Accepted Manuscript. Ultrasound in Medicine and Biologyy. The original publication is available at www.sciencedirect.com. DOI: doi:10.1016/j.ultrasmedbio.2015.04.020.Development of shear wave elastography gave access to non-invasive muscle stiffness assessment in vivo. The aim of the present study was to define a measurement protocol to quantify the shear modulus of lower limb muscles in order to be used in clinical routine. Four positions were defined to evaluate shear modulus, parallel to the fibers, in the anterior and posterior aspect of the lower limb, at rest and during passive stretching, of 10 healthy subjects. Reliability was first evaluated on 2 muscles by 3 operators, measurements were repeated 6 times. Then, reliability comparison of different muscle was evaluated on 11 muscles by 2 operators, measurements repeated 3 times. Reproducibility of shear modulus was 0.48 kPa and repeatability was 0.41 kPa, with all muscles pooled. The position did not significantly influence the reliability. SWE appeared as an appropriate and reliable tool to evaluate shear modulus of lower limb muscles with the proposed protocol.

Highlights Marjolin’s ulcers are a rare form of malignancy that present at regions exposed to chronic inflammation. They are classically encountered in lower extremities more commonly than in the upper extremities. This disease should be suspected in every case of chronic ulcer, where histological studies of the lesion must be conducted. Treatment options vary according to local and regional factors. Early recognition and control of the disease allow for better control and relapse.

Child maltreatment is a violation of human rights and includes all forms of abuse against children under 18 years of age. It is the second cause of death in children after accidental trauma and remains an active problem worldwide. In Lebanon, little work is being done nationwide to provide and explain the available screening and reporting tools for child maltreatment. In this study, we assess the diagnostic accuracy of the ESCAPE instrument and its modified version (including one additional question "Did parents/caregivers take adequate measures?") in screening child maltreatment in emergency departments, and calculate the prevalence of child abuse in Lebanon. The present diagnostic accuracy study is performed over 16 months using a convenience sampling on children under the age of 18 who presented to Lebanese emergency departments. Confirmation of maltreatment by the child protection team was considered as the cornerstone to diagnosis. Screening performance characteristics of ESCAPE and ESCAPE-modified were calculated using GPower v3.1 and SPSS v22 soft wares. 411 children with the mean age of 5.7 years were screened (38% girls). 47 children were suspected victims of child abuse (11.4%). 13 children (3.2%) were confirmed victims of child maltreatment. Sensitivity, specificity, positive and negative predictive values of this test, with 95% confidence intervals, were 100% (82.7 -100), 91.5% (88.4 -93.9), 27.7% (16.5 -41.5), and 100% (99.3 -100) respectively. The additional question added to ESCAPE did not alter the diagnostic performance of the test but was superior in terms of positive predictive value without losing in terms of negative predictive value. In this study, ESCAPE was proven to be an appropriate screening instrument for identifying children at high risk of child abuse, with excellent accuracy. The additional question of "Did parents/caregivers take adequate measures?" represents a simpler tool with a higher positive predictive value, to be used after a positive ESCAPE screening to help confirm or reject the diagnosis of child maltreatment in case of doubt.