An articulated shape model to predict paediatric lower limb bone geometry using sparse landmarks.

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.

Development of a Low-Cost Markerless Optical Motion Capture System for Gait Analysis and Anthropometric Parameter Quantification.

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.

DXA-based appendicular composition measures in healthy aging Caucasian Greek women: a cross-sectional study.

As the global population of older persons increases, age-related medical conditions will have a greater impact on public health. DXA-derived bone and soft tissue metrics are associated with adverse clinical events in aging persons. This study aims to investigate the regional body composition of the appendices by whole-body DXA scans, and the age-related relationships between measures of bone and soft tissue in healthy Caucasian females of a Greek origin residing in the Mediterranean area. Body composition of the legs and the arms was analyzed, and lean mass (LM) and fat mass (FM) metrics were calculated in 330 women aged 20-85 years, using DXA. Peak bone mineral density (BMD) of the legs and arms was achieved between ages 20-30 and 41-50 years, respectively. The overall BMD reduction with age was for the legs 43% and the arms 32.2% (p < 0.001). Peak %LM of the legs and the arms was achieved between ages 20-30. The overall reduction of %LM with age was for the legs 22.5% (p < 0.001) and arms 6.6% (p < 0.05). Peak %FM of the legs and arms was attained between ages 31-40 and 61-70, respectively. The overall %FM reduction with age was for the legs and arms 7.5% and 1.9% (p > 0.05). In appendicular sites, Greek women reach peak values of bone mass in the legs first, in early adulthood. Bone loss predominates in the legs as women age. Also, with advancing age Greek women show preferential significant decreases of %LM and %FM in the legs as opposed to the arms. Although variation in appendicular bone and soft tissue metrics is present, the implications of variable biological crosstalks among the tissue components as women age may ultimately lay the foundation for future clinical trials aimed at healthy aging.

Perception and practice of the eight limbs of yoga in yoga teachers: A cross-sectional descriptive study.

Background: Yoga is an ancient wisdom that originated in India and encompasses eight limbs, including yama, niyama, asanas, pranayama, pratyahara, dharana, dhyana, and samadhi. Despite its holistic nature, many studies on yoga tend to focus solely on its physical aspects, breathing practices, and meditation, neglecting other essential components. To address this gap, a study was conducted to determine the perception and practice of all eight limbs of yoga among yoga teachers. Method: A self-designed questionnaire containing 28 items was used for assessing the knowledge, perception, and practice of the eight limbs of yoga among yoga teachers. A total of 37 yoga teachers participated in the study. Cross-tabulation was performed to analyze the data. Results: The majority of participants (>80%) in this study on the practice of astanga yoga reported that all limbs of yoga were essential in their practice. However, there were varying degrees of emphasis placed on each limb. Pranayama (91.9%) and asana (89.2%) were given the most emphasis, while niyama (75.7%), yama (73%), pratyahara (70.3%), dhyana (70.3%), and dharana (64.9%) were given slightly less emphasis. Interestingly, those with more experience placed greater emphasis on various aspects of yoga. Conclusion: Practitioners should embrace all eight limbs of yoga when introducing it to new populations to increase access to yoga. This will help promote the benefits of yoga and make it more accessible to those who may benefit from it. Health professionals should have a comprehensive understanding of the holistic practice of yoga, including its ethics, postures, breath, mindfulness, and meditation, to promote its maximum benefits and avoid potentially harmful practices.

Effects of Bilateral or Unilateral Plyometric Training of Lower Limbs on the Bilateral Deficit During Explosive Efforts.

OBJECTIVES: 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.

Endovascular Management of Acute Lower Limb Ischemia Linked to Cocaine Abuse: A Case Report.

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.

How do users define success with a lower limb prosthesis? A focus group study.

