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Background: Physical restraint is used to prevent agitation, to continue treatments and to ensure safety in intensive care patients. Physical restraint has negative effects on physical and psychological health, and physical restraint should not be used unless necessary. Aims: The purpose of this study was to evaluate the development of vascular complications in extremities of physically restrained patients hospitalized in the intensive care unit (ICU) and the associated factors. Study Design: A prospective, observational study. The study was conducted between September 1, 2022, and March 31, 2023 in eight ICUs of a hospital located in the inner regions of Türkiye. The development of vascular complications (discolouration, distemperature, variations in capillary refill time, fluctuations in peripheral pulse, skin ulceration and oedema in the area of physical restraint) rate in patients hospitalized in the ICUs who were physically restrained. Independent sample t test, Mann–Whitney U test and Pearson‐χ2 test were used to analyse the data. Results: During the study, 2409 patients were admitted to ICUs. Physical restraint was applied to 209 of these patients. Of the 209 patients, 112 patients who met the inclusion criteria were included in the study. The physical restraint site of the patients was evaluated an average of 230.12 times and physical restraint was terminated in 9.8% of the patients (n = 112) because of vascular complications that developed in the physical restraint site. The rate of vascular complications at the site of physical restraint was higher in patients with endotracheal tubes (p <.05), lower GCS scores (p <.05) and higher INR values (p <.05). Patients with skin ulceration at the restraint site received more massages and cream applications (%95CL = 1. 1.692–34.734, OR = 7.667, p =.032). It was determined that more massage was applied to patients with changes in skin temperature at the restraint site (%95Cl = 1.062–11.599, OR = 3.510, p =.032). Conclusions: Vascular complications may develop at the restraint site in patients hospitalized in the ICU. This may be more common in ICU patients with endotracheal tube, lower GCS score and higher INR values. Relevance to Clinical Practice: Nurses should closely monitor ICUs patients with endotracheal tube, lower GCS score and higher INR values, and implement care interventions to prevent the development of vascular complications. [ABSTRACT FROM AUTHOR]

Background and Objective: Understanding the socioeconomic burden of multiple sclerosis (MS) is essential to inform policymakers and payers. Real-world studies have associated increasing costs and worsening quality of life (QoL) with disability progression. This study aims to further evaluate the impact of cognition, fatigue, upper and lower limb function (ULF, LLF) impairments, and disease progression per Expanded Disability Status Scale (EDSS) level, on costs and QoL. Methods: This was a cross-sectional cohort study including 20,988 patients from the German NeuroTransData MS registry from 2009 to 2019. QoL analyses were based on EQ-5D-5L. Cost analyses included indirect/direct medical and non-medical costs. Eight subgroups, ranging from 439 to 1812 patients were created based on presence of measures for disease progression (EDSS), cognition (Symbol Digit Modalities Test [SDMT]), fatigue (Modified Fatigue Impact 5-Item Scale [MFIS-5]), ULF (Nine-Hole Peg Test [9HPT]), and LLF (Timed 25-Foot Walk [T25FW]). Multivariable linear regression assessed the independent effect of each test's score on QoL and costs, while adjusting for EDSS and 12 other confounders. Results: Lower QoL was associated with decreasing cognition (p < 0.001), worsening ULF (p = 0.025), and increasing fatigue (p < 0.0001); however, the negative impact of LLF worsening on QoL was not statistically significant (p = 0.54). Higher costs were associated with decreasing cognition (p < 0.001), worsening of ULF (p = 0.0058) and LLF (p = 0.049), and increasing fatigue (p < 0.0001). Each 1-scale-step worsening function of SDMT, MFIS-5, 9HPT, and T25FW scores resulted in €170, €790, €330, and €520 higher costs, respectively. Modeling disability progression based on SDMT, MFIS-5, 9HPT, and T25FW scores as an interaction with EDSS strata found associations with lower QoL and higher costs at variable EDSS ranges. Conclusions: Disease progression in MS measured by 9HPT, SDMT, and MFIS-5 had a significant negative impact on QoL and broad socioeconomic costs independent of EDSS. T25FW had a significant negative association with costs. Cognition, fatigue, ULF, and LLF have stronger impact on costs and QoL in patients with higher EDSS scores. Additional determinants of MS disability status, including SDMT, MFIS-5, 9HPT, and T25FW, should be considered for assessing cost effectiveness of novel therapeutics for MS. [ABSTRACT FROM AUTHOR]

Radial dysplasia (RD) is a congenital upper limb birth defect that presents with changes to the upper limb anatomy, including a shortened or absent radius, bowed ulna, thumb malformations, a radially deviated hand and a range of muscle and tendon malformations, including absent or abnormally shaped muscle bundles. Current treatments to address wrist instability caused by a shortened or absent radius frequently require an initial soft tissue distraction intervention followed by a wrist stabilisation procedure. Following these surgical interventions, however, recurrence of the wrist deviation remains a common, long‐term problem following treatment. The impact of the abnormal soft connective tissue (muscle and tendon) anatomy on the clinical presentation of RD and the complications following surgery are not understood. To address this, we have examined the muscle, fascia and the fascial irregular connective tissue (ICT) fibroblasts found within soft connective tissues, from RD patients. We show that ICT fibroblasts isolated from RD patients are functionally abnormal when compared to the same cells isolated from control patients and secrete a relatively disordered extracellular matrix (ECM). Furthermore, we show that ICT fibroblast dysfunction is a unifying feature found in RD patients, even when the RD clinical presentation is caused by distinct genetic syndromes. [ABSTRACT FROM AUTHOR]

Background: Intestinal necrosis in uremic patients has been reported but is rare. Case presentation: A 56-year-old male patient who underwent long-term regular haemodialysis was admitted to the hospital due to involuntary shaking of the limbs and nonsense speech. The patient's symptoms improved after continuous blood purification under heparin anticoagulation, rehydration, sedation, and correction of electrolyte disturbances. However, the patient experienced a sudden onset of abdominal pain and a rapid decrease in blood pressure; high-dose norepinephrine were required to maintain his blood pressure. A plain abdominal radiograph performed at bedside showed intestinal dilation. Colonoscopy revealed inflammation and oedema of the entire colon, with purulent secretions and multiple areas of patchy necrosis. The cause of intestinal ischaemia was not clear. Conclusions: Although rare, previous causes of uremic colitis have been reported. As the patient developed abdominal pain before the onset of shock and the necrosis was seen on colonoscopy, we suspect that this is a case of fulminant uremic colitis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Step width during walking can provide important information about aging and pathology. Although knee osteoarthritis (OA) is a common disease in elderly women, little is known about how different step widths influence gait parameters in patients with knee OA. OBJECTIVE: To address this, we investigated the differences between narrower and wider step width on the center of mass (CoM) and gait biomechanics of elderly women with knee OA. METHODS: Gait and CoM data were measured using a three-dimensional motion capture system and anthropometric data were acquired via standing full-limb radiography. Thirty elderly women with knee OA were divided into two groups depending on the average step width value (0.16 m). Specifically, the narrower step width group included those with a below average step width (n = 15) and the wider step width group included those with an above average step width (n = 15). The differences between the two groups were analyzed using an independent t -test. RESULTS: Walking speed, step length, knee and ankle sagittal excursion, and medial-lateral CoM range were significantly greater in the narrower group. In contrast, the medial-lateral CoM velocity, medial-lateral ground reaction force (GRF), and foot progression angle were significantly higher in wider group. The external knee adduction moment, vertical GRF, and vertical CoM did not differ between the groups. CONCLUSIONS: Our data indicate that step width in women with knee OA is associated with trunk motion and gait patterns. People with a narrower step might improve their gait function by increasing trunk frontal control to maintain gait stability. In contrast, in those with a wider step, greater toe out angle and shorter step length might be a compensatory adaptation to reduce knee loading. [ABSTRACT FROM AUTHOR]

