Enxerto de Gordura Prévio e Transplante pela Técnica FUE em Cicatrizes do Couro Cabeludo: Atualização / Previous fat grafting and hair transplantation using the FUE technique on scalp scars: Update

Foi realizada uma revisão de literatura narrativa, sobre a associação de enxerto de gordura e transplante de cabelos com a técnica FUE (Follicular Unit Extraction) em cicatrizes do couro cabeludo. Os dados foram coletados a partir de estudos encontrados nas bases Medline, Lilacs e IBECS. Foram citados registros bibliográficos de vários autores que pesquisaram as células mesenquimais do tecido gorduroso, com descrição das técnicas utilizadas. A conclusão foi de que a técnica de transplante capilar em duas etapas, com transplante prévio de gordura é eficaz, segundo os artigos revisados.

We developed a narrative literature review on the association of fat grafting and hair transplantation using the Follicular Unit Extraction (FUE) technique in scalp scars. Data were collected from studies found in Medline, Lilacs, and IBECS databases. Bibliographical records of several authors who researched mesenchymal cells in adipose tissue were cited, describing the techniques used. The conclusion was that the two-stage hair transplantation technique, with previous fat transplantation, is effective, according to the reviewed articles.

Effects of Interactive Dynamic Scalp Acupuncture on Motor Function and Gait of Lower Limbs after Stroke: A Multicenter, Randomized, Controlled Clinical Trial / 中国结合医学杂志

OBJECTIVE@#To evaluate the effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on motor function and gait of the lower limbs in post-stroke hemiplegia patients.@*METHODS@#A total of 231 patients with post-stroke hemiplegia was randomly divided into IDSA (78 cases), SCT (78 cases), and TSA (75 cases) groups by a random number table. Scalp acupuncture (SA) and lower-limb robot training (LLRT) were both performed in the IDSA and SCT groups. The patients in the TSA group underwent SA and did not receive LLRT. The treatment was administered once daily and 6 times weekly for 8 continuous weeks, each session lasted for 30 min. The primary outcome measures included Fugl-Meyer assessment of the lower extremity (FMA-LE), berg balance scale (BBS), modified barthel index (MBI), and 6-min walking test (6MWT). The secondary outcome measures included stride frequency (SF), stride length (SL), stride width (SW), affected side foot angle (ASFA), passive range of motion (PROM) of the affected hip (PROM-H), knee (PROM-K) and ankle (PROM-A) joints. The patients were evaluated before treatment, at 1- and 2-month treatment, and 1-, and 2-month follow-up visits, respectively. Adverse events during 2-month treatment were observed.@*RESULTS@#Nineteen patients withdrew from the trial, with 8 in the IDSA and 5 in the SCT groups, 6 in the TSA group. The FMA-LE, BBS, 6MWT and MBI scores in the IDSA group were significantly increased after 8-week treatment and 2 follow-up visits compared with the SCT and TSA groups (P<0.05 or P<0.01). Compared with pre-treatment, the grade distribution of BBS and MBI scores in the 3 groups were significantly improved at 1, 2-month treatment and 2 follow-up visits (P<0.05 or P<0.01). The SF, PROM-H, PROM-K and PROM-A in the IDSA group was significantly increased compared with the SCT and TSA groups after 8-week of treatment (P<0.05 or P<0.01). Compared with the SCT group, ASFA of the IDSA group was significantly reduced after 8-week of treatment (P<0.05). SF, SL, PROM-K and PROM-A were significantly increased at the 2nd follow-up visit whereas the ASFA was significantly reduced in the IDSA group compared with the SCT groups at 1st follow-up visit (P<0.05 or P<0.01). The SF was significantly increased in the SCT group compared with the TSA group after 8-week treatment (P<0.05). Compared with the TSA group, PROM-K, PROM-A were significantly increased at the 2nd follow-up visit (P<0.05).@*CONCLUSIONS@#The effects of IDSA on lower-limb motor function and walking ability of post-stroke patients were superior to SCT and TSA. The SCT was comparable to TSA treatment, and appeared to be superior in improving the motion range of the lower extremities. (Registration No. ChiCTR1900027206).