PURPOSE: In this study, we sought to examine how lower limb prosthesis users define success, what constructs they associate with success, and what barriers and facilitators contribute to achieving success. MATERIALS AND METHODS: Purposively sampled lower limb prosthesis users were recruited to participate in a focus group study. Verbatim transcripts from focus groups were analyzed using inductive thematic analysis. Identified constructs were mapped to existing outcome measures, and a conceptual framework for success with a lower limb prosthesis was proposed. RESULTS: Thirty-one lower limb prosthesis users participated in one of five focus groups. Five themes were developed: keep moving forward, despite ups and downs; being able to live MY normal life and do the things I want to do with ease; learning what works for me and how to manage my prosthesis; only I can define my success; and what about my mental health? Several constructs that do not align with existing measures were identified, including prosthetic attention, grief/loss after amputation, and trust in prosthesis. Facilitators for success described by participants included peer connection, finding the right prosthetist, and mental health support. CONCLUSIONS: According to lower limb prosthesis users, success must be patient-driven, individually defined, and continually reassessed.

According to prosthesis users, success with a lower limb prosthesis should be patient-driven, individually defined, and continually reassessed.Lower limb prosthesis users described facilitators for success to include peer connection, finding the right prosthetist, mental health support, and access to appropriate prosthetic technology.Constructs described by lower limb prosthesis users as relating to success that are currently difficult to measure include prosthetic attention, grief/loss after amputation, prosthesis management, ability to blend in, and trust in the prosthesis.

A Mouth and Tongue Interactive Device to Control Wearable Robotic Limbs in Tasks where Human Limbs Are Occupied.

The Wearable Robotic Limb (WRL) is a type of robotic arm worn on the human body, aiming to enhance the wearer's operational capabilities. However, proposing additional methods to control and perceive the WRL when human limbs are heavily occupied with primary tasks presents a challenge. Existing interactive methods, such as voice, gaze, and electromyography (EMG), have limitations in control precision and convenience. To address this, we have developed an interactive device that utilizes the mouth and tongue. This device is lightweight and compact, allowing wearers to achieve continuous motion and contact force control of the WRL. By using a tongue controller and mouth gas pressure sensor, wearers can control the WRL while also receiving sensitive contact feedback through changes in mouth pressure. To facilitate bidirectional interaction between the wearer and the WRL, we have devised an algorithm that divides WRL control into motion and force-position hybrid modes. In order to evaluate the performance of the device, we conducted an experiment with ten participants tasked with completing a pin-hole assembly task with the assistance of the WRL system. The results show that the device enables continuous control of the position and contact force of the WRL, with users perceiving feedback through mouth airflow resistance. However, the experiment also revealed some shortcomings of the device, including user fatigue and its impact on breathing. After experimental investigation, it was observed that fatigue levels can decrease with training. Experimental studies have revealed that fatigue levels can decrease with training. Furthermore, the limitations of the device have shown potential for improvement through structural enhancements. Overall, our mouth and tongue interactive device shows promising potential in controlling the WRL during tasks where human limbs are occupied.

Accuracy of EMG linear envelope in identifying the peak of muscular activity during walking.

BACKGROUND: The linear-envelope peak (LEP) of surface EMG signal is widely used in gait analysis to characterize muscular activity, especially in clinics. RESEARCH QUESTION: 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. SIGNIFICANCE: 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.

Dynamic comparison the lower extremities length in students education in higher institutions.