Radiotherapy is considered a cornerstone as adjuvant or neo adjuvant to surgery in extremity soft tissue sarcoma (ESTS). Wound complications are the most agonizing complication that may have an impact on patient's functional outcome following radiotherapy. The best care for ESTS is by combining extensive surgical excision with safety margin and radiotherapy either preoperative (neoadjuvant) or postoperative. Preoperative radiotherapy allows for lower dose of radiation over smaller fields which is supposed to decrease long-term complications. However, several studies have shown that early complications which include wound dehiscence, infection, seroma and burn may be more frequent with preoperative radiotherapy than with postoperative radiotherapy. Most of these studies were retrospective. This study aims to prospectively assess and compare the early complications associated with radiotherapy in both techniques. Preoperative radiotherapy is not inferior to postoperative radiotherapy regarding early wound complications. Between January 2021 and June 2022, we prospectively studied 22 patients and categorized them into two groups, group A (preoperative radiotherapy) and group B (postoperative radiotherapy). We included patients with extremity soft tissue sarcoma in skeletally mature patients who were randomized into two groups with follow up 9–12 months. Wound complications, local complications, recurrence, time for wound healing and survival rate were recorded and analyzed using SPSS 25. 22 patients were included, 10 in group A and 12 in group B, their mean age was 46.4 years with mean follow up 9 months. The major wound complications were higher in group A (preoperative radiotherapy). in comparison with group B (postoperative radiotherapy), however, this was not statistically significant. While other local complications were higher in group B, it was also statistically insignificant. Time for wound healing was higher in group A more than group B and was statistically significant (p value = 0.011) No increase in the wound complications rate with preoperative radiotherapy by using low fractionated doses of radiotherapy and increasing interval before surgery to six weeks, although there is increased risk of delayed wound healing time after surgery. The size and site of the tumor may increase the risk of wound complications unrelated to the type of radiotherapy. II: clinical trial. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to explore whether offset loading in the barbell squat altered ground-reaction force (GRF) and muscle activation in the dominant (D) and nondominant (ND) lower limb compared to traditional squats. Methods: Twelve well-trained men (age 26.4 [3.2] y; 10.3 [1.9] y experience) performed 3 sets of 10 repetitions at 60% of their previously measured 1-repetition maximum. Sets were quasi-randomized between traditional loading (TDL), dominant-side offset loading (OS-D), and nondominant-side offset loading (OS-ND). All repetitions were performed on a dual force plate with electromyography sensors on the prime mover muscles of the squat. GRF symmetry was assessed using the symmetry index (SI) to determine the direction (D [+] or ND [−]) and magnitude (%) of the asymmetry. Finally, the first 3 and final 3 repetitions of each set were compared for compensatory changes in symmetry. Results: OS-D induced a significant change in limb SI relative to TDL (5.21% vs 1.44%; P =.011); however, no significant difference in limb SI was seen between TDL and OS-ND (−0.66% vs 1.44%; P =.278). No asymmetries between D and ND muscle activation were present in any condition. TDL and OS-D squats exhibited significant improvements in limb SI between the first 3 and final 3 repetitions (P =.035 and.011, respectively); however, no such improvement was seen in OS-ND. Conclusions: OS-D is capable of significantly altering GRF limb SI in a bilateral squat; however, OS-ND appears to exhibit no GRF or electromyography effects relative to TDL. Thus, the results of this study do not support the use of OS-ND in the pursuit of strengthening a weaker limb, suggesting that unilateral training may be a preferred mode of exercise for this desired outcome. [ABSTRACT FROM AUTHOR]

The analysis of gait is an important tool for evaluating postoperative outcomes of a Total Knee Replacement (TKR). There are few studies which have evaluated the gait parameters of a Kinematic retaining (Kr) prosthesis. This study therefore aims to investigate the kinetic and kinematic differences of running and walking, in the ankle, knee and hip joints in patients who underwent a Kr TKR. This study assessed the gait of 12 patients with physica lima Kr TKRs at 1 year follow up and 8 healthy controls using 3D video analysis. Data was collected on the kinetics and kinematics of walking and running at the ankle, knee and hip. Comparison was made between the operated and non-operated limbs of the patients, and between the operated and control limbs. Gait analysis showed no statistically significant difference in the hip, ankle and knee angles or moments between the non-operated and operated legs during walking and running. However, there was a statistically significant difference between the knee angles of initial contact, maximum flexion during stance and swing in the TKR knees vs controls in walking and running. Similarly, there was also a statistically significantly higher max knee flexion moment between operated knees and controls in both walking and running. This study has shown that a quadriceps avoidance gait persists in patients after TKR, and that there was symmetry and reciprocated gait parameters in non-operated limbs. These findings suggest that Kr TKRs could be capable of replicating normal knee kinematics when running and walking. [ABSTRACT FROM AUTHOR]

Clinical Scenario: Blood flow restriction (BFR) therapy has emerged as a viable treatment option to enhance clinical recovery in patients with primarily muscular injuries. However, BFR therapy has been rarely investigated in patients with osseous injuries to include extremity fracture. Focused Clinical Question: Does BFR-enhanced therapy improve clinical outcomes in patients during the acute to subacute rehabilitation period after extremity fracture? Summary of Key Findings: (1) In cases of 2 high-performing athletes with talus and osteochondral fracture of the knee, BFR was well tolerated and an effective rehabilitation regimen. (2) In 2 randomized controlled trials evaluating BFR use in patients after operative and nonoperative management of distal radius fractures, pain with activity and self-perceived function were improved in BFR-enhanced therapy as compared with a standard rehabilitation regimen. (3) Objective clinical outcomes including radiographic healing, extremity range of motion, and grip strength evaluated by the randomized controlled trials did not differ significantly between the BFR-enhanced and standard rehabilitation groups. Clinical Bottom Line: BFR-enhanced therapy may improve pain and self-perceived function of the injured extremity during the acute to subacute rehabilitation period after fracture. However, there is not yet a demonstrated benefit of BFR on hastening objective measures of clinical recovery. Large-scale clinical trials comparing BFR-enhanced rehabilitation with standard rehabilitation regimens are needed to better characterize BFR use in patients with osseous injuries. Strength of Recommendation: Two case reports and 2 randomized controlled trials provide level IIB evidence suggesting that BFR may improve pain in the acute rehabilitative stage and improve the patient's perceived function of the injured extremity, without greater improvement in objectively measured clinical parameters as compared with a standard rehabilitation regimen. [ABSTRACT FROM AUTHOR]