Jiao's scalp acupuncture combined with virtual reality rehabilitation training for motor dysfunction in patients with Parkinson's disease: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between Jiao's scalp acupuncture combined with virtual reality (VR) rehabilitation training and VR rehabilitation training alone for motor dysfunction in patients with Parkinson's disease (PD).@*METHODS@#A total of 52 patients with PD were randomly divided into an observation group and a control group, 26 cases in each group. The patients in both groups were treated with routine basic treatment, and the patients in the control group were treated with VR rehabilitation training. The patients in the observation group were treated with Jiao's scalp acupuncture on the basis of the control group. The scalp points included the movement area, balance area and dance tremor control area. Both groups were treated once a day, 5 times a week for a total of 8 weeks. Before treatment and 4 and 8 weeks into treatment, the gait parameters (step distance, step width, step speed and step frequency), timed "up and go" test (TUGT) time and unified Parkinson's disease rating scale part Ⅲ (UPDRS-Ⅲ) score were compared between the two groups, and the clinical efficacy was evaluated.@*RESULTS@#Four weeks into treatment, except for the step width in the control group, the gait parameters of the two groups were improved, the TUGT time was shortened, and the UPDRS-Ⅲ scores were reduced (P<0.01, P<0.05); the step distance in the observation group was better than that in the control group, and the UPDRS-Ⅲ score in the observation group was lower than that in the control group (P<0.05). Eight weeks into treatment, the gait parameters of the two groups were improved, the TUGT time was shortened, and the UPDRS-Ⅲ scores were reduced (P<0.01); the step distance and step speed in the observation group were better than those in the control group, the TUGT time in the observation group was shorter than that in the control group, and the UPDRS-Ⅲ score in the observation group was lower than that in the control group (P<0.05, P<0.01). The total effective rate was 92.3% (24/26) in the observation group, which was higher than 69.2% (18/26) in the control group (P<0.05).@*CONCLUSION@#Jiao's scalp acupuncture combined with VR rehabilitation training could improve the gait parameters, walking ability and motor function in patients with PD. The clinical effect is better than VR rehabilitation training alone.

Clinical application of three-dimensional printed preformed titanium mesh combined with free latissimus dorsi muscle flap in the treatment of squamous cell carcinoma with skull defect in the vertex / 中华烧伤杂志

Objective: To explore the clinical effects of three-dimensional printed preformed titanium mesh combined with latissimus dorsi muscle flap free transplantation in the treatment of wounds with skull defect after radical surgery of squamous cell carcinoma in the vertex. Methods: A retrospective observational study was conducted. From January 2010 to December 2019, 5 patients with squamous cell carcinoma in the vertex accompanied with skull invasion who met the inclusion criteria were admitted to the Department of Burns and Plastic Surgery of the Second Affiliated Hospital of Air Force Medical University, including four males and one female, aged 50 to 65 years. The original lesion areas ranged from 5 cm×4 cm to 15 cm×8 cm. The titanium mesh was prefabricated via three-dimensional technic based on the result the scope of skull resection predicted with computerized tomography three-dimensional reconstruction before surgery. During the first stage, the soft tissue defect area of scalp (8 cm×7 cm to 18 cm×11 cm) after tumor enlargement resection was repaired with the preformed titanium mesh, and the titanium mesh was covered with latissimus dorsi muscle flap, with area of 10 cm×9 cm to 20 cm×13 cm. The thoracodorsal artery/vein was anastomosed with the superficial temporal artery/vein on one side. The muscle ends in the donor site were sutured together or performed with transfixion, and then the skin on the back were covered back to the donor site. On the 10th day after the first-stage surgery, the second-stage surgery was performed. The thin intermediate thickness skin graft was taken from the anterolateral thigh to cover the latissimus dorsi muscle flap. The duration and intraoperative blood loss of first-stage surgery were recorded. The postoperative muscle flap survival after the first-stage surgery and skin graft survival after the second-stage surgery was observed. The occurrence of complications, head appearance, and recurrence of tumor were followed up. Results: The average first-stage surgery duration of patients was 12.1 h, and the intraoperative blood loss was not more than 1 200 mL. The muscle flaps in the first-stage surgery and the skin grafts in the second-stage surgery all survived well. During the follow-up of 6-18 months, no complications such as exposure of titanium mesh or infection occurred, with good shape in the recipient sites in the vertex, and no recurrence of tumor. Conclusions: Three-dimensional printed preformed titanium mesh combined with latissimus dorsi muscle flap free transplantation and intermediate thickness skin graft cover is an effective and reliable method for repairing the wound with skull defect after extended resection of squamous cell carcinoma in the vertex. This method can cover the wound effectively as well as promote both recipient and donor sites to obtain good function and appearance.

Clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns / 中华烧伤杂志

Objective: To investigate the clinical effects of in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage in the treatment of hypertrophic scar in non-functional sites after burns. Methods: A retrospective observational study was used. From June 2017 to June 2019, 33 patients (24 males and 9 females, aged 8-50 years) who met the inclusion criteria with hypertrophic scars in non-functional sites outside the face after burns were treated in General Hospital of TISCO (the Sixth Hospital of Shanxi Medical University). All patients underwent scalp transplantation after perforation of retained split scar matrix in situ (with scar thinning area of 90-500 cm2), and then the vacuum sealing drainage was performed. The hematoma and infection of wounds were observed on the 7th day after operation. At the same time, the survival rate of skin grafting was observed and calculated. The flatness and thickness of the scar in the operative area were observed in 12 months after operation, and the itching and pain of the patients were recorded. Vancouver Scar Scale was used to score the scar of patients before operation and at 3, 6 and 12 months after operation. The healing time and hair growth of donor site were observed. Data were statistically analyzed with repeated analysis of variance, paired sample t test and bonferroni correction. Results: On the 7th day after operation, local subcutaneous hematoma appeared in the wound of 2 patients, which healed after dressing change; no infection occurred. On the 7th day after operation, the survival rate of skin grafting of patients was 94.6%-99.0%(96.8±1.2)%. Scar flatness was well, the thickness of scar was not significantly higher than that of normal skin in 12 months after operation, and the symptoms of itching pain of patients disappeared or significantly relieved. Vancouver Scar Scale scores of patients before operation and at 3, 6, and 12 months after operation were 12.1±2.8, 8.5±1.5, 7.6±1.6, 6.7±1.3, respectively, and the scores of 3, 6, and 12 months after operation were all significantly lower than that before operation (with t values of 4.48, 4.06, and 3.97, respectively, P<0.01). All the donor sites of the head healed well in 4-7 days after operation. By 3-6 months after operation, all patients had good hair growth in the donor site and achieved no scar healing. Conclusions: The treatment of hypertrophic scar in non-functional sites outside the face after burns by in situ perforation of preserved split scar matrix in combination with scalp transplantation and vacuum sealing drainage can effectively improve the appearance of hypertrophic scar in non-functional areas after burn and reduce its degree of hyperplasia, with scar-free donor site healing.

Effect of Interactive Dynamic Scalp Acupuncture on Post-Stroke Cognitive Function, Depression, and Anxiety: A Multicenter, Randomized, Controlled Trial / 中国结合医学杂志

OBJECTIVE@#To compare the clinical effects of interactive dynamic scalp acupuncture (IDSA), simple combination therapy (SCT), and traditional scalp acupuncture (TSA) on cognitive function, depression and anxiety in patients with post-stroke cognitive impairment.@*METHODS@#A total of 660 patients with post-stroke cognitive impairment who were admitted to 3 hospitals in Shenzhen City between May 2017 and May 2020 were recruited and randomly assigned to the IDSA (218 cases), SCT (222 cases) and TSA groups (220 cases) according to a random number table. All the patients received conventional drug therapy for cerebral stroke and exercise rehabilitation training. Scalp acupuncture and computer-based cognitive training (CBCT) were performed simultaneously in the IDSA group, but separately in the morning and in the afternoon in the SCT group. The patients in the TSA group underwent scalp acupuncture only. The course of treatment was 8 weeks. Before treatment (M0), 1 (M1) and 2 months (M2) after treatment, as well as follow-up at 1 (M3) and 2 months (M4), the cognitive function of patients was assessed using the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment Scale (MoCA) Scales; depression, anxiety, sleep quality, and self-care ability of patients were assessed using Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), Pittsburgh Sleep Quality Index (PSQI), and Modified Barthel Index (MBI), respectively. During this trial, all adverse events (AEs) were accurately recorded.@*RESULTS@#There were no significant differences in the MMSE, MoCA, HAMD, HAMA, PSQI, and MBI scores among the 3 groups at M0 (all P>0.05). In the IDSA group, the MMSE, MoCA and MBI scores from M2 to M4 were significantly higher than those in the SCT and TSA groups, while the HAMD, HAMA and PSQI scores were significantly reduced (all P<0.01). The changes of all above scores (M2-M0, M4-M0) were significantly superior to those in the SCT and TSA groups (all P<0.01, except M4-M0 of HAMD). At M2, the severity of MMSE, HAMD, HAMA, PSQI and MBI in the IDSA group was significantly lower than that in the SCT and TSA groups (all P<0.01). There was no serious AE during this trial.@*CONCLUSIONS@#IDSA can not only significantly improve cognitive function, but also reduce depression, anxiety, which finally improves the patient's self-care ability. The effect of IDSA was significantly better than SCT and TSA. (Trial registration No. ChiCTR1900027206).

