Plerixafor for pathogen-agnostic treatment in murine thigh infection and zebrafish sepsis.

Plerixafor is a CXCR4 antagonist approved in 2008 by the FDA for hematopoietic stem cell collection. Subsequently, plerixafor has shown promise as a potential pathogen-agnostic immunomodulator in a variety of preclinical animal models. Additionally, investigator-led studies demonstrated plerixafor prevents viral and bacterial infections in patients with WHIM syndrome, a rare immunodeficiency with aberrant CXCR4 signaling. Here, we investigated whether plerixafor could be repurposed to treat sepsis or severe wound infections, either alone or as an adjunct therapy. In a Pseudomonas aeruginosa lipopolysaccharide (LPS)-induced zebrafish sepsis model, plerixafor reduced sepsis mortality and morbidity assessed by tail edema. There was a U-shaped response curve with the greatest effect seen at 0.1 µM concentration. We used Acinetobacter baumannii infection in a neutropenic murine thigh infection model. Plerixafor did not show reduced bacterial growth at 24 h in the mouse thigh model, nor did it amplify the effects of a rifampin antibiotic therapy, in varying regimens. While plerixafor did not mitigate or treat bacterial wound infections in mice, it did reduce sepsis mortality in zebra fish. The observed mortality reduction in our LPS model of zebrafish was consistent with prior research demonstrating a mortality benefit in a murine model of sepsis. However, based on our results, plerixafor is unlikely to be successful as an adjunct therapy for wound infections. Further research is needed to better define the scope of plerixafor as a pathogen-agnostic therapy. Future directions may include the use of longer acting CXCR4 antagonists, biased CXCR4 signaling, and optimization of animal models.

Giant thigh hemosiderotic/aneurysmal dermatofibroma: Case report with radiologic-pathologic correlation.

Hemosiderotic/aneurysmal variant of dermatofibroma (DF) is infrequent and may be misdiagnosed with malignant lesions. We report the case of a giant (7.6cm) subcutaneous hemosiderotic/aneurysmal DF (H/ADF) of the thigh in a 53-year-old female patient. Internal arterial and venous hypervascularity was seen by spectral Doppler ultrasound. Magnetic resonance image showed a discrete homogeneous hypointense in T1-weighted images (WI) and T2-WI mass, with hyperintense areas in fat-suppressed T2-WI. The histology revealed a monotonous fusocelular proliferation without atypia, positive for CD163, factor XIIIa and CD10. Widely distributed hemosiderin pigment and two blood-filled pseudovascular spaces lacking endothelial lining were present. H/ADF was diagnosed. The mass was removed but surgical margins were affected. The patient did not present local relapse or distant metastasis. H/ADF are unusual cutaneous soft tissue tumours that can be clinically, radiologically and histopathologically confused with malignant lesions such as melanomas, vascular lesions or sarcomas, especially in giant cases.

Effects of a physical exercise programme on bodyweight, body condition score and chest, abdominal and thigh circumferences in dogs.

BACKGROUND: Research on the effects of physical exercise on canine body composition is limited. The aim of this study was to investigate the effects of a physical exercise programme on bodyweight, body condition score (BCS) and chest, abdominal and thigh circumferences in dogs. Twenty-one healthy dogs of different breeds exercised together with their owners during an eight-week programme consisting of jogging and strength exercises. Standardised measurements were performed in triplicates with a measuring tape on standing dogs. Chest circumference was measured at three anatomical locations, abdomen at two and thigh at one. Data on bodyweight, BCS (9-point scale) and circumferences were analysed with mixed model repeated measures analyses to evaluate changes after the programme and effects of target distance. RESULTS: Seven dog owners choose a target distance of 2 km and 14 owners choose 5-10 km. Mean BCS decreased (P = 0.007) after the programme (5.1 ± 0.9 vs. 4.7 ± 0.6) but there was no effect of target distance. Almost all chest and abdominal circumference measurements decreased (P ≤ 0.007) with the 2 km group driving the reduction in chest circumference and the 5-10 km group driving the reduction in abdominal circumference. In contrast, thigh circumference (28.8 ± 0.4 vs. 30.2 ± 0.4) increased (P = 0.007) while bodyweight was maintained. There were positive correlations between BCS and abdominal/chest ratios before and after the programme (Pearson correlation; R square ≤ 0.43, P ≤ 0.0012) but the mean ratio remained constant. CONCLUSIONS: Results indicated a redistribution between total body fat and muscle mass in body composition of normal weight to slightly overweight dogs after the physical exercise programme. The use of bodyweight alone was not a reliable evaluation method to complement the BCS assessment. However, repeated measurements of chest, abdominal and thigh circumference might aid in the assessment of body composition in dogs performing physical exercise. Further research should include a control group and objective evaluations of total body fat and lean mass, in order to investigate the effectiveness of physical exercise as a freestanding method for decreasing BCS and increasing muscle mass in overweight dogs.