Background: This study conducted to determine the prevalence and severity of musculoskeletal discomfort among two-wheeler riders; however, musculoskeletal discomfort refers to pain, discomfort, or impairment in the muscles, bones, joints, tendons, ligaments, or other structures that support the body's movement. It is a common problem experienced by individuals involved in various physical activities, including motorcycle riding. Methods: This investigation was longitudinal research in which the Nordic muscular questionnaire (NMQ) was used to rule out the possibility of musculoskeletal disorders in motorcyclists. In Karachi, Pakistan, data were collected beginning in September of 2021 and continuing through February of 2022 using the convenience sampling method. Sixty-four individuals made up the sample. Participants were males ranging between the ages of 19 and 50 who rode standard motorcycles for their commute for about 6 to 8 h daily. Participants who had a tumor, an infection, or other comorbid are excluded. Results: Sixty-four participants were included in this study, out of which 40 (62.5%) reported difficulty and discomfort in their neck, followed by their lower back (48.5%), shoulders (34.4%), and hips (26.6%). Sixteen motorcyclists (25%) complained wrist pain. When asked out their level of discomfort. However, 51.6% of individuals experienced lower back pain at the 12th month, while 46.9% had neck pain. 28.1%, 17.2%, and 14.1% reported shoulder, hip, and upper back discomfort. 51.6% of individuals had not seen a specialist for lower back symptoms. Lower back, neck, shoulders, and hip have been affected the longest, according to participants. Conclusion: In conclusion, motorcyclists had a substantially greater rate of musculoskeletal problems than other drivers. Regulating musculoskeletal disorders in motorcyclists helps reduce symptoms and clinical indications of disease. [ABSTRACT FROM AUTHOR]

Recent randomised controlled trials (RCTs) have investigated the analgesic activity of sesame oil among patients with limb trauma; nevertheless, their findings are inconsistent. Hence, this review aimed to clarify the impact of topical administration of sesame oil on acute pain of adult outpatients with minor limb trauma. The online databases (e.g., Scopus, PubMed, Web of Science) were searched up to 31 January 2024. The RCTs were included if they compared the effect of applying standard treatments plus topical sesame oil to administering standard treatments alone or with a placebo/sham treatment. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) and the Cochrane Collaboration's risk of bias tool were applied to address the evidence quality and the study's methodological rigour, respectively. Four RCTs had the inclusion criteria, and their findings were pooled in a meta‐analysis employing a random‐effects approach. According to the pooled analysis, the reduction in mean change of the pain score from baseline to the second/third intervention day was significantly higher in favour of clients who received standard care plus daily massage of the trauma site with sesame oil compared to those who received a control condition (weighted mean difference: −1.10; 95% confidence interval [−1.62, −0.57]; p < 0.001). However, the evidence quality was moderate, and only two studies had good methodological rigour. Hence, more high‐quality studies are needed to make a solid evidence‐based conclusion about the favourable consequence of topical sesame oil on alleviating acute traumatic limb pain. [ABSTRACT FROM AUTHOR]

Background: The term Anterior Accessory of the Great Saphenous Vein suggest this is a branch tributary vein despite this vessel's anatomic features of a truncal vein. A multisocietal group suggested to designate this the Anterior Saphenous Vein (ASV). This study was aimed to evaluate its ultrasound anatomy in normal and varicose limbs. Methods: The clinical anatomy of the ASV was evaluated by narrative review of the literature. Additionally, the course of the ASV was evaluated in 62 limbs with no evidence of venous disease and 62 limbs with varicosities. Results: The ASV length, patterns of origin and termination are reported in both normal and patients with varicose veins. Discussion of the patterns is supported by the narrative review of the literature. Conclusions: The ASV must be considered a truncal vein and its treatment modalities should be the same that for the great and small saphenous veins rather than a tributary vein. [ABSTRACT FROM AUTHOR]

Objective: This review aimed to describe the quality and comprehensiveness of adverse event (AE) reporting in clinical trials incorporating manual therapy (MT) as an intervention for extremity conditions using the Consolidated Standards of Reporting Trials (CONSORT)-Harms extension as the benchmark. The secondary aim was to determine whether the quality of AE reporting improved after the availability of the CONSORT reporting checklist. Design: Systematic review. Methods: A literature search was conducted using multiple databases to identify trials where MT was used to treat extremity conditions. Studies that reported AEs were identified and evaluated using the CONSORT-Harms extension. The frequency of trials reporting study AEs before and after the publication of the updated 2010 CONSORT statement was calculated, along with the categorization of how study AEs were reported. Results: Of the 55,539 studies initially identified, 220 trials met all inclusion criteria. Eighty trials (36.4%) reported AE occurrence. None of the studies that reported AEs adhered to all 10 criteria proposed by the 2010 CONSORT-Harms extension. The most commonly reported criterion was number four, which clarified how AE-related information was collected (30% of trials). The least reported criterion was number six, which describes the participant withdrawals for each arm due to AEs and the experience with the allocated treatment (1.3% of trials). The nomenclature used to describe AEs varied substantially. Fifty-nine of 76 trials (33.3%) were published after the updated CONSORT Harms-checklist was available, compared to 21 of 44 trials (46.7%) published before it was available. Conclusion: Reporting of AEs in trials investigating MT for extremity conditions is poor. Every included trial lacked adherence to all 10 criteria proposed by the CONSORT-Harms Extension. The quality and comprehensiveness of AE reporting did not improve after the most recent CONSORT update recommending AE reporting. Clinicians must obtain informed consent before performing any intervention, including MT, which requires disclosing potential risks, which could be better known with improved tracking, analyzing, and reporting of AEs. The authors recommend improved adherence to best practices for adequately tracking and reporting AEs in future MT trials. [ABSTRACT FROM AUTHOR]

Simple Summary: This study assessed the overall complications in 169 patients treated for extremity soft tissue sarcomas (ESTS) with a multimodal treatment involving radiotherapy and surgery. Risk factors for complications were identified, including postoperative, acute, and chronic radiotherapy-related complications, aiming to optimize treatment strategies to reduce morbidity. Multimodal treatment of ESTSs demonstrated excellent tolerance, with manageable side effects. Introduction: Soft tissue sarcomas of the extremities (ESTSs) pose significant challenges in treatment and management due to their diverse nature and potential complications. This study aimed to assess complications associated with multimodal treatments involving surgery and radiotherapy (RT) and to identify potential risk factors. Methods: We retrospectively analyzed nonmetastatic ESTS patients treated with surgery and pre- or post-operative RT between 2007 and 2020 in Strasbourg, France. Complications, including wound complications (WCs), lymphedema, acute and chronic RT-related complications, and fractures, were meticulously evaluated. Results: A total of 169 patients diagnosed with localized ESTSs were included, with a median age of 64 years (range 21–94 years). ESTSs primarily occurred proximally (74.6%) and in the lower limbs (71%). The median follow-up was 5.5 years. WCs occurred in 22.5% of patients, with proximal and lower extremity tumors being significant risk factors. Acute RT-related complications included radiodermatitis, with grade ≥ 2 occurring in 43.1% of patients, which was associated with superficial tumors. Three patients had an edema grade ≥ 2. Chronic complications included telangiectasias (21.7%) and fibrosis (38.7%), with higher rates associated with larger PTVs and higher RT doses, respectively. Fractures occurred in 5 patients, mainly in the tibia (40%). Conclusions: Multimodal treatment of ESTSs demonstrated excellent tolerance, with manageable side effects. Numerous risk factors have been highlighted, providing insights for optimizing treatment strategies and enhancing patient care in this rare disease. [ABSTRACT FROM AUTHOR]

