and satisfaction with the NPCD (78% vs 22%) compared with APCD. No device-related adverse events were reported. CONCLUSIONS: The novel NPCD is an effective treatment for decreasing limb volume in patients with lower extremity lymphedema. The NPCD was more effective than an APCD and resulted in superior limb volume decrease, greater improved quality of life, adherence, mobility, and patient satisfaction.

Optimizing Strategies for Lymphaticovenular Anastomosis in Lower Secondary Extremity lymphedema.

BACKGROUND: Lymphovenous anastomosis (LVA) has become an increasingly common treatment for patients with secondary extremity lymphedema. The objective of this study is to optimize strategies for lower secondary extremity lymphedema using LVA techniques, with the aim of enhancing patient outcomes. METHODS: We conducted a retrospective analysis of 121 patients who underwent LVA at Taizhou Hospital of Zhejiang Province from January 2020 to December 2023. Preoperative and postoperative assessments included f intraoperative observations, functional parameters and clinical outcomes. The efficacy of LVA was evaluated based on circumferential reduction, quality of life improvements (LYMQoL questionnaire), and postoperative complications. RESULTS: This study enrolled 121 patients with lower secondary extremity lymphedema, with an average age of 58.19 years. The results revealed significant associations between incision depth, lymphatic vessel size, the number of LVAs performed, and the number of incisions per patient, all of which correlated with postoperative volume reduction. The resulted analysis that identified optimal incision depths of 10-15 mm, lymphatic vessel size of 0.4-0.6 mm, and a recommended number of 6-8 LVAs. Post-LVA, there was a marked improvement in patients' quality of life, with particularly notable enhancements in functionality and appearance. CONCLUSION: This study findings optimizing the strategy for LVA surgery recommends the depth of incision, the size of lymphatic vessels, and the number of anastomoses to improve the quality of life and limb volume in patients with secondary lymphedema of the lower limbs.

Short Term Temporal Outcomes after Intramedullary Fixation of Lateral Malleolus Fractures.

Ankle fractures are a common intra-articular trauma. The gold standard treatment for unstable ankle fractures has been Open Reduction Internal Fixation with plating and lag screw(s). Advocates for intramedullary nailing of the fibula note decreased wound complications and greater biomechanical strength. We hypothesized that time to union and time to weight bearing would be decreased with a fibular intramedullary nail compared to prior ankle ORIF literature. A retrospective cohort study was conducted of 65 consecutive ankle fracture patients treated with a fibular nail. The median follow-up time was 18.3 months (IQR: 55.4 - 97.6 days). All patients (100%) achieved clinical and radiographic union at a median of 9.6 (IQR: 54 - 78 days) and 10.8 weeks (IQR: 58 - 95 days), respectively. Post-operatively patients bore weight in walking boot and athletic shoe at a median 6.1 and 9.4 weeks, respectively. Fifteen patients suffered complications (23.1%). Patients with history or prior or active smoking were significantly correlated to longer time to union (p=0.016). Time to union also took 0.43 days longer for each additional year of age (t-value 2.13, p-value = 0.038). Nineteen out of 65 patients (29.2%) participated in the Olerud-Molander Ankle Scoring and the median functional outcome score was 71 (IQR: 56 - 93). While fibular nailing has advanced passive range of motion and weight bearing in our institution, time to weight bearing is clouded by surgeon comfort. Further study comparing fibular fracture healing and weight bearing status in regards to intramedullary and plate fixation in needed. LEVEL OF EVIDENCE: IV.

Immediate changes in stroke patients' gait following the application of lower extremity elastic strap binding technique.

Objective: To ascertain the immediate changes in stroke patients' temporal and spatial parameters of gait and the joint angles of stroke patients throughout the entire gait cycle following the application of lower extremity elastic strap binding technique. Methods: Twenty-nine stroke patients were invited as the study participants. The patient seated, flexed the hip and knee, utilized a 5 cm-wide elastic strap, positioning its midpoint beneath the affected foot and crossing it anterior to the ankle joint. Upon standing, the strap encircled the posterior aspect of the lower leg, proceeded around the back of the knee, and ascended the thigh on the affected side. Crossing anteriorly over the thigh, it then encircled the back of the waist before being secured in place. Using Qualisys motion capture system to collect kinematic data of the lower extremities during walking while wearing shoes only or strapping. A paired sample t-test was used to analyze the effects of the technique on gait spatiotemporal parameters and joint angles in stroke patients. Results: The patients' step length decreased (P = 0.024), and step width increased (P = 0.008) during the gait cycle after the strapping. In the gait cycle between 0% and 2%, 7%-77%, and 95%-100%, the hip flexion angle on the affected side was significantly larger after the strapping (P < 0.05). In the gait cycle between 0% to 69% and 94%-100%, the knee flexion angle on the affected side was significantly larger after the strapping (P < 0.05). In the gait cycle between 0% to 57% and 67%-100%, the ankle dorsiflexion angle on the affected side was significantly smaller after the strapping (P < 0.05), and in the gait cycle between 0% to 35% and 68%-100%, the ankle inversion angle on the affected side was significantly smaller after the strapping (P < 0.05). Conclusion: The lower extremity elastic strap binding technique can decrease the hip flexion and knee flexion limitations in stroke patients during walking, and reduce the ankle plantar flexion and ankle inversion angle of stroke patients. The lower extremity elastic strap binding technique enabled stroke patients to adopt a more stable gait pattern.