Thigh-worn accelerometry: a comparative study of two no-code classification methods for identifying physical activity types.

BACKGROUND: The more accurate we can assess human physical behaviour in free-living conditions the better we can understand its relationship with health and wellbeing. Thigh-worn accelerometry can be used to identify basic activity types as well as different postures with high accuracy. User-friendly software without the need for specialized programming may support the adoption of this method. This study aims to evaluate the classification accuracy of two novel no-code classification methods, namely SENS motion and ActiPASS. METHODS: A sample of 38 healthy adults (30.8 ± 9.6 years; 53% female) wore the SENS motion accelerometer (12.5 Hz; ±4 g) on their thigh during various physical activities. Participants completed standardized activities with varying intensities in the laboratory. Activities included walking, running, cycling, sitting, standing, and lying down. Subsequently, participants performed unrestricted free-living activities outside of the laboratory while being video-recorded with a chest-mounted camera. Videos were annotated using a predefined labelling scheme and annotations served as a reference for the free-living condition. Classification output from the SENS motion software and ActiPASS software was compared to reference labels. RESULTS: A total of 63.6 h of activity data were analysed. We observed a high level of agreement between the two classification algorithms and their respective references in both conditions. In the free-living condition, Cohen's kappa coefficients were 0.86 for SENS and 0.92 for ActiPASS. The mean balanced accuracy ranged from 0.81 (cycling) to 0.99 (running) for SENS and from 0.92 (walking) to 0.99 (sedentary) for ActiPASS across all activity types. CONCLUSIONS: The study shows that two available no-code classification methods can be used to accurately identify basic physical activity types and postures. Our results highlight the accuracy of both methods based on relatively low sampling frequency data. The classification methods showed differences in performance, with lower sensitivity observed in free-living cycling (SENS) and slow treadmill walking (ActiPASS). Both methods use different sets of activity classes with varying definitions, which may explain the observed differences. Our results support the use of the SENS motion system and both no-code classification methods.

The free vastus lateralis-And conjoined vastus lateralis anterolateral thigh/tensor fascia lata flap for oncological chest wall reconstruction.

INTRODUCTION: A reconstructive option for extensive chest wall reconstruction is the free myocutaneous vastus lateralis muscle (VL) flap which can be performed in isolation or in conjunction with a fasciocutaneus anterolateral thigh (cVLALT) and/or myofasciocutaneous tensor fascia lata flap (cVLTFL). We aimed to directly compare the outcomes of these reconstructive options. METHODS: Patients who underwent oncological chest wall reconstruction with a free VL, cVLALT, or cVLTFL flap between February 2010 and 2022 were included in this retrospective study. Patient demographics, surgical characteristics, as well as medical and reconstructive outcomes, were evaluated. The operative outcomes between myocutaneous VL, cVLALT, and cVLTFL flap reconstructions were compared. RESULTS: A total of 41 patients underwent chest wall reconstruction with a free myocutaneous VL (n = 25; 61%), cVLALT (n = 14; 34%), or cVLTFL Three acute flap thromboses occurred in the entire cohort (3/41, 7%), with one myocutaneous VL flap failing because of recurrent venous thrombosis during the salvage procedure. Total flap necrosis was seen in two cases (5%; VL flap: n = 1; cVLALT flap: n = 1), and partial flap necrosis in one VL flap (1/25, 4%) and in the distal ALT portion of three cVLALT flaps (3/14, 21%). No significant difference was seen between isolated VL and conjoined VL flaps regarding the partial (p = .28) or total flap necrosis rate (p = .9). CONCLUSION: The free (conjoined) VL flap provides reliable outcomes for obliterating dead space achieving durable reconstruction of complex chest wall defects.