Background: Cerebral sparganosis represents the most severe manifestation of sparganosis, with a relatively low global incidence. For cases of secondary epileptic seizures caused by sparganosis infection in the functional areas of the brain, what advanced neurosurgical techniques should be employed to precisely identify and excise the epileptic lesions in the deep functional areas of the brain, aiming to achieve maximal removal while minimising the risk of neurological deficits? This remains a current challenge for epilepsy surgeons. Case presentation: A 24-year-old Chinese male was admitted to our hospital, presenting with a history of left limb twitching persisting for over a year. His main clinical symptoms presented twitching and numbness of his left limb without loss of consciousness. Under the premise of inappropriate anti-seizure treatment, recurrent epilepsy attacked persist. The patient's diagnosis was considered as "space-occupying lesions in the several lobes of brain, secondary epilepsy" after comprehensive assessment and discussion. And experts considered that the patient's space-occupying lesions in the right frontal and parietal lobes were highly suspected to be infected by parasites. This report delved into the application of neurosurgery robot-assisted frameless stereotaxic technology and intraoperative stereotactic electroencephalography (SEEG) monitoring technology to accurately locate and optimize removal of parasite-related epileptic lesions situated in functional areas of the brain. As a result, the patient had achieved seizure freedom, leaving no symptoms of neurological deficit. Conclusions: With the highly integrated development of imaging technology, mechanical technology, computer control technology, and artificial intelligence, surgical robots are poised to play a larger role across various neurosurgical specialties in the future. Considering benefits for patients and the promising application of this technology, its utilization holds significant value. [ABSTRACT FROM AUTHOR]

Simple Summary: This study assessed the outcomes of extremity soft-tissue sarcomas (ESTS) in 169 patients treated with radiotherapy (RT) and surgery between 2007 and 2020 in Strasbourg. Predominantly grade 2–3 tumors were found, mainly deep-seated in the lower limbs. Outcomes were promising, with 5- and 10-year LC, DC, and OS rates of 91.7%, 76.8%, and 83.8% and 84.2%, 74.1%, and 77.6%, respectively. Factors influencing the outcomes included radiation dose, grade, histologic subtype, depth and treatment technique. Introduction: The prognostic factors for extremity soft-tissue sarcomas (ESTSs) treated with multimodal surgery and radiotherapy (RT) remain a subject of debate across diverse and heterogeneous studies. Methods: We retrospectively analyzed nonmetastatic ESTS patients treated with RT between 2007 and 2020 in Strasbourg, France. We assessed local control (LC), distant control (DC), overall survival (OS), and complications. Results: A total of 169 patients diagnosed with localized ESTS were included. The median age was 64 years (range 21–94 years). ESTS primarily occurred proximally (74.6%) and in the lower limbs (71%). Most tumors were grade 2–3 (71.1%), deep-seated (86.4%), and had R0 margins (63.9%). Most patients were treated with helical tomotherapy (79.3%). The median biologically effective dose (BED) prescribed was 75 BEDGy4 (range 45.0–109.9). The median follow-up was 5.5 years. The 5- and 10-year LC, DC, and OS rates were 91.7%, 76.8%, and 83.8% and 84.2%, 74.1%, and 77.6%, respectively. According to the univariate analysis, LC was worse for patients who received less than 75 BEDGy4 (p = 0.015). Deep tumors were associated with worse OS (p < 0.05), and grade 2–3 and undifferentiated pleomorphic sarcoma (UPS) were linked to both shorter DC and shorter OS (p < 0.05). IMRT was associated with longer LC than 3DRT (p = 0.018). Multivariate analysis revealed that patients with liposarcoma had better OS (p < 0.05) and that patients with distant relapse had shorter OS (p < 0.0001). Conclusion: RT associated with surgical resection was well tolerated and was associated with excellent long-term rates of LC, DC, and OS. Compared with 3DRT, IMRT improved local control. Liposarcoma was a favorable prognostic factor for OS. Intermediate- and high-grade tumors and deep tumors were associated with lower DC and OS. [ABSTRACT FROM AUTHOR]

The article discusses highlights of the 2024 Cellular, Acellular and Matrix-like Products (CAMP) Wound Care Summit, held in Miami, Florida, with topics including the use of viable placental allografts for diabetic ulcers, protection of CAMP coverage, reimbursement denials, health disparities, and approach to documentation and billing for compliance and reimbursement.

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The inclusion of health professionals who have some type of disability brings benefits, such as the increase in empathy that facilitates the relationship with patients. In this work, we present a case study on the inclusion of an undergraduate Dentistry student with upper limb agenesis. In order to improve the quality of life for people with upper limb agenesis, it is urgent to establish inclusion strategies in the educational field. This process included the use of assistive technologies to allow the manipulation of instruments used in the practice of dental clinical activities, enabling future Dentists with upper limb agenesis to have an equal education in relation to their academic peers. The case study presented in this work consists of the follow-up of G., a 23-year-old female Dentistry student. The developed adaptations were made using a low-temperature thermoplastic. The expert team that participated in this process was formed by three occupational therapists and three Dentistry professors. The process included several stages, being the last one the integration, in which training sessions were performed. The process was accessed using two main tools: quantitative questionnaires and qualitative interviews. After the proposed intervention, the volunteer presented a gradual evolution in her occupational performance with the use of most adaptations, promoting her functional training. Most adaptations allowed G. to perform the activities satisfactorily, with the precision inherent to these tasks, even with little training time. This case study demonstrates the high applicability of the proposed technologies. In order to improve the quality of life for people with upper limb agenesis, it is urgent to establish inclusion strategies in the educational field, as assessed in this study case The inclusion process of Dentistry students can include the use of assistive technology to allow the manipulation of instruments for the practice of clinical activities Our study suggests that the assistive adpatations promote a gradual evolution in the students' occupational performance, functional training and motor qualification [ABSTRACT FROM AUTHOR]

This study aimed to translate and validate the Chinese version of the Diagnostic Instrument for Limb Apraxia-Short Version (DILA-S) classic subtests in Chinese patients after ischemic stroke. The DILA-S was translated and adapted for use in Mandarin-speaking Chinese patients. Internal consistency, test-retest reliability, dimensionality, convergent validity, divergent validity, and concurrent validity were tested. A total of 112 ischemic stroke patients were included. The internal consistency (Cronbach's alpha 0.85 ~ 0.92) and test-retest reliability (ICC 0.88 ~ 0.93) were found satisfactory. Exploratory factor analysis obtained two factors for the imitation subtests and the execution scale of the pantomime of tool use. Convergent validity was supported by strong correlations (ρ > 0.7) between the scores of the DILA-S subtests and the LOTCA motor praxis subscale. Divergent validity was acceptable for weak to moderate correlations (ρ ranged from −0.25~ −0.41) between the scores of the DILA-S subtests and the NIHSS. Concurrent validity was supported by strong correlations (ρ > 0.7) between the scores of the DILA-S subtests and the MoCA, as well as strong correlations (ρ > 0.6 < 0.7) between the scores of the DILA-S subtests and the BI. The Chinese version of the DILA-S classic subtests demonstrated satisfactory psychometric properties for assessing limb apraxia in Chinese patients after ischemic stroke. [ABSTRACT FROM AUTHOR]

