Varicose veins of the lower extremities (VVs) is a common chronic vascular disease, with high prevalence rates in some countries; however, their pathogenesis remains unclear. Some studies have identified associations between changes in specific plasma lipid molecules, such as phosphatidylethanolamine (PE), phosphatidylcholine (PC), and sphingomyelin (SM), and the onset of VVs, but due to confounders and reverse causality, the causal relationship remains unclear. Meanwhile, studies on the potential link between other plasma lipids beyond PE, PC, and SM and the risk of VVs in the lower extremities are lacking. This study aimed to explore the potential causal relationship between VVs and plasma lipid levels to provide theoretical insights into the interrelation of plasma lipids and VVs in their occurrence and progression. We conducted a two-sample Mendelian randomization (MR) analysis to assess the potential connection between genetically predicted levels of individual plasma lipids and the risk of developing VVs. We utilized data from a large-scale genome-wide association study involving 7174 Finnish individuals for 179 plasma lipidomes along with VVs genome-wide association study data from 408,455 UK individuals. MR analysis employed methods, such as inverse-variance weighting, weighted median, Bayesian Weighted Mendelian Randomization, and MR-Egger regression. The inverse-variance weighting method was primarily used to assess causality. The validity of the results was demonstrated through sensitivity analysis. In total, 12 lipids were found to have their plasma levels associated with an increased risk of VVs. This includes 3 types of PE, 7 types of PC, and 2 types of phosphatidylinositol. However, no significant causal relationship was found between the plasma levels of 11 types of SM and VVs. These results support the existence of a potential causal relationship between specific types of lipid levels and the risk of VVs, which can provide clues for further studies on biological mechanisms and the exploration of potential therapeutic targets.

OBJECTIVE: This study aims to establish normative data on lower extremity entheseal tendon thicknesses in healthy children and examine correlations with age, gender, and anthropometric measures using musculoskeletal ultrasound. The secondary objective of the study is to investigate the power Doppler properties of entheseal tendons.
METHODS: A total of 192 healthy children, aged 5-18 years, participated in this cross-sectional study. Participants underwent detailed physical and ultrasonographic examinations. Entheseal tendon thickness measurements were taken from five specific regions: distal quadriceps tendon (DQT), proximal patellar ligament (PPL), distal patellar ligament (DPL), Achilles tendon (AT), and plantar fascia (PF). Correlations between thicknesses and age, weight, height, and body mass index (BMI) were analyzed. Intra-tendinous vascularity was evaluated using power Doppler. Interobserver and intraobserver agreements were assessed using intraclass correlation coefficients (ICC).
RESULTS: Normative data on lower extremity entheseal tendon thicknesses according to age, weight, height, and BMI have been established. Significant positive correlations were found between thicknesses and age, weight, height, and BMI. Weight was identified as the most influential factor, particularly for the DPL and AT. Right side tendons (AT and PF) are statistically thicker. Minimal Doppler activity was detected in 10.6% of the entheseal DQTs in the group of children aged 5-9 years. The study achieved high to excellent interobserver and intraobserver agreement.
CONCLUSIONS: This study examined the ultrasonographic characteristics of lower extremity entheseal tendons in healthy children using B-mode and power Doppler, provided normative data on their thicknesses, and demonstrated significant correlations between thicknesses and age, sex, and anthropometry.

BACKGROUND: Muscle mass and phase angle (PhA) can be measured using multi-frequency bioelectrical impedance analysis (BIA). Osteoarthritis of the hip (OAhip) causes decreased muscle mass and PhA in the deformed lower limb. However, previous studies have not accounted for the influence of sex, and thus, the relationship between muscle mass, PhA, and motor function remains unclear. This study aimed to elucidate the relationship between PhA, an index of muscle mass and quality measured using BIA, and motor function during gait and standing in female patients with OAhip.
METHODS: Muscle mass and PhA of patients with OAhip were measured using BIA. Motor function was evaluated using the Timed Up and Go test, ground reaction/weight, rate of force development/weight, and load ratio between the osteoarthritic (OA) and contralateral sides when standing up. The difference between the OA side and the contralateral lower limb was tested to clarify the characteristics of the deformed lower limb. The relationship between each motor function was determined using a partial correlation coefficient with age as a control variable and multiple regression analysis with each motor function as the dependent variable and age, OA-side muscle mass/body weight ratio, and PhA as independent variables.
RESULTS: This study involved 60 patients with OAhip (age 65.6 ± 7.6 years, height 154.2 ± 6.0 cm, weight 56.8 ± 10.5 kg) scheduled for unilateral total hip arthroplasty. Muscle mass, PhA, and lower limb load ratio were significantly decreased in the lower limbs on the OA side. Furthermore, using a partial correlation coefficient with age as a control variable, PhA showed significant correlations with motor functions related to standing up and walking, and multiple regression analysis revealed that PhA was independently related to each motor function.
CONCLUSIONS: Evaluation and interventions that consider muscle quality rather than muscle mass are important.