OBJECTIVE: Aim: Dynamic comparison of the lower limbs length, depending on the type of sport, followed by the construction of a mathematical model for predicting sports abilities. PATIENTS AND METHODS: Materials and Methods: The comparison of the lower limbs length in dynamics was carried out on 132 students of higher education institutions of Bukovyna. While the primary study was carried out during September-October 2021, next study of these same students was conducted in September-October 2022. The main group consists of 92 (69.7%) students, the control group - 40 (30.30%) students aged 16 to 18 years. All students underwent an anthropometric study (determination of the length of the lower limbs) according to the method of P.P. Shaparenka. The comparesment of anthropometric parameters in the main group depending on the type of sport used the Kruskel-Wallis test (non-parametric analysis of variance) in order to identify a reliable difference in the average indicators of the respondents depending on the type of sport (the median of the distribution was considered as a measure of central tendency). In order to establish which pairs of age groups had a statistical difference in the medians, the Conover-Iman test was used. A paired t-test (t-test of paired samples) was performed to compare the length of the respondents' lower limbs during the first measurement and again one year later. Statistical analysis of the obtained data was performed using the licensed RStudio program. RESULTS: Results: The distribution of the length of the right lower limb of the respondents of the main group by measurement shows that the average value of the length of the right lower limb has changed: a significant difference in the length of the right lower limb was found between the first (M = 88.812, SD = 5.287) and the second (M = 89.377, SD = 5.347) measurements; t (68) = -5.223, p < 0.001. The distribution of the length of the left lower limb shows that the average value of the length of the left lower limb has changed also: a significant difference in the length of the left lower limb was found between the first (M = 88.667, SD = 5.266) and the second (M = 89.435, SD = 5.309) measurements; t (68) = -8.289, p < 0.001. CONCLUSION: Conclusions: In order to dynamically compare the length of the lower limbs for comprehensive control and selection of promising students in football, volleyball, handball and basketball, a mathematical model was derived for predicting the length of the lower limbs, in corresponding sports: right lower limb y = 0.506 x and left y = 0.507x, where y - is the length of the left lower limb, x - is the height. The coefficient of determination is 99.8%. A significant predictor for the length of both lower limbs is the height.

Randomized comparative study of negative pressure wound therapy versus compression dressing on split-thickness skin grafts of the lower limbs in an elderly population.

INTRODUCTION: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.

Classification of Motor Imagery Tasks Derived from Unilateral Upper Limb based on a Weight-optimized Learning Model.

BACKGROUND: The accuracy of decoding fine motor imagery (MI) tasks remains relatively low due to the dense distribution of active areas in the cerebral cortex. METHODS: To enhance the decoding of unilateral fine MI activity in the brain, a weight-optimized EEGNet model is introduced that recognizes six types of MI for the right upper limb, namely elbow flexion/extension, wrist pronation/supination and hand opening/grasping. The model is trained with augmented electroencephalography (EEG) data to learn deep features for MI classification. To address the sensitivity issue of the initial model weights to classification performance, a genetic algorithm (GA) is employed to determine the convolution kernel parameters for each layer of the EEGNet network, followed by optimization of the network weights through backpropagation. RESULTS: The algorithm's performance on the three joint classification is validated through experiment, achieving an average accuracy of 87.97%. The binary classification recognition rates for elbow joint, wrist joint, and hand joint are respectively 93.92%, 90.2%, and 94.64%. Thus, the product of the two-step accuracy value is obtained as the overall capability to distinguish the six types of MI, reaching an average accuracy of 81.74%. Compared to commonly used neural networks and traditional algorithms, the proposed method outperforms and significantly reduces the average error of different subjects. CONCLUSIONS: Overall, this algorithm effectively addresses the sensitivity of network parameters to initial weights, enhances algorithm robustness and improves the overall performance of MI task classification. Moreover, the method is applicable to other EEG classification tasks; for example, emotion and object recognition.

Effectiveness of Extracorporeal Shock Wave Therapy in Treatment of Spasticity of Different Aetiologies: A Systematic Review and Meta-Analysis.

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.

Adaptive Expectation-Maximization-Based Kalman Filter/Finite Impulse Response Filter for MEMS-INS-Based Posture Capture of Human Upper Limbs.