Objective To summarize the clinical characteristics of peripheral nerve hyperexcitability syndrome (PNHS). Methods and Results Ten patients with PNHS were admitted to He'nan Provincial People's Hospital from October 2018 to April 2022, with the clinical phenotypes of Morvan syndrome in 5 cases, Issacs syndrome in 4 cases, and cramp-fasciculation syndrome (CFS) in one case. There were 10 cases with clinical manifestations of muscle twitching, 8 of dysautonomia, 7 of central nervous system symptoms, 7 of limb weakness, 6 of sensory deficits, and 2 of cramping and muscle stiffness. Five cases were positive for autoimmune antibodies. Two cases had MRI abnormalities located in the brainstem, left occipital lobe and right thalamus. Ten cases had EMG abnormalities, including afterdischarges of F-wave in 10 cases, unit potential of spontaneous motion abnormalities in 10 cases, fasciculation potentials in 10 cases, myokymic discharges in 8 cases, and neuromyotonic and myokymic discharges in 3 cases. Three cases underwent only symptomatic therapy, and 7 cases underwent symptomatic therapy and immunomodulatory treatments. Except for one case who lost of follow-up, 5 cases had a good prognosis, 2 cases with poor prognosis, and 2 cases died. Conclusions PNHS is a heterogeneous group of clinical manifestations. Electrophysiological appearance of afterdischarges may be a sensitive indicator for the diagnosis of PNHS. [ABSTRACT FROM AUTHOR]

The article focuses on evaluating a new scoring system for diagnosing protein energy wasting (PEW) in children with chronic kidney disease (CKD), particularly emphasizing the importance of lean body mass (LBM) measured by dual-energy x-ray absorptiometry (DEXA) as diagnostic biomarker. Topics include the criteria and biomarkers for diagnosing PEW, the utility of LBM measurement by DEXA in detecting subclinical PEW, and considerations regarding the limitations and practicality of using DEXA.

Background: Synchroa medogensis, a new species of Synchroidae Lacordaire, 1859, is described and illustrated, based on a single male collected from Mêdog, Xizang, China. This new species is close to S. elongatula Nikitsky, 1999 and S. melanotoides Lewis, 1895, but could be distinguished by the elongated antennae and elytra, the apically narrowed prosternal process and the stout parameres. New information: The new information of this new species provided in this paper include: description, type information, distribution and comparison amongst S. medogensis sp. nov., S. elongatula and S. melanotoides. [ABSTRACT FROM AUTHOR]

It is known that clinical Pilates improves strength, core stability, balance, gait, fatigue, and quality of life (QOL) in patients with multiple sclerosis (PwMS). On the other hand, there is insufficient information about whether similar benefits can be achieved with Pilates-based telerehabilitation (Pilates-TR). We aimed to investigate the effects of Pilates-TR on physical performance and QOL in PwMS. Thirty PwMS were recruited and randomly allocated into two groups. The Pilates-TR group received Pilates-TR via videoconferences three days per week during six weeks at home. The control group (CG) was a waitlist with no Pilates-TR treatment. Physical performance measures included extremity muscle strength, core endurance and power, balance, gait analysis, and functional exercise capacity. In addition, fatigue and QOL were evaluated. Extremity muscle strength, core endurance and power, balance, walking speed, cadence, distance, functional exercise capacity, and QOL were improved after Pilates-TR (p < 0.05). Fatigue level and the effects of fatigue on functions decreased in Pilates-TR, while fatigue level increased in CG (p <.05). The CG showed no changes in any other measurements (p >.05). Pilates-TR was effective in improving physical performance and QOL in PwMS. Pilates-TR can be recommended as an effective option, especially for patients with barriers to reaching the clinic. Trial registration: ClinicalTrials.gov (NCT04838886) Pilates-based telerehabilitation (Pilates-TR) is an effective means of improving muscle strength, core stability, balance, walking, functional exercise capacity, and fatigue in patients with multiple sclerosis (PwMS). Pilates-TR seems like an appropriate option for improving both the mental and physical dimensions of quality of life in PwMS. Clinicians can safely use Pilates-TR to increase physical performance and quality of life in PwMS who have limitations to participate in clinical Pilates for various reasons. [ABSTRACT FROM AUTHOR]

Aarskog–Scott syndrome (AAS), also known as facio-digito-genital syndrome, is a rare heterogenous syndrome characterized by facial dysmorphism, brachydactyly, and genetic abnormalities. Although severe craniofacial abnormalities have been reported in AAS, little is known about speech and resonance issues in AAS. Specifically, published data to date have only indicated reports of hypernasality associated with a cleft palate in AAS. This case report provides clinical and anatomic information surrounding hypernasal speech in the absence of an overt cleft palate in a patient with AAS. [ABSTRACT FROM AUTHOR]

Background: It remains poorly understood why only some hemodynamically unstable patients who receive aggressive treatment with vasopressor medications develop limb necrosis. Objective: To determine the incidence of limb necrosis and the factors associated with it following high-dose vasopressor therapy. Methods: A retrospective case-control medical records review was performed of patients aged 18 to 89 years who received vasopressor therapy between 2012 and 2021 in a single academic medical center. The study population was stratified by the development of limb necrosis following vasopressor use. Patients who experienced necrosis were compared with age- and sex-matched controls who did not experience necrosis. Demographic information, comorbidities, and medication details were recorded. Results: The incidence of limb necrosis following vasopressor administration was 0.25%. Neither baseline demographics nor medical comorbidities differed significantly between groups. Necrosis was present in the same limb as the arterial catheter most often for femoral catheters. The vasopressor dose administered was significantly higher in the necrosis group than in the control group for ephedrine (P =.02) but not for the other agents. The duration of therapy was significantly longer in the necrosis group than in the control group for norepinephrine (P =.001), epinephrine (P =.04), and ephedrine (P =.01). The duration of vasopressin administration did not differ significantly between groups. Conclusion: The findings of this study suggest that medication-specific factors, rather than patient and disease characteristics, should guide clinical management of necrosis in the setting of vasopressor administration. [ABSTRACT FROM AUTHOR]

The aims of the present study were to: i) analyse the between-session reliability of dry-land and in-water swimming tests, and ii) investigate the prevalence of meaningful asymmetries in swimming athletes. Twenty-eight swimmers (21 males, 7 females) performed anthropometric, shoulder range of motion (ROM), countermovement jump, shoulder isokinetic torque, and 15-s tethered swimming tests two times, 1 week apart. Inter-limb asymmetries were calculated for each variable. Raw data reliability was determined using the intraclass coefficient correlation (ICC) and the typical error of measurement (TEM), and effect size (ES) was used to determine systematic bias between test sessions. At an individual level, inter-limb asymmetries were compared to the coefficient of variation (CV) to determine whether they were real. The between-session reliability was good to excellent (0.75 to 1.00) for most of the raw data, except for ROM. Between-session ES was predominately "trivial" or "small" for raw data and asymmetries, reinforcing that the values did not change significantly between the sessions. In addition, real asymmetries were seen in some tested metrics, depending on the test. In conclusion, the tested variables presented good levels of between-session reliability and were able to detect real and consistent asymmetries. [ABSTRACT FROM AUTHOR]

Few studies have reported the cardiovascular health effects of different high-intensity interval training (HIIT) protocols among sedentary young women. We investigated the impact of a traditional HIIT programme and a high-intensity circuit training (HICT) programme on lipid profiles and inflammatory cytokine levels in sedentary young women. Forty-two women were randomly assigned to HICT (body weight-based training), HIIT (cycling-based training), or control groups (n = 14 each). HICT and HIIT participants completed an 8-week training programme of three sessions per week. Total cholesterol (TC), triglyceride, high- and low-density lipoprotein, leptin, resistin, tumour necrosis factor-alpha (TNF-α), interleukin-8, and interferon-gamma levels were measured before and after the intervention. Post-intervention, TC and leptin were decreased in the HICT group. The HICT group also demonstrated increased lean mass, upper and lower limb strength, and balance, while the HIIT group displayed improved lower limb strength. Additionally, the control group showed significant increases in triglyceride levels, weight, body mass index, and fat mass. In conclusion, although both HICT and HIIT interventions showed improvements in cardiovascular health and physical fitness, participants in the HICT group experienced more health benefits. [ABSTRACT FROM AUTHOR]