Enhancing peak landing forces and ensuring faster stabilization in the lower limbs during jumping activities can significantly improve performance and decrease the risk of injury among basketball players. This study aimed to compare the effects of unilateral (uPJT) and bilateral plyometric jump training (bPJT) programs on various performance measures, including countermovement jump (CMJ), squat jump (SJ), and single-leg land and hold (SLLH) test outcomes, assessed using force plates. A randomized multi-arm study design was employed, comprising two experimental groups (n = 25; uPJT and n = 25; bPJT) and one control group (n = 25), conducted with youth male regional-level basketball players (16.3 ± 0.6 years old). Participants underwent assessment twice, both before and after an 8-week intervention training period. The uPJT program exclusively involved plyometric drills (e.g., vertical jump exercises; horizontal jump exercises) focusing on single-leg exercises, whereas the bPJT program utilized drills involving both legs simultaneously. The outcomes analyzed included CMJ peak landing force, CMJ peak power, SJ peak force, SJ maximum negative displacement, SLLH time to stabilization, and SLLH peak landing force. The control group exhibited significantly greater SLLH time to stabilization compared to both the uPJT (p < 0.001) and bPJT (p < 0.030) groups. Additionally, time to stabilization was also significantly higher in bPJT than in uPJT (p = 0.042). Comparisons between groups in regards SLLH peak landing force after intervention revealed that the value was significantly smaller in uPJT than in bPJT (p = 0.043) and control (p < 0.001). In the remaining outcomes of CMJ and SJ, both uPJT and bPJT showed significant improvement compared to the control group (p > 0.05), although there was no significant difference between them. In conclusion, our study suggests that utilizing uPJT is equally effective as bPJT in enhancing performance in bilateral jump tests. However, it significantly outperforms bPJT in improving time to stabilization and peak landing forces during single-leg land and hold test. uPJT could be advantageous not for maximizing performance but also for potentially decreasing injury risk by enhancing control and balance during single-leg actions, which are common in basketball.

BACKGROUND: Individuals with subacute severe hemiplegia often undergo alternate gait training to overcome challenges in achieving walking independence. However, the ankle joint setting in a knee-ankle-foot orthosis (KAFO) depends on trunk function or paralysis stage for alternate gait training with a KAFO. The optimal degree of ankle joint freedom in a KAFO and the specific ankle joint conditions for effective rehabilitation remain unclear. Therefore, this study aimed to investigate the effects of different degrees of freedom of the ankle joint on center-of-pressure (CoP) parameters and muscle activity on the paretic side using a KAFO and to investigate the recommended setting of ankle joint angle in a KAFO depending on physical function.
METHODS: This study included 14 participants with subacute stroke (67.4 ± 13.3 years). The CoP parameters and muscle activity of the gastrocnemius lateralis (GCL) and soleus muscles were compared using a linear mixed model (LMM) under two ankle joint conditions in the KAFO: fixed at 0° and free ankle dorsiflexion. We confirmed the relationship between changes in CoP parameters or muscle activity under different conditions and physical functional characteristics such as the Fugl-Meyer Assessment of Lower Extremity Synergy Score (FMAs) and Trunk Impairment Scale (TIS) using LMM.
RESULTS: Anterior-posterior displacement of CoP (AP_CoP) (p = 0.011) and muscle activity of the GCL (p = 0.043) increased in the free condition of ankle dorsiflexion compared with that in the fixed condition. The FMAs (p = 0.004) and TIS (p = 0.008) demonstrated a positive relationship with AP_CoP. A positive relationship was also found between TIS and the percentage of medial forefoot loading time in the CoP (p < 0.001).
CONCLUSIONS: For individuals with severe subacute hemiplegia, the ankle dorsiflexion induction in the KAFO, which did not impede the forward tilt of the shank, promotes anterior movement in the CoP and muscle activity of the GCL. This study suggests that adjusting the dorsiflexion mobility of the ankle joint in the KAFO according to improvement in physical function promotes loading of the CoP to the medial forefoot.