Scalp-nape acupuncture as adjuvant therapy for pharyngeal dysphagia of stroke at recovery stage: a randomized controlled trial / 中国针灸

OBJECTIVE@#To observe the therapeutic effect of scalp-nape acupuncture for pharyngeal dysphagia of stroke at recovery stage on the basis of neuromuscular electrical stimulation (NMES) and rehabilitation training.@*METHODS@#A total of 42 patients with pharyngeal dysphagia of stroke at recovery stage were randomized into an observation group and a control group, 21 cases in each group. Conventional medical symptomatic treatment was given in both groups. NMES and rehabilitation training were adopted in the control group, 30 min for each one. On the basis of the treatment in the control group, scalp-nape acupuncture was given in the observation group, scalp acupuncture was applied at lower 2/5 of anterior and posterior oblique lines of parietal and temporal, nape acupuncture was applied at Fengchi (GB 20), Yiming (EX-HN 14), Gongxue (Extra), Zhiqiang (Extra), Tunyan (Extra), etc. The treatment was given once a day, 5 days a week for 3 weeks in both groups. Before and after treatment, the videofluoroscopic dysphagia scale (VDS) score, the Kubota water swallowing test grade, the functional oral intake scale (FOIS) grade and the swallowing quality of life (SWAL-QOL) score were observed in both groups.@*RESULTS@#After treatment, the VDS scores were decreased and the SWAL-QOL scores were increased compared before treatment (P<0.05), the Kubota water swallowing test grade and FOIS grade were improved compared before treatment (P<0.05) in both groups. The changes of VDS score and SWAL-QOL score, Kubota water swallowing test grade and FOIS grade in the observation group were superior to those in the control group (P<0.05).@*CONCLUSION@#Based on NMES and rehabilitation training, scalp-nape acupuncture can enhance the therapeutic effect on pharyngeal dysphagia of stroke at recovery stage, and improve the patients' swallowing function and quality of life.

Clinical observation on cluster acupuncture at scalp points combined with exercise therapy in treatment of limb spasm after stroke / 中国针灸

OBJECTIVE@#To observe the clinical effect of cluster acupuncture at scalp points in treating limb spasm after stroke on the basis of conventional exercise therapy.@*METHODS@#A total of 72 patients with limb spasm after stroke were randomly divided into an observation group (36 cases, 5 cases dropped off) and a control group (36 cases, 6 cases dropped off). The control group was treated with exercise therapy. In the observation group, on the basis of the control group, penetrating technique of acupuncture was exerted at Qianding (GV 21) to Baihui (GV 20), Xinhui (GV 22) to Qianding (GV 21), etc. once a day, 5 days a week for 4 weeks. Before and after treatment, the changes of the modified Ashworth scale (MAS), simplified Fugl-Meyer motor assessment (FMA), and modified Barthel index (MBI) scores of the two groups were compared.@*RESULTS@#After treatment, the MAS scores of upper and lower limbs in the two groups were lower than before treatment (P<0.05), and those in the observation group were lower than the control group (P<0.05). After treatment, the scores of FMA and BMI in the two groups were higher than before treatment (P<0.05), and the score of MBI in the observation group was higher than the control group (P<0.05).@*CONCLUSION@#On the basis of conventional exercise therapy, cluster acupuncture at scalp points can reduce the spasm, improve motor function and activities of daily living in patients with limb spasm after stroke.