Introduction: Guidelines on the management of open tibia fractures recommend timely treatment in a limb reconstruction center which offer joint orthopedic-trauma and plastic surgery services. However, patient's transfer between centers remains inevitable. This review aims to evaluate the clinical outcomes and hospital factors for patients directly admitted and transferred patients to a limb-reconstruction center. Methods: A research protocol adhering to PRISMA standards was established. The search included databases like MEDLINE, EMBASE, and the Cochrane library up until March 2023. Nine articles met the inclusion criteria, focusing on open tibia fractures. Exclusion criteria were experimental studies, animal studies, and case reports. Outcomes of interest were operation and infection rates, nonunion, limb salvage, and the Enneking limb score. Results: The analysis involved data from 520 patients across nine studies published between 1990 and 2023, with the majority (83.8%) having Gustilo Anderson type III open tibia fractures. Directly admitted patients showed lower overall infection rates (RR 0.30; 95% CI 0.10–0.90; P = 0.03) and fewer deep infections (RR 0.39; 95% CI 0.22–0.68; P = 0.001) compared to transferred patients. Transferred patients experienced an average five-day delay in soft tissue closure and extended hospital stays by eight days. Patients transferred without initial surgical management underwent fewer total surgical procedures. The direct admission group displayed more favorable functional outcomes. Conclusion: Low- to moderate-quality evidence indicates worse clinical outcomes for transferred patients compared to directly admitted patients. Early treatment in specialized limb reconstruction units is essential for improved results in the management of open tibia fractures. Level of evidence: Therapeutic level IIa. [ABSTRACT FROM AUTHOR]

Since the discovery of magnetic resonance imaging (MRI) as an imaging modality, it has evolved immensely and is still doing so. Most imaging modalities have made bedside or emergency imaging possible due to their portability. This aspect is yet to be fully evaluated and established in the case of MRI as its high-field strength requires specialized infrastructure and its time-consuming nature makes its portability questionable. The goal of this review is to access the efficiency and feasibility of low-field portable MRI (pMRI) systems in a wide array of health care applications. Articles from indexed journals, on PubMed, Springer, Elsevier, etc. databases, relevant to this study were searched and reviewed. This review provides an atypical design that could be used in making a pMRI unit that could find its potential in diagnosing a wide variety of pathologies with an added advantage of imaging critical patients in the intensive care unit or patients in isolation due to its portability, imaging patients with implants or prosthesis effectively due to its low field, pediatric imaging due to its high speed, for guided interventions, imaging obese and claustrophobic patients due to its open nature, in dental imaging, extremity scanning, etc. With its vast spectrum of applications in the health care system, the future of low-field pMRI units seems to be bright. [ABSTRACT FROM AUTHOR]

Copyright of Lege Artis Medicine (LAM) is the property of LifeTime Media Kft. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Several classification systems are used to grade the severity of lymphedema. Their agreement with each other has not been reported. To evaluate the agreement between the American Physical Therapy Association (APTA) criteria, the criteria of Ramos et al., and the International Society of Lymphology (ISL) criteria in patients with upper and lower extremity lymphedema. A total of 156 patients (63 and 93 patients with upper and lower extremity lymphedema, respectively) were included. The circumference measurements and limb volume were measured. The severity of lymphedema of the patients was classified as mild, moderate, and severe lymphedema using the APTA criteria, the criteria of Ramos et al., and the ISL criteria. The agreement between the classification systems was assessed with Krippendorff's alpha. An acceptable and poor agreement were found between the criteria in upper (Krippendorff's alpha > 0.667) and lower extremity lymphedema (Krippendorff's alpha < 0.667), respectively. In pairwise comparisons, an acceptable agreement was found among each comparison in upper extremity lymphedema (Krippendorff's alpha > 0.667), and a poor agreement was found among each comparison in lower extremity lymphedema (Krippendorff's alpha < 0.667) except between the APTA criteria and the criteria of Ramos et al (Krippendorff's alpha > 0.667). Patients with upper extremity lymphedema classified according to these criteria can be assumed to be samples of the same population; however, patients with lower extremity lymphedema graded according to the ISL criteria may be included in a different classification when they grade with the APTA criteria and the criteria of Ramos et al. [ABSTRACT FROM AUTHOR]

A mixed-methods approach was used to study an individually-tailored community exercise program for people with a range of chronic neurological conditions (e.g., stroke, spinal cord injury, brain injury, multiple sclerosis, Parkinson's disease) and abilities. The program was delivered to older adults (mean age: 62 ± 9 years) with chronic neurological conditions across a 12-week and an 8-week term. Participants attended 88% of sessions and completed 89% of prescribed exercises in those sessions. There were no adverse events. Clinically important improvements were achieved by all evaluated participants (n = 8) in at least one testing domain (grip strength, lower-extremity strength, aerobic endurance, and balance). Interviews with participants identified key program elements as support through supervision, social connection, individualized programming, and experiential learning. Findings provide insight into elements that enable a community exercise program to meet the needs of a complex and varied group. Further study will support positive long-term outcomes for people aging with neurological conditions. [ABSTRACT FROM AUTHOR]

A systematic search was performed of online databases for any Achilles tendon (AT) injuries occurring within the National Basketball Association (NBA). Video was obtained of injuries occurring during competition and downloaded for analysis in Dartfish. NBA athletes (n = 27) were identified with AT rupture over a 30-year period (1991–2021). Of the 27 NBA athletes found to have AT ruptures (mean age: 29.3 [3.3] y; average time in the NBA: 8.5 [3.8] y), 15 in-game videos were obtained for analysis. Noncontact rupture was presumed to have occurred in 12/13 cases. Eight of the 13 athletes had possession of the ball during time of injury. The ankle joint of the injured limb for all 13 athletes was in a dorsiflexed position during the time of injury (47.9° [6.5°]). All 13 athletes performed a false-step mechanism at time of injury where they initiated the movement by taking a rearward step posterior to their center of mass with the injured limb before translating forward. NBA basketball players that suffered AT ruptures appeared to present with a distinct sequence of events, including initiating a false step with ankle dorsiflexion of the injured limb at the time of injury. [ABSTRACT FROM AUTHOR]

