OBJECTIVE: To assess risk factors of retroperitoneal and lower extremity musculoskeletal bleed in acquired haemophilia (AHA) and perform an objective assessment of disability and influence on survival.
METHODS: We included 49 patients with AHA from November 2017 to May 2023. The occurrence of any retroperitoneal or/and lower extremities bleeding manifestation was investigated. On clinical follow-up, we search for compressive femoral neuropathy and quadriceps amyotrophy. The lower extremity functional scale (LEFS) was carried out one year after the last bleeding event in all AHA patients.
RESULTS: A 61.2% of patients in our AHA cohort presented with any retroperitoneal and/or lower extremities musculoskeletal manifestation. Those patients had higher percentage of major bleeding EACH2/ISTH criteria (90% vs. 57%, p = .01), needs of blood transfusions (86% vs. 57% of patients, p = .03), and haemostatic by-pass products (90% vs. 63%, p = .02). Hypertension (HR 2.6, 95% CI 1.1-5.9, p = .02), presence of autoimmune disease (HR 13, 95% CI 1.7-99, p = .01), and inhibitor level > 20 BU (HR 2.6 95% CI 1.0-6.8, p = .04) significantly predicted retroperitoneal/lower extremities clinical manifestations. Most frequent sequelae were quad atrophy (30.6%) and femoral nerve palsy (20.4%). Quad atrophy and LEFS scores under 50 were associated with increased mortality (HR 3, 95% CI 1.1-8.6 and HR 12, 95% CI 3.3-45, respectively).
CONCLUSIONS: AHA with retroperitoneal/lower extremities bleeding involvement is of greater severity and shows high disability and worst survival outcomes. Quadriceps atrophy and LEFS scale scoring under 50 predicted mortality in our AHA patients.

Numerous studies have established a robust body of evidence for botulinum toxin A (BoNT-A) therapy as a treatment for upper motor neuron syndrome. These studies demonstrated improvements in spasticity, range of joint motion, and pain reduction. However, there are few studies that have focused on improvement of paralysis or functional enhancement as the primary outcome. This paper discusses the multifaceted aspects of spasticity assessment, administration, and rehabilitation with the goal of optimising the effects of BoNT-A on lower-limb spasticity and achieving functional improvement and gait reconstruction. This paper extracts studies on BoNT-A and rehabilitation for the lower limbs and provides new knowledge obtained from them. From these discussion,, key points in a walking reconstruction strategy through the combined use of BoNT-A and rehabilitation include: (1) injection techniques based on the identification of appropriate muscles through proper evaluation; (2) combined with rehabilitation; (3) effective spasticity control; (4) improvement in ankle joint range of motion; (5) promotion of a forward gait pattern; (6) adjustment of orthotics; and (7) maintenance of the effects through frequent BoNT-A administration. Based on these key points, the degree of muscle fibrosis and preintervention walking speed may serve as indicators for treatment strategies. With the accumulation of recent studies, a study focusing on walking functions is needed. As a result, it is suggested that BoNT-A treatment for lower limb spasticity should be established not just as a treatment for spasticity but also as a therapeutic strategy in the field of neurorehabilitation aimed at improving walking function.

To explore the characteristics of hematologic indicators and related risk factors of lower extremity deep vein thrombosis (LDVT) in patients with cerebral infarction.
METHODS: This study retrospectively analyzed data from 174 patients with cerebral infarction admitted to The Rehabilitation Department of Shanghai Fifth Rehabilitation Hospital and Shanghai First People\'s Hospital from June 2022 to June 2023. Based on the results of lower limb venous color Doppler ultrasound examinations, patients were divided into two groups: the LDVT group (35 cases) and the non-LDVT group (139 cases). We compared the clinical data and hematologic indicators (D-dimer value, fibrinogen, white blood cells, platelets, uric acid, creatinine, etc.) of the two groups to identify the risk factors of cerebral infarction complicated with LDVT.
RESULTS: Statistical analysis revealed that the D-dimer values of the LDVT group were significantly (P<0.05) higher than those of the non-LDVT group. The uric acid value of the LDVT group was significantly lower than that of the non-LDVT group, with statistical significance (P<0.05). The Brunnstrom staging in the LDVT group was significantly different from that in the non-LDVT group (P<0.05). Meanwhile, binary logistic regression analysis showed that LDVT complicated with cerebral infarction was associated with D-dimer level [OR=1.302, 95% CI (1.077, 1.575)], uric acid level [OR=0.995, 95% CI (0.990, 1.000)], and Brunnstrom staging [OR=3.005, 95% CI (1.312, 6.880)].
CONCLUSIONS: D-dimer value, uric acid value, and Brunnstrom stage I to II are closely related to the occurrence of LDVT in patients with cerebral infarction. High D-dimer value, low uric acid value, and Brunnstrom stage I to II are independent risk factors for LDVT in cerebral infarction. Early assessment of D-dimer value, uric acid value, and Brunnstrom stage of cerebral infarction should be considered in clinical practice.