Effect of Fang's scalp acupuncture on perceived stress and sleep structure in insomnia patients: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the efficacy on insomnia between Fang 's scalp acupuncture combined with conventional acupuncture and the simple conventional acupuncture.@*METHODS@#A total of 66 patients with insomnia were randomly divided into an observation group (33 cases, 1 case dropped off) and a control group (33 cases, 2 cases dropped off). In the control group, the routine acupuncture therapy was applied to Shenmen (HT 7), Baihui (GV 20), Zhaohai (KI 6) and Sanyinjiao (SP 6), etc. Based on the treatment as the control group, Fang's scalp acupuncture therapy was supplemented at fuxiang tou, fuzang shangjiao, fuzang zhongjiao, siwei, etc. At these scalp points, the needles were inserted perpendicularly with flying needling technique and manipulated with trembling one. In either group, the treatment was given once daily, continuously for 2 weeks. Before and after treatment, separately, the score of Pittsburgh sleep quality index (PSQI) and the score of Chinese perceived stress scale (CPSS) were observed, as well as the parameters monitored by polysomnography, i.g. total sleep time (TST), sleep onset latency (SOL), wakefulness after the sleep onset (WASO), sleep efficiency (SE), the percentages of the time of rapid eye movement sleep phase (REM) and non-rapid eye movement sleep phase 1, 2, 3 and 4 in TST (REM%, N1%, N2%, N3%). The efficacy was compared between two groups.@*RESULTS@#After treatment, the scores of each factor and the total scores of PSQI, as well as CPSS scores were all lower than those before treatment in the two groups (P<0.01, P<0.05); except the score for sleep quality, the score of each factor and the total score of PSQI, as well as CPSS score in the observation group were lower than those in the control group (P<0.01, P<0.05). After treatment, TST, SE%, REM% and N3% were increased and SOL, WASO, N1% were decreased as compared with before treatment in the two groups (P<0.01, P<0.05), and N2% in the observation group was decreased (P<0.01); SE%, REM% and N3% in the observation group were higher than the control group (P<0.05) and N1% and N2% were lower than the control group (P<0.05). The total effective rate was 93.8% (30/32) in the observation group, higher than 87.1% (27/31) in the control group (P<0.05).@*CONCLUSION@#Fang 's scalp acupuncture, on the base of routine acupuncture, obviously improves the sleep quality and perceived stress and adjusts the sleep structure in the patients with insomnia.

Moniletrix of the scalp from almost normal aspect to total alopecia: variable intrafamilial expressiveness

Abstract Monilethrix is a rare defect of the hair shaft, with most cases showing an autosomal dominant pattern of inheritance and variable clinical expression. It is characterized by hypotrichosis secondary to hair fragility. The diagnosis is made through trichoscopy, detecting typical findings such as periodic narrowing at regular intervals, giving the hair the appearance of beads in a rosary. This article reports the case of six members of a family diagnosed with monilethrix with alopecia of varying degrees.

Case of large lentigo maligna melanoma of the scalp treated with 5% and 3. 75% Imiquimod

Abstract The paper presents a case of lentigo maligna melanoma of the scalp in an elderly patient treated for the nodular part with surgery and the residual melanoma in situ with 5% Imiquimod and subsequently with 3.75% Imiquimod (each concentration for 4 months, 5 times per week), with complete regression of the lesion. 3.75% Imiquimod, which is already used for the treatment of actinic keratosis, could be a useful weapon with the same effectiveness and fewer side effects compared to 5% Imiquimod.

Endometrial carcinoma metastatic to the scalp: a rare case report and literature review / O Carcinoma endometrial é uma causa rara de metástases cutâneas

ABSTRACT: Endometrial carcinoma is a very rare cause of cutaneous metastasis.The most frequent presentations of cutaneous metastasis are fast developing nodules or tumors, which are evi-dence of widespread dissemination in such patients.We report a case of scalp metastasis from an endometrial adenocarcinoma with a fatal prognosis. (AU)

RESUMO: O carcinoma endometrial é uma causa rara de metástases cutâneas.A apresentação mais frequente de metástases cutâneas são nódulos ou tumores de rápido desenvolvimento, que evidenciam uma disseminação generalizada nesses pacientes.Relatamos um caso de metástase no couro cabeludo de um adenocarcinoma endometrial com prognóstico fatal. (AU)

Reconstrucción de cuero cabelludo, por quemadura química extensa, en tiempos de COVID / Scalp reconstruction, from extensive chemical burn, in time of COVID

Las quemaduras químicas en cuero cabelludo, que se producen en lugares públicos como salones de belleza o peluquerías causadas por mezclas de sustancias activas como persulfatos y peróxido de hidrógeno, secundarias a la decoloración de cabellos, producen graves secuelas de alopecias en pacientes jóvenes. Se trata de un caso clínico, de quemadura química, espesor completo, extensa, en cuero cabelludo. Productos utilizados en forma cotidiana en salones de belleza, peluquerías o domicilios, que tiene estrecha relación con el daño. Resolución del caso con colgajos locales, con tiempos de internación y quirúrgicos cortos, en tiempos de COVID. Enfoque de la falta de control de sustancias usadas en peluquerías, pocos casos publicados y secuelas psicosociales importantes, con pronta mejoría de calidad de vida y reinserción social