To obtain precise positional information, in this study, we propose an adaptive expectation-maximization (EM)-based Kalman filter (KF)/finite impulse response (FIR) integrated filter for inertial navigation system (INS)-based posture capture of human upper limbs. Initially, a data fusion model for wrist and elbow position is developed. Subsequently, the Mahalanobis distance is utilized to evaluate the performance of the filter. The integrated filter employs the EM-based KF to enhance noise estimation accuracy when the performance of KF declines. Conversely, upon deterioration in the performance of the EM-based KF, which is evaluated using the Mahalanobis distance, the FIR filter is employed to maintain the effectiveness of the data fusion filter. This research utilizes the proposed EM-based KF/FIR integrated filter to ascertain wrist and elbow positions. The empirical results demonstrate the proficiency of the proposed approach in estimating these positions, thereby overcoming the challenge and highlighting its inherent effectiveness.

Establishment and validation of a nomogram model for predicting the specific mortality risk of melanoma in upper limbs based on the SEER database.

For patients with upper limb melanoma, the significance of specific death is more important than that of all-cause death, and traditional survival analysis may overestimate the mortality rate of patients. Therefore, the nomogram model for predicting the specific mortality risk of melanoma in the upper limbs was developed. A population with melanoma in the upper limbs, diagnosed from 2010 to 2015, were selected from the National Cancer Institute database of Surveillance, Epidemiology, and End Results (SEER). The independent predictive factors of specific death were confirmed by the competing risk model of one-factor analysis and multi-factor analysis, and the nomogram was constructed according to the independent predictive factors. 17,200 patients with upper limb melanoma were enrolled in the study (training cohort: n = 12,040; validation cohort: n = 5160). Multi-factor analysis of the competing risk model showed that age, marital status, gender, tumor stage, T stage, M stage, regional lymph node surgery information, radiotherapy, chemotherapy, mitotic cell count, ulcer and whether there were multiple primary cancers, were independent factors affecting the specific death of upper limb melanoma patients (P < 0.05). The nomogram has good predictive ability regarding the specific mortality risk of melanoma in the upper limbs, and could be of great help to formulate prognostic treatment strategies and follow-up strategies that are conducive to survival.

The biomechanical influence of transtibial Bone-Anchored limbs during walking.

Individuals with unilateral transtibial amputation (TTA) using socket prostheses demonstrate asymmetric joint biomechanics during walking, which increases the risk of secondary comorbidities (e.g., low back pain (LBP), osteoarthritis (OA)). Bone-anchored limbs are an alternative to socket prostheses, yet it remains unknown how they influence multi-joint loading. Our objective was to determine the influence of bone-anchored limb use on multi-joint biomechanics during walking. Motion capture data (kinematics, ground reaction forces) were collected during overground walking from ten participants with unilateral TTA prior to (using socket prostheses) and 12-months after bone-anchored limb implantation. Within this year, each participant completed a rehabilitation protocol that guided progression of loading based on patient pain response and optimized biomechanics. Musculoskeletal models were developed at each testing timepoint (baseline or 12-months after implantation) and used to calculate joint kinematics, internal joint moments, and joint reaction forces (JRFs). Analyses were performed during three stance periods on each limb. The between-limb normalized symmetry index (NSI) was calculated for joint moments and JRF impulses. Discrete (range of motion (ROM), impulse NSI) dependent variables were compared before and after implantation using paired t-tests with Bonferroni-Holm corrections while continuous (ensemble averages of kinematics, moments, JRFs) were compared using statistical parametric mapping (p < 0.05). When using a bone-anchored limb, frontal plane pelvic (residual: pre = 9.6 ± 3.3°, post = 6.3 ± 2.5°, p = 0.004; intact: pre = 10.2 ± 3.9°, post = 7.9 ± 2.6°, p = 0.006) and lumbar (residual: pre = 15.9 ± 7.0°, post = 10.6 ± 2.5°, p = 0.024, intact: pre = 17.1 ± 7.0°, post = 11.4 ± 2.8°, p = 0.014) ROM was reduced compared to socket prosthesis use. The intact limb hip extension moment impulse increased (pre = -11.0 ± 3.6 Nm*s/kg, post = -16.5 ± 4.4 Nm*s/kg, p = 0.005) and sagittal plane hip moment impulse symmetry improved (flexion: pre = 23.1 ± 16.0 %, post = -3.9 ± 19.5 %, p = 0.004, extension: pre = 29.2 ± 20.3 %, post = 8.7 ± 22.9 %, p = 0.049). Residual limb knee extension moment impulse decreased compared to baseline (pre = 15.7 ± 10.8 Nm*s/kg, post = 7.8 ± 3.9 Nm*s/kg, p = 0.030). These results indicate that bone-anchored limb implantation alters multi-joint biomechanics, which may impact LBP or OA risk factors in the TTA population longitudinally.