Creating musculoskeletal models in a paediatric population currently involves either creating an image-based model from medical imaging data or a generic model using linear scaling. Image-based models provide a high level of accuracy but are time-consuming and costly to implement, on the other hand, linear scaling of an adult template musculoskeletal model is faster and common practice, but the output errors are significantly higher. An articulated shape model incorporates pose and shape to predict geometry for use in musculoskeletal models based on existing information from a population to provide both a fast and accurate method. From a population of 333 children aged 4-18 years old, we have developed an articulated shape model of paediatric lower limb bones to predict bone geometry from eight bone landmarks commonly used for motion capture. Bone surface root mean squared errors were found to be 2.63 ± 0.90 mm, 1.97 ± 0.61 mm, and 1.72 ± 0.51 mm for the pelvis, femur, and tibia/fibula, respectively. Linear scaling produced bone surface errors of 4.79 ± 1.39 mm, 4.38 ± 0.72 mm, and 4.39 ± 0.86 mm for the pelvis, femur, and tibia/fibula, respectively. Clinical bone measurement errors were low across all bones predicted using the articulated shape model, which outperformed linear scaling for all measurements. However, the model failed to accurately capture torsional measures (femoral anteversion and tibial torsion). Overall, the articulated shape model was shown to be a fast and accurate method to predict lower limb bone geometry in a paediatric population, superior to linear scaling.

Technological advancements have expanded the range of methods for capturing human body motion, including solutions involving inertial sensors (IMUs) and optical alternatives. However, the rising complexity and costs associated with commercial solutions have prompted the exploration of more cost-effective alternatives. This paper presents a markerless optical motion capture system using a RealSense depth camera and intelligent computer vision algorithms. It facilitates precise posture assessment, the real-time calculation of joint angles, and acquisition of subject-specific anthropometric data for gait analysis. The proposed system stands out for its simplicity and affordability in comparison to complex commercial solutions. The gathered data are stored in comma-separated value (CSV) files, simplifying subsequent analysis and data mining. Preliminary tests, conducted in controlled laboratory environments and employing a commercial MEMS-IMU system as a reference, revealed a maximum relative error of 7.6% in anthropometric measurements, with a maximum absolute error of 4.67 cm at average height. Stride length measurements showed a maximum relative error of 11.2%. Static joint angle tests had a maximum average error of 10.2%, while dynamic joint angle tests showed a maximum average error of 9.06%. The proposed optical system offers sufficient accuracy for potential application in areas such as rehabilitation, sports analysis, and entertainment.

OBJECTIVE: Bilateral Deficit (BLD) occurs when the force generated by both limbs together is smaller than the sum of the forces developed separately by the two limbs. BLD may be modulated by physical training. Here, were investigated the effects of unilateral or bilateral plyometric training on BLD and neuromuscular activation during lower limb explosive extensions.
METHODS: Fourteen young males were randomized into the unilateral (UL_) or bilateral (BL_) training group. Plyometric training (20 sessions, 2 days/week) was performed on a sled ergometer, and consisted of UL or BL consecutive, plyometric lower limb extensions (3-to-5 sets; 8-to-10 repetitions). Before and after training, maximal explosive efforts with both lower limbs or with each limb separately were assessed. Electromyography of representative lower limb muscles was measured.
RESULTS: BL_training significantly and largely decreased BLD (p=0.003, effect size=1.63). This was accompanied by the reversion from deficit to facilitation of the electromyography amplitude of knee extensors during bilateral efforts (p=0.007). Conversely, UL_training had negligible effects on BLD (p=0.781). Also, both groups showed similar improvements in their maximal explosive power generated after training.
CONCLUSIONS: Bilateral plyometric training can mitigate BLD, and should be considered for training protocols focused on improving bilateral lower limb motor performance.