Chemical burns in scalp after hair bleaching are produced in public places such as hairdressing salons and are caused by the combination of active agents like persulfate and hydrogen peroxide. The burns leave severe sequels of alopecia in young patients. This is about a clinical case of a chemical burn in the sculp which is full thickness and has a great large. Products used on a daily basis in hairdressing salons or in the domiciles have a close connection with the hurt. In times of COVID the case was resolved with local flaps, and short period of hospitalization and surgical. Focus on the lack of control in the usage of substances made by hairdressing salons, the existence of few published cases and the main psychosocial sequels, a speedy recovery in the quality of life and social reintegration

Aggressive parotid gland and neck metastasis caused by cutaneous squamous cell carcinoma of the scalp: a case report / Metástasis agresiva de glándula parótida y cuello causada por carcinoma cutáneo de células escamosas decuero cabelludo: reporte de un caso

Introduction: The head and neck are frequent sites for the development of cutaneous cancer and squamous cell carcinoma of the skin (SCC), one of the more frequent malignant non-melanoma skin neoplasms in Chile (436 per 100,000 inhabitants). Between 5-10% skin SCC progresses aggressively generating metastasis to parotid and cervical lymph nodes. Case Report: A 82 years old male, presents painful increased volume lesion in the mandibular area. He has a history of chronic arterial hypertension, acute renal failure, SCC of the scalp, extra-pulmonary tuberculosis, chronic sun exposure and smoking. Extraoral examination showed a 4 cm lesion in the posterior third of the mandibular branch, with undefined edges, a firm consistency and painful on palpation. Intraorally, erythematous mucosa is observed, as well as lack of lubrication, tenderness and cortical bone expansion. Incisional biopsy is performed, imaging and histological exams are requested. The results indicate the presence of SCC, and therefore referral to secondary care. Many risk factors are associated with SCC development, with ultraviolet radiation the most relevant in this case, favoring its appearance on the scalp. The probability of metastasis is low, but when it happens, the majority of cases that started in the scalp, disseminate to the parotid and cervical region. Conclusion: The SCC has a good prognosis. However, there are antecedents, such as size and location, that must alert the professional to perform the monitoring, early screening, control of metastatic nodes in maxillofacial area.

Introducción: La cabeza y el cuello son sitios frecuentes de desarrollo de cáncer cutáneo y el carcinoma epidermoide de piel (CEC) es una de las neoplasias malignas sin melanoma más frecuentes en Chile (436 por 100.000 habitantes). Entre el 5% y el 10% del CCE cutáneo progresa de forma agresiva y genera metástasis en los ganglios linfáticos parótidos y cervicales. Reporte de Caso: Varón de 82 años, presenta lesión dolorosa de aumento de volumen en zona mandibular. Tiene antecedentes de hipertensión arterial crónica, insuficiencia renal aguda, CCE del cuero cabelludo, tuberculosis extrapulmonar, exposición crónica al sol y tabaquismo. El examen extraoral mostró una lesión de 4 cm en el tercio posterior de la rama mandibular, con bordes indefinidos, consistencia firme y dolorosa a la palpación. Intraoralmente se observa mucosa eritematosa, así como falta de lubricación, dolor a la palpación y expansión del hueso cortical. Se realiza biopsia incisional, se solicitan exámenes de imagen e histológicos. Los resultados indican la presencia de CCE y, por tanto, derivación a atención secundaria. Son muchos los factores de riesgo asociados al desarrollo de CEC, siendo la radiación ultravioleta la más relevante en este caso, favoreciendo su aparición en el cuero cabelludo. La probabilidad de metástasis es baja, pero cuando ocurre, la mayoría de los casos que comenzaron en el cuero cabelludo se diseminan a la región parotídea y cervical. Conclusión: El SCC tiene un buen pronóstico. Sin embargo, existen antecedentes, como tamaño y ubicación, que deben alertar al profesional para realizar el seguimiento, cribado precoz, control de ganglios metastásicos en zona maxilofacial.