Do osteophytes alter thumb carpometacarpal Biomechanics? a preliminary in vitro study.

Osteoarthritis (OA) of the thumb carpometacarpal (CMC) joint is prevalent and debilitating, marked by substantial loss of range of motion (ROM) and overall function. CMC OA is associated with osteophyte growth, but the impact of this growth on CMC ROM has not been systematically characterized. Our goal was to determine whether osteophytes decrease CMC ROM and, if so, whether these decreases are direction-dependent. A robotic musculoskeletal simulation system was used to manipulate 18 CMC specimens with a range of joint health following three test protocols: (1) Rotational ROM in flexion, extension, abduction, adduction, and 20 combined directions, (2) Internal/External Rotation (IR/ER), and (3) Translational ROM in volar, dorsal, radial, ulnar, and 4 combined directions. Osteophyte volume (OV) was computed in total and by volar, dorsal, radial, and ulnar quadrants, and correlations with ROM were computed by direction and in total. We found that an increase in overall trapezial OV was associated with a reduction in overall rotational ROM and IR/ER, but not with translational ROM. We found decreased extension was associated with increased ulnar, volar, and radial OV, and decreased abduction was associated with increased volar OV. Decreased internal rotation was associated with increased ulnar, volar, and radial OV. The proposed method and findings of this pilot study will lay the groundwork for a larger investigation into the relationship between pathological structure and function in the CMC joint.

A systematic review and meta-analysis on effect of different exercise training on grip strength and upper extremity muscle strength in patients with type 2 diabetes mellitus.

BACKGROUND: Individuals with type 2 diabetes mellitus (T2DM) are prone to musculoskeletal complications, particularly in the upper extremities (UE), which can significantly impair their grip strength and UE muscle strength. This review will provide valuable insights for developing optimized exercise interventions aimed at enhancing upper limb functionality and improving patient outcomes. AIM: To determine the effect of different exercise training on grip strength & UE muscle strength in patients suffering from T2DM. METHODOLOGY: A comprehensive search from electronic databases was performed based on the selection criteria and 13 randomized controlled trials (RCT's) were included in the study. Mean changes in grip strength and UE muscle strength were the primary outcome measures. Included studies ranked high on the PEDro rating scale and eta-analysis was performed by Rev Man 5.4 software. RESULTS: Meta-analysis results indicated that there was a statistically significant improvement in UE muscle strength of experimental group when compared to control group (mean differences [MD] = 2.91, 95% confidence interval = 0.12, 5.71; p = 0.04) with moderate heterogeneity (I2 = 49%, p < 0.07). Grip strength improved significantly in the experimental group when compared to the control group with (MD = 2.93, 95% CL = -0.00, 5.86; p = 0.05) and moderate heterogeneity (I2 = 66%, p < 0.08). CONCLUSION: This review indicated a positive role of supervised resistance & aerobic exercises on UE muscle strength in patients with T2DM. Due to lack of RCT's, grip strength needs to be explored by further investigations in these patients.

Ultrasound-guided percutaneous thrombin injection for the management of upper extremity pseudoaneurysms: 20 years of tertiary care center experience.