Background: Tourniquets (TQ) have been increasingly adopted in pre-hospital settings recently. This study examined the effectiveness and safety of applying TQ in the pre-hospital settings for civilian patients with traumatic vascular injuries to the extremities. Materials and methods: We systematically searched the Ovid Embase, PubMed, and Cochrane Central Register of Controlled Trials databases from their inception to June 2023. We compared pre-hospital TQ (PH-TQ) use to no PH-TQ, defined as a TQ applied after hospital arrival or no TQ use at all, for civilian vascular extremity trauma patients. The primary outcome was overall mortality rate, and the secondary outcomes were blood product use and hospital stay. We analyzed TQ-related complications as safety outcomes. We tried to include randomized controlled trials (RCTs) and non-randomized studies (including non-RCTs, interrupted time series, controlled before-and-after studies, cohort studies, and case-control studies), if available. Pooled odds ratios (ORs) were calculated and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Results: Seven studies involving 4,095 patients were included. In the primary outcome, pre-hospital TQ (PH-TQ) use significantly decrease mortality rate in patients with extremity trauma (odds ratio [OR], 0.48, 95% confidence interval [CI] 0.27–0.86, I2 = 47%). Moreover, the use of PH-TQ showed the decreasing trend of utilization of blood products, such as packed red blood cells (mean difference [MD]: -2.1 [unit], 95% CI: -5.0 to 0.8, I2 = 99%) or fresh frozen plasma (MD: -1.0 [unit], 95% CI: -4.0 to 2.0, I2 = 98%); however, both are not statistically significant. No significant differences were observed in the lengths of hospital and intensive care unit stays. For the safety outcomes, PH-TQ use did not significantly increase risk of amputation (OR: 0.85, 95% CI: 0.43 to 1.68, I2 = 60%) or compartment syndrome (OR: 0.94, 95% CI: 0.37 to 2.35, I2 = 0%). The certainty of the evidence was very low across all outcomes. Conclusion: The current data suggest that, in the pre-hospital settings, PH-TQ use for civilian patients with vascular traumatic injury of the extremities decreased mortality and tended to decrease blood transfusions. This did not increase the risk of amputation or compartment syndrome significantly. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to formulate a numerical approach (finite element modelling (FEM)) to calculate pressure values generated by compression garments on a compressible limb analogue, and to validate the numerical approach using experimental measurements. Existing models were also compared. Method: Experimentally measured pressure values and deformation caused by compression bands on a compressible human limb analogue were compared with values predicted using the Young–Laplace equation, a previously formulated analytical model and the FEM. Results: The FEM provided greater accuracy in predicting the pressure generated by compression bands compared to existing models. The FEM also predicted deformation of the limb analogue with good agreement relative to experimental values. Conclusion: It was concluded that modelling the non-uniform manner in which the way a limb analogue is compressed should be incorporated into future modelling of the pressures generated by compression garments on a compressible limb analogue. Declaration of interest: The authors have no conflicts of interest to declare. [ABSTRACT FROM AUTHOR]

Indirect lymphatic system imaging is essential for diagnosing lymphatic diseases. The basic methodology involves intradermal or subcutaneous injection of a contrast agent into the surrounding lymphatic capillary, and the flow of the contrast agent is identified using a detector. Many contrast agents that use near-infrared dye, including indocyanine green (ICG) fluorescent lymphography, are available. ICG is rapidly spreading as a convenient and safe lymphedema diagnostic method, because it does not involve radiation exposure, and the imaging equipment is more compact than other devices. The lymphatic system is a semi-open circulatory system with numerous lymphatic capillaries acting as blind ends. Anatomical information on the injection site and observation of specific lymphatic vessels and nodes is important. However, this anatomical information is lacking. Recent reports suggest that ICG fluorescent lymphography can be applied to cadavers in the same manner as living bodies. Furthermore, these reports have demonstrated the functional aspects of the capillary lymph vessel networks as well as their relationship with lymphatic vessels and lymph nodes. This review article describes the historical progression from the old to the new functional lymphatic anatomy and introduces a new functional lymphography technique for the lower limbs. [ABSTRACT FROM AUTHOR]

Goltz syndrome is a rare X-linked dominant multisystem disorder that presents with ectoderm and mesoderm-derived symptoms. Skin manifestations including congenital patchy skin aplasia, congenital nodular fat herniation, congenital hypo- or hyperpigmentation along Blaschko's lines, telangiectasia, and congenital ridged dysplastic nails are typical in this disorder. Almost all cases of Goltz syndrome correspond to female newborns and that hemizygosis makes the syndrome fetal in males. Triple X syndrome is a relatively common congenital disorder that presents with mild to no symptoms in the developmental and psychiatric realm. The patient reported here was born with multisystem anomaly affecting the eyes, craniofacial region, cardiovascular system, skin, and limbs. A G-banding chromosomal study revealed 47, XXX. She was diagnosed with Goltz syndrome owing to her distinctive skin manifestations. The congenital cervical skin defect healed with conservative treatment. The facial cleft, cleft lip-palate, and syndactyly were successfully treated with multiple surgical treatments. The combination of triple X syndrome and Goltz syndrome is very rare. We describe the expression of presenting with both syndromes simultaneously. [ABSTRACT FROM AUTHOR]

The sit-to-stand test is an essential tool used to assess lower limb function and muscle strength in older adults and various patient populations, and also plays a role in sarcopenia screening. Among its forms, the five-time sit-to-stand test (FTSST) is widely used, with previous studies suggesting cutoff values of >10 seconds and >11 seconds for the sitting-to-standing and standing-to-sitting transitions, respectively. The 30-second and 1-minute sit-to-stand tests (30STS and 1MSTS, respectively) also provide comprehensive assessments. While much of the current research on sarcopenia focuses on the FTSST, there is a burgeoning need for an in-depth exploration of the 30STS and 1MSTS. Studies on these tests are vital to refine the criteria for sarcopenia, establish accurate cutoff values, and enhance diagnostic precision and treatment effectiveness. This need highlights the importance of further research into the 30STS and 1MSTS for refining the diagnostic criteria for sarcopenia. [ABSTRACT FROM AUTHOR]

Background: Kennedy disease (KD) is a slowly progressive lower motor neuron degenerative disease. The prevalence of KD is unknown in India. Aim: To describe the phenotypic and laboratory features of an Indian cohort of KD patients. Methods: A retrospective study was done on seven genetically confirmed KD patients based on demographic, clinical and laboratory details. Results: Mean age at onset and presentation was 37 ± 11.9 and 44.6 ± 13.5 years respectively. Progressive asymmetric proximal and distal limb weakness was the commonest symptom (57.1%). All patients had motor symptoms along with non‐specific symptoms such as cramps from the onset. Easy fatigability, decremental response along with ptosis were noted in two patients, which was a novel finding. Gynaecomastia and tongue wasting with fasciculations were universal findings. All five patients with nerve conduction studies showed sensorimotor neuropathy. Magnetic resonance imaging muscle done in two patients showed a prominent moth‐eaten appearance in the thigh and posterior leg compartment in one patient. The mean cytosine‐adenine‐guanine repeats were 44 ± 3.7, and there was no association between age of onset or severity with repeat length. Only one patient required an assistive device for ambulation after 15 years of symptom onset. Conclusions: This study showed phenotypic heterogeneity in the Indian cohort. The age of onset was earlier with a slowly progressive indolent course as compared with other ethnic cohorts. This highlights the importance of considering the KD diagnosis in patients with the indolent course and suspected ALS diagnosis even with ptosis and fatigability in an appropriate clinical context. [ABSTRACT FROM AUTHOR]