BACKGROUND: Posterolateral decompression and fusion with internal fixation is a commonly used surgical approach for treating degenerative lumbar spinal stenosis (DLSS). This study aims to evaluate the impact of preserving a portion of the unilateral facet joint during decompression on surgical outcomes and long-term recovery in patients.
METHODS: This study analyzed 73 patients with DLSS accompanied by bilateral lower limb neurological symptoms who underwent single-level L4/5 posterolateral decompression and fusion surgery from January 2022 to March 2023. Patients were categorized into two groups based on the type of surgery received: Group A comprised 31 patients who underwent neural decompression without facet joint preservation, while Group B consisted of 42 patients who underwent neural decompression with preservation of partial facet joints on one side. Regular follow-up evaluations were conducted, including clinical and radiological assessments immediately postoperatively, and at 3 and 12 months thereafter. Key patient information was documented through retrospective chart reviews.
RESULTS: Most patients in both groups experienced favorable surgical outcomes. However, four cases encountered complications. Notably, during follow-up, Group B demonstrated superior 1-year postoperative interbody fusion outcomes (P < 0.05), along with a trend towards less interbody cage subsidence and slower postoperative intervertebral disc height loss. Additionally, Group B showed significantly reduced postoperative hospital stay (P < 0.05).
CONCLUSIONS: Under strict adherence to surgical indications, the posterior lateral lumbar fusion surgery, which preserves partial facet joint unilaterally during neural decompression, can offer greater benefits to patients.

Purpose: The aim of this work was to investigate and compare back and lower extremity joint moments and muscle excitation during stoop and squat postures by incorporating gender-based differences and analyzing lifting phases. Methods: 18 healthy adults (9 males and 9 females; age: 24.44 ± 4.96 years, body mass: 66.00 ± 12.10 kg, height: 170.11 ± 9.20 cm, lean body mass: 48.46 ± 7.66 kg) lifted an object 30% of their lean body mass using squat and stoop postures. Marker-based motion capture, force plate, and surface electromyography were synchronously used to acquire joint moments and muscle excitation. A 3-way mixed model analysis was performed to determine the effect of gender, posture, and phase on internal joint moments and muscle excitation of the lower back and extremities. Results: Significant differences were observed in the interaction of lifting posture and phase on lower extremity moments and excitation of rectus femoris and medial gastrocnemius. Individual effects of posture were significant for peak internal joint moments of the lower extremities only. Anterior lower extremity muscles showed significantly increased excitation during squat, whereas medial gastrocnemius was higher in stoop. Joint moments and muscle excitations were all higher during the lifting than the bending phase. Gender differences were found only in the peak lumbosacral sagittal plane moment and rectus femoris muscle excitation. Conclusions: The study identified significant variations in the joint moments and muscle excitation in lifting, influenced by gender, posture, and phase, highlighting its complex nature. Overall interactions were lacking, however individual effects were evident, necessitating larger future studies.