PURPOSE: To evaluate the safety and efficacy of ultrasound-guided percutaneous thrombin injection for the treatment of upper extremity pseudoaneurysms. METHODS: An institutional database containing 8,316,467 radiology reports was searched for suitable cases over a 241-month period. Fourteen female and 10 male patients, average age of 69.7 years (range 29-93) underwent a total of 26 procedures for the management of upper extremity pseudoaneurysms, involving the radial (n = 9), brachial (n = 9) or other upper extremity arteries (n = 6). Baseline demographic and pseudoaneurysm characteristics were documented, together with primary and secondary success, failures, and complications. All procedures were performed with real-time ultrasound guidance. RESULTS: The mean pseudoaneurysm volume was 9.93 cm3 (range 0.06-111.62 cm3). Twelve cases were related to central line placement or arterial access. Primary success was obtained in 50% (n = 12) after a single ultrasound-guided thrombin injection, and secondary success was achieved in an additional six (for a total success of 75%). Success was highest for the treatment of brachial artery pseudoaneurysms (87.5%), and in those who were diagnosed within 7 days of the inciting event, findings that were statistically significant (p-value 0.046 and 0.002, respectively). CONCLUSIONS: Ultrasound-guided percutaneous thrombin injection is safe and effective for managing upper extremity pseudoaneurysms.

Identifying the content of the Lower Extremity Motor Activity Log based on the International Classification of Functioning, Disability and Health.

PURPOSE: To identify the content and the constructs measured in the Lower Extremity Motor Activity Log (LE-MAL) based on the International Classification of Functioning, Disability and Health (ICF) framework and to determine whether the instrument items fit within the ICF mobility domain. METHODS: Concepts and constructs measured within each scale were linked to the best-matched ICF categories and classified using established linking rules. Two independent researchers determined the initial linkages. A final consensus was reached with the other researchers. The agreement was analysed through the agreement percentage and the kappa coefficient. RESULTS: The subscales assess performance through information about need or dependency, personal and environmental factors, and appraisal of the items. Thirteen concepts were identified in LE-MAL: two concepts for the Assistance Scale are covered in the environmental factors component; 10 concepts for the Functional Performance Scale where all items are covered in the mobility domain; one concept for the confidence scale is covered in the body functions component. CONCLUSIONS: The general construct of LE-MAL assessed is performance in the ICF mobility domain and provides additional information about the mental function, environmental factors, independence, appraisal, and personal factors. The study highlighted the conceptual connection between the LE-MAL and the ICF framework.

The use of the lower extremities influences the quality and independence of gait in neurological populations.No studies have analysed the Lower Extremity Motor Activity Log (LE-MAL) content with a theoretical framework.Theoretical framework linkage complements the content validity of the LE-MAL.Linking with the International Classification of Functioning, Disability and Health (ICF) aids clinics in report writing and treatment planning.

Trends in inpatient versus outpatient upper extremity fracture surgery from 2008 to 2021 and their implications for equitable access: a retrospective cohort study.

PURPOSE: The aim of this study is to describe trends in inpatient and outpatient upper extremity fracture surgery between 2008 and 2021, along with identifying patient factors (age, sex, race, socioeconomic status) associated with outpatient surgery. METHODS: Retrospectively, 12,593 adult patients who underwent upper extremity fracture repair from 2008 to 2021 at one of five urban hospitals in the Northeastern USA were identified. Using Distressed Communities Index (DCI), patients were divided into five quintiles based on their level of socioeconomic distress. Multivariable logistic regression was performed on patients from 2008 to 2019 to identify independent factors associated with outpatient management. RESULTS: From 2008 to 2019, outpatient procedures saw an average increase of 31%. The largest increases in the outpatient management were seen in humerus (132%) and forearm fractures (127%). Carpal and hand surgeries had the lowest percent increase of 8.1%. Clavicle and wrist fractures were independently associated with outpatient management. Older age, male sex, higher Elixhauser comorbidity index, DCI scores in the 4th or 5th quintile, and fractures of the scapula, humerus, elbow, and forearm were associated with inpatient management. During the onset of the COVID-19 pandemic, there was a decrease in outpatient procedures. CONCLUSION: There is a shift toward outpatient surgical management of upper extremity fractures from 2008 to 2021. Application of our findings can serve as an institutional guide to allocate patients to appropriate surgical settings. Moreover, physicians and institutions should be aware of the potential socioeconomic disparities and implement plans to allow for equal access to care.

A Rare Presentation of Becker's Nevus on the Lower Extremity With Dermoscopic Features: A Case Report.

Becker's nevus (BN) is a unilateral epidermal hamartoma that presents as a hyperpigmented and hypertrichotic lesion, typically appearing during adolescence. While BN frequently occurs on the upper trunk and proximal upper limbs, its manifestation on the lower limb is rare. Dermoscopy serves as a helpful diagnostic tool alongside clinical examination, revealing features such as pigment networks, hypertrophic follicles, and distinct skin furrows. We presented a case of a 17-year-old boy with typical dermoscopic features of BN located on the lower extremity. Although there is no definitive treatment for BN, most therapeutic interventions are primarily aimed at improving cosmetic appearance. In cases like ours, where the patient is not concerned about the cosmetic aspect, treatment may not be necessary. Laser therapies, in particular, have been shown to be effective in treating BN. There are no reported cases of malignant transformation in the literature. While associations with conditions such as malignant melanoma, vitiligo, and various skin appendages have been documented in case reports, BN is generally considered a benign clinical condition in most patients.