Bilateral Persistent Sciatic Artery - An Infrequent Occurrence: A Case Report with Review of Literature.

A persistent sciatic artery (PSA) is a rare congenital vascular anomaly with an extremely low incidence of about 0.04%-0.06%. It is due to the persistence of the embryological axial limb artery, representing a continuation of the internal iliac artery into the thigh through the greater sciatic foramen below the piriformis muscle and down the thigh alongside the sciatic nerve. In normal embryologic development of the lower limb, the axial artery normally regresses after week 12. Persistent sciatic artery is often asymptomatic until a complication develops, it can be classified into two types, complete and incomplete. PSA can cause serious lower limb complications such as acute or critical limb ischemia.

RésuméUne artère sciatique persistante (APS) est une anomalie vasculaire congénitale rare avec une incidence extrêmement faible d'environ 0,04 % à 0,06 %. Cela est dû à la persistance de l'artère axiale embryologique des membres, représentant une continuation de l'artère iliaque interne dans la cuisse à travers la grande foramen sciatique sous le muscle piriforme et le long de la cuisse le long du nerf sciatique. Dans le développement embryologique normal de la partie inférieure membre, l'artère axiale régresse normalement après la semaine 12. L'artère sciatique persistante est souvent asymptomatique jusqu'à ce qu'une complication se développe, elle peut être classés en deux types, complets et incomplets. Le PSA peut entraîner des complications graves des membres inférieurs telles qu'une ischémie aiguë ou critique des membres.

Clinical and morphological features of eccrine acrospiroma: analysis of literature data and case from practice.

Eccrine acrospiroma is a rare benign tumor of the skin arising from the epithelial cells of eccrine sweat ducts. The clinical picture is characterized by its variability, so a detailed morphological study of the operative material is necessary to establish a diagnosis. Differential diagnosis must be carried out with hemangioma, melanoma, infected sebaceous cyst, metastatic skin lesion, and other tumors from elements of the sweat gland. In the article the authors presented the clinical and morphological analysis of own case from practice of large eccrine acrospiroma on the back surface of the left thigh which was diagnosed in a 56-year-old man.

Pedicled SCIP-based vascularized lymphnode and lymphatic vessels transfer (VLNT and VLVT) for deep lymphatic system reconstruction and dead space obliteration after medial thigh sarcoma resection: A case report.

Soft-tissue sarcomas represent a cohort of rare and heterogeneous malignant tumors that could affect various body parts, with a higher incidence in the lower extremity. When these tumors are surgically removed, both the superficial and deep lymphatic pathways could also be damaged and might require immediate reconstruction to prevent lymphatic complications. In the present report, we describe a case of a patient affected by a high-grade (G3) spindle cell pleomorphic rhabdomyosarcoma of the upper medial thigh. A 22 × 20 cm mass was removed with exposure of the deep femoral vessels and the great saphenous vein. After intraoperative indocyanine green lymphography, it was determined that the superficial lymphatic vessels were intact, but the deep lymphatic system was unavoidably damaged. As a reconstructive procedure, we performed a pedicled SCIP-based vascularized lymphatic vessel transfer and vascularized lymph node transfer to restore the deep lymphatic system and dead space obliteration. The procedure was successful, and no signs of lymphatic impairment were observed during the two-year follow-up period. We believe that this novel approach might be helpful in cases of large and profound defects that involve the deep lymphatic system. The combination of these two techniques could help restore deep lymph drainage, minimizing the risk of superficial system overload and lymphatic dysfunction. No other cases have been described so far employing the same approach. Considering the obtained results, this procedure might be worth further investigation.