OBJECTIVE: Risk factors for lower limb amputation (LLA) in individuals with diabetes have been under-studied. We examined how 1/demographic and socioeconomic, 2/medical, and 3/lifestyle risk factors may be associated with LLA in people with newly diagnosed diabetes.
METHODS: Using the Swedish national diabetes register from 2007 to 2016, we identified all individuals ≥18 years with an incident diabetes diagnosis and no previous amputation. These individuals were followed from the date of diabetes diagnosis to amputation, emigration, death, or the end of the study in 2017 using data from the In-Patient Register and the Total Population Register. The cohort consisted of 66,569 individuals. Information about demographic, socioeconomic, medical, and lifestyle risk factors was ascertained around the time of the first recorded diabetes diagnosis, derived from the above-mentioned registers. Cox proportional hazard models were used to obtain hazard ratios (HR) with 95% confidence intervals (CI).
RESULTS: During the median follow-up time of 4 years, there were 133 individuals with LLA. The model adjusting for all variables showed a higher risk for LLA with higher age, HR 1.08 (95% CI 1.05-1.10), male sex, HR 1.57 (1.06-2.34), being divorced, HR 1.67 (1.07-2.60), smokers HR 1.99 (1.28-3.09), insulin treated persons HR 2.03 (1.10-3.74), people with low physical activity (PA) HR 2.05 (1.10-3.74), and people with an increased foot risk at baseline HR > 4.12. People with obesity had lower risk, HR 0.46 (0.29-0.75).
CONCLUSIONS: This study found a higher risk for LLA among people with higher age, male sex, who were divorced, had a higher foot risk group, were on insulin treatment, had lower PA levels, and were smokers. No significant association was found between risk for LLA and education level, country of origin, type of diabetes, blood glucose level, hypertension, hyperlipidemia, creatinine level, or glomerular filtration rate. Obesity was associated with lower risk for LLA. Identified variables may have important roles in LLA risk among people with diabetes.

UNASSIGNED: Evidence-based guidelines are needed to inform rehabilitation practice including the effect of non-paralytic lower limb resistance exercise with abdominal drawing-in technique (ADIM) on recovery of trunk control, balance and daily living after stroke survivors.
UNASSIGNED: The purpose of this study was to compare the effects of trunk control strengthening performed in non-paralytic lower limb resistance exercise with ADIM on trunk control, balance, daily living in stroke survivors.
UNASSIGNED: The 24 participants with stroke were randomly divided into three groups: lower limb resistance exercise group (LRAG; n = 8), lower limb exercise group (LAG; n = 8), and control group (CG; n = 8). The training sessions were conducted three times a week for four weeks. Outcome measures included the Korean version Trunk Impairment Scale (K-TIS), Postural Assessment Scale of Stroke (PASS), Modified Functional Reach Test (mFRT), Berg Balance Scale (BBS), Foot print and Modified Barthel\'s Index (MBI).
UNASSIGNED: The results showed that the LRAG had a significant effect on the K-TIS, PASS, mFRT, Foot print and MBI than the LAG and CG (p < 0.05). The BBS results showed a significant difference the CG (p < 0.05).
UNASSIGNED: This study showed that repeated non-paralytic lower limb resistance exercises with ADIM can be used clinically as a training method for general physiotherapy in patients with reduced postural control, balance and daily living.

BACKGROUND: This study assessed the effect of perineural dexamethasone on block duration, opioid requirement, blood glucose levels, and stress response to surgery as measured by the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR), following pediatric foot and ankle surgery.
METHODS: In this parallel, double-blinded randomized controlled trial, 90 children (ages 2-5 years, >5 kg) scheduled for foot or ankle surgery under spinal anesthesia with ultrasound-guided single-shot popliteal sciatic nerve block were randomized into 3 groups: 0.5% ropivacaine with saline (control), 0.5% ropivacaine plus dexamethasone 0.1 mg/kg (DEX0.1), and 0.5% ropivacaine plus dexamethasone 0.05 mg/kg (DEX0.05). Primary outcome was the time to first rescue opioid analgesia. Secondary outcomes included motor block duration, pain scores, NLR, PLR, and blood glucose levels.
RESULTS: Time to first rescue opioid analgesia was significantly longer in the DEX0.1 group compared with the DEX0.05 group (18.4 hours, SD 2.6 hours vs 16 hours, SD 2.8 hours), with a mean difference of 2.2 hours (95% CI 0.7 to 3.6), p<0.01; and the control group (8.5 hours, SD 1.5 hours), with a mean difference of -9.9 (95% CI -11.4 to -8.4), p<0.001. Motor block was significantly longer in the DEX0.1 group (17.3 hours, SD 2.5 hours) compared with the DEX0.05 (15.2 hours, SD 2.7 hours; p<0.01) and control groups (7.8±1.1, p<0.001). Total opioid consumption was significantly lower in the DEX0.1 group compared with the control group (p=0.01). NLR, PLR, and glucose levels did not differ significantly between the groups at baseline, 24 hours, and 48 hours post surgery.
CONCLUSIONS: Perineural dexamethasone significantly prolonged postoperative motor block duration and did not influence blood glucose, NLR, or PLR levels.
BACKGROUND: NCT06086418.