A Rare Presentation of Cryoglobulinemic Vasculitis Associated with Primary Sjögren's Syndrome.

INTRODUCTION: Sjögren's syndrome is a chronic autoimmune disorder that results in dry eyes and mouth. It is rarely associated with cryoglobulinemia, the agglutination of cryoglobulins at cold temperatures that leads to systemic inflammation and organ damage. We have, herein, presented a case of Cryoglobulinemic Vasculitis (CryoVas), which presents as cryoglobulinemic glomerulonephritis and Central Nervous System (CNS) vasculitis and peripheral neuropathy. CASE REPORT: A 52-year-old woman with a past medical history of Sjögren's syndrome was admitted to the intensive care unit with severe hyponatremia, orthopnea, and progressive lower extremity weakness, and was found to have an intradural extramedullary hematoma with mass effect in the thoracic spine and diffuse hyperintense cord signal abnormality in thoracic spine suggestive of intermixed proteinaceous or hemorrhagic material. Further testing demonstrated that the patient experienced worsening neuropathy, proteinuria, hematuria, declining renal function, and the presence of cryoglobulins in the blood. After a thorough examination and a renal biopsy, the patient was diagnosed with cryoglobulinemic glomerulonephritis and cryoglobulinemic vasculitis of the spine. The patient was treated with rituximab and pulse-dose steroids, with which the patient exhibited improved renal function and resolution of a previously seen intradural hematoma on repeat MRI. CONCLUSION: We have, herein, discussed a rare case of cryoglobulinemic vasculitis that has led to a rare CNS manifestation and concomitant cryoglobulinemic glomerulonephritis. This suggests that clinicians should consider cryoglobulinemic vasculitis as the etiology that could manifest with multiorgan involvement, especially in patients with underlying rheumatic diseases.

Effects of motor imagery-based brain-computer interface-controlled electrical stimulation on lower limb function in hemiplegic patients in the acute phase of stroke: a randomized controlled study.

Background: Lower limb motor dysfunction is one of the most serious consequences of stroke; however, there is insufficient evidence for optimal rehabilitation strategies. Improving lower limb motor function through effective rehabilitation strategies is a top priority for stroke patients. Neuroplasticity is a key factor in the recovery of motor function. The extent to which neuroplasticity-based rehabilitation therapy using brain-computer interface (BCI) is effective in treating lower limb motor dysfunction in acute ischemic stroke patients has not been extensively investigated. Objective: This study aimed to assess the impact of BCI rehabilitation on lower limb motor dysfunction in individuals with acute ischemic stroke by evaluating motor function, walking ability, and daily living activities. Methods: This study was conducted in a randomized controlled trial, involving 64 patients with acute ischemic stroke who experienced lower limb motor dysfunction. All patients were divided into two groups, with 32 patients assigned to the control group was given conventional rehabilitation once a day for 70 min, 5 times a week for 2 weeks, and the experimental group (n = 32) was given BCI rehabilitation on top of the conventional rehabilitation for 1 h a day, 30 min of therapy in the morning and an additional 30 min in the afternoon, for a total of 20 sessions over a two-week period. The primary outcome was lower extremity motor function, which was assessed using the lower extremity portion of the Fugl-Meyer Rating Scale (FMA-LE), and the secondary endpoints were the Functional Ambulation Scale (FAC), and the Modified Barthel index (MBI). Results: After 20 sessions of treatment, both groups improved in motor function, walking function, and activities of daily living, and the improvements in FMA-LE scores (p < 0.001), FAC (p = 0.031), and MBI (p < 0.001) were more pronounced in the experimental group compared with the control group. Conclusion: Conventional rehabilitation therapy combined with BCI rehabilitation therapy can improve the lower limb motor function of hemiplegic patients with stroke, enhance the patient's ability to perform activities of daily living, and promote the improvement of walking function, this is an effective rehabilitation policy to promote recovery from lower extremity motor function disorders.

Ultrasonographic assessment of the risk of free-floating thrombus detachment in the lower extremity deep veins in patients with fracture.