Correlation between the vascular resistance index and arteriography for assessment of the distal arterial bed in chronic limb threatening ischemia.

Background: Patients with chronic limb threatening ischemia (CLTI) of the lower limbs (LL) undergo arteriography for revascularization surgery planning. Doppler ultrasound (DU) is non-invasive and can provide information about the distal arteries through measurement of the resistance index (RI). Objectives: To correlate the Rutherford Angiographic Classification with the RI for assessment of the distal arterial bed of the LL. Methods: A cross-sectional study, conducted at a public tertiary hospital with 120 patients with LL CLTI, from September 2019 to April 2022. The RI of arteries that were candidates for revascularization was compared with the images of the same arteries obtained using arteriography, using the Rutherford Angiographic Classification of the distal bed. Results: A total of 120 LL were assessed in 120 patients with a mean age of 68.6 years. The sample was 50.0% male and 90.0% of the patients in the sample were classified as Rutherford category five. The RI values found for the arteries of the leg exhibited a statistically significant positive correlation with the Rutherford Classification (anterior tibial, p< 0.01; posterior tibial, p = 0.012 fibular, p = 0.034; and dorsalis pedis, p < 0.001). Conclusions: In this study, RIs for the arteries of the leg measured using Doppler ultrasound exhibited a positive correlation with the Rutherford Classification. This index could be useful for assessment of the distal arterial bed of the lower limbs of patients with chronic limb threatening ischemia.

Novel Angiogenesis Role of GLP-1(32-36) to Rescue Diabetic Ischemic Lower Limbs via GLP-1R-Dependent Glycolysis in Mice.

BACKGROUND: Restoring the capacity of endothelial progenitor cells (EPCs) to promote angiogenesis is the major therapeutic strategy of diabetic peripheral artery disease. The aim of this study was to investigate the effects of GLP-1 (glucagon-like peptide 1; 32-36)-an end product of GLP-1-on angiogenesis of EPCs and T1DM (type 1 diabetes) mice, as well as its interaction with the classical GLP-1R (GLP-1 receptor) pathway and its effect on mitochondrial metabolism. METHODS: In in vivo experiments, we conducted streptozocin-induced type 1 diabetic mice as a murine model of unilateral hind limb ischemia to examine the therapeutic potential of GLP-1(32-36) on angiogenesis. We also generated Glp1r-/- mice to detect whether GLP-1R is required for angiogenic function of GLP-1(32-36). In in vitro experiments, EPCs isolated from the mouse bone marrow and human umbilical cord blood samples were used to detect GLP-1(32-36)-mediated angiogenic capability under high glucose treatment. RESULTS: We demonstrated that GLP-1(32-36) did not affect insulin secretion but could significantly rescue angiogenic function and blood perfusion in ischemic limb of streptozocin-induced T1DM mice, a function similar to its parental GLP-1. We also found that GLP-1(32-36) promotes angiogenesis in EPCs exposed to high glucose. Specifically, GLP-1(32-36) has a causal role in improving fragile mitochondrial function and metabolism via the GLP-1R-mediated pathway. We further demonstrated that GLP-1(32-36) rescued diabetic ischemic lower limbs by activating the GLP-1R-dependent eNOS (endothelial NO synthase)/cGMP/PKG (protein kinase G) pathway. CONCLUSIONS: Our study provides a novel mechanism with which GLP-1(32-36) acts in modulating metabolic reprogramming toward glycolytic flux in partnership with GLP-1R for improved angiogenesis in high glucose-exposed EPCs and T1DM murine models. We propose that GLP-1(32-36) could be used as a monotherapy or add-on therapy with existing treatments for peripheral artery disease. REGISTRATION: URL: www.ebi.ac.uk/metabolights/; Unique identifier: MTBLS9543.