Simple Summary: A total of 217 Japanese patients who underwent surgical resection for extremity STS were included. The Sarculator-predicted 10-year probability of overall survival (pr-OS) was stratified into two subgroups: lower risk (10-year pr-OS ≥ 60%) and higher risk (10-year pr-OS < 60%). The modified Glasgow prognostic score (mGPS) varied from 0 to 2. We showed that Sarculator is a validated nomogram designed to predict overall survival. Among the patients with a higher risk, those with an mGPS of 1 or 2 had poorer OS compared to those with a score of 0. The mGPS could potentially play an important role in identifying patients who are at high risk of death and metastasis in the higher-risk group on the Sarculator. Background: Sarculator is a validated nomogram designed to predict overall survival (OS) in extremity soft tissue sarcoma (STS). Inflammation plays a critical role in cancer development and progression. There were no reports which investigated the relationship between Sarculator and inflammation. Methods: A total of 217 patients with extremity STS were included. The Sarculator-predicted 10-year probability of OS (pr-OS) was stratified into two subgroups: lower risk (10-year pr-OS ≥ 60%) and higher risk (10-year pr-OS < 60%). The modified Glasgow prognostic score (mGPS) varied from 0 to 2. Results: Out of the 217 patients, 67 were classified as higher risk, while 150 were lower risk. A total of 181 patients had an mGPS of 0, and 36 had a score of 1 or 2. The 5-year OS was 83.3%. When patients were divided into two groups according to the 10-year pr-OS, those with a higher risk had poorer OS than those with a lower risk. Among the patients with a higher risk, those with an mGPS of 1 or 2 had poorer OS compared to those with a score of 0. Conclusions: The mGPS could potentially play an important role in identifying patients who are at high risk of death and metastasis in the higher-risk group on the Sarculator. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: To observe the effect of the whole-process care model of the medical union on the improvement of kinesiophobia and bone mineral density in patients with osteoporosis. Methods: In this descriptive study, a convenient sampling method was used to select 148 patients with osteoporosis who visited the hospital from January 2020 to December 2021. Patients aged ≥ 18 years and diagnosed with osteoporosis through quantitative computed tomography (QCT) were included in the study. They were able to cooperate during follow-up and had normal cognitive function. Patients with combined spinal curvature, thoracic deformity, and pulmonary dysfunction, accompanied by severe cardiovascular or limb dysfunction, and those who withdrew midway or participated in other clinical studies were excluded. According to whether to use the whole-process care model of the medical union, they were divided into intervention group and control group, with 74 cases each. The control group used conventional care, and the intervention group used the whole-process care model of the medical association. The occurrence of kinesiophobia between the two groups were compared. The dual-energy X-ray absorption detector is used to measure differences in bone density changes. Results: There was no significant difference between the two groups in the TSK scale score and the incidence of kinesiophobia before intervention (P > 0.05). The TSK scale scores of patients in the intervention group were higher than those in the control group at 3 months and 6 months after operation (P < 0.05). The incidence of kinesiophobia in the intervention group for 3 months and 6 months was significantly lower than that in the control group (P < 0.05). There was no significant difference in bone mineral density between the two groups before and 3 months after intervention (P > 0.05). The bone mineral density of lumbar spine, femoral neck and total hip in the intervention group was significantly higher than that in the control group after 6 months of intervention (P < 0.05). Conclusion: The whole-process care model of the medical association is used for osteoporosis patients, which might reduce the risk of kinesiophobia and improve the bone density of the lumbar spine and total hip in patients. But further promotion and improvement of relevant support systems are needed to achieve comprehensive promotion and maximize clinical benefits in this field. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Limb hypertrophy is an unusual presentation associated with neurocutaneous syndromes. The mechanism behind this presentation may vary from case to case. Here, we describe a case series of three different syndromes linked by a common clinical finding of limb hypertrophy. [ABSTRACT FROM AUTHOR]

We performed a meta‐analysis to compare the effect of preoperative and postoperative radiotherapy on wound complications after resection of extremity soft tissue sarcoma (ESTS). A comprehensive computerised search of the PubMed, Cochrane Library, Web of Science, EMBASE, China National Knowledge Infrastructure (CNKI), VIP, and Wanfang databases was conducted from their inception to August 2023 to identify studies comparing the effect of preoperative and postoperative radiotherapy on wound complications after ESTS resection. Two investigators independently screened the literature, extracted the data, and assessed the quality of the articles. The meta‐analysis was performed using RevMan 5.4 software. Nine studies with 1271 patients were included, with 631 and 640 patients in the preoperative and postoperative radiotherapy groups, respectively. The results showed that the incidence of postoperative wound complications after ESTS resection was significantly higher with preoperative radiotherapy than with postoperative radiotherapy (27.26% vs. 12.03%, odds ratio [OR]: 2.88, 95% confidence interval [CI]: 2.12–3.91, p < 0.001). However, the rate of local recurrence of ESTS was significantly lower with preoperative radiotherapy than with postoperative radiotherapy (8.75% vs. 14.81%, OR: 0.57, 95% CI: 0.36–0.91, p = 0.02), and the 3‐year overall survival was significantly higher in the preoperative radiotherapy group than in the postoperative radiotherapy group (82.24% vs. 70.04%, OR: 1.97, 95% CI: 1.05–3.71, p = 0.03). This pooled analysis suggests that although preoperative radiotherapy increases the rate of wound complications in ESTS compared with postoperative radiotherapy, it significantly reduces the rate of local recurrence after ESTS resection and improves the overall survival of patients. Owing to the limitations in the number and quality of the included studies, additional prospective cohort studies or randomised controlled trials are required to confirm these findings. [ABSTRACT FROM AUTHOR]

Simple Summary: In a cohort of 828 patients undergoing surgery for sarcomas of the extremities, pelvis, and trunk, approximately half of them were advised to receive radiotherapy. Notably, 4.7% declined the recommended treatment regimen, resulting in a decrease of both overall survival and local recurrence-free survival. Similarly, 40% of patients within the same group were advised to undergo chemotherapy; 8.8% of these patients rejected the recommendation, leading to a reduced local recurrence-free survival. Enhancing physician-patient communication and addressing underutilization of recommended therapies in sarcoma patients should be a priority for surgeons and oncologists alike. Background: In soft tissue or bone sarcomas, multimodal therapeutic concepts represent the standard of care. Some patients reject the therapeutic recommendations due to several reasons. The aim of this study was to assess the impact of that rejection on both prognosis and local recurrence. Methods: Between 2012 and 2019, a total of 828 sarcoma patients were surgically treated. Chemotherapy was scheduled as a neoadjuvant, and adjuvant multi-agent therapy was performed following recommendations from an interdisciplinary tumor board. Radiotherapy, if deemed appropriate, was administered either in a neoadjuvant or an adjuvant manner. The recommended type of therapy, patient compliance, and the reasons for refusal were documented. Follow-ups included local recurrences, diagnosis of metastatic disease, and patient mortality. Results: Radiotherapy was recommended in 407 (49%) patients. A total of 40 (10%) individuals did not receive radiation. A reduction in overall survival and local recurrence-free survival was evident in those patients who declined radiotherapy. Chemotherapy was advised for 334 (40%) patients, 250 (75%) of whom did receive all recommended cycles. A total of 25 (7%) individuals did receive a partial course while 59 (18%) did not receive any recommended chemotherapy. Overall survival and local recurrence-free survival were reduced in patients refusing chemotherapy. Overall survival was worst for the group of patients who received no chemotherapy due to medical reasons. Refusing chemotherapy for non-medical reasons was seen in 8.8% of patients, and refusal of radiotherapy for non-medical reasons was seen in 4.7% of patients. Conclusions: Divergence from the advised treatment modalities significantly impacted overall survival and local recurrence-free survival across both treatment modalities. There is an imperative need for enhanced physician-patient communication. Reducing treatment times, as achieved with hypofractionated radiotherapy and with therapy in a high-volume sarcoma center, might also have a positive effect on complying with the treatment recommendations. [ABSTRACT FROM AUTHOR]

Copyright of Casos & Revisiones de Salud is the property of Victor Manuel Mendoza Nunez, Universidad Nacional Autonoma de Mexico and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)