Cocaine abuse is a public health concern with well-documented cardiovascular complications. However, acute limb ischemia remains a rare and underreported consequence. We present a case of a 36-year-old man with acute right lower limb ischemia following heavy cocaine use, successfully managed with systemic heparin and intra-arterial nitroglycerin. The case highlights considering cocaine as a potential cause of acute limb ischemia and the efficacy of endovascular therapy. Further case reports with this diagnosis and their management are crucial for establishing the best strategies and improving outcomes in these scenarios.

BACKGROUND: The linear-envelope peak (LEP) of surface EMG signal is widely used in gait analysis to characterize muscular activity, especially in clinics.
OBJECTIVE: This study is designed to evaluate LEP accuracy in identifying muscular activation and assessing activation timing during walking.
METHODS: Surface EMG signals from gastrocnemius lateralis (GL) and tibialis anterior (TA) were analyzed in 100 strides per subject (31 healthy subjects) during ground walking. Signals were full-wave rectified and low-pass filtered (cut-off frequency=5 Hz) to extract the linear envelope. LEP accuracy in identifying muscle activations and the associated error in peak detection were assessed by direct comparison with a reference method based on wavelet transform. LEP accuracy in identifying the timing of higher signalenergy levels was also assessed, increasing the reference-algorithm selectivity.
RESULTS: The detection error (percentage number of times when LEP falls outside the correspondent reference activation interval) is close to zero. Detection error increases up to 70% for intervals including only signal energy higher than 90% of energy peak. Mean absolute error (MAE, the absolute value of the distance between LEP timing and the correspondent actual timing of the sEMG-signal peak computed by reference algorithm) is 54.1±20.0 ms. Detection error and MAE are significantly higher (p<0.05) in TA data compared to GL signals. Differences among MAE values detected adopting different values for LE cut-off frequency are not statistically significant.
CONCLUSIONS: LEP was found to be accurate in identifying the number of muscle activations during walking. However, the use of LEP to assess the timing of highest sEMG-signal energy (signal peak) should be considered carefully. Indeed, it could introduce a relevant inaccuracy in muscle-activation identification and peak-timing quantification. The type of muscle to analyze could also influence LEP performances, while the cut-off frequency chosen for envelope extraction appears to have a limited impact.

UNASSIGNED: Failure to adequately secure the skin graft to the lower limbs recipient bed can result in loss of the graft. Our objective was to compare the healing of split-thickness skin grafts three weeks postoperatively, using either negative pressure wound therapy (NPWT) or conventional compression bandaging.
UNASSIGNED: In this multicenter randomized controlled study, patients with tissue loss ranging from 50 cm2 to 600 cm2 on the lower limbs and treated with split-thickness skin grafts were included in three French hospitals. A digital photographic evaluation was performed at 3 weeks.
UNASSIGNED: During 9 years, 70 patients were included in the study and allocated to a treatment group. The grafted area was similar in both groups. Loss of graft was significantly reduced in the NPWT group with 14.6 cm2 compared to 29 cm2 in the control group (p = 0.0003). The hospital stay was also significantly reduced in the NPWT group, at 4 days versus 6.5 days in the control group (p = 0.0284). In the NPWT group, 60% reported pain compared to 22.9% in the control group (p = 0.0048).
UNASSIGNED: The use of NPWT dressings improves skin graft take by reducing necrosis, improving the graft\'s adherence to the recipient site, and reducing hospital length-of-stay.

Background: Spasticity is a motor disorder characterised by exaggerated movements of the tendons and accompanied by hyperreflexia and hypertonia. Extracorporeal shock wave therapy (ESWT) is used as a treatment for spasticity, although more evidence is needed on the effectiveness of this therapy in the treatment of spasticity. Therefore, the aim of this study was to assess the effectiveness ESWT in the treatment of upper and lower limbs spasticity in both children and adults through different aetiologies. Methods: A systematic search was performed in different databases from inception to December 2023. Random-effects meta-analysis was used to estimate the efficacy of ESWT on spasticity using the Modified Ashworth Scale. Results: Sixteen studies were included in the systematic review and meta-analysis. The effect of ESWT on spasticity measured with the Modified Ashworth Scale shows a significant decrease in spasticity in the upper limbs and in the lower limbs in adults with chronic stroke and in children with cerebral palsy, is more effective immediately after application, and maintains its effect up to 12 weeks post treatment. Conclusions: These findings are important for clinical practice since they show evidence that ESWT is effective in reducing spasticity in both children and adults.