Posterior thigh muscles activity during the active H-test: An electromyographic and kinematic analysis.

The Askling's H-test is considered a useful return to play criterion after a hamstring muscle injury (HMI). However, it assesses only the active and passive flexibility of posterior thigh muscles. This may lead the practitioner to underestimate a compensation or abnormal movement pattern. The aim of this study was to analyze these kinematic aspects and their reliability, and evaluate the hamstring (HM) and gluteus maximus (GM) muscles' activities. Twelve healthy male volunteers were tested during two session of three trials for passive and active tests. Dynamic flexibility (97.2 ± 6.0°) was significantly greater than the passive one (70.5 ± 14.7°) (p < 0.001), and good intra-individual reproductibility for most kinematic characteristics was observed. Biceps Femoris long head, semitendinosus and GM mean activities (20.1 ± 11.2%; 14.3 ± 7.3% and 25.2 ± 22.1%, respectively) were found to be low to moderate, indicating that only a moderate level of activity occurred during the active H-test, in comparison to other movements such as sprinting itself. In addition, the activity of the posterior thigh muscles during the active H-test appeared to be variable among the volunteers. These findings suggest that the H-test should be interpreted on an individual basis rather than relying on general characteristics, and be considered as an intermediate tool before more strenuous activities such as returning to sprint. With this comprehensive approach, clinicians can gain a more accurate understanding of their patients' progress and make more informed decisions about their readiness to return to play.

Thigh muscle mass evaluated by point-of-care ultrasound is associated with short-term mortality in patients with sepsis in the emergency department.

Muscle mass depletion is associated with mortality and morbidity in various conditions including sepsis. However, few studies have evaluated muscle mass using point-of-care ultrasound in patients with sepsis. This study aimed to evaluate the association between thigh muscle mass, evaluated using point-of-care ultrasound with panoramic view in patients with sepsis in the emergency department, and mortality. From March 2021 to October 2022, this prospective observational study used sepsis registry. Adult patients who were diagnosed with sepsis at the emergency department and who underwent point-of-care ultrasounds for lower extremities were included. The thigh muscle mass was evaluated by the cross-sectional area of the quadriceps femoris (CSA-QF) on point-of-care ultrasound using panoramic view. The primary outcome was 28 day mortality. Multivariable Cox proportional hazard model was performed. Of 112 included patients with sepsis, mean CSA-QF was significantly lower in the non-surviving group than surviving group (49.6 [34.3-56.5] vs. 63.2 [46.9-79.6] cm2, p = 0.002). Each cm2 increase of mean CSA-QF was independently associated with decreased 28 day mortality (adjusted hazard ratio 0.961, 95% CI 0.928-0.995, p = 0.026) after adjustment for potential confounders. The result of other measurements of CSA-QF were similar. The muscle mass of the quadriceps femoris evaluated using point-of-care ultrasound with panoramic view was associated with mortality in patients with sepsis. It might be a promising tool for determining risk factors for mortality in sepsis patients in the early stages of emergency department.

Primary Lymphovenous Anastomosis After Extended Soft Tissue Resection in the Medial Thigh for Reduction of Lymphocele and Lymphedema.

INTRODUCTION: Postoperative chronic lymphocele and lymphedema represent severe burdens for soft tissue sarcoma patients who are already physically handicapped after an extensive surgery and a long recovery time. Incidences are high in the upper medial thigh. We have shifted our focus to lymphedema and lymphocele risk reduction with immediate lymphovenous anastomosis (LVA) after sarcoma resection. METHODS: We performed immediate lymphatic reconstruction in 11 patients after soft tissue sarcoma resection in the upper medial thigh. The postoperative course was followed up closely, and postoperative occurrence of lymphocele and lymphedema was clinically assessed. A literature search outlining the latest clinical data, current treatment strategy landscape, and their application into clinical practice was added to the investigation. RESULTS: A total of 19 LVA and 2 lympho-lymphatic anastomoses were performed in 11 patients immediately after tumor resection in an end-to-end manner. We found a postoperative lymphedema rate of 36% and a postoperative lymphocele rate of 27%. Mean follow-up time was 17 months. Average tumor volume was 749 cc. Our literature search yielded 27 articles reporting on immediate LVA in cancer patients. Incidences of secondary lymphedema after LVA for lymphedema prevention vary between 0% and 31.1%. Lymphocele prevention with LVA is poorly studied in sarcoma patients. CONCLUSION: Immediate lymphatic reconstruction improved the overall postoperative course of our patients. The current literature does not serve with high-quality studies about primary LVA preventing lymphedema and lymphocele formation. We conclude that this technique should be seen as an additional concept to achieve overall better postoperative outcomes in these challenging surgical settings. We strongly recommend to either anastomose or ligate severed lymphatics under the microscope primarily after sarcoma resection in the upper medial thigh area.