OBJECTIVE: To explore the ultrasonographic features and influencing factors of free-floating thrombus (FFT) detachment in the lower extremity deep veins (LEDVs) of patients with fractures. METHODS: Clinical data of patients diagnosed with FFT in the LEDVs and implanted with an inferior vena cava filter (IVCF) in our hospital between July 2021 and August 2023 were retrospectively analysed. The patients were divided into the thrombus detachment group (the experimental group, n = 92) and the non-thrombus detachment group (the control group, n = 103) based on the presence of detached thrombus in the IVCF. The effects of thrombus echogenicity, floating degree, thrombus location, thrombin time, D-dimer and fibrinogen on thrombus shedding were analysed. The nomogram method was used to establish the model and predict the probability of delayed postoperative recovery. RESULTS: The proportions of patients with extremely hypoechoic thrombus and medium and high floating degrees increased in the experimental group compared with those in the control group, and the differences between the two groups were statistically significant (P < 0.05). Extremely hypoechoic thrombus (P = 0.021, 95 % CI: 1.109-13.748) and high (P = 0.001, 95 % CI: 3.854-28.573) and medium floating degrees (P = 0.004, 95 % CI: 1.792-13.453) were risk factors for deep veins FFT (DV FFT) detachment. The results of receiver operating characteristic curve analysis showed that the area under the curve of the model was 0.893, with a 95 % CI of 0.856-0.937, indicating a high prediction accuracy. CONCLUSION: Ultrasonographic parameters, including thrombus echogenicity and floating degree, are valuable in predicting DV FFT detachment in patients with traumatic fractures, providing references for IVCF implantation.

Different strategies for landing from different heights among people with chronic ankle instability.

BACKGROUND: Lateral ankle sprain (LAS) usually occurs during landing from heights among people with chronic ankle instability (CAI). Although the kinematics when landing on the flat surface has been reported, no studies have explored the effect of different heights on the landing strategies using a trapdoor device among people with CAI. RESEARCH QUESTION: Do people with CAI adopt different landing strategies when drop-landing on the trapdoor device from three heights? METHODS: Thirty-one participants with CAI (24 males and 7 females, age=21.1±1.8 years, height=176.9±7.4 cm, body mass=71.9±9.2 kg, injured side=18 R&13 L) were recruited. They dropped from three different heights (low height (16 cm), medium height (23 cm), high height (30 cm)) with their affected foot landing on a movable surface of a trapdoor device, which was tilted 24° inward and 15° forward to simulate LAS. Kinematic data was collected using a twelve-camera motion capture system. One-way analysis of variance with repeated measures was used to compare the differences between the three heights. RESULTS: Significant height effects were detected in the peak ankle inversion angle (p=0.009, η2p=0.280) and angular velocity (p<0.001, η2p=0.444), and the peak ankle plantarflexion (p=0.002, η2p=0.360), knee flexion (p<0.001, η2p=0.555), and hip flexion (p=0.030, η2p=0.215) angles at the time of peak ankle inversion. Post-hoc tests showed that all the angles and velocities were higher at a low height than at medium (p: 0.001-0.045, d: 0.14-0.44) and high heights (p: 0.001-0.023, d: 0.28-0.66), except for the ankle plantarflexion angle, which was lower at a low height than at medium (p<0.001, d=0.44) and high (p=0.021, d=0.38) heights. SIGNIFICANCE: People with CAI adopt a protective strategy during drop-landing at medium and high heights compared to a low height. This strategy involves increased ankle dorsiflexion angle as well as knee and hip flexion angles.

Short-latency afferent inhibition and its relationship to covert sensory and motor hand impairment in multiple sclerosis.

OBJECTIVE: To investigate sensorimotor integration by quantifying short-latency afferent inhibition (SAI) in people with MS who experience manual dexterity problems compared to controls. METHODS: 22 people with MS with self-reported manual dexterity problems and 10 sex and age-matched controls were assessed using various upper extremity clinical tests. SAI was assessed by a transcranial magnetic stimulation pulse over the primary motor cortex preceded by peripheral nerve stimulation to the median nerve at 6 interstimulus intervals 2 - 8 ms longer than individualized N20 latencies. RESULTS: Although within normal limits, persons with MS exhibited significantly slower Nine Hole Peg Test performance and pinch strength in the dominant hand. They also exhibited greater sensory impairment (monofilament test) in the dominant hand. Persons with MS showed significantly greater disinhibition of SAI in the dominant hand compared to controls, which was significantly correlated with weaker pinch strength. CONCLUSION: Reduced SAI in people with MS, particularly in the dominant hand, signifies disruptions in cortical cholinergic inhibitory activity and is associated with lower pinch strength. SIGNIFICANCE: Evaluating changes in SAI may offer insight into the disrupted cortical cholinergic inhibitory activity that contributes to sensorimotor disintegration, potentially advancing disease management in persons with MS.