Aspectos epidemiológicos de pacientes vitimados de escalpelamento assistidos em um hospital referência na Região Amazônica / Epidemiological aspects of scalping victims attended at a hospital in the Amazon Region

Introdução: O escalpelamento é trauma que causa ferimentos e lesões por avulsão parcial ou total do couro cabeludo, provocado, principalmente, pelo contato acidental dos cabelos compridos com o eixo do motor comumente utilizado em embarcações da Região Amazônica. Objetivo: Analisar o perfil epidemiológico de pacientes internados vítimas de escalpelamento assistidos em um hospital de referência materno infantil da Região Amazônica. Métodos: Tratase de um estudo epidemiológico, transversal, retrospectivo, documental, quantitativo realizado em hospital de referência às vítimas de escalpelamento, atendidos no período de janeiro de 2016 a dezembro de 2018. Após triagem inicial dos prontuários, 40 se enquadraram nos critérios de inclusão. Resultados: Em relação aos dados sociodemográficos, constatou-se no total de prontuários a prevalência do sexo feminino (97,5%), sendo sua maioria proveniente da mesorregião do Marajó (47,5%), tendo como principal característica o escalpelamento total (65,0%) por eixo de motor (95,0%). Dentre as complicações encontradas, a infecção oriunda do escalpelamento apresentou percentual de 12,5% (<0,001). Em relação aos procedimentos cirúrgicos, com 17,5%, a reconstrução do pavilhão auricular e trepanação apresentaram maior relevância (<0,001). Conclusão: Pode-se observar que as vítimas de escalpelamento passam longos períodos em tratamento e acompanhamento, implicando em um longo processo de hospitalização sendo submetidas a diversas intervenções cirúrgicas operatórias reparadoras e plásticas. Além disso, a extensividade do tratamento pode causar traumas devido às alterações anatomofisiológicas craniofacial. (AU)

Introduction: Scalping is trauma that causes injuries due to partial or total avulsion of the scalp, caused mainly by the accidental contact of long hair with the motor shaft commonly used in vessels in the Amazon region. Objective: To analyze the epidemiological profile of scalpel victims assisted at a maternal and child referral hospital in the Amazon region. Methods: This is an epidemiological, cross-sectional, retrospective, documentary, quantitative study conducted in a referral hospital for scalpel victims, from January 2016 to December 2018. After initial screening of medical records, 40 patients met the inclusion criteria. Results: Regarding the sociodemographic data, the prevalence of females (97.5%) was found in all medical records, most of them coming from the mesoregion of Marajó (47.5%), having as main characteristic the total scalping (65.0%) per motor axis (95.0%). Among the complications found, the infection resulting from scalping presented a percentage of 12.5% (<0.001). Regarding the surgical procedures, with 17.5%, the reconstruction of the pinna and trepanning were more relevant (<0.001). Conclusion: Scalping victims spend long periods of treatment and follow-up, implying a long hospitalization process and undergoing various repair and plastic surgical interventions. In addition, the extensiveness of the treatment can cause trauma due to craniofacial and anatomophysiological changes. (AU)

Scalp acupuncture combined with suspension training for balance dysfunction in patients with stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To explore the effect of scalp acupuncture combined with suspension training on balance ability and motor function in stroke patients with balance dysfunction.@*METHODS@#A total of 105 stroke patients with balance dysfunction were randomly divided into a combined group (35 cases, 2 cases dropped off), a scalp acupuncture group (35 cases, 3 cases dropped off) and a suspension training group (35 cases, 2 cases dropped off). The scalp acupuncture group was treated with scalp acupuncture at bilateral suboccipital lateral line, parietal midline, upper 1/5 line of anterior oblique line of parietal and temporal and line 1 of the parietal lateral line on the opposite side of hemiplegia. The suspension training group was treated with suspension training. The combined group was treated with suspension training at the same time of scalp acupuncture. All the treatment was given once a day, 30 min each time, 5 days a week, for a total of 6 weeks. The Berg balance scale (BBS) score, balance tester and Fugl-Meyer assessment (FMA) score were used to evaluate the motor function and balance ability before treatment, 3 and 6 weeks into treatment. The clinical efficacy was evaluated in the 3 groups.@*RESULTS@#The scores of BBS and FMA in each group at 3 and 6 weeks into treatment were higher than those before treatment (@*CONCLUSION@#Scalp acupuncture combined with suspension training could improve the balance ability and motor function in stroke patients with balance dysfunction, and the curative effect is better than simple scalp acupuncture and simple suspension training.