The human dermal white adipose tissue (dWAT) morphology: A multimodal imaging approach.

BACKGROUND: Dermal white adipose tissue (dWAT) in humans can be characterized as a relaxed dermal skin compartment consisting of functionally interlinked adipocytes. dWAT is typically discerned both in terms of morphology and function from subcutaneous white adipose tissue (sWAT). In particular in human thigh, the dWAT appears as thin extensions from the adipose panniculus to the dermis, and it is primarily associated with pilosebaceous units, hair follicles, sebaceous glands, and erector pili muscles. In this work, human fat tissue samples obtained post-mortem from the gluteo-femoral region were analyzed focusing on the thin extensions of dWAT named dermal cones. This anatomical region was chosen to deepen the dWAT morphological features of this site which is interesting both for clinical applications and genetical studies. The purpose of this exploratory methodological study was to gain deeper insights into the morphological features of human dWAT through a multimodal imaging approach. METHODS: Optical microscopy, Magnetic Resonance Imaging (MRI) and Scanning Electron Microscopy (SEM), have been employed in this study. The cones' length and their distances were measured on the acquired images for optical microscopy and SEM. The cone's apparent regular distribution in MRI images was evaluated using a mathematical criterion, the conformity ratio, which is the ratio of the mean nearest-neighbor distance to its standard deviation. RESULTS: The imaging techniques revealed white adipocytes forming a layer, referred to as sWAT, with cones measuring nearly 2 mm in size measured on SEM and Optical images (2.1 ± 0.4 mm), with the lower part embedded in the sWAT and the upper part extending into the dermis. The distance between the cones results about 1 mm measured on MRI images and they show an overall semiregular distribution. CONCLUSIONS: MRI images demonstrated an orderly arrangement of cones, and their 3D reconstruction allowed to elucidate the dermal cones' disposition in the tissue sample and a more general comprehensive visualization of the entire fat structure within the dermis.

Pushing boundaries: Anterolateral thigh free flaps for extensive scalp defects beyond previous limits, leveraging imaging modalities with ultrasound and indocyanine green.

BACKGROUND: Scalp defect reconstruction poses considerable challenges, with ongoing debates regarding the most effective strategies. While the latissimus dorsi (LD) flap has traditionally been favored, the anterolateral thigh (ALT) flap has been well described as a versatile alternative for addressing extensive scalp defects. This study underscores the success of scalp reconstruction using ALT flaps, notably pushing the boundaries of previously reported flap sizes. Our approach leverages the use of indocyanine green (ICG) perfusion to guide precise preoperative planning and vascular modification, contributing to improved outcomes in challenging cases. METHODS: We performed 43 ALT flap reconstructions for scalp defects between 2016 and 2023. We collected patients' demographic and clinical data and evaluated flap size and recipient vessels and additional surgical techniques. Detailed preoperative plans with ultrasound and ICG use for intraoperative plans were performed to find perforators location. The cohort was divided into two, with or without complications on flaps, and analyzed depending on its surgical details. RESULTS: This study involved 38 patients with extensive scalp defects (mean age: 69.4 ± 11 years) who underwent ALT perforator flap transfers (mean flap size: 230.88 ± 145.6 cm2). There was only one case of unsuccessful flap transfer, and four cases had a few complications. The characteristics of the complication group included a large flap size (303.1 ± 170.9 vs. 214.9 ± 136.6 cm2, P = .211), few perforator numbers without pedicle manipulation, lack of intraoperative indocyanine green administration (75% vs. 25%, P = .607), and the use of superficial temporal vessels as recipient vessels. CONCLUSIONS: Scalp reconstruction using large ALT free flaps with the aid of imaging modalities facilitates the optimization of surgical techniques, such as pedicle manipulation, perforator numbers, and vein considerations, thereby contributing to successful reconstruction.