Clinical outcomes measurement in pediatric lower limb prosthetics: A scoping review.

OBJECTIVE: This study aimed to identify clinical measures that have been used to evaluate function, health related quality of life (HRQoL), and/or satisfaction in children who use lower limb prostheses (LLP). The data reported on psychometric properties for children who use LLP were collected for each measure. METHODS: First, PubMed, CINAHL, and Web of Science databases were searched using broad search terms to identify standardized outcome measures of function, HRQoL, and/or satisfaction with treatment used in pediatric LLP research published in 2001 or after. For each of the eligible measures found, a second search was performed to identify psychometric properties (e.g., validity, reliability) assessed with children who use LLP. RESULTS: Forty-four standardized outcome measures were identified from 41 pediatric LLP research articles. Five measures (i.e., Gait Outcomes Assessment for Lower Limb Differences, Functional Mobility Assessment, Child Amputee Prosthetics Project- Prosthesis Satisfaction Inventory, Child Amputee Prosthetics Project- Functional Scale Index, and Lower Limb Function Questionnaire) had data on psychometric properties for children who use LLP. CONCLUSIONS: Few studies report psychometric data for assessing the overall HRQoL, function, and/or satisfaction for children who use LLP. Further research is needed to validate or create new outcome measures that assess the HRQoL, satisfaction, and/or function of children who use LLP.

Cortical and spinal responses to short-term strength training and detraining in young and older adults in rectus femoris muscle.

INTRODUCTION: Strength training mitigates the age-related decline in strength and muscle activation but limited evidence exists on specific motor pathway adaptations. METHODS: Eleven young (22-34 years) and ten older (66-80 years) adults underwent five testing sessions where lumbar-evoked potentials (LEPs) and motor-evoked potentials (MEPs) were measured during 20 and 60% of maximum voluntary contraction (MVC). Ten stimulations, randomly delivered, targeted 25% of maximum compound action potential for LEPs and 120, 140, and 160% of active motor threshold (aMT) for MEPs. The 7-week whole-body resistance training intervention included five exercises, e.g., knee extension (5 sets) and leg press (3 sets), performed twice weekly and was followed by 4 weeks of detraining. RESULTS: Young had higher MVC (~ 63 N·m, p = 0.006), 1-RM (~ 50 kg, p = 0.002), and lower aMT (~ 9%, p = 0.030) than older adults at baseline. Young increased 1-RM (+ 18 kg, p < 0.001), skeletal muscle mass (SMM) (+ 0.9 kg, p = 0.009), and LEP amplitude (+ 0.174, p < 0.001) during 20% MVC. Older adults increased MVC (+ 13 N·m, p = 0.014), however, they experienced decreased LEP amplitude (- 0.241, p < 0.001) during 20% MVC and MEP amplitude reductions at 120% (- 0.157, p = 0.034), 140% (- 0.196, p = 0.026), and 160% (- 0.210, p = 0.006) aMT during 60% MVC trials. After detraining, young and older adults decreased 1-RM, while young adults decreased SMM. CONCLUSION: Higher aMT and MEP amplitude in older adults were concomitant with lower baseline strength. Training increased strength in both groups, but divergent modifications in cortico-spinal activity occurred. Results suggest that the primary locus of adaptation occurs at the spinal level.