Therapeutic effect of electric-balance stimulation with scalp acupuncture for motor aphasia after cerebral infarction / 中国针灸

OBJECTIVE@#To compare the clinical efficacy between scalp acupuncture electrical stimulation and routine scalp acupuncture for motor aphasia in subacute stage of cerebral infarction.@*METHODS@#A total of 54 patients with motor aphasia in subacute stage of cerebral infarction were randomly divided into an observation group (27 cases, 1 case dropped off) and a control group (27 cases, 2 cases dropped off ). Both groups were treated with routine medication and language training. In the observation group, scalp acupuncture was given at bilateral lower 2/5 of the parietal and temporal anterior oblique line and temporal frontline; after the arrival of @*RESULTS@#After treatment, the scores of listening comprehension, retelling, naming, spontaneous conversation and BDAE grade in the two groups were improved compared with those before treatment (@*CONCLUSION@#The scalp acupuncture electrical stimulation could improve cerebral circulation, activate specific functional areas of cerebral cortex, and promote the reconstruction and recovery of brain language function. Its curative effect is better than conventional scalp acupuncture.

Scalp acupuncture combined with lower-limb intelligent feedback training for lower-limb motor dysfunction after stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the efficacy of scalp acupuncture combined with lower-limb intelligent feedback training and lower-limb intelligent feedback training alone for lower-limb motor dysfunction after stroke.@*METHODS@#A total of 154 patients with lower-limb motor dysfunction after stroke were randomly divided into an observation group (76 cases, 6 cases dropped off) and a control group (78 cases, 8 cases dropped off). The patients in both groups were treated with conventional medication and exercise rehabilitation training. In addition, the patients in the observation group were treated with scalp acupuncture combined with lower-limb intelligent feedback training. The scalp acupuncture was given at upper 1/5 of the anterior oblique line of parietal temporal area and upper 1/5 of the posterior oblique line of parietal temporal area. The patients in the control group were treated with lower-limb intelligent feedback training alone. All the treatment was given once a day, 6 days a week, totaling for 8 weeks. The affected-side lower-limb Brunnstrom stage and modified Ashworth scale (MAS) grade, 6-minute walk test (6MWT), Berg balance scale (BBS) score and modified Barthel index (MBI) score were evaluated before and after treatment in the two groups. The plantar pressure was measured by gait function evaluation system.@*RESULTS@#Compared before treatment, the Brunnstrom stage in the two groups was improved after treatment (@*CONCLUSION@#The scalp acupuncture combined with lower-limb intelligent feedback training could reduce the muscle tension of lower limbs, promote the separation movement mode of lower limbs, improve the plantar pressure distribution, and improve the balance ability and walking ability in stroke patients, and the curative effect is better than lower-limb intelligent feedback training alone.

Interactive scalp acupuncture for cognitive dysfunction after stroke: a randomized controlled trial / 中国针灸

OBJECTIVE@#To compare the efficacy of interactive scalp acupuncture, scalp acupuncture alone and scalp acupuncture plus cognitive training for cognitive dysfunction after stroke.@*METHODS@#A total of 660 patients with cognitive dysfunction after stroke were randomly divided into an interactive scalp acupuncture group (218 cases, 18 cases dropped off), a scalp acupuncture group (220 cases, 20 cases dropped off) and a scalp acupuncture plus cognitive training group (222 cases, 22 cases dropped off). All the patients were treated with routine medication and exercise rehabilitation training. The interactive scalp acupuncture group was treated with scalp acupuncture on the parietal midline, and contralateral anterior parietal temporal oblique line and posterior parietal temporal oblique line at the same time of cognitive training; the scalp acupuncture group was treated with scalp acupuncture alone, and the scalp acupuncture plus cognitive training group was treated with scalp acupuncture and cognitive training in the morning and afternoon respectively. All the treatments were given once a day, 6 times a week for 8 weeks. Montreal cognitive assessment (MoCA) scale score was used to evaluate the cognitive function before treatment, 4 weeks and 8 weeks into treatment.@*RESULTS@#Compared before treatment, the total score of MoCA was increased after 4-week treatment and 8-week treatment in the three groups (@*CONCLUSION@#The interactive scalp acupuncture could significantly improve the cognitive function in patients with cognitive dysfunction after stroke, and the efficacy is superior to scalp acupuncture alone and scalp acupuncture plus cognitive training.