Chronic myeloid leukaemia with soft tissue mass formed by mature granulocytes.

Extramedullary lesions in patients with chronic myeloid leukaemia (CML) suggest progression to the blast phase because such lesions generally consist of immature granulocytes. We here report a case of an extramedullary mass formed by mature granulocytes during the chronic phase of CML. A 60-year-old woman who had discontinued treatment for CML with dasatinib of her own accord several years ago presented to our hospital with a complaint of right thigh pain. She had a mass on her right leg, which was located on her right thigh and was elastic, soft and fist-sized. Blood tests and the bone marrow findings were compatible with the chronic phase of CML, and a CT-guided needle biopsy showed an infiltrate containing numerous mature neutrophils and foam cells. The mass disappeared with dasatinib alone, without antibacterial agents or drainage.Although the detailed pathogenesis of mass formation with mature granulocytes in the chronic phase of CML has not been elucidated, the clinical course of the current case highlights the importance of prompt biopsy, pathological examination and the early initiation of appropriate treatment.

Nineteen-Year-Old Woman with Symptomatic Intramuscular Thigh Hemangioma-Radiographic Changes and Management: A Case Report.

CASE: We report a case of an intramuscular thigh hemangioma in a 19-year-old woman with a several year history of atraumatic thigh pain. Radiographs obtained by her primary care physician demonstrated periosteal bone reaction, prompting referral to Orthopaedic Oncology department. The patient had successful symptomatic management with propranolol. CONCLUSION: The case highlights the diagnosis and potential treatments. In a stepwise approach to care for symptomatic benign vascular lesions, propranolol has been a proven therapeutic option and may be a useful first-line therapy for symptomatic hemangiomas.

Unsupervised Machine Learning in Countermovement Jump and Isometric Mid-Thigh Pull Performance Produces Distinct Combat and Physical Fitness Clusters in Male and Female U.S. Marine Corps Recruits.

INTRODUCTION: Several challenges face the U.S. Marine Corps (USMC) and other services in their efforts to design recruit training to augment warfighter mobility and resilience in both male and female recruits as part of an integrated model. Strength and power underpin many of the physical competencies required to meet the occupational demands one might face in military. As the military considers adopting force plate technology to assess indices of strength and power, an opportunity presents itself for the use of machine learning on large datasets to deduce the relevance of variables related to performance and injury risk. The primary aim of this study was to determine whether cluster analysis on baseline strength and power data derived from countermovement jump (CMJ) and isometric mid-thigh pull (IMTP) adequately partitions men and women entering recruit training into distinct performance clusters. The secondary aim of this study is then to assess the between-cluster frequencies of musculoskeletal injury (MSKI). MATERIALS AND METHODS: Five hundred and sixty-five males (n = 386) and females (n = 179) at the Marine Corps Recruit Depots located at Parris Island and San Diego were enrolled in the study. Recruits performed CMJ and IMTP tests at the onset of training. Injury data were collected via medical chart review. Combat fitness test (CFT) and physical fitness test (PFT) results were provided to the study team by the USMC. A k-means cluster analysis was performed on CMJ relative peak power, IMTP relative peak force, and dynamic strength index. Independent sample t-tests and Cohen's d effect sizes assessed between-cluster differences in CFT and PFT performance. Differences in cumulative incidence of lower extremity %MSKIs were analyzed using Fisher's exact test. Relative risk and 95% confidence intervals (CIs) were also calculated. RESULTS: The overall effects of cluster designation on CMJ and IMTP outcomes ranged from moderate (relative peak power: d = -0.68, 95% CI, -0.85 to -0.51) to large (relative peak force: d = -1.69, 95% CI, -1.88 to -1.49; dynamic strength index: d = 1.20, 95% CI, 1.02-1.38), indicating acceptable k-means cluster partitioning. Independent sample t-tests revealed that both men and women in cluster 2 (C2) significantly outperformed those in cluster 1 (C1) in all events of the CFT and PFT (P < .05). The overall and within-gender effect of cluster designation on both CFT and PFT performance ranged from small (d > 0.2) to moderate (d > 0.5). Men in C2, the high-performing cluster, demonstrated a significantly lower incidence of ankle MSKI (P = .04, RR = 0.2, 95% CI, 0.1-1.0). No other between-cluster differences in MSKI were statistically significant. CONCLUSIONS: Our results indicate that strength and power metrics derived from force plate tests effectively partition USMC male and female recruits into distinct performance clusters with relevance to tactical and physical fitness using k-means clustering. These data support the potential for expanded use of force plates in assessing readiness in a cohort of men and women entering USMC recruit training. The ability to pre-emptively identify high and low performers in the CFT and PFT can aid in leadership developing frameworks for tailoring training to enhance combat and physical fitness with benchmark values of strength and power.

Reciprocal inhibition of the thigh muscles in humans: A study using transcutaneous spinal cord stimulation.

Evaluating reciprocal inhibition of the thigh muscles is important to investigate the neural circuits of locomotor behaviors. However, measurements of reciprocal inhibition of thigh muscles using spinal reflex, such as H-reflex, have never been systematically established owing to methodological limitations. The present study aimed to clarify the existence of reciprocal inhibition in the thigh muscles using transcutaneous spinal cord stimulation (tSCS). Twenty able-bodied male individuals were enrolled. We evoked spinal reflex from the biceps femoris muscle (BF) by tSCS on the lumber posterior root. We examined whether the tSCS-evoked BF reflex was reciprocally inhibited by the following conditionings: (1) single-pulse electrical stimulation on the femoral nerve innervating the rectus femoris muscle (RF) at various inter-stimulus intervals in the resting condition; (2) voluntary contraction of the RF; and (3) vibration stimulus on the RF. The BF reflex was significantly inhibited when the conditioning electrical stimulation was delivered at 10 and 20 ms prior to tSCS, during voluntary contraction of the RF, and during vibration on the RF. These data suggested a piece of evidence of the existence of reciprocal inhibition from the RF to the BF muscle in humans and highlighted the utility of methods for evaluating reciprocal inhibition of the thigh muscles using tSCS.

Extended anterolateral thigh flap reconstruction of a recurrent pelvic chondrosarcoma excision defect with exposed bowel.

The pedicled anterolateral thigh (ALT) flap has proven to be a reliable and versatile technique for the reconstruction of complex abdominal wall defects. Its robust vascular supply, large skin paddle and potential for a two-team approach make it an excellent choice for such challenging reconstructions. This case report emphasises the effectiveness of the pedicled ALT flap in managing complex abdominal wall defects, providing both functional restoration and satisfactory aesthetic results. However, careful patient selection and meticulous surgical planning remain paramount to ensure optimal outcomes.

Synergistic clinical application of synthetic electrospun fiber wound matrix in the management of a complex traumatic wound: degloving left groin and thigh auger injury.

BACKGROUND: Managing complex traumatic soft tissue wounds involving a large surface area while attempting to optimize healing, avoid infection, and promote favorable cosmetic outcomes is challenging. Regenerative materials such as ECMs are typically used in wound care to enhance the wound healing response and proliferative phase of tissue formation. CASE REPORT: The case reported herein is an example of the efficacious use of an SEFM in the surgical management of a large complex traumatic wound involving the left lower extremity and lower abdominal region. The wound bed was successfully prepared for skin grafting over an area of 1200 cm2, making this among the largest applications of the SEFM reported in the literature. CONCLUSION: This case report demonstrates the clinical versatility of the SEFM and a synergistic approach to complex traumatic wound care. The SEFM was successfully used to achieve tissue granulation for a successful skin graft across a large surface in an anatomic region with complex topography.